The primary objective of this phase I study is to evaluate the safety and to establish the recommended dose of CD19-CART01 infused in pediatric patients affected by relapsed/refractory B-ALL or NHL with measurable Bone Marrow (BM) involvement. The phase II extension is aimed at testing the efficacy of the treatment at the optimal dose defined in the phase I.
The study will consist of 2 phases, a Phase I or dose escalation phase and a Phase II or expansion phase. Paediatric/young adult patients with relapsed or refractory B cell ALL will be enrolled. Eligible patients will undergo leukapheresis in order to harvest T cells, which is the starting material for the manufacture. Autologous CAR T product directed against CD19-expressing tumor cells (CD19-CART01) will be produced and, after a lymphodepletion with conventional chemoterapic agents, the patient will receive CD19-CART01 intravenously. The construct contains also the suicide gene safety switch "inducible Caspase 9"; therefore, in case of relevant toxicities, the patient will receive the dimerizing agent in order to induce the apoptosis of the cells. After the treatment, the patients will then enter a 36-month follow-up period.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
29
Following lymphodepletion with chemotherapy (cyclophosphamide and fludarabine) patients will be treated with 0.5 to 3.0 x 10⁶/kg CD19 Chimeric Antigen Receptor (CAR) positive T cells as a single dose. In case of toxicity, the patient will receive the dimerizing drug activating the suicide safety switch in order to improve the safety of the treatment
Ospedale Pediatrico Bambino Gesù
Roma, Italy
Phase I - Identification of the dose limiting toxicity (DLT)
Toxicity will be assessed according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) scale, version 4 and the number of patients experiencing DLT will be evaluated
Time frame: 4 weeks after CAR T cell infusion
Phase II - Efficacy
Complete remission rate minimal residual disease (MRD) negative response
Time frame: 4 weeks after CAR T cell infusion
Overall Response Rate (ORR)
Assessment of CR with incomplete blood count recovery (CRi), Partial Response (PR) and Stable Disease (SD).
Time frame: 4 weeks after CAR T cell infusion
In vivo persistence/expansion of infused CAR T cell
Detection of infused CAR T cell in the peripheral and bone marrow blood
Time frame: Up to 5 years
Function of infused CAR T cell
Assessment through functional assays (such as ELISPOT for interferon-gamma release using CD19-positive cells and CD19-negative target cells) and immunophenotyping on peripheral blood mononuclear cells (PBMCs) isolated from the patients
Time frame: Up to 5 years
Cytokine profiling
Define serum cytokine profile after T cell infusion and correlation with cytokine release syndrome (CRS)
Time frame: 10 days after CAR T cell infusion
Disease Outcome
Assessment of relapse rate
Time frame: Up to 3 years
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Overall Survival
Time frame: Up to 3 years
Disease-free survival
Time frame: Up to 3 years
Elimination of CAR T cell in case of toxicity
Assessment the kinetics of CAR T cells elimination after AP1903 infusion
Time frame: Up to 15 years