Using modified T cells to treat relapsed B cell leukemia in children and young adults

Pilot Study of Autologous Anti-CD22 Chimeric Antigen Receptor Redirected T Cells in Pediatric Patients With Chemotherapy Resistant Or Refractory Acute Lymphoblastic Leukemia

This study is testing if a new treatment using modified T cells can help children and young adults with relapsed B-cell leukemia by targeting and killing the leukemia cells.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 41 (estimated)
• Ages: 1 Year to 29 Years
• Sex: All
• Sponsor: University of Pennsylvania (Academic / other)
• Drugs / interventions: inotuzumab, CART, chemotherapy
• Locations: 1 site (Philadelphia, Pennsylvania)
• Trial ID: NCT02650414 on ClinicalTrials.gov

What this trial studies

This pilot study evaluates the safety and feasibility of administering a single dose of autologous T cells that express CD22 chimeric antigen receptors in pediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia. The study is structured as a single center, open-label trial with three cohorts, where patients receive either CART22 or CART22-65s cells over different time frames. The aim is to assess the effectiveness of these modified T cells in targeting and eliminating leukemia cells in this vulnerable population.

Who should consider this trial

Good fit: Ideal candidates include pediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia who meet specific eligibility criteria.

Not a fit: Patients with early-stage B-cell leukemia or those who have not yet undergone multiple lines of chemotherapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for children and young adults with difficult-to-treat B cell leukemia.

How similar studies have performed: Other studies using CAR T-cell therapies have shown promising results in treating similar conditions, indicating a potential for success with this approach.

Eligibility criteria

1. Signed informed consent form must be obtained prior to any study procedure.
2. Relapsed or refractory B-cell ALL:

   1. 2nd or greater relapse OR
   2. Any marrow or extramedullary relapse after allogeneic HSCT and ≥ 6 months from SCT at infusion OR
   3. Any marrow relapse after CAR-modified T cell therapy OR
   4. Refractory disease defined as having not achieved a CR after \> 2 chemotherapy regimens OR
   5. Patients with Ph+ ALL are eligible if they are intolerant to or have failed tyrosine kinase inhibitor therapy OR
   6. Ineligible for allogeneic SCT because of:

   i. Comorbid disease ii. Other contraindications to allogeneic SCT conditioning regimen iii. Lack of suitable donor iv. Prior SCT v. Declines allogeneic SCT as a therapeutic option after documented discussion, with expected outcomes, about the role of SCT with a BMT physician not part of the study team g. Patients with CNS3 disease will be eligible if CNS disease is responsive to therapy (at infusion, must meet criteria in Section 5.2)
3. Documentation of CD22 tumor expression in bone marrow, other tumor biopsy, CSF or peripheral blood by flow cytometry (or a recent marrow in the case of refractory disease). If the patient has received CD22-directed therapy (i.e., inotuzumab), then the marrow or other sample should be obtained after this therapy to show CD22 expression.
4. Adequate organ function defined as:

   a. A serum creatinine based on age/gender as follows:
   1. A serum creatinine based on age/gender as follows:

      Maximum Serum Creatinine (mg/dL) Age 1 to \< 2 years Male 0.6 Female 0.6 Age 2 to \< 6 years Male 0.8 Female 0.8 Age 6 to \< 10 years Male 1.0 Female 1.0 Age 10 to \< 13 years Male 1.2 Female 1.2 Age 13 to \< 16 years Male 1.5 Female 1.4 Age ≥ 16 years Male 1.7 Female 1.4
   2. Adequate liver function

   i. ALT \< 500 U/L ii. Bilirubin \<3x upper limit of normal

   iii. ALT and/or bilirubin that exceed these ranges is acceptable if, in the opinion of the investigator (or by liver biopsy), the abnormalities are directly related to ALL infiltration of the liver

   c. Must have a minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea, pulse oxygen \> 92% on room air; DLCO \> 40% (corrected for anemia) if PFTs are clinically appropriate as determined by the treating investigator

   d. Left Ventricle Shortening Fraction (LVSF) ≥ 28% or Ejection Fraction (LVEF) ≥ 40% confirmed by ECHO/MUGA; in cases where quantitative assessment of LVEF is not possible, a statement by the cardiologist that the ECHO shows qualitatively normal ventricular function will suffice.
5. Evidence of disease by standard morphologic or by MRD criteria. If the results of a historical biopsy (obtained at the time of the patient's most recent relapse) are available, this does not need to be repeated at screening.
6. Age 1-29 years.
7. Adequate performance status (Lansky or Karnofsky score ≥50).
8. Subjects of reproductive potential must agree to use acceptable birth control methods.

Exclusion Criteria:

1. Active hepatitis B or active hepatitis C.
2. HIV Infection.
3. Active acute or chronic graft-versus-host disease (GVHD) requiring systemic therapy.
4. Concurrent use of systemic steroids or immunosuppressant medications. Recent or current use of inhaled steroids or physiologic replacement with hydrocortisone is not exclusionary.
5. CNS3 disease that is progressive on therapy, or with CNS parenchymal lesions that might increase the risk of CNS toxicity.
6. Pregnant or nursing (lactating) women.
7. Receipt of a prior investigational study agent within 4 weeks prior to screening visit. \*Note - patients who have received anti-CD19 CART cells (e.g., CART19/CTL019) on an investigational study where cell infusion occurred greater than 4 weeks before the screening visit are NOT excluded.

Where this trial is running

Philadelphia, Pennsylvania

• Children's Hospital of Philadelphia — Philadelphia, Pennsylvania, United States (Recruiting)

Study contacts

• Principal investigator: Stephan Grupp, MD, PhD — Children's Hospital of Philadelphia
• Study coordinator: Shamar Durham

Conditions B Cell Leukemias; B Cell Lymphomas; Biological: CART 22