A Study of CAR-T Cells Therapy for Patients With Relapsed and/or Refractory Central Nervous System Hematological Malignancies

Official title

Clinical Trial for the Safety and Efficacy of CAR-T Cells Therapy for Patients With the Central Nervous System Involvement of Relapsed and/or Refractory B-cell Acute Lymphoblastic Leukemia or B-cell Non-Hodgkin's Lymphoma

Overview

A Study of CAR-T Cells Therapy for Patients With Relapsed and/or Refractory Central Nervous System Hematological Malignancies

Detailed description

This is a single arm, open-label, single-center study. This study is indicated for relapsed or refractory central nervous system CD19+ B-cell hematological malignancies, including acute lymphoblastic leukemia and B-cell non-Hodgkin's lymphoma. The selections of dose levels and the numberof subjects are based on clinical trialsof similar foreign products. Two groups of patients will be enrolled, 36 in eachgroup. Primary objective is to explore the safety, main consideration is dose-related safety.

Interventions

• Drug CAR-T cells
  Each subject receive CAR T-cells by intravenous infusion
• Procedure Ommaya Reservoir
  Surgical catheter placement into the fourth ventricle of the brain

Primary outcome measures

• Dose-limiting toxicity (DLT) [Time frame: Baseline up to 28 days after CAR T-cells infusion]
• Incidence of treatment-emergent adverse events (TEAEs) [Time frame: Up to 2 years after CAR T-cells infusion]

Secondary outcome measures (9)

• B-cell acute lymphocytic leukemia(B-ALL), Overall response rate (ORR) [Time frame: At Month 1, 3, 6, 12, 18 and 24]
• B-ALL, Overall survival (OS) [Time frame: Up to 2 years after CAR-T cells infusion]
• B-ALL, Event-free survival (EFS) [Time frame: Up to 2 years after CAR-T cells infusion]
• B cell non-hodgkin's lymphoma (B-NHL), Overall response rate (ORR) [Time frame: At Week 4, 12, and Month 6, 12, 18, 24]
• B-NHL, disease control rate (DCR) [Time frame: At Week 12 and Month 6, 12, 18, 24]
• Quality of life [Time frame: At Baseline, Month 1, 3, 6, 9 and 12]
• IADL score [Time frame: At Baseline, Month 1, 3, 6, 9 and 12]
• ADL score [Time frame: At Baseline, Month 1, 3, 6, 9 and 12]
• HADS score [Time frame: At Baseline, Month 1, 3, 6, 9 and 12]

Eligibility criteria

Inclusion criteria

• Inclusion criteria only for B-ALL:

• Male or female aged 3-70 years;
• Histologically confirmed diagnosis of B-ALL per the US National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Acute Lymphoblastic Leukemia (2016.v1);
• Relapsed or refractory CD19+ B-ALL (meeting one of the followingconditions):

• CR not achieved after standardized chemotherapy;
• CR achieved following the first induction, but CR duration isless than 12 months;
• Ineffectively after first or multiple remedial treatments;
• 2 or more relapses;
• The number of primordial cells (lymphoblast and prolymphocyte)in bone marrow is>5% (by morphology), and/or >1% (by flowcytometry);
• Philadelphia-chromosome-negative (Ph-) patients; or Philadelphia-chromosome-positive (Ph+) patients who cannot tolerate TKI treatments or do not respond to 2 TKI treatments;
• Inclusion criteria only for B-NHL:

• Male or female aged 18-75 years;
• Histologically confirmed diagnosis of DLBCL (NOS), FL, DLBCL transformed from CLL/SLL, PMBCL, and HGBCL per the WHOClassification Criteria for Lymphoma (2016);
• Relapsed or refractory B-NHL (meeting one of the followingconditions):

• No response or relapse after second-line or abovechemotherapy regimens;
• Primary drug resistance;
• Relapse after auto-HSCT;
• At least one assessable tumor lesion per Lugano 2014 criteria;
• Common inclusion criteria for B-ALL and B-NHL:

• Highly suspected or confirmed central nervous system involvement of hematological malignancies;
• Total bilirubin ≤ 51 umol/L, ALT and AST ≤ 3 times of upper limit ofnormal, creatinine ≤ 176.8 umol/L;
• Echocardiogram shows left ventricular ejection fraction (LVEF) ≥50%;
• No active infection in the lungs, blood oxygen saturation in indoorair is ≥ 92%;
• Estimated survival time ≥ 3 months;
• ECOG performance status 0 to 2;
• Patients or their legal guardians volunteer to participate in the study and sign the informed consent.

Exclusion criteria

Subjects with any of the following exclusion criteria were not eligible for this trial:

• History of craniocerebral trauma, conscious disturbance,epilepsy,cerebrovascular ischemia, and cerebrovascular hemorrhagic diseases;
• Electrocardiogram shows prolonged QT interval, severe heart diseases such as severe arrhythmia in the past;
• Pregnant (or lactating) women;
• Patients with severe active infections (excluding simple urinarytractinfectionand bacterial pharyngitis);
• Active infection of hepatitis B virus or hepatitis C virus;
• Concurrent therapy with systemic steroids within 2 weeks prior to screening, except for the patients recently or currently receiving inhaled steroids;
• Previously treated with any CAR-T cell product or other genetically-modified T cell therapies;
• Creatinine>2.5mg/dl, or ALT / AST > 3 times of normal amounts,orbilirubin>2.0 mg/dl;
• Other uncontrolled diseases that were not suitable for this trial;
• Patients with HIV infection;
• Any situations that the investigator believes may increase the risk ofpatients or interfere with the results of study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• The First Affiliated Hospital，College of Medicine, Zhejiang University — Hangzhou

Identifiers

NCT: NCT04532203 · CNSL-ZhejiangU

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗