Allogeneic TRAC Locus-inserted CD19-targeting Synthetic T-cell Receptor Antigen Receptor (STAR) T Cells for Relapsed/Refractory B-cell Non-Hodgkin's Lymphoma
The team has developed the synthetic T cell receptor (TCR) and antigen receptor (STAR) T cells which were demonstrated safety in relapsed or refractory (r/r) B-cell non-Hodgkin' s lymphoma (B-NHL) (NCT05631912). Based on this research, allogeneic STAR-T cell products utilized the CRISPR-Cas9 gene editing tool to knock out endogenous receptor α constant (TRAC), human leukocyte antigen (HLA)-A/B, CIITA, and programmed death 1 (PD-1) genes simultaneously in T cells from healthy donors, and integrated the STAR molecule into the TRAC locus using adenovirus associated virus. This strategy can reduce graft-versus-host-disease (GvHD) toxicity and host-versus-graft response, decrease the sensitivity of STAR T cells to immunosuppressive signals, and improve their anti-tumor activity. In this single center, prospective, open-label, single-arm, phase 1/2 study, the safety and efficacy of allogeneic CD19-targeting STAR T cell therapy will be evaluated in patients with r/r B-NHL.
• Age 18-75 (inclusive).
• Patients with histologically confirmed CD19-positive B-cell NHL, including the following types defined by the World Health Organization (WHO) 2016:
‣ Diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS), including activated B-cell type (ABC) / germinal center B-cell Type (GCB);
⁃ Primary mediastinal (thymic) large B-cell lymphoma (PMBCL);
⁃ Transformed follicular lymphoma (TFL);
⁃ High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBCL);
⁃ Follicular lymphoma (FL);
⁃ Mantle cell lymphoma (MCL) \[pathologically confirmed, with documentation of monoclonal B cells that have a chromosome translocation t(11;14)(q13;q32) and/or overexpress cyclin D1\];
⁃ Marginal zone lymphoma (MZL), including nodal or splenic marginal zone B-cell lymphoma and mucosa-associated lymphoid tissue (MALT) lymphoma.
• Relapse after treatment with ≥2 lines systemic therapy for all the above disease types, or refractory disease for aggressive types (DLBCL-NOS, PMBCL, TFL and HGBCL). Relapse disease is defined as disease progression after last regimen. Refractory disease is defined as no CR to first-line therapy:
‣ Evaluation of PD (never reached response or SD) after standard first-line treatment, or
⁃ SD as best response after at least 4 cycles of first-line therapy (eg, 4 cycles of R-CHOP), or
⁃ PR as best response after at least 6 cycles and biopsy-proven residual disease or disease progression ≤ 6 months of therapy, or
⁃ Refractory post-autologous stem cell transplant (ASCT): i. Disease progression or relapsed less than or equal to 12 months of ASCT (must have biopsy proven recurrence in relapsed individuals); ii. If salvage therapy is given post-ASCT, the individual must have had no response to or relapsed after the last line of therapy.
• Individuals must have received adequate prior therapy:
• For MCL, prior therapy must have included:
⁃ Anthracycline or bendamustine-containing chemotherapy and
⁃ Anti-CD20 monoclonal antibody (unless investigator determines that tumor is CD20-negative) and
⁃ Bruton tyrosine kinase inhibitor (BTKi)
• For other types, prior therapy must have included:
⁃ Anti-CD20 monoclonal antibody (unless investigator determines that tumor is CD20-negative) and
⁃ Anthracycline containing chemotherapy regimen.
• For individual with TFL must have relapse or refractory disease after transformation to DLBCL.
• The estimated survival time is over 3 months.
• The Eastern Cooperative Oncology Group (ECOG) score is 0-2.
• According to Lugano response criteria 2014, there should be at least one evaluable tumor focus. Evaluable tumor focus was defined as that with the longest diameter of intranodal focus \> 1.5cm, the longest diameter of extranodal focus \> 1.0cm assessed by computed tomography (CT) or magnetic resonance imaging (MRI).
• Subjects must be willing to undergo either excised or large-needle lymph node or tissue biopsy, or provide formalin-fixed paraffin-embedded (FFPE) tumor tissue block or freshly cut unstained slides.
• Functions of important organs meet the following requirements:
‣ Echocardiography showed left ventricular ejection fraction ≥50%;
⁃ Serum creatinine ≤1.5 × upper limit of normal range (ULN) or endogenous creatinine clearance ≥45mL/min (cockcroft-gault formula);
⁃ Total bilirubin ≤1.5× ULN;
⁃ Pulmonary function: ≤CTCAE grade 1 dyspnea and oxygen saturation of blood (SaO2) ≥91% in indoor air environment.
⁃ Blood routine: hemoglobin (Hgb) ≥ 80g/L, neutrophil count (ANC) ≥ 1 × 10 \^ 9/L, platelet count (PLT) ≥ 75 × 10 \^ 9/L. Excluding when there is bone marrow infiltration. It is not allowed to obtain normal values through growth factor intervention.
⁃ Pregnancy tests for women of childbearing age shall be negative; Both men and women agreed to use effective contraception during treatment and during the subsequent 1 year.
⁃ Toxicity from previous antitumor therapy ≤ grade 1 (according to CTCAE version 5.0) or to an acceptable level of inclusion/exclusion criteria (other toxicities such as alopecia and vitiligo considered by the investigator to pose no safety risk to the subject).
⁃ No obvious hereditary diseases.
⁃ Able to understand the requirements and matters of the trial, and willing to participate in clinical research as required.
⁃ Informed consent must be signed.