CD19-directed CAR-T Cell Therapy for Refractory or Relapsed Acute Lymphoblastic Leukemia or Non-Hodgkin Lymphoma: a Multicenter Phase I/II Trial.
The goal of this prospective, multicentric, single-arm, phase I/II clinical trial is to evaluate the safety and efficacy of a novel CD19-directed CAR-T cell locally produced in an academic institution in Brazil in patients with refractory or relapsed acute lymphoblastic leukemia or non-Hodgkin lymphoma. Participants will receive a single intravenous infusion of an autologous academic anti-CD19 CAR-T cell and will be followed for 5 years.
∙ For non-Hodgkin Lymphomas (B-NHL):
• Provision of signed Informed Consent form;
• Age between 18 and 70 years;
• Performance status according to the Eastern Cooperative Oncology Group \< 2;
• Relapsed or refractory B-NHL of the following types (confirmed by biopsy):
‣ Diffuse large B-cell lymphoma (DLBCL, NOS);
⁃ High-grade B-cell lymphoma (HGBCL);
⁃ Diffuse large B-cell lymphoma/high-grade B-cell lymphoma with MYC and BCL-2 rearrangement;
⁃ Follicular lymphoma (FL) grade 3B; or
⁃ Transformed follicular lymphoma (tFL)
• Refractory or relapsed to two or more lines of systemic therapy, with at least one scheme containing an anti-CD20 monoclonal antibody and anthracycline, as defined below:
‣ Refractoriness: partial response (PR), stable disease (SD), or progressive disease (PD) as the best response to the last treatment, assessed by PET-CT, according to the Lugano criteria and confirmed by a new biopsy.
⁃ Relapsed disease: disease reappearance after obtaining a complete response to the last treatment, assessed by PET-CT, according to the Lugano criteria and confirmed by a new biopsy.
• Have performed, or be ineligible for, autologous hematopoietic progenitor cell transplantation (ASCT). Ineligibility is defined by:
‣ Lack of at least partial response after salvage chemotherapy; or
⁃ Failure to mobilize and/or collect hematopoietic progenitor cells (HPC), as defined by the investigator.
• Measurable disease, defined as:
‣ Nodal lesions \>15 mm in the long axis, regardless of the length of the short axis, and/or
⁃ Extranodal lesions (outside lymph node or nodal mass, but including liver and spleen) \>10 mm in long axis, regardless of the length of the short axis.
• Adequate organ function:
∙ Renal function defined as:
• estimated glomerular filtration rate (eGFR) ≥ 40 mL/min/1.73 m2
∙ Hepatic function defined as:
• Alanine Transaminase (ALT) and Aspartate Transaminase (AST) ≤ 2.5 × ULN; and
• Total bilirubin ≤ 1.5 × ULN, except for patients with Gilbert syndrome.
∙ Hematologic Function (regardless of transfusions for 14 days) defined as:
• Absolute neutrophil count (ANC) \>500/uL
• Platelets ≥ 50,000/uL
• Hemoglobin \>7.0 g/dl
‣ In women of childbearing potential, willingness to use effective means of birth control for 1 year after CAR-T cell infusion.
⁃ In male participants, willingness to use a barrier birth control method for 1 year after CAR-T cell infusion
⁃ Able to comply with inpatient treatment, outpatient treatment, laboratory monitoring, and required clinic visits for the duration of study participation.
∙ For Acute Lymphoblastic Leukemia (B-ALL):
• Provision of signed Informed Consent form;
• Age ≥ 3 and \< 25 years;
• Performance status \< 2, according to the Eastern Cooperative Oncology Group for patients ≥ 16 years old, or ≥ 50%, according to the Lansky performance status for patients younger than 16 years old;
• Relapsed or refractory CD19 positive B-ALL, with documentation of CD19 disease expression within 3 months of screening visit.
• Relapsed or refractory disease as defined below;
‣ Failure to obtain hematologic complete remission (bone marrow with \< 5% lymphoblasts by morphologic assessment) after 2 distinct chemotherapy lines; or
⁃ Relapsed or refractoriness after at least 1 previous chemotherapy regimen and ineligibility for allogeneic hematopoietic progenitor cell transplantation (HSCT) due to lack of available donor (including alternative donors), comorbidity, have previously undergone or refused HSCT; or
⁃ Relapsed disease ≥ 6 months after HSCT; or
⁃ Relapsed or refractoriness after ≥ TKi for Philadelphia-positive B-ALL.
• Bone marrow with ≥ 5% lymphoblasts by morphologic assessment within 30 days from screening
• Adequate organ function:
∙ Renal function defined as:
• Estimated glomerular filtration rate (eGFR) ≥ 40 mL/min/1.73 m2
∙ Hepatic function defined as:
• Alanine Transaminase (ALT) and Aspartate Transaminase (AST) ≤ 5 × ULN; and
• Total bilirubin ≤ 2 × ULN, except for patients with Gilbert syndrome.
‣ In women of childbearing potential, willingness to use effective means of birth control for 1 year after CAR-T cell infusion.
⁃ In male participants, willingness to use a barrier birth control method for 1 year after CAR-T cell infusion
⁃ Able to comply with outpatient treatment, laboratory monitoring, and required clinic visits for the duration of study participation. duration of the parent study and the long-term follow-up observational study