Phase I Study of T Cells Expressing an Anti-CD19 Chimeric Receptor in Children and Young Adults With B Cell Malignancies
Background:
Chimeric antigen receptors (CAR) that recognize the CD19 antigen have been constructed and
are in clinical trials at several institutions. In this trial, the POB will utilize a
chimeric receptor containing the signaling domains of CD28 and CD3-zeta, currently under
study in the CCR in adults, for children and young adults with CD19 expressing malignancies.
In co-cultures with CD19-expressing acute lymphoblastic leukemia cells, anti-CD19
CARtransduced T cells show robust killing, and in xenograft models, can rapidly clear CD19-
expressing ALL cell lines.
Objectives:
Primary: To determine the safety and feasibility of administering escalating doses of anti-
CD19-CAR engineered peripheral blood lymphocytes in two strata (prior allogeneic stem cell
transplant -SCT- vs. no prior SCT) of children and young adults with B cell malignancies
following a cyclophosphamide/fludarabine preparative regimen.
Secondary: 1) To determine if the administration of anti-CD19-CAR engineered peripheral
blood lymphocytes can mediate antitumor effects in children with B cell malignancies. 2) To
measure persistence of adoptively-transferred anti-CD19-CAR-transduced T cells in the blood
and CSF of patients.
Eligibility:
Patients 1-30 years of age, at least 15 kg, with a CD19-expressing B-cell malignancy that
has recurred after or not responded to one or more standard chemotherapy-containing regimens
for their malignancy and is deemed incurable by standard therapy. Patients with a history of
allogeneic SCT who meet all eligibility criteria are eligible to participate.
Design:
On Day -11 PBMC will be obtained by leukapheresis, CD3+ cells enriched and cultured in the
presence of anti-CD3/-CD28 beads followed by retroviral vector supernatant containing the
anti-CD19 CAR. Total culture time is 13 days.
On Day -4, patients will begin induction chemotherapy comprising fludarabine 25 mg/m2 on
Days -4, -3 and -2 and cyclophosphamide 900 mg/m2 on day -2.
The CD19-CAR cells will be infused on Day 0, with up to a 48h delay allowed if needed for
resolution of clinical toxicities related to chemotherapy or to generate adequate cell
numbers.
A phase I cell dose escalation scheme will be performed using 3 dose levels (1 x 106
transduced T cells/kg; 3 x 106 transduced T cells/kg; 1 x 107 transduced T cells/kg) in two
strata: patients who have undergone prior SCT and patients who have not previously undergone
SCT. Three patients will be enrolled at each dose level, with the cohort expanded to 6 if
dose limiting toxicity (DLT) occurs. If a cohort of patients previously treated with prior
SCT completes a dose level without DLT, patients in the other stratum (without previous SCT)
may dose escalate simultaneously. An expanded group of 12 patients at the maximum tolerated
dose (MTD) or the highest dose achieved if no MTD was determined, will be accrued to provide
additional information regarding the feasibility, safety and efficacy of this treatment.
Patients will be monitored for toxicity, response and T cell persistence.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
To determine the safety and feasibility of administering escalating doses of anti- CD19-CAR engineered peripheral blood lymphocytes in two strata prior allogeneic stem cell transplant ASCT vs. no prior ASCT in children plus young adults with B c...
Daniel W Lee, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
120112
NCT01593696
April 2012
December 2015
Name | Location |
---|---|
National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |