Evaluating a new treatment for relapsed and refractory B-cell leukemia

To Evaluate the Safety, Efficacy and Pharmacokinetics of ThisCART19A in Patients With Relapsed and Refractory Acute B-cell Leukemia

This study is testing a new treatment called ThisCART19A to see if it can help adults with relapsed or hard-to-treat B-cell leukemia feel better.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 16 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: Zhejiang University (Academic / other)
• Drugs / interventions: berintoomumab, CAR-T, prednisone
• Locations: 2 sites (Hangzhou, Zhejiang and 1 other locations)
• Trial ID: NCT05350787 on ClinicalTrials.gov

What this trial studies

This open-label, phase I study aims to assess the safety, efficacy, and pharmacokinetics of ThisCART19A in patients diagnosed with relapsed and refractory acute B-cell leukemia (B-ALL). The trial will involve adult participants aged 18 to 65 who have experienced recurrence or have refractory disease after standard treatments. Participants will receive ThisCART19A, and the outcomes will be closely monitored to determine the treatment's effectiveness and safety profile.

Who should consider this trial

Good fit: Ideal candidates for this study are adults aged 18-65 with relapsed or refractory B-ALL who have not responded to previous treatments.

Not a fit: Patients with B-ALL who are not relapsed or refractory, or those outside the specified age range, may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with difficult-to-treat B-ALL.

How similar studies have performed: While this approach is being evaluated in this specific context, similar CAR-T therapies have shown promise in treating other forms of leukemia.

Eligibility criteria

Inclusion Criteria:

1. All subjects or legal representatives must sign a voluntary letter of consent approved by the IRB in person prior to the commencement of any screening procedure;
2. Patients diagnosed with B-ALL according to the Chinese Guidelines for the Diagnosis and Treatment of Adult Acute Lymphoblastic Leukemia (2021 edition);
3. There is no gender limitation, age 18-65 (upper limit not included);
4. Consistent with the diagnosis of recurrent refractory B-ALL. Recurrence： was defined as the recurrence of lymphoblasts（≥5%） in peripheral blood or bone marrow or extramedullary diseasefor patients who had acquired CR ; Refractory ：was defined as failure to CR or CRi at the end of induction therapy (generally referred to 4-week regimen or Hyper-CVAD regimen);Patients with Ph+ R/R ALL who failed after 2-line TKI treatment, were intolerant to TKI treatment or were not suitable for TKI treatment;

   The following factors can coexist:

   A) Failure to prepare autologous CAR-T (definition: too few autologous lymphocytes \[200/ML\] or cannot meet the release standard); B) Experienced treatment with auto car-T/berintoomumab/ CD22 antibody conjugation drugs; C) ≥100 days after hematopoietic stem cell transplantation; D) high-risk patients (High risk was defined as a high white blood cell count ≥30×109/L at diagnosis or with poor cytogenetic prognosis);
   * Hypodiploid (\<44 chromosomes);
   * KMT2A rearrangement: t (4;11) or otherwise;
   * t (v;q32)/IgH;
   * t (9;22) (q34;q11.2) or BCR-ABL1;
   * Complex karyotype (≥5 chromosomal abnormalities);
   * BCR-ABL1-like (Ph-like) ALL;

     * JAK-STAT (CRLF2r, EPORr, JAK1/2/3r, TYK2r, mutations of SH2B3, IL7r, Jak1/2/3 );
     * ABL class( rearrangement of ABL1, ABL2, PDGFRA, PDGFRB, FGFR);
     * Other (NTRKr, FLT3r, LYNr, PTK2Br);
   * Intrachromosomal amplification of chromosome 21 (IAMP21-ALL);
   * t (17;19) : TCF3-HLF fusion ;
   * Alterations of IKZF1; E) Extramedullary lesions.
5. The expected survival time is ≥12 weeks;
6. ECOG score 0-1;
7. Had good organic function during screening
8. CD19 was still expressed in leukemia cells in bone marrow, peripheral blood or biopsy tissue by flow cytometry within one month prior to informed consent (after the last treatment).

Exclusion Criteria:

1. Allergic to preconditioning measures.
2. Patients with other malignancies other than B-cell malignancies within 5 years prior to screening. Patients with cured skin squamous carcinoma,basal carcinoma, non-primary invasive bladder cancer, localized low-risk prostate cancer, in situ cervical/breast cancer can be recruited.
3. Uncontrollable bacterial, fungal and viral infection during screening.
4. Patients had pulmonary embolism within 3 months prior to enrollment.
5. Had intolerant severe cardiovascular and cerebrovascular diseases and hereditary diseases prior to enrollment.
6. Imaging confirmed the presence of central nervous system involvement (both primary and secondary) and obvious symptoms at the time of screening.
7. Active HBV or HCV or HIV or Syphilis infection. HBV-DNA \< 2000 IU/mL can be enrolled, but should admitted to use anti-virus drugs such as entecavir, tenufovir, etc, and supervisory the relative indication during the treatment.
8. Combined systemic steroid use (e.g., prednisone ≥20mg) within 3 days prior to screening. Or systemic diseases that require long-term use of immunization Inhibitor.
9. Vaccinated with influenza vaccine within 2 weeks prior to cleansing (SARS-COV19 can be included, inactivated, live/non-live adjuvant vaccinations allowed to be included) .
10. Patients who are receiving GvHD treatment; Patients without GvHD and who had stopped immunosuppressive drugs for at least 1 month were eligible for inclusion.
11. Women who are in pregnant or lactating, and female subjects or partners who plan to be pregnant within 1 year after cell infusion. Male subjects who plan pregnancy within 1 year after infusion.
12. Any ineligibility conditions considered by the investigator that may increase the risk of the subject or interfere with the results of the study;

Where this trial is running

Hangzhou, Zhejiang and 1 other locations

• The First Hospital of Zhejiang Medical Colleage Zhejiang University — Hangzhou, Zhejiang, China (Recruiting)
• The first affiliated hospital of medical college of zhejiang university — Hangzhou, Zhejiang, China (Recruiting)

Study contacts

• Principal investigator: He Huang, Doctor — The first hospital affiliated Zhejiang University
• Study coordinator: Mingming Zhang, Doctor

Conditions B-ALL