T Cells Expressing Fully-human Anti-CD19 and Anti-CD20 Chimeric Antigen Receptors for Treating B-cell Malignancies and Hodgkin Lymphoma

This is an interventional treatment trial for Lymphoma, B-Cell focused on measuring Autologous T Cells Infusion, Hu1928-Hu20BB, Hodgkin Reed-Sternberg Cells, Adoptive T Cell Therapy, Gene Therapy Read More

• INCLUSION CRITERIA:

MALIGNANCY CRITERIA:

Note: As of approval of Amendment A, no patients with Hodgkin lymphoma can be enrolled until at least 6 patients with B-cell malignancies are treated without incidence of Guillain-Bare syndrome

• Patients must have any B-cell lymphoma, or chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), Gray-zone lymphoma, nodular lymphocyte-predominant Hodgkin lymphoma, or classical Hodgkin lymphoma with any cluster of differentiation 19 (CD19) or cluster of differentiation 20 (CD20) expression on Reed-Sternberg cells. Lower grade lymphomas or CLL transformed to diffuse large B-cell lymphoma (DLBCL) are potentially eligible as is primary mediastinal B-cell lymphoma and all other subtypes of DLBCL. Burkitt and mantle cell lymphoma are potentially eligible.
• For classical Hodgkin lymphoma only, a biopsy from any time from any institution that shows any CD19 or CD20 expression on Reed-Sternberg cells is adequate for eligibility. CD19 or CD20 expression on the Reed-Sternberg cells that is weak or only present on some Reed-Sternberg cells by immunohistochemistry is compatible with protocol eligibility.
• For all lymphoma types except for classical Hodgkin lymphoma, either CD19 or CD20 expression must be uniform. Uniform CD19 or CD20 expression is defined as no obvious lymphoma population lacking antigen expression is present. Antigen expression can be assessed by either immunohistochemistry or flow cytometry.
• Only when insufficient biopsy material is available to allow CD19 and CD20 expression assessment at the National Institutes of Health (NIH), CD19 and/or CD20 staining performed at another institution can be used
• DLBCL patients must have received at least two prior chemotherapy-containing regimens at least one of which must have contained doxorubicin and a monoclonal antibody. Follicular lymphoma patients must have received at least 2 prior regimens including at least 1 regimen with chemotherapy. All other B-cell lymphoma and leukemia patients must have had at least 1 prior chemotherapy-containing regimen. All patients with CLL or small lymphocytic lymphoma must have had prior treatment with ibrutinib or another signal transduction inhibitor and venetoclax.

• Hodgkin lymphoma patients must have:

  • had at least 3 prior lines of therapy.
  • had at least 1 prior cytotoxic chemotherapy-containing regimen.
  • had prior exposure to brentuximab vedotin.
  • had undergone autologous stem cell transplant or been transplant ineligible or refused autologous transplantation
• Eligibility will be expanded to include CD19 and CD20-negative classical Hodgkin lymphoma if any 2 patients with classical Hodgkin lymphoma and CD19/CD20 expression on Reed-Sternberg (RS) cells have durations of response 6 months or greater (responses could be partial responses (PRs) or complete responses (CRs) or a CR of 3 months or greater.
• All patients must have measurable malignancy as defined by at least one of the criteria below.
• Lymphoma or leukemia masses that are measurable (minimum 1.5 cm in largest diameter) by computed tomography (CT) scan is required for all diagnoses except CLL. All masses must be less than or equal to 10.0 cm in the largest diameter.
• For a lymphoma mass to count as measurable malignancy, it must have abnormally increased metabolic activity when assessed by positron emission tomography (PET) scan. CLL masses do not need to have increased activity on positron emission tomography (PET) scan.
• For CLL and lymphoma with only bone marrow involvement no mass is necessary, but if a mass is not present, bone marrow malignancy must be detectable by flow cytometry in lymphoma and CLL. Note that leukemia cells must make up 1% or less of peripheral blood lymphocytes in CLL patients for these patients to be eligible.

OTHER INCLUSION CRITERIA:

• Greater than or equal to 18 years of age.
• Able to understand and sign the Informed Consent Document.
• Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0-1
• Room air oxygen saturation of 92% or greater
• Patients of both sexes must be willing to practice birth control from the time of enrollment on this study and for four months after receiving the protocol treatment.
• A patient with a negative blood polymerase chain reaction (PCR) test for hepatitis B deoxyribonucleic acid (DNA) test can be enrolled. If hepatitis B DNA (PCR) testing is not available, patients with a negative hepatitis B surface antigen and negative hepatitis B core antibody can be enrolled.
• Patients must be tested for the presence of Hepatitis C antigen by PCR and be hepatitis C virus (HCV) ribonucleic acid (RNA) negative in order to be eligible. Only if Hepatitis C PCR testing is not available in a timely manner, patients who are Hepatitis C antibody-negative can be enrolled.
• Absolute neutrophil count greater than or equal to 1000/mm^3 without the support of filgrastim or other growth factors.
• Platelet count greater than or equal to 50,000/mm^3 without transfusion support
• Hemoglobin greater than 8.0 g/dl.
• For CLL only, less than or equal to 1% malignant cells in the peripheral blood lymphocytes must be documented by flow cytometry of blood within 2 weeks of protocol enrollment.
• Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less or equal to 3 times the upper limit of the institutional normal unless liver involvement by malignancy is demonstrated.
• Serum creatinine less than or equal to 1.5 mg/dl.
• Total bilirubin less than or equal to 2.0 mg/dl.
• Normal cardiac ejection fraction (greater than or equal to 50% by echocardiography) and no evidence of hemodynamically significant pericardial effusion as determined by an echocardiogram within 4 weeks of treatment start.
• Patients must not take corticosteroids including prednisone, dexamethasone or any other corticosteroid for 14 days before apheresis and chimeric antigen receptors (CAR) T-cell infusion. Patients must also not take corticosteroids at doses higher than 5 mg/day of prednisone or equivalent at any time after the CAR T cell infusion.
• Patients must be able to understand and be willing to sign a written informed consent.

• Patients who have either been previously treated on protocols of genetically-modified T cells on a clinical trial at the National Cancer Institute (NCI) or received T cells modified with the murine stem cell virus-based splice-gag (MSGV) or murine stem cell virus-based splice-gag 1 (MSGV1) gamma-retroviral vectors at any institution are potentially eligible under these conditions:

  • At least 3 months have elapsed since the last genetically-modified T-cell therapy that the patient received, and there is no evidence of replication-competent retroviruses (evidence must be provided from prior protocol Principal Investigator), and persisting genetically-modified T cells are either not detectable in the patient's blood or detectable at levels less than or equal to 0.2% of blood T cells as measured by flow cytometry using the Kip-1 antibody in the flow cytometry lab of the NCI Laboratory of Pathology (Maryalice Stetler-Stevenson's lab).

EXCLUSION CRITERIA:

• Patients that require urgent therapy due to tumor mass effects or spinal cord compression.
• Patients must not have received any anti-CD20 or anti-CD19 antibody products in the past 30 days prior to CAR T-cell infusion.
• Any history of receiving programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors
• Patients that have active hemolytic anemia.
• Human immunodeficiency virus (HIV)-positive patients are excluded because HIV causes complicated immune deficiency and study treatment can pose more risks for these patients.
• Patients with second malignancies in addition to their B-cell malignancy are not eligible if the second malignancy has required treatment (including maintenance therapy) within the past 3 years or is not in complete remission. There are two exceptions to this criterion: successfully treated non-metastatic basal cell or squamous cell skin carcinoma.
• Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the preparative chemotherapy on the fetus or infant.

Pregnant women are excluded from this study because study therapy can cause fetal harm. Because there is potential risk for adverse events in nursing infants secondary to treatment of the mother with study therapy, breastfeeding should be discontinued if the mother is treated with study drugs.

• Active uncontrolled systemic infections (defined as infections causing fevers and infections requiring intravenous antibiotics when intravenous antibiotics have been administered for less than 72 hours), active coagulation disorders or other major uncontrolled medical illnesses of the cardiovascular, respiratory, endocrine, renal, gastrointestinal, genitourinary or immune system, history of myocardial infarction, history of ventricular tachycardia or ventricular fibrillation, active cardiac arrhythmias (active atrial fibrillation is not allowed, resolved atrial fibrillation not requiring current treatment is allowed (anticoagulants count as current treatment)), active obstructive or restrictive pulmonary disease, active autoimmune diseases such as rheumatoid arthritis.
• Hospitalization within the 7 days prior to enrollment.
• Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease).
• Prior allogeneic stem cell transplant
• Systemic lymphoma treatment of any type and corticosteroid steroid therapy of any dose greater than 5 mg/day or more of prednisone or equivalent is not allowed within 14 days prior to the required leukapheresis, or the initiation of the conditioning chemotherapy regimen. Corticosteroid creams, ointments, and eye drops are allowed.
• History of severe immediate hypersensitivity reaction to any of the agents used in this study.
• Patients on systemic anticoagulant therapy except aspirin.
• Active central nervous system metastases or cerebrospinal fluid malignancy. Patients with known brain metastases will be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
• Any current neurologic disorders except migraine headaches.