Symptoms and General Pathology

All Conditions

Neoplasms

Blood and Lymph Conditions

Immune System Diseases

Behaviors and Mental Disorders

Rare Diseases

Recurrence

Lymphoma

Leukemia

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia, Lymphoid

Leukemia, Lymphocytic, Chronic, B-Cell

Lymphoma, B-Cell

Aggression

Lymphoma, Non-Hodgkin

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Hematologic Diseases

Leukemia, B-Cell

Chronic Disease

Disease Attributes

Lymphosarcoma

Acute Lymphoblastic Leukemia

Lymphoblastic Lymphoma

Chronic Graft Versus Host Disease

Chronic Lymphocytic Leukemia

B-cell Lymphoma

Acute Graft Versus Host Disease

Each patient will receive a dose of CD19 CAR T Cells administered as an infusion. Each infusion will consist of CD19.CAR/28 T cells and CD19.CAR/28137 T cells.

Each patient will receive the maximum tolerated dose (MTD) of CD19 CAR T Cells administered as an infusion. Each infusion will consist of CD19.CAR/28 T cells and CD19.CAR/28137 T cells.

Three dose levels will be evaluated.

Group 1: CD19.CAR/28137ζ at 1×10\^6 cells/m\^2 and CD19.CAR/28ζ at 1×10\^6 cells/m\^2

Group 2: CD19.CAR/28137ζ at 5×10\^6 cells/m\^2 and CD19.CAR/28ζ at 5×10\^6 cells/m\^2

Group 3: CD19.CAR/28137ζ at 2×10\^7 cells/m\^2 and CD19.CAR/28ζ at 2×10\^7 cells/m\^2

Dose Escalation Phase:CD19.CAR/28 and CD19.CAR/28137 T cells

The primary goal of the expanded cohort is to further study the safety profiles of CAR-T cells in each of the disease settings, both with or without lymphodepleting chemotherapy given before CAR-T cell infusion.

Expansion Phase: CD19.CAR/28 and CD19.CAR/28137 T cells

Carlos A Ramos, MD

Mahshid Azamian

Carlos A. Ramos, MD

Subjects on this study have a type of lymph gland cancer called Non-Hodgkin Lymphoma, acute lymphocytic leukemia, or chronic Lymphocytic Leukemia (these diseases will be referred to as "lymphoma" or "leukemia"). The lymphoma or leukemia has come back or has not gone away after treatment.

The body has different ways of fighting infection and disease. No one way seems perfect for fighting cancers. This research study combines two different ways of fighting disease, antibodies and T cells, hoping that they will work together. Both antibodies and T cells have been used to treat patients with cancer. They have shown promise, but have not been strong enough to cure most patients.

T cells can kill tumor cells but normally there are not enough of them to kill all the tumor cells. Some researchers have taken T cells from a person's blood, grown more of them in the laboratory and then given them back to the person.

The antibody used in this study is called anti-CD19. It first came from mice that have developed immunity to human lymphoma. This antibody sticks to lymphoma cells because of a substance on the outside of these cells called CD19. CD19 antibodies have been used to treat people with lymphoma and leukemia. For this study, anti-CD19 has been changed so that instead of floating free in the blood it is now joined to the T cells. When an antibody is joined to a T cell in this way it is called a chimeric receptor.

In the laboratory, the investigators found that T cells work better if they also add proteins that stimulate T cells, such as one called CD28. Adding the CD28 makes the cells last longer in the body but not long enough for them to be able to kill the lymphoma cells. The investigators believe that if they add an extra stimulating protein, called CD137, the cells will have a better chance of killing the lymphoma cells.

The investigators are going to see if this is true by putting the CD19 chimeric receptor with CD28 alone into half of the cells and the CD19 chimeric receptor with CD28 and CD137 into the other half of the cells. These CD19 chimeric receptor T cells with CD28 and with or without CD137 are investigational products not approved by the FDA.

The purpose of this study is to find the biggest dose of chimeric T cells that is safe, to see how long the T cell with each sort of chimeric receptor lasts, to learn what the side effects are and to see whether this therapy might help people with lymphoma or leukemia.

Patients will give the investigators blood to make CD19 CD28 (with and without CD137) chimeric receptor-T cells in the laboratory. These cells will be grown and frozen. To make the T cells, investigators will take blood (or blood from a donor) and stimulate it with growth factors to make the T cells grow. To get the CD19 antibody and CD28 (with or without CD137) to attach to the surface of the T cell, they will insert the antibody gene into the T cell. This is done with a virus called a retrovirus that has been made for this study and will carry the antibody gene into the T cell. This virus also helps to find the T cells in the blood after injecting them; in order to tell them apart investigators have made two viruses that are slightly different because one has CD137. These two viruses can be told apart by a special laboratory test. Because the patient will receive cells with a new gene in them, the patient will be followed for a total of 15 years to see if there are any long term side effects of gene transfer. If the patient cannot visit the clinic, he or she will be contacted by the research coordinator or physician.

When subjects enroll on this study, they will be assigned a dose of CD19 chimeric receptor-T cells. Several studies suggest that the infused T cells need room to be able to proliferate and accomplish their functions and that this may not happen if there are too many other T cells in circulation.

Because of that, if the subject's level of circulating T cells is relatively high, s/he may receive one treatment of cyclophosphamide (Cytoxan) and fludarabine if the doctor thinks this is appropriate. This drug will decrease the numbers of the subject's own T cells before infusion of the CD19 chimeric receptor T cells. If subject is already receiving chemotherapy, this may not be needed. The investigators would prefer subjects do not receive other chemotherapy until 6 weeks after cell infusion but they can do so if their doctor thinks it is medically necessary.

Patients will be given an injection of cells into the vein through an IV at the assigned dose. The injection will take about 20 minutes. The investigators will follow them in the clinic after the injection for up to 3 hours.

If after a 6 week evaluation period after the infusion, the patient seems to be experiencing a benefit (confirmed by radiological studies, physical exam and/or symptoms), s/he may be able to receive up to five additional doses of the T cells if s/he wishes. The first repeat infusion can only take place at least 6 weeks after the first infusion. Any additional infusions after that would be at least 4 weeks apart. All additional infusions will be at the same dose level received the first time or a lower dose. The treatment will be given by the Center for Cell and Gene Therapy at Texas Children's Hospital or Houston Methodist Hospital.

Activated T-Cells Expressing 2nd or 3rd Generation CD19-Specific CAR, Advanced B-Cell NHL, ALL, and CLL (SAGAN)

Phase I Study of Activated T-Cells Expressing Second or Third Generation CD19-Specific Chimeric Antigen Receptors for Advanced B-Cell Non-Hodgkin's Lymphoma, Acute Lymphocytic Leukemia and Chronic Lymphocytic Leukemia (SAGAN)

Toxicity will be evaluated according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) scale, version 4. DLT will be defined as any of the following that is NOT (1) pre-existing, or (2) due to infection (to which patients with CLL and NHL are predisposed), or (3) due to underlying malignancy, and that may, after consultation with the FDA when indicated, be considered possibly, probably, or definitely related to the study cellular products: (1) Non-hematologic DLT is any grade 3 or grade 4 non-hematologic toxicity, including allergic reactions to T cell infusions; (2) Hematologic DLT is defined as any grade 4 hematologic toxicity. Patients with evidence of bone marrow disease (metastases or diffuse infiltration) are not evaluable for hematologic dose limiting toxicity.

Survival will be measured by a real time Q-PCR assay to detect CD19.CAR-ATLs in peripheral blood from subjects. Plots will be generated to depict patterns of survival. Also, longitudinal modeling techniques will be used.

To compare the changes in frequency of two different T-cell products in the same patient, two different Q-PCR assays will be used, which distinguish each CAR by the presence or absence of the CD137 co-stimulatory endodomain gene.

Tumor responses will be assessed by the International Working Group Revised Response Criteria for Malignant Lymphoma or the National Cancer Institute CLL Working Group Recommendations, as applicable.

Changes in the percentage of circulating modified T cells after additional doses will be measured by each respective real time Q-PCR assay to detect CD19.CAR-ATLs in peripheral blood from subjects. Plots will be generated to depict patterns of survival. Also, longitudinal modeling techniques will be used.

To study the function of CD19.CAR-ATLs, the following assays will be performed on PBMCs isolated from subjects: (1) ELISPOT for interferon-gamma release using CD19-positive cells and CD19-negative target cells; (2) Other functional assays, such as in vitro reactivation of PBMCs, in patients on whom the appropriate reagents are available; and (3) Immunophenotyping.

Center for Cell and Gene Therapy, Baylor College of Medicine

The Methodist Hospital Research Institute

Baylor College of Medicine

Professor

Lymphoma, Mantle-Cell

Lymphoma, Follicular

Lymphoma, B-Cell, Marginal Zone

Mantle Cell Lymphoma

Follicular Lymphoma

Marginal Zone Lymphoma

Antineoplastic Agents

Antirheumatic Agents

All Drugs and Chemicals

Cyclophosphamide

Fludarabine

Fludarabine phosphate

Bendamustine Hydrochloride

Immunosuppressive Agents

Immunologic Factors

Antineoplastic Agents, Alkylating

Alkylating Agents

Up to 12 patients will receive a single infusion of CAR.k.28. The starting dose will be 2.5x10\^5 cells/kg of each product. Up to 3 dose levels of CAR.k.28 cells will be tested with at least 3 patients enrolled at each dose cohort before dose escalation is considered based on the incidence of dose limiting toxicity (DLT). An expansion cohort will enroll up to 8 patients at the recommended phase 2 dose. Prior to receiving the infusions, patients will undergo lymphodepletion with fludarabine and bendamustine. Patients with a known history of intolerance to bendamustine may be considered for lymphodepletion with fludarabine and cyclophosphamide.

Three dose levels will be evaluated: Dose level 1 (5x10\^5 cells/kg), Dose level 2 (1x10\^6), and dose level 3 (2x10\^6 cells/kg).

CAR.k.28

500 mg/m\^2/day IV for 3 consecutive days

70 mg/m\^2/day administered over 3 consecutive days.

Bendamustine

Catherine Cheng

Kelly Hoye

Natalie Grover, MD

Paul Armistead

Anne Beaven, MD

James Coghill

Christopher Dittus, MD

Gianpietro Dotti

Paul Eldridge

Katarzyna Jamieson

Emily Kassam

Grace Park

Alicia Pinto

Marcie Riches

Barbara Savoldo

Jonathan Serody, MD

Thomas Shea, MD

Benjamin Vincent

Kimberly Wehner

William Wood

Ashley Zanter

This study will combine both T cells and antibodies in order to create a more effective treatment. The treatment tested in this study uses modified T-cells called Autologous T Lymphocyte Chimeric Antigen Receptor (ATLCAR) cells targeted against the kappa light chain antibody on cancer cells. For this study, the anti-kappa light chain antibody has been changed so instead of floating free in the blood, a part of it is now joined to the T cells. Only the part of the antibody that sticks to the lymphoma cells is attached to the T cells. When an antibody is joined to a T cell in this way, it is called a chimeric receptor. The kappa light chain chimeric (combination) receptor-activated T cells are called ATLCAR.κ.28 cells. These cells may be able to destroy lymphoma cancer cells. They do not, however, last very long in the body so their chances of fighting the cancer are unknown.

Previous studies have shown that a new gene can be put into T cells to increase their ability to recognize and kill cancer cells. A gene is a unit of DNA. Genes make up the chemical structure carrying your genetic information that may determine human characteristics (i.e., eye color, height and sex). The new gene that is put in the T cells in this study makes an antibody called an anti-kappa light chain. This anti-kappa light chain antibody usually floats around in the blood. The antibody can detect and stick to cancer cells called lymphoma cells because they have a substance on the outside of the cells called kappa light chains.

The purpose of this study is to determine whether receiving the ATLCAR.κ.28 cells is safe and tolerable and learn more about the side effects and how effective these cells are in fighting lymphoma. Initially, the study doctors will test different doses of the ATLCAR.κ.28, to see which dose is safer for use in lymphoma patients. Once a safe dose is identified, the study team will administer this dose to more patients, to learn about how these cells affect lymphoma cancer cells and identify other side effects they might have on the body.

This is the first time ATLCAR.κ.28 cells are given to patients with lymphoma. The Food and Drug Administration (FDA), has not approved giving ATLCAR.κ.28 as treatment for lymphoma. This is the first step in determining whether giving ATLCAR.κ.28 to others with lymphoma in the future will help them.

This study is a single center, open-label phase 1 clinical trial designed to determine the safety of escalating doses of autologous activated T lymphocytes (ATLs) expressing the chimeric antigen receptor specific for the kappa-light chain of human immunoglobulins (CAR.κ) in subjects with relapsed/refractory kappa-positive (κ+) mantle cell and indolent non-Hodgkin lymphomas (NHL). During dose finding, up to 12 subjects will receive a single infusion of ATL product expressing the CAR.κ encoding the CD28 co-stimulatory endodomain (CAR.κ.28). The starting dose will be 5.0 × 105 cells/kg. Up to 3 dose levels of CAR.κ.28 cells will be tested with at least 3 subjects enrolled in each dose cohort before dose escalation is considered based on the incidence of dose limiting toxicity (DLT). Prior to receiving the cell product, subjects will undergo lymphodepletion with fludarabine and bendamustine or cyclophophamide. Dose escalation will be guided by the modified 3+3 design. Any dose level may be expanded to 4-9 subjects to obtain more data at that dose or to include subjects for which insufficient cells are manufactured to enroll on their assigned higher dose level. If due to the expansion the estimated DLT rate at a dose is ≥0.33, the study would not escalate to the next highest dose level and the recommended phase 2 dose (RP2D) would be exceeded. If needed, an expansion cohort will enroll up to 8 subjects at the RP2D to further assess safety and efficacy of CAR.κ.28 cells. Secondary endpoints include evaluation of progression free survival (PFS), response rate (RR), duration of response (DoR) and overall survival (OS). The persistence of CAR.κ.28 cells in the peripheral blood will be assessed as an exploratory objective. The final RP2D including expansion data will be the dose with the DLT rate closest to 0.2.

The adoptive transfer of T cells targeting the kappa light chain (CAR.κ) is a promising treatment for patients with relapsed/refractory κ + NHL and has shown encouraging preclinical activity \[37\]. The CD8α stalk incorporated into CD28 signaling domain within the CAR, may improve the persistence of the CAR.κ T cells. Therefore, subjects in this study are being infused with this newly modified version of CAR.κ.28 so that persistence and efficacy will be improved compared to the older version of the CAR.κ molecule.

We hypothesize that CAR.κ.28 will be well tolerated in subjects with relapsed/refractory indolent and aggressive lymphomas positive for the kappa light chain and will show efficacy. We also anticipate that CAR.κ.28 will show fast expansion in the peripheral blood in the first 2 - 3 weeks, but also longer term persistence than the previous version of CAR.κ.28.

In this phase 1 single center study, peripheral blood will be collected for production of CAR.κ.28 cells prior to conditioning chemotherapy in subjects with relapsed/refractory κ+ indolent lymphoma including follicular lymphoma grade 1-3b, splenic marginal zone lymphoma, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone lymphoma, and mantle cell lymphoma. During the approximately 1-2 months necessary for CAR-T cell production, subjects may undergo standard of care treatment ("bridging therapy") per physician's discretion. Subjects must sign consent forms before cells are procured and again prior to undergoing lymphodepleting chemotherapy and cellular treatment. At 2-14 days (preferably 2-4 days) after lymphodepletion with bendamustine and fludarabine, we will infuse the CAR.κ.28 cell product. Subjects in this study will receive CAR.κ.28 cell product in one of the three planned dose escalation cohorts. Dose levels of CAR.κ.28 cells administered will range between 5.0 × 105 cells/kg and 2 × 106 cells/kg. These doses have been evaluated in previous phase 1 studies of CAR-T cell lymphocytes \[37-39\] including a phase 1 trial targeting the kappa light chain on malignant B cells in which the construct included the CD28 co-stimulatory endodomain \[37\]. An expansion cohort will enroll up to 8 subjects at the RP2D to further assess safety and efficacy of CAR.κ.28 cells. In all subjects, we will measure the persistence of CAR.κ.28 cells in the peripheral blood at different time points by measuring the level of the transgene and by phenotypic analyses.

OUTLINE

Cell Procurement Peripheral blood, up to 300 mL (in up to 3 collections) will be obtained from subjects for cell procurement. In subjects with inadequate lymphocyte count in the peripheral blood, a leukapheresis may be performed to isolate sufficient T cells. The parameters for apheresis will be up to 2 blood volumes.

Lymphodepleting Regimen Subjects will receive a "pre-conditioning" cytoreductive regimen of bendamustine 70 mg/m2/day administered IV followed by fludarabine 30 mg/m2/day administered IV over 3 consecutive days. These agents will be administered per institutional guidelines. Prophylaxis (e.g., hydration, antiemetics, etc.) needed prior to fludarabine and bendamustine chemotherapy will be provided per institutional guidelines. At the discretion of the clinical investigator, subjects with a known history of intolerance to bendamustine may be considered for lymphodepletion with cyclophosphamide 500 mg/m2/day administered IV followed by an IV dose of fludarabine 30 mg/m2/day administered over 3 consecutive days. These agents will be administered per institutional guidelines.

Cell Administration The cellular product consisting of CAR.κ.28 cells will be administered by a licensed healthcare provider (oncology nurse or physician) via intravenous injection over 5 - 10 minutes through either a peripheral or a central line. The volume of infusion will depend upon the concentration of the cells when frozen and the size of the subject. The expected volume will be 1-50cc.

Post lymphodepletion, subjects who meet eligibility criteria for cellular therapy will receive CAR.κ.28 cells within 2 - 14 days, but preferably within 2-4 days, after completing the lymphodepleting chemotherapy regimen.

During dose finding, a single dose of CAR.κ.28 will be given after lymphodepletion. The cell dose levels that will be evaluated are outlined below.

Expansion Cohort, CAR.κ.28 will be given after lymphodepletion. Subjects will receive the RP2D.

Duration of Therapy

Therapy in LCCC1811-ATL involves a single cell infusion of CAR.K.28 cells. Treatment with at least one infusion will be administered unless:

* Subject decides to withdraw from study treatment, or
* General or specific changes in the subject's condition render the subject unacceptable for further treatment in the judgment of the investigator.

Duration of Follow-up Subjects will be followed for up to 15 years for RCR evaluation or until death, whichever occurs first. In addition to this follow-up, subjects removed from study treatment for unacceptable adverse events will be followed until resolution or stabilization of the adverse event.

Subjects who experience unequivocal disease progression and start alternate therapy after receiving a cell infusion still be required to complete abbreviated follow up procedures.

Study of Kappa Chimeric Antigen Receptor (CAR) T Lymphocytes Co-Expressing the Kappa and CD28 CARs for Relapsed/Refractory Kappa+ Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

Phase 1 Study of the Administration of T Lymphocytes Expressing the Kappa Chimeric Antigen Receptor (CAR) and CD28 Endodomain for Relapsed/Refractory Kappa+ Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

The duration of response will be defined as time from documentation of tumor response per Lugano criteria for Non-Hodgkin Lymphoma (NHL) or International Workshop on Chronic Lymphocytic Leukemia (IWCLL) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL).

Toxicity is classified and graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, version 5.0). Grade 1 Mild; asymptomatic or mild symptoms; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting instrumental Activities of Daily Living (ADL). Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL. Grade 4 Life-threatening consequences; urgent intervention indicated. Grade 5 Death related to Adverse Event (AE). Immune effector cell-associated neurotoxicity syndrome (ICANS) symptoms will be graded per American Society for Blood and Marrow Transplantation (ASBMT) ICANS Consensus Grading for Adults (scale from 1-mild to 4-critical) and cytokine release syndrome (CRS) symptoms will be graded according to ASBMT CRS Consensus Grading (a scale from 1-mild to 5-death).

PFS is defined from the date of administration of CAR.κ.28 infusion to progression, or death as a result of any cause per revised Lugano criteria for Non-Hodgkin Lymphoma (NHL) and International Workshop on Chronic Lymphocytic Leukemia (IWCLL) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL).

Overall survival will be measured from the date of administration of CAR.κ.28 infusion to date of death

The objective response rate will be defined as the rate of complete responses (CR) + partial responses (PR) by 8 weeks post CAR.κ.28 infusion per revised Lugano criteria for Non-Hodgkin Lymphoma (NHL). For Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) patients, the rate of CR + PR will be defined by the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) criteria by 8 weeks post-CAR.κ.28 infusion

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Activated T-Cells Expressing 2nd or 3rd Generation CD19-Specific CAR, Advanced B-Cell NHL, ALL, and CLL (SAGAN)	NCT01853631	Non-Hodgkin Lym... Chronic Lymphoc... Acute Lymphocyt...	Dose Escalation... Expansion Phase...	- 75 Years	Baylor College of Medicine
Study of Kappa Chimeric Antigen Receptor (CAR) T Lymphocytes Co-Expressing the Kappa and CD28 CARs for Relapsed/Refractory Kappa+ Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.	NCT04223765	Mantle Cell Lym... Follicular Lymp... Splenic Margina... Extranodal Marg... Nodal Marginal ... Indolent Non-ho...	CAR.k.28 Fludarabine Cyclophosphamid... Bendamustine	18 Years -	UNC Lineberger Comprehensive Cancer Center

Spots Global Cancer Trial Database for cd28

Every month we try and update this database with for cd28 cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for cd28

Every month we try and update this database with for cd28 cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for cd28 cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.