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Natural Killer Cell (CYNK-001) Infusions in Adults With COVID-19 (CYNKCOVID)

Primary Purpose

Coronavirus, Coronavirus Infection, Severe Acute Respiratory Syndrome Coronavirus 2

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CYNK-001
Sponsored by
Celularity Incorporated
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronavirus focused on measuring CYNK-001, Coronavirus, COVID-19, SARS-Cov-2, cell therapy, NK cells, natural killer cells, CYNKCOVID, CYNK-001-COVID-19

Eligibility Criteria

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

Patient Inclusion Criteria:

  • Patient has confirmed positivity for SARS-CoV-2 as measured by rRT-PCR or other approved test to detect SAR-CoV-2 per institutional practice.
  • Patient is experiencing any symptom/clinical sign of COVID-19 illness or has a positive disease-related chest x-ray/CT scan at screening.
  • Patient is ≥ 18 years of age at the time of signing the Study informed consent form (ICF).
  • Patient understands and voluntarily signs the Study ICF prior to any study-related assessments/procedures are conducted.
  • Patient is willing and able to adhere to the study schedule and other protocol requirements.
  • SpO2 ≥ 88% on room air; oxygen is permitted as delivered by nasal cannula and/or face mask at any flow rate to achieve this SpO2. Patients must have an SpO2 ≥ 92% if on supplementary oxygen.
  • Ability to be off immunosuppressive drugs for 3 days prior to infusion, unless clinically indicated. Steroids are permitted if clinically indicated and at the discretion of the treating physician. If clinically indicated, careful consideration should be taken regarding the timing and tapering of high-dose steroids.
  • Female of childbearing potential (FCBP)* must not be pregnant and agree to not becoming pregnant for at least 28 days following the last infusion of CYNK-001. FCBP must agree to use an adequate method of contraception during the treatment period.

    • FCBP is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
  • Male Patients must agree to use a condom during sexual contact for at least 28 days following the last infusion of CYNK-001, even if he has undergone a successful vasectomy.

Patient Exclusion Criteria

  • Patient requires supplemental oxygen delivered by mechanical ventilation, either invasive or bilevel positive airway pressure.
  • Patient admitted to Intensive Care Unit / Pulmonary Acute Care Unit designated area with severe pulmonary pneumonia, ARDS or Sepsis.
  • Patient is pregnant or breastfeeding.
  • Patient has a history of chronic asthma requiring ongoing medical therapy or other chronic pulmonary disease that, at the discretion of the treating physician, would contraindicate participation in this study.
  • Patient has any other organ dysfunction [Common Terminology Criteria for AEs (CTCAE) Version 5.0 Grade 3] that will interfere with the administration of the therapy according to this protocol.
  • Patient has inadequate organ function as defined below at time of Treatment Eligibility Period:

    1. Patient has aspartate aminotransferase (AST), alanine aminotransferase (ALT), or alkaline phosphatase ≥ 5 x the upper limit of normal (ULN). (It is anticipated that the infection may impact liver.)
    2. Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m^2 as calculated using the Modification of Diet in Renal Disease Study equation (Levey, 2006) or history of an abnormal eGFR < 60. A decline of > 15 mL/min/1.73 m^2 below normal in the past year prior to infection. (It is anticipated that the infection may impact renal function.)
    3. Patient has a bilirubin level > 2 mg/dL (unless Patient has known Gilbert's Syndrome).
  • Patient has a known sensitivity or allergy to treatment additives or diluent substances of dimethyl sulfoxide (DMSO), PlasmaLyte A or human serum albumin (HSA). Please refer to investigational brochure (IB).
  • Patient has active autoimmune disease other than controlled connective tissue disorder or those who are not on active therapy.
  • Patient is immunocompromised, has known human immunodeficiency virus (HIV) positivity, or has actively been treated with immunosuppressive products prior to being infected with SARS-CoV-2.
  • Patient has known active malignancy, unless the Patient has been free of disease for > 3 years from the date of signing the ICF. Exceptions include the following noninvasive malignancies:

    1. Basal cell carcinoma of the skin
    2. Squamous cell carcinoma of the skin
    3. Carcinoma in situ of the cervix
    4. Carcinoma in situ of the breast
    5. Incidental histological finding of prostate cancer (TNM stage of T1a or T1b)
  • Detection of other respiratory viruses from mucosal surfaces that would interfere with the study treatment plan; detection of another respiratory virus is not in itself an exclusion criteria unless the investigator believes it would interfere with administration of CYNK-001.
  • Patient must not have a history of unconsciousness or hemoptysis within 2 weeks of signing informed consent form.
  • Patients must not have a history of unconsciousness or hemoptysis within 2 weeks of signing ICF.
  • Patients must not have end stage liver disease and/or cirrhosis.
  • Patient has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from participating in the study.
  • Patient has any condition including the presence of laboratory abnormalities which places the patient at unacceptable risk if he or she were to participate in the study.
  • Patient has any condition that confounds the ability to interpret data from the study.

Sites / Locations

  • UC Irvine
  • UC Davis Medical Center
  • Scripps Health
  • Hackensack University Medical Center
  • Atlantic Health
  • Atlantic Health
  • Multicare Health System

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Phase I

Phase II

Arm Description

CYNK-001 infusions on Days 1, 4, and 7

Randomized, open label; CYNK-001 infusions on Days 1, 4, and 7 compared to Control Group: Best Supportive Care

Outcomes

Primary Outcome Measures

Phase 1: Frequency and Severity of Adverse Events (AE)
Number and severity of adverse events
Phase 1 Futility Check for go/no decision to move to Phase 2: Rate of clinical improvement
Proportion of patients who improved clinical symptoms as measured by the Ordinal Scale for Clinical Improvement (OSCI)
Phase 2: Time to Clinical Improvement by Ordinal Scale for Clinical Improvement (OSCI)
Time to clinical improvement measured by OSCI

Secondary Outcome Measures

Rate of Clearance of SARS-CoV-2
Proportion of patients with "negative" measurement of COVID-19 by rRT-PCR
Time to Clearance of SARS-CoV-2
Time to clearance of SARS-CoV-2 by rRT-PCR testing of mucousal samples with "negative" measurement of COVID-19 by rRT-PCR
Phase 2: Frequency and Severity of Adverse Events (AE)
Number and severity of adverse events
Overall Clinical Benefit by time to medical discharge
Time to medical discharge as an assessment of overall clinical benefit
Overall Clinical Benefit by hospital utilization
Hospital utilization will be measured as an assessment of overall clinical benefit
Overall Clinical Benefit by measuring mortality rate
Mortality rate will be measured as an assessment of overall clinical benefit
Impact of CYNK-001 on sequential organ failure assessment (SOFA) score
Assess the impact of CYNK-001 on changes in sequential organ failure assessment (SOFA) score.
Time to Pulmonary Clearance
Time from randomization to the date of disappearance of virus from lower respiratory tract infection (LRTI) specimen where it has previously been found (induced sputum, endotracheal aspirate).
Rate of Pulmonary Clearance
Proportion of patients who had disappearance of virus from lower respiratory tract infection (LRTI) specimen where it has previously been found.
Supplemental oxygen-free days
For ventilatory support patients, the days with supplemental oxygen-free.
Proportion of patients requiring ventilation
Proportion of patients who need invasive or non-invasive ventilation
Duration of hospitalization
Time from hospitalization to medical discharge
Radiologic Evaluation Score
Chest x-ray and/or CT scan results will be evaluated and scored
All-cause mortality rate
Proportion of patients who died
Time to clinical improvement by NEWS2 Score
Time to clinical improvement measured by NEWS2 Score
Rate of clinical improvement by NEWS2 Score
Proportion of patients who achieved clinical symptom improvement measured by NEWS2 Score

Full Information

First Posted
April 22, 2020
Last Updated
May 24, 2022
Sponsor
Celularity Incorporated
Collaborators
Access to Advanced Health Institute (AAHI), Lung Biotechnology PBC, California Institute for Regenerative Medicine (CIRM)
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1. Study Identification

Unique Protocol Identification Number
NCT04365101
Brief Title
Natural Killer Cell (CYNK-001) Infusions in Adults With COVID-19
Acronym
CYNKCOVID
Official Title
A Phase I/II Study of Human Placental Hematopoietic Stem Cell Derived Natural Killer Cells (CYNK-001) for the Treatment of Adults With COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 13, 2020 (Actual)
Primary Completion Date
December 30, 2021 (Actual)
Study Completion Date
June 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Celularity Incorporated
Collaborators
Access to Advanced Health Institute (AAHI), Lung Biotechnology PBC, California Institute for Regenerative Medicine (CIRM)

4. Oversight

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

5. Study Description

Brief Summary
This study is a Phase 1 / 2 trial to determine the safety and efficacy of CYNK-001, an immunotherapy containing Natural Killer (NK) cells derived from human placental CD34+ cells and culture-expanded, in patients with moderate COVID-19 disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronavirus, Coronavirus Infection, Severe Acute Respiratory Syndrome Coronavirus 2, Pneumonia, Pneumonia, Viral, Lung Diseases, Respiratory Tract Disease, Respiratory Tract Infections, Coronaviridae Infections, Nidovirales Infections, RNA Virus Infections, Virus Disease, Immunologic Disease, ARDS, Immunologic Factors, Physiological Effects of Drugs, Antiviral Agents, Anti-infective Agents, Analgesics, Antimetabolites, Antineoplastic
Keywords
CYNK-001, Coronavirus, COVID-19, SARS-Cov-2, cell therapy, NK cells, natural killer cells, CYNKCOVID, CYNK-001-COVID-19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Phase I will evaluate the safety and efficacy of multiple doses of CYNK-001 (Days 1,4, and 7) in 14 patients. Phase II will utilize a randomized, open-label design; multiple doses of CYNK-001 will be compared to the control group: Best Supportive Care. Up to 72 patients will be included in the Phase II portion of the study with a 1:1 randomization ratio.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
86 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Phase I
Arm Type
Experimental
Arm Description
CYNK-001 infusions on Days 1, 4, and 7
Arm Title
Phase II
Arm Type
Active Comparator
Arm Description
Randomized, open label; CYNK-001 infusions on Days 1, 4, and 7 compared to Control Group: Best Supportive Care
Intervention Type
Biological
Intervention Name(s)
CYNK-001
Intervention Description
CYNK-001 is an allogeneic off the shelf cell therapy enriched for CD56+/CD3- NK cells expanded from human placental CD34+ cells.
Primary Outcome Measure Information:
Title
Phase 1: Frequency and Severity of Adverse Events (AE)
Description
Number and severity of adverse events
Time Frame
Up to 6 months
Title
Phase 1 Futility Check for go/no decision to move to Phase 2: Rate of clinical improvement
Description
Proportion of patients who improved clinical symptoms as measured by the Ordinal Scale for Clinical Improvement (OSCI)
Time Frame
Study Day 15
Title
Phase 2: Time to Clinical Improvement by Ordinal Scale for Clinical Improvement (OSCI)
Description
Time to clinical improvement measured by OSCI
Time Frame
Study Day 28
Secondary Outcome Measure Information:
Title
Rate of Clearance of SARS-CoV-2
Description
Proportion of patients with "negative" measurement of COVID-19 by rRT-PCR
Time Frame
Study Day 28
Title
Time to Clearance of SARS-CoV-2
Description
Time to clearance of SARS-CoV-2 by rRT-PCR testing of mucousal samples with "negative" measurement of COVID-19 by rRT-PCR
Time Frame
Study Day 28
Title
Phase 2: Frequency and Severity of Adverse Events (AE)
Description
Number and severity of adverse events
Time Frame
up to 6 months
Title
Overall Clinical Benefit by time to medical discharge
Description
Time to medical discharge as an assessment of overall clinical benefit
Time Frame
up to 6 months
Title
Overall Clinical Benefit by hospital utilization
Description
Hospital utilization will be measured as an assessment of overall clinical benefit
Time Frame
up to 6 months
Title
Overall Clinical Benefit by measuring mortality rate
Description
Mortality rate will be measured as an assessment of overall clinical benefit
Time Frame
up to 6 months
Title
Impact of CYNK-001 on sequential organ failure assessment (SOFA) score
Description
Assess the impact of CYNK-001 on changes in sequential organ failure assessment (SOFA) score.
Time Frame
Up to 28 days
Title
Time to Pulmonary Clearance
Description
Time from randomization to the date of disappearance of virus from lower respiratory tract infection (LRTI) specimen where it has previously been found (induced sputum, endotracheal aspirate).
Time Frame
Up to 28 days
Title
Rate of Pulmonary Clearance
Description
Proportion of patients who had disappearance of virus from lower respiratory tract infection (LRTI) specimen where it has previously been found.
Time Frame
Up to 28 days
Title
Supplemental oxygen-free days
Description
For ventilatory support patients, the days with supplemental oxygen-free.
Time Frame
Up to 28 days
Title
Proportion of patients requiring ventilation
Description
Proportion of patients who need invasive or non-invasive ventilation
Time Frame
Up to 28 days
Title
Duration of hospitalization
Description
Time from hospitalization to medical discharge
Time Frame
Study Day 28
Title
Radiologic Evaluation Score
Description
Chest x-ray and/or CT scan results will be evaluated and scored
Time Frame
Study Day 28 and Month 6
Title
All-cause mortality rate
Description
Proportion of patients who died
Time Frame
Study Day 28 and Month 6
Title
Time to clinical improvement by NEWS2 Score
Description
Time to clinical improvement measured by NEWS2 Score
Time Frame
Study Day 28
Title
Rate of clinical improvement by NEWS2 Score
Description
Proportion of patients who achieved clinical symptom improvement measured by NEWS2 Score
Time Frame
Study Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Patient Inclusion Criteria: Patient has confirmed positivity for SARS-CoV-2 as measured by rRT-PCR or other approved test to detect SAR-CoV-2 per institutional practice. Patient is experiencing any symptom/clinical sign of COVID-19 illness or has a positive disease-related chest x-ray/CT scan at screening. Patient is ≥ 18 years of age at the time of signing the Study informed consent form (ICF). Patient understands and voluntarily signs the Study ICF prior to any study-related assessments/procedures are conducted. Patient is willing and able to adhere to the study schedule and other protocol requirements. SpO2 ≥ 88% on room air; oxygen is permitted as delivered by nasal cannula and/or face mask at any flow rate to achieve this SpO2. Patients must have an SpO2 ≥ 92% if on supplementary oxygen. Ability to be off immunosuppressive drugs for 3 days prior to infusion, unless clinically indicated. Steroids are permitted if clinically indicated and at the discretion of the treating physician. If clinically indicated, careful consideration should be taken regarding the timing and tapering of high-dose steroids. Female of childbearing potential (FCBP)* must not be pregnant and agree to not becoming pregnant for at least 28 days following the last infusion of CYNK-001. FCBP must agree to use an adequate method of contraception during the treatment period. FCBP is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Male Patients must agree to use a condom during sexual contact for at least 28 days following the last infusion of CYNK-001, even if he has undergone a successful vasectomy. Patient Exclusion Criteria Patient requires supplemental oxygen delivered by mechanical ventilation, either invasive or bilevel positive airway pressure. Patient admitted to Intensive Care Unit / Pulmonary Acute Care Unit designated area with severe pulmonary pneumonia, ARDS or Sepsis. Patient is pregnant or breastfeeding. Patient has a history of chronic asthma requiring ongoing medical therapy or other chronic pulmonary disease that, at the discretion of the treating physician, would contraindicate participation in this study. Patient has any other organ dysfunction [Common Terminology Criteria for AEs (CTCAE) Version 5.0 Grade 3] that will interfere with the administration of the therapy according to this protocol. Patient has inadequate organ function as defined below at time of Treatment Eligibility Period: Patient has aspartate aminotransferase (AST), alanine aminotransferase (ALT), or alkaline phosphatase ≥ 5 x the upper limit of normal (ULN). (It is anticipated that the infection may impact liver.) Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m^2 as calculated using the Modification of Diet in Renal Disease Study equation (Levey, 2006) or history of an abnormal eGFR < 60. A decline of > 15 mL/min/1.73 m^2 below normal in the past year prior to infection. (It is anticipated that the infection may impact renal function.) Patient has a bilirubin level > 2 mg/dL (unless Patient has known Gilbert's Syndrome). Patient has a known sensitivity or allergy to treatment additives or diluent substances of dimethyl sulfoxide (DMSO), PlasmaLyte A or human serum albumin (HSA). Please refer to investigational brochure (IB). Patient has active autoimmune disease other than controlled connective tissue disorder or those who are not on active therapy. Patient is immunocompromised, has known human immunodeficiency virus (HIV) positivity, or has actively been treated with immunosuppressive products prior to being infected with SARS-CoV-2. Patient has known active malignancy, unless the Patient has been free of disease for > 3 years from the date of signing the ICF. Exceptions include the following noninvasive malignancies: Basal cell carcinoma of the skin Squamous cell carcinoma of the skin Carcinoma in situ of the cervix Carcinoma in situ of the breast Incidental histological finding of prostate cancer (TNM stage of T1a or T1b) Detection of other respiratory viruses from mucosal surfaces that would interfere with the study treatment plan; detection of another respiratory virus is not in itself an exclusion criteria unless the investigator believes it would interfere with administration of CYNK-001. Patient must not have a history of unconsciousness or hemoptysis within 2 weeks of signing informed consent form. Patients must not have a history of unconsciousness or hemoptysis within 2 weeks of signing ICF. Patients must not have end stage liver disease and/or cirrhosis. Patient has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from participating in the study. Patient has any condition including the presence of laboratory abnormalities which places the patient at unacceptable risk if he or she were to participate in the study. Patient has any condition that confounds the ability to interpret data from the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Corey Casper, MD MPH
Organizational Affiliation
Access to Advanced Health Institute (AAHI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
UC Irvine
City
Irvine
State/Province
California
ZIP/Postal Code
92697
Country
United States
Facility Name
UC Davis Medical Center
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States
Facility Name
Scripps Health
City
San Diego
State/Province
California
ZIP/Postal Code
92121
Country
United States
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
Atlantic Health
City
Morristown
State/Province
New Jersey
ZIP/Postal Code
07960
Country
United States
Facility Name
Atlantic Health
City
Summit
State/Province
New Jersey
ZIP/Postal Code
07901
Country
United States
Facility Name
Multicare Health System
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98405
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
16908915
Citation
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006 Aug 15;145(4):247-54. doi: 10.7326/0003-4819-145-4-200608150-00004. Erratum In: Ann Intern Med. 2008 Oct 7;149(7):519. Ann Intern Med. 2021 Apr;174(4):584.
Results Reference
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Natural Killer Cell (CYNK-001) Infusions in Adults With COVID-19

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