CD19/CD22 Bicistronic Chimeric Antigen Receptor (CAR) T Cells in Children and Young Adults With Recurrent or Refractory B Cell Malignancies
Phase 1/2 Dose Escalation Study of CD19/CD22 Bicistronic Chimeric Antigen Receptor (CAR) T Cells in Children and Young Adults With Recurrent or Refractory B Cell Malignancies
Who can join
As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.
- Age
- 3 Years to 39 Years
- Sex
- All sexes
- Healthy volunteers
- Not accepted
- Compensation
- Not stated
Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.
What to expect
No one can promise a trial will help you personally — that is what the research is trying to find out.
What participation involves
- Time periods mentioned: 28 days, 15 years
- Procedures mentioned: Urine samples, Biopsies, Physical exams, Spinal tap (lumbar puncture)
Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.
Show the study's own words
- "This will include: Physical exam Blood and urine tests Tests of their lung and heart function Imaging scans Bone marrow biopsy."
- "Lumbar puncture."
- "Participants will visit the clinic 2 times a week for 28 days after treatment."
- "Follow-up will continue for 15 years...."
- Compensation
- Not stated
- Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
- Participants are monitored closely by the research team throughout the study.
- Some participants may receive access to an investigational treatment, which is still being studied.
- Your participation helps researchers learn whether this approach could help future patients.
About this study
In plain language
This study tests CAR T-cell therapy made from a person's own blood cells, changed in a lab to fight cancer. The cells target two proteins, CD19 and CD22, on cancer cells. It is for people ages 3 to 39 with certain B-cell leukemias or lymphomas that came back or did not respond to treatment.
Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. About 90% of children and young adults who are treated for ALL can now be cured. But if the disease comes back, the survival rate drops to less than 50%. Better treatments are needed for ALL relapses. Objective: To test chimeric antigen receptor (CAR) therapy. CARs are genetically modified cells created from each patient s own blood cells. his trial will use a new type of CAR T-cell that is targeting both CD19 and CD22 at the same time. CD19 and CD22 are proteins found on the surface of most types of ALL. Eligibility: People aged 3 to 39 with ALL or related B-cell lymphoma that has not been cured by standard therapy. Design: Participants will be screened. This will include: Physical exam Blood and urine tests Tests of their lung and heart function Imaging scans Bone marrow biopsy. A large needle will be inserted into the body to draw some tissues from the interior of a bone. Lumbar puncture. A needle will be inserted into the lower back to draw fluid from the area around the spinal cord. Participants will undergo apheresis. Their blood will circulate through a machine that separates blood into different parts. The portion containing T cells will be collected; the remaining cells and fluids will be returned to the body. The T cells will be changed in a laboratory to make them better at fighting cancer cells. Participants will receive chemotherapy starting 4 or 5 days before the CAR treatment. Participants will be admitted to the hospital. Their own modified T cells will be returned to their body. Participants will visit the clinic 2 times a week for 28 days after treatment. Follow-up will continue for 15 years....
Compensation is read from the study's own description and may be missing — always confirm with the study team.
Eligibility
Who can join
- Be ages 3 to 39 with a confirmed, eligible type of B-cell leukemia or fast-growing B-cell lymphoma. Cancer must still be found on tests.
- Cancer must have come back or resisted both standard chemotherapy and at least one later treatment. People with Philadelphia chromosome-positive ALL must also have tried a targeted drug that failed.
- Be unable to get a donor stem cell transplant, have refused one, or have cancer that returned after one. An approved CD19 CAR T-cell treatment must be unavailable in time, unsuitable, or have failed.
- Cancer cells must have CD19, CD22, or both proteins, depending on the study group.
- Meet the study's rules for daily activity, blood counts, and liver, kidney, heart, and lung health. Some low blood counts caused by leukemia are allowed.
- If able to become pregnant or father a child, use effective birth control during treatment and afterward: 12 months for women and 4 months for men.
- Stop or delay breastfeeding during study treatment and until 1 month after CAR T-cell treatment.
- You or your legal representative must agree to the study and to join a separate long-term safety follow-up study.
Who can't join
- Certain levels of leukemia in the brain or spinal fluid, worsening nerve-related signs of cancer there, or active lymphoma in the brain or spinal cord.
- A very high number of immature cancer blood cells: 50,000 or more per microliter.
- A positive pregnancy test.
- Not enough time since earlier cancer treatments, a donor transplant, or cell therapy. Required waiting times vary, and some exceptions apply.
- Active graft-versus-host disease requiring medicines that weaken the immune system. This is when donor cells attack the body after a transplant.
- Tests showing active HIV, hepatitis B, or hepatitis C infection.
- Another active cancer, with limited exceptions, or a past severe, immediate allergic reaction to substances like those used in this study.
- An uncontrolled illness with symptoms, or a social situation that would make study visits and care hard to follow or create an unacceptable safety risk.
Simplified for readability. The official criteria below are what the study team uses.
Official eligibility criteria
* INCLUSION CRITERIA: * Diagnosis * Participant must: * Have pathology confirmed B cell ALL (not isolated to the testis or CNS), CML with ALL transformation, or high-grade lymphoma (e.g., Burkitt's lymphoma, B-lymphoblastic lymphoma, diffuse large B-cell lymphoma, inclusive of low-grade lymphoma that has transformed to high grade disease); and * Have relapsed or been refractory after at least one standard chemotherapy regimen and at least one salvage treatment. Participants with Philadelphia chromosome + ALL must have failed prior tyrosine kinase inhibitor; and * Be ineligible for allogeneic stem cell transplant (SCT), have refused SCT, or have recurred after SCT; and * Be unable to access (in a timely manner), ineligible for, or have relapsed/failed after or not responded to a commercially available CD19 CAR T-cell construct; and * Have evidence of at least minimal residual disease or PET-avid disease (lymphoma) at the time of enrollment. * CD22/CD19 expression * Cohorts A1b, B1b, C2b * CD19 must be detected on \>15% of the malignant cells by immunohistochemistry or \> 80% by flow cytometry. * CD22 positivity must be confirmed. * Cohorts D1b, 2 B-ALL * CD19 or CD22 positivity must be confirmed * Age \>= 3 years of age and \<=39 years of age at time of enrollment. * Clinical Performance status: Participants \>= 16 years of age: Karnofsky \>= 50%; Participants \< 16 years of age: Lansky scale \>= 50%. * Participants must have adequate organ and marrow function as defined below: * leukocytes \>= 750/mcL\* * platelets \>= 50,000/mcL\* * total bilirubin \<=2 X ULN (except in the case of participants with documented Gilbert's disease \> 3x ULN) * AST(SGOT)/ALT(SGPT) \<=10 X institutional upper limit of normal * creatinine \<= the maximum for age listed in the table below OR * measured creatinine clearance \>=60 mL/min/1.73 m\^2 for participants with creatinine levels above the max listed below per age. * Age (Years) \<= 5 / Maximum Serum Creatinine (mg/dL) \<= 0.8 * Age (Years) 6 to \<= 10 / Maximum Serum Creatinine (mg/dL) \<= 1.0 * Age (Years) \>10 / Maximum Serum Creatinine (mg/dL) \<= 1.2 * a participant will not be excluded because of pancytopenia \>= Grade 3 if it is due to underlying bone marrow involvement by leukemia * Central nervous system (CNS) Status * Participants with leukemia with CNS 1 and 2 disease are eligible in the absence of exclusion criteria * Participants of child-bearing or child-fathering potential must be willing to practice effective birth control from the time of enrollment until 12 months following completion of study treatment for women and for 4 months following completion of study treatment for men. * Participants who are breastfeeding or plan to breastfeed must agree to discontinue/postpone breastfeeding while on study therapy and until 1 month after the administration of CAR. * Cardiac function: Left ventricular ejection fraction \>= 45% or fractional shortening \>=28% * Pulmonary Function * Baseline oxygen saturation \>92% on room air at rest * Ability of participant or Legally Authorized Representative (LAR) to understand and the willingness to sign a written informed consent document. * Ability and willingness of participant or Legally Authorized Representative (LAR) to co- enroll on 15-C-0028: Follow-up Evaluation for Gene-Therapy Related Delayed Adverse Events after Participation in Pediatric Oncology Branch Clinical Trials. EXCLUSION CRITERIA: Participants meeting any of the following criteria are not eligible for participation in the study: * Participants with CNS3 disease, progressing neurologic signs\* of CNS disease, radiologically detected active CNS lymphoma (\*resolving manifestation or persistent and/or irreversible findings from prior CNS involvement (e.g., blindness) is not exclusionary) * Hyperleukocytosis (\>= 50,000 blasts/microL) * Positive serum or urine beta-HCG pregnancy test performed at screening. * Participants will be excluded based on prior therapy if they fail to meet following washout criteria: * Therapy: Systemic Chemotherapy, anti-neoplastic agents, antibody- based therapies * Washout\*: \>=2 weeks * Exceptions: 6 weeks for clofarabine or nitrosoureas; No washout for prior intrathecal chemotherapy, steroid therapy, hydroxyurea (no dose increases within prior 2 weeks) or ALL maintenance-type chemotherapy (vincristine, 6-mercaptopurine, oral methotrexate, or a tyrosine kinase inhibitor for participants with Ph+ ALL) provided there is recovery from any acute toxic effects * Therapy: Radiation * Washout\*: \>=3 weeks * Exceptions: No time restriction with radiation therapy if the volume of bone marrow treated is less than 10% and the participant has measurable/evaluable disease outside the radiation window * Therapy: Allogeneic Stem Cell Transplant * Washout\*: \>= 100 days since SCT; \>= 30 days since completion of immunosuppression; \>= 6 weeks since donor lymphocyte infusion (DLI) * Exceptions: Cannot have evidence of active graft-versus-host disease (GVHD) requiring systemic immunosuppression * Therapy: CAR T-Cell Therapy or other Adoptive Cell Therapy * Washout\*: \> 30 days post infusion * Washout: Time between therapy and apheresis * Positive HIV antibodies consistent with active HIV. * Positive hepatitis C antibodies or positive Hepatitis B surface antigen (HbsAG) indicative of current/active HCV/HBV. * Active second malignancy other than in situ carcinoma of the cervix, unless the tumor was treated with curative intent at least two years previously and participant is in remission. * History of severe, immediate hypersensitivity reaction attributed to compounds of similar chemical or biologic composition to any agents used in study or in the manufacturing of the cells. * Uncontrolled, symptomatic, intercurrent illness or social situations that would limit compliance with study requirements or in the opinion of the PI would pose an unacceptable risk to the participant.
Study sites (1)
MD
- National Institutes of Health Clinical Center · Bethesda, MD 20892For more information at the NIH Clinical Center contact National Cancer Institute Referral Office · Study contact · 888-624-1937More trials in Bethesda