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Safety and Efficacy of Anti-CD123 CAR-T Therapy in Patients With Refractory/ Relapsed CD123+ Acute Myeloid Leukemia.

Primary Purpose

CD123+ Acute Myeloid Leukemia

Status
Unknown status
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Third-generation anti-CD123 CAR-T cells
Sponsored by
Wuhan Union Hospital, China
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for CD123+ Acute Myeloid Leukemia

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Pathological and histological examination confirmed CD123+ refractory or relapsed Acute Myeloid Leukemia.

    A. Diagnostic criteria for recurrent AML: After complete remission (CR), leukemia cells or bone marrow primordial cells > 0.050 (except for bone marrow regeneration after consolidation chemotherapy) or extramedullary leukemia cell infiltration appears again in peripheral blood.

    B.Diagnostic criteria for refractory AML(Meeting one of the following)

    i. ineffectiveness after the first standard regimen treatment of 2 courses.

    ii. patients relapse within 12 months after consolidation and intensive treatment after CR.

    iii. Patients relapse 12 months later and fail to respond to conventional chemotherapy.

    iv. Patients with two or more recurrences.

    v. Patients with persistent extramedullary leukemia.

    vi. Patients with recurrence after CR and unsuitable for HSCT (auto/allo-HSCT).

  2. Aged 18 to 70 years (including 18 and 70 years old).
  3. At least one measurable or evaluable lesion:AML patients with positive or relapsed positive bone marrow MRD.
  4. ECOG≤ 2 and expected lifetime ≥3 months.
  5. Adequate organ function:

    A. Liver function: ALT/AST≤3 ULN. Total bilirubin≤2 ULN.

    B. Renal function: eGFR> 60 mL/min/1.73 m2, or creatinine clearance ≥45mL/min.

    C. Lung function: Carbon Monoxide (DLCO) or Forced Expiratory Volume in the first second (FEV1) > 45% predicted.

    D. Cardiac function: LVEF ≥ 50%.

  6. The patients did not receive any anticancer treatments such as chemotherapy, radiotherapy and immunotherapy (such as immunosuppressive drugs) within 4 weeks before admission, and the toxicity related to previous treatments had returned to < 1 level at admission (except for low toxicity such as alopecia).
  7. Women of child-bearing potential and all male participants must use effective methods of contraception for at least 12 months after infusion.
  8. Informed Consent/Assent: All subjects must have the ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

  1. Women who are pregnant (urine/blood pregnancy test positive) or lactating.
  2. Male or female with a conception plan in the past 1 years.
  3. Patients cannot guarantee effective contraception (condom or contraceptives, etc.) within 1 years after enrollment.
  4. Uncontrolled infectious disease within 4 weeks prior to enrollment.
  5. Active hepatitis B/C virus.
  6. HIV infected patients.
  7. Suffering from a serious autoimmune disease or immunodeficiency disease.
  8. The patient is allergic and is allergic to macromolecular biopharmaceuticals such as antibodies or cytokines.
  9. The patient participated in other clinical trials within 6 weeks prior to enrollment.
  10. Systemic use of hormones within 4 weeks prior to enrollment (except for patients with inhaled corticosteroids).
  11. Suffering from mental illness.
  12. Patient has drug abuse/addiction.
  13. Central nervous system involvement.
  14. According to the investigator's judgment, the patient has other unsuitable grouping conditions.

Sites / Locations

  • Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CD123+ Acute Myeloid Leukemia

Arm Description

Patients will receive CD123-targeted CAR-T cells in the dose-climbing trial. Each dose group has 3 patients and the the maximum dose can be extended.

Outcomes

Primary Outcome Measures

Incidence of Treatment-related Adverse Events
Therapy-related adverse events will be recorded and assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, Version 4.0).

Secondary Outcome Measures

Overall remission rate(ORR) of anti-CD123 CAR-T Therapy in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
ORR will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Overall survival(OS) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
OS will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Duration of Response(DOR) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
DOR will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Progress-free survival(PFS) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
PFS will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Rate of anti-CD123 CAR-T cells in bone marrow cells and peripheral blood cells
In vivo (bone marrow and peripheral blood) rate and quantity of anti-CD123 CAR-T cells were determined by means of flow cytometry.
Quantity of anti-CD123 CAR copies in bone marrow cells and peripheral blood cells
In vivo (bone marrow and peripheral blood) quantity of anti-CD123 CAR copies were determined by means of qPCR.

Full Information

First Posted
July 2, 2019
Last Updated
August 5, 2019
Sponsor
Wuhan Union Hospital, China
Collaborators
Wuhan Bio-Raid Biotechnology Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04014881
Brief Title
Safety and Efficacy of Anti-CD123 CAR-T Therapy in Patients With Refractory/ Relapsed CD123+ Acute Myeloid Leukemia.
Official Title
Single-center, Open-label, Single-arm Clinical Study of Efficacy and Safety of Anti-CD123 CAR-T Therapy in Patients With Refractory/Relapsed CD123+ Acute Myeloid Leukemia.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Unknown status
Study Start Date
July 6, 2019 (Actual)
Primary Completion Date
July 1, 2021 (Anticipated)
Study Completion Date
July 1, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Wuhan Union Hospital, China
Collaborators
Wuhan Bio-Raid Biotechnology Co., Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a single-center, open-label, single-arm study to evaluate the safety and efficacy of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia.
Detailed Description
CD123 is a transmembrane subunit of the IL-3 receptor expressed on AML blasts. The investigators have conducted a third generationCD123-targeted CAR containing CD137 and CD28 costimulatory domains.This study aims to evaluate the safety and efficacy of anti-CD123 CAR-T cells in patients with relapsed/refractory CD123+ Acute Myeloid Leukemia.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
CD123+ Acute Myeloid Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This study was a single-center, open-label, single-arm, non-randomized,3+3 dose escalation clinical trial.Each dose group has 3 patients.If no DLT emerges in the group, then the next group uses the subsequent higher dose. If DLT emerges in a single subject in any dose level, 3 more subjects will be enrolled to the same dose level. The maximum dose could be extended.
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CD123+ Acute Myeloid Leukemia
Arm Type
Experimental
Arm Description
Patients will receive CD123-targeted CAR-T cells in the dose-climbing trial. Each dose group has 3 patients and the the maximum dose can be extended.
Intervention Type
Biological
Intervention Name(s)
Third-generation anti-CD123 CAR-T cells
Intervention Description
From the minimum dose, If no DLT emerges in the group, then the next group uses the subsequent higher dose. If DLT emerges in a single subject in any dose level, 3 more subjects will be enrolled to the same dose level.
Primary Outcome Measure Information:
Title
Incidence of Treatment-related Adverse Events
Description
Therapy-related adverse events will be recorded and assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, Version 4.0).
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Overall remission rate(ORR) of anti-CD123 CAR-T Therapy in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
Description
ORR will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Time Frame
3 years
Title
Overall survival(OS) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
Description
OS will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Time Frame
3 years
Title
Duration of Response(DOR) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
Description
DOR will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Time Frame
3 years
Title
Progress-free survival(PFS) of anti-CD123 CAR-T cells in patients with refractory/relapsed CD123+ Acute Myeloid Leukemia
Description
PFS will be assessed from the first CAR-T cell infusion to death or last follow-up (censored).
Time Frame
3 years
Title
Rate of anti-CD123 CAR-T cells in bone marrow cells and peripheral blood cells
Description
In vivo (bone marrow and peripheral blood) rate and quantity of anti-CD123 CAR-T cells were determined by means of flow cytometry.
Time Frame
3 years
Title
Quantity of anti-CD123 CAR copies in bone marrow cells and peripheral blood cells
Description
In vivo (bone marrow and peripheral blood) quantity of anti-CD123 CAR copies were determined by means of qPCR.
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pathological and histological examination confirmed CD123+ refractory or relapsed Acute Myeloid Leukemia. A. Diagnostic criteria for recurrent AML: After complete remission (CR), leukemia cells or bone marrow primordial cells > 0.050 (except for bone marrow regeneration after consolidation chemotherapy) or extramedullary leukemia cell infiltration appears again in peripheral blood. B.Diagnostic criteria for refractory AML(Meeting one of the following) i. ineffectiveness after the first standard regimen treatment of 2 courses. ii. patients relapse within 12 months after consolidation and intensive treatment after CR. iii. Patients relapse 12 months later and fail to respond to conventional chemotherapy. iv. Patients with two or more recurrences. v. Patients with persistent extramedullary leukemia. vi. Patients with recurrence after CR and unsuitable for HSCT (auto/allo-HSCT). Aged 18 to 70 years (including 18 and 70 years old). At least one measurable or evaluable lesion:AML patients with positive or relapsed positive bone marrow MRD. ECOG≤ 2 and expected lifetime ≥3 months. Adequate organ function: A. Liver function: ALT/AST≤3 ULN. Total bilirubin≤2 ULN. B. Renal function: eGFR> 60 mL/min/1.73 m2, or creatinine clearance ≥45mL/min. C. Lung function: Carbon Monoxide (DLCO) or Forced Expiratory Volume in the first second (FEV1) > 45% predicted. D. Cardiac function: LVEF ≥ 50%. The patients did not receive any anticancer treatments such as chemotherapy, radiotherapy and immunotherapy (such as immunosuppressive drugs) within 4 weeks before admission, and the toxicity related to previous treatments had returned to < 1 level at admission (except for low toxicity such as alopecia). Women of child-bearing potential and all male participants must use effective methods of contraception for at least 12 months after infusion. Informed Consent/Assent: All subjects must have the ability to understand and the willingness to sign a written informed consent. Exclusion Criteria: Women who are pregnant (urine/blood pregnancy test positive) or lactating. Male or female with a conception plan in the past 1 years. Patients cannot guarantee effective contraception (condom or contraceptives, etc.) within 1 years after enrollment. Uncontrolled infectious disease within 4 weeks prior to enrollment. Active hepatitis B/C virus. HIV infected patients. Suffering from a serious autoimmune disease or immunodeficiency disease. The patient is allergic and is allergic to macromolecular biopharmaceuticals such as antibodies or cytokines. The patient participated in other clinical trials within 6 weeks prior to enrollment. Systemic use of hormones within 4 weeks prior to enrollment (except for patients with inhaled corticosteroids). Suffering from mental illness. Patient has drug abuse/addiction. Central nervous system involvement. According to the investigator's judgment, the patient has other unsuitable grouping conditions.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yu Hu, M.D., Ph.D
Phone
86-13986183871
Email
dr_huyu@126.com
First Name & Middle Initial & Last Name or Official Title & Degree
Heng Mei, M.D., Ph.D
Phone
86-13886160811
Email
hmei@hust.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Heng Mei, M.D., Ph.D
Organizational Affiliation
Wuhan Union Hospital, China
Official's Role
Principal Investigator
Facility Information:
Facility Name
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
City
Wuhan
State/Province
Hubei
ZIP/Postal Code
430022
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yu Hu, M.D., Ph.D
Phone
86-13986183871
Email
dr_huyu@126.com
First Name & Middle Initial & Last Name & Degree
Heng Mei, M.D., Ph.D
Phone
86-13886160811
Email
hmei@hust.edu.cn

12. IPD Sharing Statement

Citations:
PubMed Identifier
31109711
Citation
Hansrivijit P, Gale RP, Barrett J, Ciurea SO. Cellular therapy for acute myeloid Leukemia - Current status and future prospects. Blood Rev. 2019 Sep;37:100578. doi: 10.1016/j.blre.2019.05.002. Epub 2019 May 11.
Results Reference
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PubMed Identifier
28479045
Citation
Arcangeli S, Rotiroti MC, Bardelli M, Simonelli L, Magnani CF, Biondi A, Biagi E, Tettamanti S, Varani L. Balance of Anti-CD123 Chimeric Antigen Receptor Binding Affinity and Density for the Targeting of Acute Myeloid Leukemia. Mol Ther. 2017 Aug 2;25(8):1933-1945. doi: 10.1016/j.ymthe.2017.04.017. Epub 2017 May 4.
Results Reference
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PubMed Identifier
27518241
Citation
Cartellieri M, Feldmann A, Koristka S, Arndt C, Loff S, Ehninger A, von Bonin M, Bejestani EP, Ehninger G, Bachmann MP. Switching CAR T cells on and off: a novel modular platform for retargeting of T cells to AML blasts. Blood Cancer J. 2016 Aug 12;6(8):e458. doi: 10.1038/bcj.2016.61.
Results Reference
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PubMed Identifier
25083319
Citation
Tettamanti S, Biondi A, Biagi E, Bonnet D. CD123 AML targeting by chimeric antigen receptors: A novel magic bullet for AML therapeutics? Oncoimmunology. 2014 May 14;3:e28835. doi: 10.4161/onci.28835. eCollection 2014.
Results Reference
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PubMed Identifier
28246194
Citation
Tasian SK, Kenderian SS, Shen F, Ruella M, Shestova O, Kozlowski M, Li Y, Schrank-Hacker A, Morrissette JJD, Carroll M, June CH, Grupp SA, Gill S. Optimized depletion of chimeric antigen receptor T cells in murine xenograft models of human acute myeloid leukemia. Blood. 2017 Apr 27;129(17):2395-2407. doi: 10.1182/blood-2016-08-736041. Epub 2017 Feb 28.
Results Reference
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PubMed Identifier
24030378
Citation
Mardiros A, Dos Santos C, McDonald T, Brown CE, Wang X, Budde LE, Hoffman L, Aguilar B, Chang WC, Bretzlaff W, Chang B, Jonnalagadda M, Starr R, Ostberg JR, Jensen MC, Bhatia R, Forman SJ. T cells expressing CD123-specific chimeric antigen receptors exhibit specific cytolytic effector functions and antitumor effects against human acute myeloid leukemia. Blood. 2013 Oct 31;122(18):3138-48. doi: 10.1182/blood-2012-12-474056. Epub 2013 Sep 12.
Results Reference
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Safety and Efficacy of Anti-CD123 CAR-T Therapy in Patients With Refractory/ Relapsed CD123+ Acute Myeloid Leukemia.

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