Using modified T cells to treat relapsed or refractory Non-Hodgkin Lymphoma

A Phase 1 Clinical Trial of Anti-CD19 Chimeric Antigen Receptor T Cells for Treatment of Relapsed or Refractory Non-Hodgkin Lymphoma

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

Quick facts

• Phase: PHASE1
• Study type: Interventional
• Enrollment: 36 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of California, San Francisco (other)
• Drugs / interventions: CAR-T, chemotherapy, chimeric antigen receptor, CAR T
• Locations: 1 site (San Francisco, California)
• Trial ID: NCT04545762 on ClinicalTrials.gov

What this trial studies

This pilot study evaluates the safety and feasibility of infusing genetically modified T cells that target the CD19 antigen in patients with relapsed or refractory B-cell Non-Hodgkin Lymphoma. Participants will undergo apheresis to collect their own blood cells, which will then be modified to express a chimeric antigen receptor. The study will utilize a dose-finding approach to determine the maximum tolerated dose of these CAR-T cells, followed by a dose expansion at the recommended phase 2 dose. The primary focus is on assessing safety and determining the recommended dose for future studies.

Who should consider this trial

Good fit: Ideal candidates are patients with relapsed or refractory B-cell Non-Hodgkin Lymphoma who have failed multiple lines of prior therapy.

Not a fit: Patients with indolent lymphomas who have not progressed after prior therapies may not benefit from this aggressive treatment approach.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with difficult-to-treat forms of Non-Hodgkin Lymphoma.

How similar studies have performed: Previous studies using CAR-T cell therapy targeting CD19 have shown promising results in similar patient populations.

Eligibility criteria

THE DOSE ESCALATION COHORT IS CLOSED TO FURTHER ENROLLMENT.

Inclusion Criteria:

Dose expansion Cohorts:

Cohort B (Burkitt):

1. Participants must have a diagnosis of relapsed or refractory Burkitt Lymphoma

   * Participants with Burkitt lymphoma must have relapsed or failed to respond to at least 1 prior line of multiagent chemoimmunotherapy with prior exposure to both an anti-CD20 antibody agent and an anthracycline.
   * No significant circulating disease, defined as an elevated total lymphocyte count above the upper limit of normal (ULN) due to the presence of malignant cells.
2. Participants must have measurable disease as defined below:

   * Participants with Burkitt Lymphoma must have Positron Emission Tomography (PET)-positive disease according to "Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification"

Cohort M/W (Marginal/Waldenström):

1. Participants must have a diagnosis of relapsed or refractory Marginal Zone Lymphoma (MZL), or Lymphoplasmacytic Lymphoma (LPL)/Waldenström Macroglobulinemia (WM):

   o Participants with indolent lymphomas (nodal or extranodal marginal zone lymphoma, and lymphoplasmacytic lymphoma) must have relapsed after or have been refractory to ≥ 2 prior lines of multi-agent chemoimmunotherapy including prior exposure to an anti-CD20 antibody and an alkylating agent.
2. Participants must have measurable disease as defined below:

   o Participants with Marginal Zone Lymphoma or Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia: must either have PET-positive disease according to "Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification" or serum monoclonal immunoglobulin M (IgM) paraprotein \> 0.5 g/dL.
3. Participants with indolent lymphoma (Marginal Zone Lymphoma or Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia) must have symptomatic disease necessitating systemic treatment.

In addition, all participants must meet the following criteria:

1. CD19-positive by either immunohistochemistry or flow cytometry analysis on any biopsy. If prior anti-CD19 therapy has been administered, CD19-positivity has to be re-established on the most recent biopsy.
2. Age ≥18 years at the time of consent.
3. Absolute lymphocyte count \> 100/UL.
4. Eastern Cooperative Oncology Group (ECOG) performance status \< 2.
5. Adequate organ function, defined as:

   1. Adequate bone marrow function for apheresis and lymphodepleting chemotherapy
   2. Hemoglobin \>8 gm/dl (transfusions allowed)
   3. Platelets \>50,000/uL (transfusions allowed)
   4. Absolute Neutrophil Count (ANC) \> 500/uL
   5. alanine aminotransferase (ALT)/aspartate aminotransferase (AST) \< 3 x institutional upper limit of normal (ULN) and Total bilirubin \< 1.5 mg/dl x institutional ULN, except with Gilbert's syndrome
   6. Serum Creatinine \< 2 x the institutional ULN
   7. Adequate cardiac function, defined as left ventricular ejection fraction (LVEF) \> 40% as assessed by echocardiogram or multiple uptake gated acquisition (MUGA) within 3 months of screening. Repeat testing may occur at Investigator's discretion.
6. Adequate vascular access for leukapheresis procedure (either peripheral line or surgically placed line).
7. Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) must have a negative serum or urine pregnancy test AND agree to use highly effective methods of contraception for 1 year after the last dose of anti-CD19 CAR-T cells.
8. Males who have partners of childbearing potential must agree to use an effective barrier contraceptive method.
9. Ability to understand a written informed consent document, and the willingness to sign it.

Exclusion Criteria:

1. Autologous transplant within 6 weeks of planned CAR-T cell infusion.
2. Recipient of prior CAR-T cell therapy targeting CD19 outside of this protocol.
3. Active other malignancy, other than non-melanoma skin cancer, carcinoma in situ (e.g., cervix, bladder, or breast).
4. Human immunodeficiency virus (HIV) seropositivity.
5. Serologic status reflecting active hepatitis B or C infection. Participants that are positive for hepatitis B core antibody, hepatitis B surface antigen (HBsAg), or hepatitis C antibody must have a negative polymerase chain reaction (PCR) prior to enrollment. (PCR positive participants will be excluded.)
6. Participants with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, pulmonary abnormalities or psychiatric illness/social situations that would limit compliance with study requirements.
7. Pregnant or breastfeeding women are excluded from this study because CAR-T cell therapy may be associated 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-T cells, breastfeeding should be discontinued. These potential risks may also apply to other agents used in this study. NOTE: Women of childbearing potential must have a negative serum or urine pregnancy test.
8. Participants with history of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure disorders, paresis, aphasia, uncontrolled cerebrovascular disease, severe brain injuries, dementia and Parkinson's disease.
9. History of autoimmune disease (e.g., rheumatoid arthritis, systemic lupus erythematosus) with requirement of immunosuppressive medication within 6 months.
10. Body weight \<40 kilograms(kg).

Eligibility for Infusion of Investigational Product:

Participants will undergo an evaluation of eligibility on day 1 prior to infusion of anti-CD19 CAR-T cell product. This eligibility criterion will include the inclusion and exclusion criteria required for enrollment with the following exceptions and additions:

1. No significant laboratory abnormalities. Laboratory result abnormalities that are considered not clinically significant by the principal investigator AND are not the result of a demonstrated active infection or an active central nervous system condition.
2. ECOG performance status \< 2
3. No evidence of uncontrolled intercurrent illness including, but not limited to ongoing or active infection, inflammatory response, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, pulmonary abnormalities or psychiatric illness/social situations.
4. No new neurologic symptoms suggestive of an active central nervous system condition, or uncontrolled CNS involvement by lymphoma.
5. No corticosteroid use within 7 days prior to infusion (with exception of agents used for prevention of emesis during lymphodepletive chemotherapy).

Where this trial is running

San Francisco, California

• University of California, San Francisco — San Francisco, California, United States (RECRUITING)

Study contacts

• Principal investigator: Carrie Ho, MD — University of California, San Francisco
• Study coordinator: UCSF HDFCCC Cancer Immunotherapy Program

Conditions: Refractory Non-Hodgkin Lymphoma, Burkitt Lymphoma, Mantle Cell Lymphoma, Follicular Lymphoma, Lymphoplasmacytic Lymphoma, Primary Mediastinal Large B Cell Lymphoma, Diffuse Large B Cell Lymphoma, Small Lymphocytic Lymphoma