CD19 CAR-T therapy for adults with relapsed CD19-positive AML

Prospective Non-randomized Phase I Study Investigating the Safety of CD19 CAR-T Cells in Patients With Refractory/Relapsed AML Expressing CD19.

This will try CD19-directed CAR-T cell therapy in adults with relapsed or refractory AML whose leukemia cells express CD19.

Quick facts

• Phase: PHASE1
• Study type: Interventional
• Enrollment: 5 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University Hospital, Lille (other)
• Drugs / interventions: CAR-T, chemotherapy, zumab, CAR T
• Locations: 1 site (Lille)
• Trial ID: NCT06649227 on ClinicalTrials.gov

What this trial studies

This Phase 1, interventional program at CHU de Lille tests the safety of autologous CD19-directed CAR-T cells in adults with relapsed or refractory AML that expresses CD19. Eligible patients must have high CD19 expression on blasts (≥70%), adequate blood counts, ECOG performance status <2, and no active CNS involvement. Patients include primary or secondary refractory cases and post-transplant relapses after other options have been exhausted. The protocol focuses on monitoring for treatment-related toxicities, CAR-T cell expansion, and early signs of anti-leukemia activity.

Who should consider this trial

Good fit: Adults (≥18) with relapsed or refractory AML demonstrating CD19 expression on ≥70% of blasts, ECOG <2, platelet count ≥30,000/µL, absolute lymphocyte count ≥200/µL, no CNS involvement, and lacking other accessible targeted therapies are the intended candidates.

Not a fit: Patients whose leukemia does not express CD19, those with poor performance status, uncontrolled CNS disease, very short expected survival, or contraindicating comorbidities are unlikely to benefit from this approach.

Why it matters

Potential benefit: If successful, the approach could induce remissions in patients with CD19-positive relapsed AML who have limited treatment options.

How similar studies have performed: A few case reports and small series have reported remissions with CD19-targeted therapies including bispecific antibodies and CAR-T in t(8;21) CD19-positive AML, but larger evidence is limited.

Eligibility criteria

Inclusion Criteria:

* Subject is ≥ 18 years of age at the time of signing the informed consent form,
* Patient with AML that expresses CD19 by Flow-cytometry, (CD19 expression ≥ 70% of AML blasts)
* Patients with R/R AML defined as:

  * Primary refractory: absence of remission after two courses of induction chemotherapy,
  * Secondary refractory: absence of remission after salvage treatment in relapsing patients,
  * Post-transplant relapse in patients having had allo-HCT.
* Lack of accessible targeted therapy that has not been previously utilized.
* Eastern Cooperative Oncology Group (ECOG) performance status of \< 2,
* Estimated life expectancy of \> 2 months,
* Magnetic resonance imaging (MRI) of the brain showing no evidence of central nervous system (CNS) involvement,
* Toxicities due to prior therapy must be stable and recovered to ≤ Grade 1 (except for clinically non-significant toxicities, such as alopecia),
* Platelet count ≥ 30000/uL,
* Absolute lymphocyte count ≥ 200/uL,
* Creatinine clearance (as estimated by Cockcroft Gault) ≥ 40 mL/min,
* Serum ALT/AST ≤ 2.5 upper limit of normal (ULN),
* Total bilirubin ≤ 1.5 mg/dl, except in subjects with Gilbert's syndrome,
* Cardiac ejection fraction ≥ 45 %,
* No clinically significant electrocardiogram (ECG) findings,
* No clinically significant pleural effusion,
* Baseline oxygen saturation \> 92 % on room air,
* Female patients of childbearing potential must:

  1. have a negative pregnancy test (blood) at screening visit.
  2. either commit to true abstinence from heterosexual contact or agree to use, and be able to comply with, effective measures of contraception without interruption, from screening through 1 year following the CAR-T cell infusion. A highly effective method of contraception or birth control (failure rate less than 1% per year when used consistently and correctly) must be practiced. The patient should be informed of the potential risks associated with becoming pregnant while enrolled in this clinical trial. Reliable methods for this trial are: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, sexual abstinence or vasectomized sexual partner. Abstinence is only accepted as true abstinence: when this is in line with the preferred and usual lifestyle of the patient. (Periodic abstinence \[e.g. calendar, ovulation, symptothermal, post-ovulation methods and withdrawal\] are not acceptable methods of contraception.) Postmenopausal (no menses for at least 1 year without alternative medical cause) or surgically sterile female patients (tubal ligation, hysterectomy or bilateral oophorectomy) may be enrolled.
  3. Agree to abstain from breast feeding during the study participation and for 1 year after the CAR-T cell infusion.
* Male patients must practice true abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential for at least 1 year after the CAR-T cell infusion, even if he has undergone a successful vasectomy.

Exclusion Criteria:

* Patient unable to sign the informed consent,
* Patient with R/R AML that does not expresses CD19,
* History of malignancy other than nonmelanoma skin cancer or carcinoma in situ (e.g. cervix, bladder, breast) unless disease-free and without anticancer therapy for at least 3 years,
* Prior CD19 targeted therapy,
* Prior CAR therapy or other genetically modified T cell therapy,
* Presence or suspicion of fungal, bacterial, viral, or other infection that is uncontrolled or requiring intravenous (IV) antimicrobials for management,
* History of human immunodeficiency virus (HIV) or HTLV1,
* Infection or acute or chronic active hepatitis C infection,
* Infection or acute or chronic active hepatitis (Hep) B. Subjects with history of Hep B or Hep C infection must have cleared their infection as determined by standard serological and genetic testing per current Infectious Diseases Society of America (IDSA) guidelines,
* Subjects with detectable cerebrospinal fluid malignant cells or known brain metastases or with a history of cerebrospinal fluid (CSF) malignant cells or brain metastases,
* History or presence of non-malignant CNS disorder, such as seizure disorder, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, or any autoimmune disease with CNS involvement,
* Patient placed under guardianship or curatorship,
* Females either pregnant/breast-feeding or planning to become pregnant,
* Any contraindication due to hypersensitivity to the active substance or to any of the excipients,
* Contraindication to the lymphodepleting chemotherapy,
* Absence of medical insurance cover.

Where this trial is running

Lille

• CHU de Lille — Lille, France (RECRUITING)

Study contacts

• Principal investigator: Ibrahim Yakoub-Agha, MD,PhD — University Hospital, Lille
• Study coordinator: Ibrahim Yakoub-Agha, MD,PhD

Conditions: Relapsed Adult AML, Relapsed/refractory AML expressing CD19, AML, CD19, CAR-T cells