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Safety, Efficacy and Pharmacokinetics of XKDCT023 in DLBCL

Primary Purpose

Diffuse Large B Cell Lymphoma

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Autologous anti-CD19 CAR-T cell injection
Sponsored by
The Affiliated Hospital of Qingdao University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diffuse Large B Cell Lymphoma focused on measuring Diffuse large B-cell lymphoma, Autologous anti-CD19 CAR-T cells

Eligibility Criteria

18 Days - 75 Days (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • All subjects or legal guardians must sign the informed consent approved by the ethics committee in writing before starting any screening procedure.
  • Adult patients aged 18 and over with recurrent or refractory DLBCL.
  • Bone marrow negative or bone marrow lymphoma cells in screening stage determined by CT scan < 30%.
  • The subject had been adequately treated before.
  • According to the revised IWG malignant lymphatic efficacy evaluation criteria (2007 Edition), there was at least one measurable lesion in the baseline period.
  • Estimated survival ≥ 12 weeks.
  • The baseline ECoG score was 0 or 1.
  • Adequate organ function.
  • Hemodynamics determined by echocardiography or multichannel radionuclide angiography (MUGA) were stable and left ventricular ejection fraction (LVEF) ≥ 45%.
  • Sufficient bone marrow reserve without blood transfusion.
  • There must be non mobilized apheresis or peripheral blood collected cells for car-t cell production.
  • According to the judgment of the researcher, the patient has fully recovered from the toxicity of previous anti-tumor treatment and is suitable for pretreatment chemotherapy and car-t cell treatment.
  • Women of childbearing age and all male subjects must agree to use efficient contraceptive methods until at least 12 months after xkdct023 infusion, and until two consecutive PCR tests show that car-t cells are no longer present in the body.

Exclusion Criteria:

  • Patients who have previously received any anti-CD19 / anti-CD3 treatment, or any other anti-CD19 treatment;
  • Patients previously treated with any gene therapy product, including car-t treatment;
  • Patients with detectable cerebrospinal fluid malignant cells or brain metastasis, or patients with a history of central nervous system (CNS) lymphoma or primary CNS lymphoma;
  • Patients with testicular invasion, including patients with orchiectomy;
  • Patients with current or history of central nervous system diseases, such as epilepsy, cerebrovascular ischemia / hemorrhage, dementia, cerebellar diseases or any autoimmune diseases involving the central nervous system;
  • Patients who had previously received allogeneic hematopoietic stem cell transplantation (HSCT);
  • Patients who are suitable and willing to receive autologous hematopoietic stem cell transplantation (ASCT);
  • The feasibility evaluation screening stage showed that the lymphocyte transfection efficiency of patients was less than 5%, or patients whose T cell culture could not be expanded (< 5 times).
  • Patients who received chemotherapy other than lymphocyte clearance chemotherapy within 2 weeks before xkdct023 infusion;
  • Patients who had received other study drugs within 30 days before screening;
  • Patients who received radiotherapy within 2 weeks before infusion;
  • Active hepatitis B (defined as hepatitis B virus DNA detection value > 1000 copies/ml) or hepatitis C virus (HCV RNA positive) patients.
  • HIV positive or Treponema pallidum positive patients;
  • Patients with acute life-threatening bacterial, viral or fungal infections that have not been controlled (e.g. positive blood culture ≤ 72 hours before infusion);
  • Patients with unstable angina pectoris and / or myocardial infarction within 6 months before screening;
  • Patients with previous or concurrent malignancies, with the following exceptions: well treated basal cell or squamous cell carcinoma (sufficient wound healing is required before enrollment in the study); Cervical cancer or breast cancer in situ cancer, after curable treatment, had no recurrence at least 3 years before the study. The primary malignant tumor has been completely removed and completely relieved for ≥ 5 years.
  • Pregnant or lactating female patients (women of childbearing age are verified as positive results by serum or urine pregnancy test during the screening period);
  • There are arrhythmia patients without medical management control;
  • Patients who received oral anticoagulant therapy within 1 week before car-t cell infusion;
  • Patients who had previously received any adoptive T cell therapy;
  • active neuroautoimmune or inflammatory disorders (e.g. Guillian Barre syndrome, amyotrophic lateral sclerosis).

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Autologous anti-CD19 CAR-T cell injection

    Arm Description

    with 1.00×106 CAR+T cells/kg, 3.00×106 CAR+T cells /kg and 9.00×106 CAR+T cells/kg

    Outcomes

    Primary Outcome Measures

    Adverse event
    Type, incidence and severity of adverse events
    Maximum tolerated dose
    The maximum dose that does not cause death of the subject
    Recommended dose for phase II
    Determine the recommended dose for phase II clinical trials

    Secondary Outcome Measures

    Peak time,Tmax
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Maximum concentration, Cmax
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Area Under Curve, AUC1-30d
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Pharmacodynamics
    The peak value of cytokines within 1 month after car-t cell infusion and the time to return to the baseline state or normal range.
    Total remission rate
    The total remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Complete remission rate
    The complete remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Partial remission rate
    The partial remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Distribution of car-t cells in bone marrow
    The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR to evaluate the distribution of car-t cells in bone marrow. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Survival of car-t cells
    Survival of car-t cells in adult patients with recurrent or refractory DLBCL.

    Full Information

    First Posted
    December 3, 2021
    Last Updated
    March 4, 2022
    Sponsor
    The Affiliated Hospital of Qingdao University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05269914
    Brief Title
    Safety, Efficacy and Pharmacokinetics of XKDCT023 in DLBCL
    Official Title
    Safety, Efficacy and Pharmacokinetics of XKDCT023 in Adult Patients With Recurrent or Refractory Diffuse Large B-cell Lymphoma
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    April 2022 (Anticipated)
    Primary Completion Date
    December 31, 2022 (Anticipated)
    Study Completion Date
    June 30, 2023 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    The Affiliated Hospital of Qingdao University

    4. Oversight

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

    5. Study Description

    Brief Summary
    This study is a phase I multicenter, single arm, open, dose increasing, single treatment clinical study. This study plans to recruit a total of about 10-16 adult patients with CD19 positive recurrent or refractory DLBCL for a single autologous car-t cell therapy. There are three dose groups in the study. The first dose group has one patient. If there is no dose limiting toxicity (DLT), it can be increased to the second dose group, otherwise it will continue to be enrolled according to the "3 + 3" method; The follow-up dose group is conducted according to the traditional "3 + 3" design, that is, three subjects are first enrolled in a dose group. If there is no dose limiting toxicity (DLT) in the three patients in the dose group, it can be increased to the next higher dose after completing the DLT observation period; If DLT occurs in 1 of the 3 patients in the dose group, it is necessary to continue to enroll 3 patients in the dose group for DLT observation. The highest dose level of DLT in less than or equal to 1 of the last 6 confirmed patients will be defined as MTD. The safety of car-t treatment was evaluated by observing the adverse events after cell therapy; Evaluate the effectiveness of car-t treatment compared with the results or historical data of the patient's own previous standard treatment regimen. Blood and bone marrow were collected before and 12 months after cell infusion, the number and activity of car-t cells were detected, and the pharmacokinetics (PK) of car-t cells was evaluated.
    Detailed Description
    This study is a phase I multicenter, single arm, open, dose increasing, single treatment clinical study. This study plans to recruit a total of about 10-16 adult patients with CD19 positive recurrent or refractory DLBCL for a single autologous car-t cell therapy. There were three dose groups in the study, and one patient in the first dose group, If there is no dose limiting toxicity (DLT), it can be increased to the second dose group, otherwise it will continue to be included in the group according to the "3 + 3" method; the follow-up dose group is designed according to the traditional "3 + 3" design, that is, three subjects will be included in a dose group first, if there is no dose limiting toxicity in the three patients in the dose group (DLT), after completing the DLT observation period, it can be increased to the next higher dose; if one of the three patients in the dose group has DLT, it is necessary to continue to join the group of three patients in the dose group for DLT observation. The highest dose level of DLT in less than or equal to one of the six patients finally confirmed will be defined as MTD. By observing the adverse events after cell therapy, the patients will be evaluated Evaluate the safety of car-t treatment; Evaluate the effectiveness of car-t treatment compared with the results or historical data of the patient's own previous standard treatment regimen. Blood and bone marrow were collected before and 12 months after cell infusion to detect the number and activity of car-t cells, Evaluate the pharmacokinetics (PK) of car-t cells. During the study, the blood samples used for the production of car-t cells will be transported to Shenzhen xiankangda Life Sciences Co., Ltd. (sponsor). After the production of car-t cells is completed, the car-t cells will be sent to the research unit so that the researchers can infuse them to the corresponding subjects.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Diffuse Large B Cell Lymphoma
    Keywords
    Diffuse large B-cell lymphoma, Autologous anti-CD19 CAR-T cells

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Sequential Assignment
    Model Description
    Single infusion of autologous anti-CD19 car-t cells
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    10 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Autologous anti-CD19 CAR-T cell injection
    Arm Type
    Experimental
    Arm Description
    with 1.00×106 CAR+T cells/kg, 3.00×106 CAR+T cells /kg and 9.00×106 CAR+T cells/kg
    Intervention Type
    Other
    Intervention Name(s)
    Autologous anti-CD19 CAR-T cell injection
    Intervention Description
    According to preclinical research, existing preliminary clinical data and similar approved therapeutic products (kte-c19 of Kate company, the trade name is yescarta ®) According to the clinical trial results, three doses (the number of cells per unit body weight) were selected as the therapeutic dose of this study. Among the patients who increased the dose according to the "3 + 3" design, the number of target cells in each dose group was: (1) the first dose group was 1.00 × 106 Car + T cells / kg, 20% dose error is allowed. (2) the second dose group is 3.00 × 106 Car + T cells / kg, 20% dose error is allowed. (3) the third dose group is 9.00 × 106 Car + T cells / kg, 20% dose error is allowed.
    Primary Outcome Measure Information:
    Title
    Adverse event
    Description
    Type, incidence and severity of adverse events
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Maximum tolerated dose
    Description
    The maximum dose that does not cause death of the subject
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Recommended dose for phase II
    Description
    Determine the recommended dose for phase II clinical trials
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Secondary Outcome Measure Information:
    Title
    Peak time,Tmax
    Description
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Maximum concentration, Cmax
    Description
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Area Under Curve, AUC1-30d
    Description
    Venous blood samples were collected once during the infusion period D1, D2, D4, D6, D8, D10, D12, D14, D16, D18, D21, D24, d27, d30 and follow-up period. The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR, and the PK parameters, PK characteristics and distribution of car-t cells in bone marrow were evaluated. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Pharmacodynamics
    Description
    The peak value of cytokines within 1 month after car-t cell infusion and the time to return to the baseline state or normal range.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Total remission rate
    Description
    The total remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Complete remission rate
    Description
    The complete remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Partial remission rate
    Description
    The partial remission rate of each dose group and all patients evaluated at 1 month, 3 months, 6 months, 9 months and 12 months after car-t treatment.M3 was scanned with systemic CT ± head, neck, chest, abdomen and pelvis enhanced CT. For M6, M9 and M12, enhanced CT or MRI of head, neck, chest and abdominal basin was used.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Distribution of car-t cells in bone marrow
    Description
    The proportion and count of car-t cells in peripheral blood and bone marrow were detected by flow cytometry and RT-PCR to evaluate the distribution of car-t cells in bone marrow. The probe method of fluorescence quantitative PCR was used to monitor the copy number of CAR.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.
    Title
    Survival of car-t cells
    Description
    Survival of car-t cells in adult patients with recurrent or refractory DLBCL.
    Time Frame
    The follow-up visit within 2 months is allowed to have a time window of ± 2 days, and the follow-up visit from the 3rd to 12th months is allowed to have a time window of ± 5 days.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Days
    Maximum Age & Unit of Time
    75 Days
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: All subjects or legal guardians must sign the informed consent approved by the ethics committee in writing before starting any screening procedure. Adult patients aged 18 and over with recurrent or refractory DLBCL. Bone marrow negative or bone marrow lymphoma cells in screening stage determined by CT scan < 30%. The subject had been adequately treated before. According to the revised IWG malignant lymphatic efficacy evaluation criteria (2007 Edition), there was at least one measurable lesion in the baseline period. Estimated survival ≥ 12 weeks. The baseline ECoG score was 0 or 1. Adequate organ function. Hemodynamics determined by echocardiography or multichannel radionuclide angiography (MUGA) were stable and left ventricular ejection fraction (LVEF) ≥ 45%. Sufficient bone marrow reserve without blood transfusion. There must be non mobilized apheresis or peripheral blood collected cells for car-t cell production. According to the judgment of the researcher, the patient has fully recovered from the toxicity of previous anti-tumor treatment and is suitable for pretreatment chemotherapy and car-t cell treatment. Women of childbearing age and all male subjects must agree to use efficient contraceptive methods until at least 12 months after xkdct023 infusion, and until two consecutive PCR tests show that car-t cells are no longer present in the body. Exclusion Criteria: Patients who have previously received any anti-CD19 / anti-CD3 treatment, or any other anti-CD19 treatment; Patients previously treated with any gene therapy product, including car-t treatment; Patients with detectable cerebrospinal fluid malignant cells or brain metastasis, or patients with a history of central nervous system (CNS) lymphoma or primary CNS lymphoma; Patients with testicular invasion, including patients with orchiectomy; Patients with current or history of central nervous system diseases, such as epilepsy, cerebrovascular ischemia / hemorrhage, dementia, cerebellar diseases or any autoimmune diseases involving the central nervous system; Patients who had previously received allogeneic hematopoietic stem cell transplantation (HSCT); Patients who are suitable and willing to receive autologous hematopoietic stem cell transplantation (ASCT); The feasibility evaluation screening stage showed that the lymphocyte transfection efficiency of patients was less than 5%, or patients whose T cell culture could not be expanded (< 5 times). Patients who received chemotherapy other than lymphocyte clearance chemotherapy within 2 weeks before xkdct023 infusion; Patients who had received other study drugs within 30 days before screening; Patients who received radiotherapy within 2 weeks before infusion; Active hepatitis B (defined as hepatitis B virus DNA detection value > 1000 copies/ml) or hepatitis C virus (HCV RNA positive) patients. HIV positive or Treponema pallidum positive patients; Patients with acute life-threatening bacterial, viral or fungal infections that have not been controlled (e.g. positive blood culture ≤ 72 hours before infusion); Patients with unstable angina pectoris and / or myocardial infarction within 6 months before screening; Patients with previous or concurrent malignancies, with the following exceptions: well treated basal cell or squamous cell carcinoma (sufficient wound healing is required before enrollment in the study); Cervical cancer or breast cancer in situ cancer, after curable treatment, had no recurrence at least 3 years before the study. The primary malignant tumor has been completely removed and completely relieved for ≥ 5 years. Pregnant or lactating female patients (women of childbearing age are verified as positive results by serum or urine pregnancy test during the screening period); There are arrhythmia patients without medical management control; Patients who received oral anticoagulant therapy within 1 week before car-t cell infusion; Patients who had previously received any adoptive T cell therapy; active neuroautoimmune or inflammatory disorders (e.g. Guillian Barre syndrome, amyotrophic lateral sclerosis).

    12. IPD Sharing Statement

    Learn more about this trial

    Safety, Efficacy and Pharmacokinetics of XKDCT023 in DLBCL

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