A Multi-center Single Arm Phase II Study to Evaluate the Safety and Efficacy of Genetically Engineered Autologous Cells Expressing Anti-CD20 and Anti-CD19 Specific Chimeric Antigen Receptor in Subjects With Relapsed and/or Refractory Diffuse Large B Cell Lymphoma
DALY II USA is a phase II, multi-center, single arm study to evaluate the efficacy, safety, and pharmacokinetics of zamtocabtagene autoleucel (MB-CART2019.1) in patients with relapsed and/or refractory B cell lymphoma (BCL). Cohorts include subjects with diffuse large B-cell lymphoma (DLBCL) after receiving at least 2 lines of therapy, primary or secondary central nervous system (CNS) lymphoma (PCNSL) and (SCNSL) after receiving at least one line of therapy, mantle cell lymphoma (MCL) and Richter's transformation (RT) after receiving at least one line of therapy, and DLBCL transplant-ineligible after receiving at least one line of therapy.
• Histologically confirmed B-cell non-Hodgkin's lymphoma:
⁃ DLBCL cohort (both cohorts)
• DLBCL or associated subtype, defined by WHO 2016 classification
• DLBCL not otherwise specified (NOS)
• High-grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements
• High-grade B cell lymphoma (NOS)
• Primary mediastinal (thymic) large B cell lymphoma
• Transformed lymphoma (e.g., transformed follicular, or marginal zone lymphoma, follicular lymphoma (FL Grade 3)
• o CNS cohort
• B-cell primary or secondary central nervous system lymphoma (PCNSL or SCNSL)
• o Mantle Cell Lymphoma (MCL) cohort
• Histologically confirmed MCL determined by overexpression of cyclin D1 or presence of t(11;14) (q13; q32) translocation
• o Richter's Transformation (RT) cohort
• Histologically confirmed RT to a diffuse large B-cell lymphoma (DLBCL) subtype from underlying CLL (clonally related)
• Relapsed or refractory disease is defined for DLBCL (and associated subtypes) population as:
‣ For DLBCL cohort (after receiving at least two prior lines of therapy): persistent disease after failure of 2 or more lines of chemotherapy including rituximab or equivalent and anthracycline and either after failed ASCT, or ineligible, not intended for or not consenting to ASCT
• Chemotherapy-refractory disease (applies to all cohorts) is defined as persistent disease after last line of therapy or relapsed or persistent disease after prior ASCT for lymphoma
• Disease relapse in subjects without prior ASCT is defined as relapse of disease after the last dose of most recent therapy regimen
‣ For disease specific cohorts added after the initial DLBCL cohort the definition of relapsed/refractory disease is as described below:
‣ CNS cohort: Subjects with relapsed/refractory PCNSL that have failed (or unable to tolerate) at least first-line therapy.
• First-line therapy is defined as either high dose methotrexatebased therapy, temozolomide, high dose cytarabine, pemetrexed, lenalidomide or Bruton tyrosine kinase (BTK) inhibitor-based therapy.
• No contraindications for MRI evaluation
• CNS cohort: Subjects with SCNSL must have relapsed or refractory disease after having received at least one prior line of systemic therapy
• Prior lines of systemic therapy should include an anti-CD20 monoclonal antibody and anthracycline containing chemotherapy regimen and/or with or without an autologous stem cell transplant
‣ MCL cohort: Subjects with relapsed/refractory disease after at least one prior systemic treatment, that must include:
• Cytotoxic rituximab \[or equivalent\] based chemotherapy regimen (eg, rituximab bendamustine, R-CHOP, R-DHAP, R-ARA-C) AND
• BTK inhibitor
‣ RT cohort: Subject must have relapsed/refractory disease after at least one prior systemic treatment following Richter's Transformation
‣ DLBCL transplant ineligible 2nd cohort: subject must have failure of first-line chemotherapy (including rituximab or equivalent and anthracycline).
• For this cohort subjects are considered transplant ineligible if they meet one of the following criteria:
• Age ≥70 years
• ECOG status is 2 at screening
• Impaired pulmonary function: diffusing capacity of the lung for carbon monoxide \[DLCO\] ≤ 60% adjusted for gender-specific hemoglobin concentration (Coates formula)
• Impaired cardiac function: left ventricular ejection fraction (LVEF) \< 50%; must be assessed by echocardiogram or multiple uptake gated acquisition (MUGA) scan performed within 4 weeks of determination of eligibility
• Impaired renal function: calculated creatinine clearance (Cockcroft and Gault) \< 60 mL/min
• Impaired hepatic function: aspartate aminotransferase (AST)/alanine aminotransferase (ALT) \> 2 x upper limit of normal (ULN)
‣ In addition, all subjects must have:
• Age ≥18 years
• Eastern Cooperative Oncology Group (ECOG) performance status that is either 0 or 1 at screening. ECOG performance status of 2 at screen is allowed if the decrease in performance status is due to lymphoma
⁃ Subjects in DLBCL transplant-ineligible 2nd-line cohort with ECOG performance status of 2, regardless of attribution, will be allowed for inclusion
• Measurable disease will be assessed by FDG-PET/CT in systemic lymphoma . and by brain/spine MRI for CNS disease
• Subject must have a tumor biopsy sample (at least 16 unstained slides of tissue or tissue block) from the most recent relapse available prior to MB-CART2019.1 infusion. If medically not feasible to obtain a biopsy from the most recent relapse and for cases when the amount of tissue is limited, the sponsor should be consulted, to confirm adequacy of the sample for study required analyses
• No clinical suspicion of central nervous system (CNS) lymphoma (not applicable to CNS cohort)
⁃ Subjects in DLBCL transplant-ineligible 2nd-line cohort with SCNSL will be allowed for inclusion
• If the subject has history of CNS disease (not applicable to CNS cohort), then he/she must have no signs or symptoms of CNS disease, have no active disease on magnetic resonance imaging (MRI), have no large cell lymphoma present in cerebral spinal fluid (CSF), regardless of the number of white blood cells (WBCs)
• If has history of cerebral vascular accident (CVA), the CVA event must be greater than 12 months prior to leukapheresis. Any neurological deficits must be stable
• A creatinine clearance (as estimated by direct urine collection or Cockcroft-Gault Equation) \> 45mL/min
• Cardiac ejection fraction (EF) ≥ 45% as determined by an echocardiogram (ECHO) or Multigated Radionuclide Angiography (MUGA)
• Subjects in DLBCL transplant-ineligible 2nd-line cohort with a lower ejection fraction of \> 40% will be allowed for inclusion
• Resting O2 saturation \>90% on room air
• Serum alanine aminotransferase (ALT) / aspartate aminotransferase (AST)\<5 times the Upper Limit of Normal (ULN) for age
• Total bilirubin \<1.5 mg/dl, except in individuals with Gilbert's syndrome
• Subjects in DLBCL transplant-ineligible 2nd-line cohort with a total bilirubin of \< 2.0 mg/dL will be allowed for inclusion
• Absolute neutrophil count (ANC) \> 1000/μL
• Absolute lymphocyte count \> 100/μL
• Platelet count \> 50,000/µL
• Estimated life expectancy of more than 3 months other than primary disease