Phase I Clinical Trial of CART Cell Therapy for Refractory/Relapsed Acute Lymphoblastic Leukemia in Children, Adolescents and Young Adults

Official title

A Phase I Clinical Trial of CART Cell Therapy for Refractory/ Relapsed Acute Lymphoblastic Leukemia With Unmet Needs in Children, Adolescents and Young Adults: Feasibility and Safety Study (REALL_CART).

Overview

The goal of this clinical trial is to test the feasibility and safety of an academic production of two different anti-CD19 chimeric antigen receptor T cells (CART) products according to the different biomarkers of the disease in children and young adults with relapsed/refractory CD19+ B cell acute lymphoblastic leukemia (r/r B-ALL) or relapsed/refractory T-cell acute lymphoblastic leukemia (r/r T-ALL). The main questions it aims to answer are: 1. The safety and feasibility of autologous CART-19/22 in children, adolescents and young adults with a CD19+/- CD22+ relapse/ refractory disease for a r/r B-ALL. 2. The safety and feasibility of allogeneic CART-NKG2D (chimeric-antigen receptor Natural-killer group 2, member D) in children, adolescents and young adults with r/r T-ALL.

Detailed description

Incredible progress has been made in the treatment of relapsed/refractory CD19+ acute lymphoblastic leukemia (r/r ALL) by the application of anti-CD19 chimeric antigen receptor (CAR) T cells (CART19). However, equivalent progress has not been achieved in the treatment of relapsed/refractory T-cell acute lymphoblastic leukemia (T-ALL). Furthermore and although the majority of patients with CD19+ r/r ALL respond to CART19, 30-60% of patients relapse after this treatment, probably due to the short persistence of CAR T-cells and the immune escape or down-regulation of CD19 antigen. Patients with relapsed ALL after CART19 have a very poor prognosis and novel treatment approaches are urgently needed. To date, both relapse after CART19 malignancies and T-ALL represent an unmet medical need where no effective or targeted therapies currently exist. Recently, we and other groups have reported how T-ALL and acute myeloid leukemia (AML) cell lines were more sensitive to CART-NKG2D (chimeric-antigen receptor Natural-killer group 2, member D) cytotoxicity than B-ALL cell lines. We have previous experience in the production and administration, under compassionate use, of CART cells targeting dual CD19/CD22 antigens and NKG2D ligands. In this context, this phase I clinical trial is designed to test the feasibility and safety of an academic production of two different CART products according to the different biomarkers of the disease.

In the present study (ReALL\_CART), we propose an umbrella design methodology using autologous dual CART-19/22 for CD19+/-CD22+/- relapse after CART19 or allogeneic CART-NKG2D for NKG2DL+ r/r T-ALL.

Interventions

• Biological Autologous CD19/CD22 CAR T cells
  A total of two doses of autologous CD19/CD22 CAR T cells (first dose of up to 0.75x106/kg fresh cells), and a second infusion of unfrozen cells (same dose) if there has been no ≥ grade 1 cytokine-release syndrome (CRS) in the next 72 h; intravenously.
• Biological Allogeneic CART-NKG2D cells
  A total of up to 3x106/kg allogeneic CART-NKG2D cells divided in three doses of up to 1x106/kg will be infused; intravenously. First infusion of fresh cells, and the 2nd and 3rd infusion of unfrozen cells (same dose) if there has been no ≥ grade 1 CRS (every 48 hours).

Primary outcome measures

• Incidence and severity of adverse events in patients that received autologous CART-19/22 [Time frame: Through study completion, an average of 5 years]
• Incidence and severity of adverse events in patients that received allogenic CART-NKG2D T [Time frame: Through study completion, an average of 5 years]

Secondary outcome measures (6)

• Expression of CD19/CD22 and NKG2DL on primary B- or T- cell ALL, respectively [Time frame: Through study completion, an average of 5 years]
• Persistence of CART19/22 and CART-NKG2D cells in patients' samples [Time frame: Through study completion, an average of 5 years]
• Cytokine profile [Time frame: Through study completion, an average of 5 years]
• DNA methylation profile of NKG2DL [Time frame: Through study completion, an average of 5 years]
• Presence of soluble NKG2DL, and ANTI-MICA and ANTI-MICB antibodies [Time frame: Through study completion, an average of 5 years]
• Overall rate response in both arms [Time frame: Through study completion, an average of 5 years]

Eligibility criteria

Inclusion criteria

• ARM A: CD19+/- CD22+ B-ALL with relapsed or refractory disease not responding to conventional chemotherapy and with no other curative therapy available. Treatment with previous CART CD19 therapy is permitted, but is not mandatory, OR:
• ARM B: T-ALL with relapsed or refractory disease not responding to conventional chemotherapy and with no other curative therapy available.
• Patients diagnosed with ALL must be suitable for allogeneic HSCT and willing to proceed to transplant if the CART treatment induces complete remission and the investigator believes it is the best option.
• For ARM B there must be a suitable haploidentical donor (following local standard operating procedures).
• Lansky (age <16 years) or Karnofsky (age ≥16 years) score of 50 or greater.
• Life expectancy greater than 12 weeks.
• Absolute neutrophil count (ANC) ≥ 500/μL unless, in the opinion of the investigator, cytopenia is due to underlying leukemia and is potentially reversible with leukemia therapy.
• Platelet count ≥ 50,000/μL unless, in the opinion of the investigator, cytopenia is due to underlying leukemia and is potentially reversible with leukemia therapy.
• Absolute lymphocyte count ≥ 100/μL.
• Adequate renal, hepatic, pulmonary, and cardiac function.
• Adequate venous access and absence of contraindications for lymphoapheresis
• Patients with a seizure disorder may be enrolled if well controlled with anticonvulsants.
• Patients or patients' legal representative, parent(s), or guardian able to provide written informed consent.

Exclusion criteria

• Enrolled in another clinical trial in the previous 4 weeks.
• Active infection requiring systemic medical therapy including clinically significant viral infection or uncontrolled viral reactivation of EBV, CMV, adenovirus, BK-virus, HHV-6 or Aspergillus.
• Any of the following cardiac criteria: cardiac echocardiography with LVSF<30% or LVEF<40%; or clinically significant pericardial effusion.
• Presence of CNS-3 disease or uncontrolled seizure disorder.
• Active immunosuppressive therapy with the exception of prednisone 10 mg/day (or equivalent), within 7 days prior to enrolment.
• GFR <30 ml/min or bilirubin >3 times the upper limit of normality (unless due to Gilbert's syndrome).
• Any other condition that, in the opinion of the PI, may interfere with the efficacy and/or safety evaluation of the trial.
• Pregnant or lactating women.
• Sexually active patients must be willing to utilize one of the more effective birth control methods for at least 12 months after the infusion and until CAR-T cells are no longer present on two consecutive tests. Male partner should use a condom. Women of child-bearing potential are defined as all women physiologically capable of becoming pregnant.
• Sexually active males should use a condom during intercourse for at least 12 months after the infusion and until CAR-T cells are no longer present on two consecutive tests.

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

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Spain · 1 center

• Hospital Universitario La Paz — Madrid

Publications

• Gonzalez-Martinez B, Galan-Gomez V, Navarro-Zapata A, Mirones-Aguilar I, Cobo M, Pernas-Sanchez A, Vallejo S, Sanchez-Zapardiel E, Leon-Triana O, Echecopar C, Martinez-Romera I, Guerra-Garcia P, San Roman-Pacheco S, Escudero A, Izquierdo E, Izquierdo M, Naharro S, Martin-Ayuso A, Bareke H, Paris-Munoz A, Hu P, Schneider D, Orentas RJ, Minguillon J, Perez-Martinez A. Tandem CD19/CD22 CAR T-cells as PMID 40753722

Identifiers

NCT: NCT06709469 · HULP 6614

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗