Using CD79b-19 CAR T cells to treat Non-Hodgkin Lymphoma

A Phase I Study of Bivalent CD79b and CD19 Directed CAR T Cells in Patients With Relapsed/Refractory Non-Hodgkin Lymphoma

This study is testing a new treatment using modified immune cells to see if it can help people with relapsed or hard-to-treat Non-Hodgkin Lymphoma.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 24 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Massachusetts General Hospital (Academic / other)
• Drugs / interventions: CAR T, chemotherapy, prednisone, Cyclophosphamide, Fludarabine
• Locations: 1 site (Boston, Massachusetts)
• Trial ID: NCT06026319 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the use of CD79b-19 CAR T cells for patients with relapsed or refractory Non-Hodgkin Lymphoma. It consists of two parts: a dose escalation phase to determine the highest safe dose of the treatment, followed by an expansion cohort where participants receive the established dose. The study aims to evaluate the safety and efficacy of this investigational therapy, which utilizes the patient's own immune cells to target and kill cancer cells. Participants will be monitored for side effects and treatment outcomes over a period of up to two years.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with relapsed or refractory Non-Hodgkin Lymphoma who have undergone at least two prior lines of systemic therapy.

Not a fit: Patients with Non-Hodgkin Lymphoma that is not relapsed or refractory, or those who do not meet the inclusion criteria, 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 Non-Hodgkin Lymphoma.

How similar studies have performed: While CAR T cell therapies have shown success in treating various hematological malignancies, this specific approach using CD79b-19 CAR T cells is novel and has not been previously tested in humans.

Eligibility criteria

Inclusion Criteria:

* Voluntarily sign informed consent form(s)
* ≥18 years of age at the time of signing informed consent
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Karnofsky ≥60%, see Appendix A)
* Diagnosis of histologically or cytologically confirmed relapsed/refractory (R/R) Non Hodgkins lymphoma as defined as one of the following (Note: only patients with indolent lymphomas that warrant treatment should be treated, this will include those with local symptoms due to progressive/bulky disease, compromised organ function, B symptoms, extra-nodal disease, cytopenias from marrow involvement and/or in the opinion of the treating physician believe that any of the above symptoms or potentially life threatening involvement will occur will be treated):

  1. Follicular Lymphoma (FL) grade 1, grade 2, or grade 3a

     1\. R/R disease after 2 or more prior lines of systemic therapy
  2. Marginal Zone Lymphoma (MZL) nodal of extranodal:

     1\. R/R disease after 2 or more prior lines of systemic therapy
  3. Diffuse large B-cell lymphoma (DLBCL), including transformed follicular lymphoma (FL), primary mediastinal B-cell lymphoma (PMBCL), high-grade B-cell lymphoma (HGBCL) and grade 3b Follicular Lymphoma (FL).

     1. R/R disease after 2 or more prior lines of therapy OR
     2. Relapsed following autologous SCT, OR
     3. Ineligible for autologous SCT.
  4. Mantle cell lymphoma

     1. R/R disease as defined by disease progression after last regimen (including autologous SCT) OR
     2. Refractory disease as defined as failure to achieve a CR to last regimen.
     3. Prior therapy must include:

        * Anthracycline or bendamustine-containing chemotherapy AND
        * Anti-CD20 monoclonal antibody therapy AND
        * BTKi therapy (progression does not have to be documented on BTKi).
* Subjects must have measurable disease according to appropriate disease specific criteria.
* Adequate absolute lymphocyte count (ALC \> 100 cells/ul) within one week of apheresis.
* Adequate bone marrow function defined by absolute neutrophil count (ANC) \>1000 cells/mm3 without growth factor support (filgrastim within 7 days or pegfilgrastim within 14 days) and untransfused platelet count \>50,000 mm3.
* Left ventricular ejection fraction \> 40%
* Adequate hepatic function defined by aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 2.5 × upper limit of normal (ULN) and direct bilirubin \< 1.5 × ULN.
* Adequate renal function defined by creatinine clearance \>60 ml/min using the Cockcroft-Gault formula.
* The effects of CD79b-19 CAR T cells on the developing human fetus are unknown. For this reason, women of child-bearing potential and men with partners of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to leukapheresis. Women of childbearing potential are required to use adequate contraception for up to 1 year post CD79b-19 CAR T cell infusion. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men with partners of childbearing potential treated or enrolled on this protocol must also agree to use adequate contraception prior to the study and until 6 months after last CD79b-19 CAR T cells administration.
* Ability and willingness to adhere to the study visit schedule and all protocol requirements

Inclusion Criteria for treatment (Initiating Lymphodepletion/Cell Infusion):

* Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Karnofsky ≥60%, see Appendix A)
* No active, uncontrolled, systemic bacterial, viral, or fungal infection. If febrile, the patient must have negative blood cultures x48 hours at time of cell infusion AND on appropriate broad spectrum antibiotic therapy
* Oxygen saturation \>92% on room air while awake
* No additional anti-cancer therapy since leukapheresis excluding steroids at or below physiologic dosing.

Infusion may be delayed by up to 5 days after completion of LD chemo, without sponsor approval, in the event that these issues resolve in that time frame.

The above criteria need to be met to start treatment (for both initiation of lymphodepletion and cell infusion).

Exclusion Criteria for Leukapheresis for Parts A and B:

* Treatment with an any investigational cellular therapy within 8 weeks prior to apheresis.
* Any systemic anti-cancer therapy within 1 weeks or 5 half-lives of leukapheresis, whichever is shortest, excluding steroids (prednisone) at or below physiologic dosing (5mg).
* No bispecific T cell engagers within 6 months of leukapheresis.
* No bendamustime within 6 months of leukapheresis.
* Ongoing treatment with chronic immunosuppressants (e.g., cyclosporine or systemic steroids above physiologic dosing). Intermittent topical, inhaled, or intranasal corticosteroids are allowed.
* Ongoing systemic immunosuppression for acute and/or chronic GVH as a result of previous allogeneic bone marrow transplant and at least 12 weeks out from prior allogeneic SCT.
* Presence of active CNS disease
* Significant co-morbid condition or disease which in the judgment of the Principal Investigator would place the subject at undue risk or interfere with the study; examples include, but are not limited to, cirrhotic liver disease, sepsis, and/or recent significant traumatic injury.
* Active, uncontrolled, systemic bacterial, viral, or fungal infection.
* Subjects with a history of class III or IV congestive heart failure or with a history of non- ischemic cardiomyopathy.
* Subjects with unstable angina, myocardial infarction, or ventricular arrhythmia requiring medication or mechanical control within the previous 3 months.
* Subjects with arterial vascular disease such as history of cerebrovascular accident or peripheral vascular disease requiring therapeutic anti-coagulation.
* Subjects with history of a new pulmonary embolism (PE) /deep vein thrombosis (DVT) within 6 months of beginning lymphodepletion requiring ongoing anticoagulation.
* Subjects with second malignancies if the second malignancy has required therapy in the last 3 years or is not in complete remission; exceptions to this criterion include successfully treated non-metastatic basal cell or squamous cell skin carcinoma, or prostate cancer that does not require therapy other than hormonal therapy.
* Pregnant or lactating women. Pregnant women are excluded from this study because CAR-79b-19 T cell drug product is an agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with CAR-79b-19 T cell drug product, breastfeeding should be discontinued if the mother is treated with CAR-79b-19 T cell drug product.

Additional Exclusion Criteria for Leukapheresis for Part B, Arm B.2:

* Prior CD19-directed cellular therapy.

Where this trial is running

Boston, Massachusetts

• Massachusetts General Hospital — Boston, Massachusetts, United States (Recruiting)

Study contacts

• Principal investigator: Matthew Frigault, MD — Massachusetts General Hospital
• Study coordinator: Matthew Frigault, MD

Conditions Non-hodgkin Lymphoma; Relapsed Non-Hodgkin Lymphoma; Refractory Non-Hodgkin Lymphoma; Follicular Lymphoma; Marginal Zone Lymphoma; Diffuse Large B Cell Lymphoma; Primary Mediastinal Large B-cell Lymphoma; High-grade B-cell Lymphoma