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CD19 CAR T-Cell Therapy for R/R Non-Hodgkin Lymphoma and Acute Lymphoblastic Leukemia

Primary Purpose

B-Cell Non Hodgkin Lymphoma, B-Cell Acute Lymphoblastic Leukemia

Status
Recruiting
Phase
Phase 1
Locations
Vietnam
Study Type
Interventional
Intervention
anti-CD19 CAR T-cells
Sponsored by
Vinmec Research Institute of Stem Cell and Gene Technology
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for B-Cell Non Hodgkin Lymphoma

Eligibility Criteria

1 Year - 60 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria: B-cell acute lymphoblastic leukemia: refractory to two cycles of chemotherapy, relapsed after chemotherapy, or hematopoietic stem cell transplantation. B-cell non-Hodgkin lymphoma: refractory to two lines of chemotherapy, relapsed after chemotherapy, or hematopoietic stem cell transplantation. Age: From 1 to 60 years old (both males and females) Adequate organ functions: Serum creatinine ≤ 1.5 x ULN or eGFR ≥ 60 mL/min/1.73 m2 ALT and AST ≤ 5 x ULN; Bilirubin ≤ 2.0 mg/dl No chronic lung diseases, such as obstructive pulmonary disease or bronchial asthma, required continuous medications without respiratory failure (SpO2 oxygen saturation > 92% at room temperature). No arrhythmia, no intracardiac thrombus or vascular wall, no heart failure, LVEF ≥ 45% Blood test: Absolute neutrophil count (ANC) ≥ 1,000/mm3 (1 G/l) without filgrastim Absolute lymphocyte count ≥ 100/mm3 (0.1 G/l) Absolute platelet count ≥ 75,000/mm3 (75 G/l) Hemoglobin ≥ 8.0 g/dl Positive for CD19 measured by immunohistochemistry or flow cytometry. Agree to participate in the study Agree to use safe methods of contraception for female patients. Exclusion criteria: Involved central nervous system invasion at the time of screening. Medical history of veno-occlusive disease (VOD). Required acute treatment due to tumors such as intestinal obstructions, vascular compression, or respiratory failure. Having active hemolytic anemia. Diagnosed with primary immunodeficiency. Medical history of autoimmune neurological diseases or neuromyelitis. Receiving immunosuppressive medication, except for ≤ 30 mg prednisolone or equivalent at the time of CAR-T-cell transfusion. Having acute, progressive, or chronic graft-versus-host disease (GvHD). Having active infectious diseases determined by clinical, imaging, or other laboratory tests (blood culture, PCR, etc.) Patients who are critically ill or at risk of premature death characterized by: Acute liver failure requiring dialysis Heart failure requiring vasopressors Systemic infection unresponsive to antibiotics ECOG performance status ≥ 3 points at the time of screening Having other severe concomitant diseases (e.g., uncontrolled arterial hypertension, heart failure NYHA III-IV). Unstable angina within 3 months prior to screening. Any previous or concurrent malignancy was not B-cell lymphoma or B-ALL. Medical history of clinically relevant central nervous system disease, such as epilepsy, convulsions, paralysis, aphasia, uncontrolled cerebrovascular disease, traumatic brain injury, and Parkinson's disease. Intolerance to excipients from cellular products. Pregnant women or those who expect to be pregnant or reastfeeding. Other diseases or other conditions and circumstances that, according to the investigator's assessment, make it difficult to ensure compliance with study treatment. Participation in another clinical trial at the time of screening

Sites / Locations

  • Vinmec Research Institute of Stem Cell and Gene TechnologyRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment Regimen

Arm Description

Experimental: Treatment Regimen. Leukapheresis to collect white blood cells using Spectra Optia Apheresis system. T cells selection, transduction, and CAR T-cell manufacturing using CliniMACS Prodigy. During this process, T cells will be genetically modified to express CD19 CAR. Lymphodepleting chemotherapy conditioning regimen for 3 days. CAR T-cells targeting CD19 will be infused intravenously at a dose between 1 and 2x10e6 cells/kg for 15-30 minutes. Following the T-cell infusion, patients will stay in the clinic for approximately 21-28 days to monitor toxicity. Outpatient follow-up will take place after 1 month, 3 months, and 6 months after infusion.

Outcomes

Primary Outcome Measures

Assessment of the frequency and severity of adverse events and serious adverse events (AEs/SAEs) of the therapy
The incidence of adverse events (AEs) and serious adverse events (SAEs) will be recorded and classified according to CTCAE v5 (grade 1-5). CRS and ICANs will be classified using the ASTCT criteria (grade 1-5). These parameters will be used to assess the safety of the therapy.

Secondary Outcome Measures

Proportion of patients with complete response and partial response after CD19 CAR T-cell infusion (%)
Patients with B-ALL will receive bone marrow biopsy assessed on day 30 and day 90 to check blast frequency and MRD. The response will be classified according to NCCN guidelines. Patients with NHL will be examined PET-CT or CT on day 90. The response will be classified according to Cheson guidelines.
Progression-free survival (PFS) (months)
PFS is defined as the time from CAR T-cell infusion, until disease progression or death from any cause. Progression is defined as an increase of tumor load, the development of new lesions.
Event-free survival (EFS) (months)
EFS is defined as time to treatment failure (including complete remission with incomplete hematologic or platelet recovery), relapse from complete remission, or death from any cause.
Overall survival (OS) (months)
EFS is defined as time to death

Full Information

First Posted
July 28, 2023
Last Updated
September 5, 2023
Sponsor
Vinmec Research Institute of Stem Cell and Gene Technology
Collaborators
National Institute of Hematology and Blood Transfusion, Vietnam
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1. Study Identification

Unique Protocol Identification Number
NCT06027957
Brief Title
CD19 CAR T-Cell Therapy for R/R Non-Hodgkin Lymphoma and Acute Lymphoblastic Leukemia
Official Title
Phase I Clinical Trial Evaluating the Safety and Efficacy of Point-of-care CAR-T-cell Therapy in the Treatment of Relapsed/Refractory CD19+ Non-Hodgkin Lymphoma and Acute Lymphoblastic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 2, 2023 (Actual)
Primary Completion Date
July 31, 2025 (Anticipated)
Study Completion Date
July 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vinmec Research Institute of Stem Cell and Gene Technology
Collaborators
National Institute of Hematology and Blood Transfusion, Vietnam

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
Brief Summary: Cluster of differentiation 19 (CD19) is expressed on B cells. CD19+ tumor cells in patients with non-Hodgkin lymphoma and acute lymphoblastic leukemia can be targeted using T cells expressing CD19-specific chimeric antigen receptor (CAR). Objective: This study aims to evaluate the safety and efficacy of single-dose anti-CD19 CAR T-cell therapy in the treatment of relapsed/refractory CD19+ non-Hodgkin lymphoma and acute lymphoblastic leukemia. Eligibility: People aged 1 to 60 years with relapsed/refractory CD19+ non-Hodgkin lymphoma and acute lymphoblastic leukemia. Design: Phase 1 clinical trial, uncontrolled, single dose of CD19 CAR T-cells.
Detailed Description
Objectives: Evaluate the frequency and severity of adverse events and serious adverse events (AEs/SAEs) of the therapy. Evaluate the response rate after CD19 CAR T-cell infusion according to the following criteria: Proportion of patients with complete response and partial response after CD19 CAR T-cell infusion Progression-free survival (PFS) after infusion of CD19 CAR T-cells Event-free survival (EFS) after infusion of CD19 CAR T-cells Overall survival (OS) after infusion of CD19 CAR T-cells

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
B-Cell Non Hodgkin Lymphoma, B-Cell Acute Lymphoblastic Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment Regimen
Arm Type
Experimental
Arm Description
Experimental: Treatment Regimen. Leukapheresis to collect white blood cells using Spectra Optia Apheresis system. T cells selection, transduction, and CAR T-cell manufacturing using CliniMACS Prodigy. During this process, T cells will be genetically modified to express CD19 CAR. Lymphodepleting chemotherapy conditioning regimen for 3 days. CAR T-cells targeting CD19 will be infused intravenously at a dose between 1 and 2x10e6 cells/kg for 15-30 minutes. Following the T-cell infusion, patients will stay in the clinic for approximately 21-28 days to monitor toxicity. Outpatient follow-up will take place after 1 month, 3 months, and 6 months after infusion.
Intervention Type
Biological
Intervention Name(s)
anti-CD19 CAR T-cells
Other Intervention Name(s)
Chemotherapy Drug
Intervention Description
For Biological: CD19 CAR T-cells Dose: 1-2.10e6 cells/kg of weight Route: intravenous infusion For Chemotherapy Drug: Fludarabine (30 mg/m2/day) given intravenously (IV) on day -5 to -3. Cyclophosphamide 500 mg/m2/day for NHL and 250 mg/m2/day for ALL given IV from day -5 to -3. Mesna 500 mg/m2/day for NHL and 250 mg/m2/day for ALL, divided in three infusions: one day before the cyclophosphamide infusion, and 4 and 8 hours after.
Primary Outcome Measure Information:
Title
Assessment of the frequency and severity of adverse events and serious adverse events (AEs/SAEs) of the therapy
Description
The incidence of adverse events (AEs) and serious adverse events (SAEs) will be recorded and classified according to CTCAE v5 (grade 1-5). CRS and ICANs will be classified using the ASTCT criteria (grade 1-5). These parameters will be used to assess the safety of the therapy.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Proportion of patients with complete response and partial response after CD19 CAR T-cell infusion (%)
Description
Patients with B-ALL will receive bone marrow biopsy assessed on day 30 and day 90 to check blast frequency and MRD. The response will be classified according to NCCN guidelines. Patients with NHL will be examined PET-CT or CT on day 90. The response will be classified according to Cheson guidelines.
Time Frame
Day 30 and day 90 after CAR-T infusion for B-ALL; day 90 after CAR-T infusion for NHL
Title
Progression-free survival (PFS) (months)
Description
PFS is defined as the time from CAR T-cell infusion, until disease progression or death from any cause. Progression is defined as an increase of tumor load, the development of new lesions.
Time Frame
6 months
Title
Event-free survival (EFS) (months)
Description
EFS is defined as time to treatment failure (including complete remission with incomplete hematologic or platelet recovery), relapse from complete remission, or death from any cause.
Time Frame
6 months
Title
Overall survival (OS) (months)
Description
EFS is defined as time to death
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: B-cell acute lymphoblastic leukemia: refractory to two cycles of chemotherapy, relapsed after chemotherapy, or hematopoietic stem cell transplantation. B-cell non-Hodgkin lymphoma: refractory to two lines of chemotherapy, relapsed after chemotherapy, or hematopoietic stem cell transplantation. Age: From 1 to 60 years old (both males and females) Adequate organ functions: Serum creatinine ≤ 1.5 x ULN or eGFR ≥ 60 mL/min/1.73 m2 ALT and AST ≤ 5 x ULN; Bilirubin ≤ 2.0 mg/dl No chronic lung diseases, such as obstructive pulmonary disease or bronchial asthma, required continuous medications without respiratory failure (SpO2 oxygen saturation > 92% at room temperature). No arrhythmia, no intracardiac thrombus or vascular wall, no heart failure, LVEF ≥ 45% Blood test: Absolute neutrophil count (ANC) ≥ 1,000/mm3 (1 G/l) without filgrastim Absolute lymphocyte count ≥ 100/mm3 (0.1 G/l) Absolute platelet count ≥ 75,000/mm3 (75 G/l) Hemoglobin ≥ 8.0 g/dl Positive for CD19 measured by immunohistochemistry or flow cytometry. Agree to participate in the study Agree to use safe methods of contraception for female patients. Exclusion criteria: Involved central nervous system invasion at the time of screening. Medical history of veno-occlusive disease (VOD). Required acute treatment due to tumors such as intestinal obstructions, vascular compression, or respiratory failure. Having active hemolytic anemia. Diagnosed with primary immunodeficiency. Medical history of autoimmune neurological diseases or neuromyelitis. Receiving immunosuppressive medication, except for ≤ 30 mg prednisolone or equivalent at the time of CAR-T-cell transfusion. Having acute, progressive, or chronic graft-versus-host disease (GvHD). Having active infectious diseases determined by clinical, imaging, or other laboratory tests (blood culture, PCR, etc.) Patients who are critically ill or at risk of premature death characterized by: Acute liver failure requiring dialysis Heart failure requiring vasopressors Systemic infection unresponsive to antibiotics ECOG performance status ≥ 3 points at the time of screening Having other severe concomitant diseases (e.g., uncontrolled arterial hypertension, heart failure NYHA III-IV). Unstable angina within 3 months prior to screening. Any previous or concurrent malignancy was not B-cell lymphoma or B-ALL. Medical history of clinically relevant central nervous system disease, such as epilepsy, convulsions, paralysis, aphasia, uncontrolled cerebrovascular disease, traumatic brain injury, and Parkinson's disease. Intolerance to excipients from cellular products. Pregnant women or those who expect to be pregnant or reastfeeding. Other diseases or other conditions and circumstances that, according to the investigator's assessment, make it difficult to ensure compliance with study treatment. Participation in another clinical trial at the time of screening
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Thanh Liem Nguyen, PhD
Phone
+84 4 3974 3556
Ext
1420
Email
v.liemnt@vinmec.com
First Name & Middle Initial & Last Name or Official Title & Degree
Van T. Hoang, PhD
Phone
+84 93 644 94 81
Email
v.vanht8@vinmec.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thanh Liem Nguyen, PhD
Organizational Affiliation
Vinmec Research Institute of Stem Cell and Gene Technology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Vinmec Research Institute of Stem Cell and Gene Technology
City
Hanoi
ZIP/Postal Code
100000
Country
Vietnam
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nguyen T Liem, Prof

12. IPD Sharing Statement

Plan to Share IPD
No

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CD19 CAR T-Cell Therapy for R/R Non-Hodgkin Lymphoma and Acute Lymphoblastic Leukemia

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