The REMIT trial will investigate radiotherapy as a preferred bridging method prior to Tisagenlecleucel infusion in patients with relapsed or refractory Diffuse Large B Cell Lymphoma
The REMIT Trial is an open label, single arm phase IIa study investigating Radiotherapy as preferred bridging method prior to Tisagenlecleucel treatment in patients with relapsed or refractory Diffuse Large B Cell Lymphoma approved to receive CD19 CAR-T cells as per their licensed indication. The trial will recruit 20 patients who have been approved to receive Tisagenlecleucel treatment and where the tumour is amendable to radiotherapy as per standard of care. Trial subjects (patients) during a 14 day screening phase will have their metabolic tumour burden assessed by PET-CT and bridging radiotherapy will be planned. Bridging radiotherapy will commence immediately after leukapheresis with dose adjustments according to disease burden and localisation. Disease areas requiring effective long-term control will receive full dose radiotherapy, 20 - 30Gy /5-15# and other areas will receive low dose radiotherapy, 4Gy / 2# for optimal tumour debulking and priming effects. Standard lymphodepletion will be given day -5 to day -3 followed by Tisagenlecleucel infusion on day 0. A window of 14-21 days will be left from last dose of radiotherapy and day 0. Patients will be followed up at 3 and 6 months after Tisagenlecleucel infusion for a minimum of 12 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
6
Bridging Radiotherapy will start immediately after leukapheresis and before Tisagenlecleucel treatment
St James's University Hospital
Leeds, United Kingdom
Kings College Hospital
London, United Kingdom
Freeman Hospital
Newcastle, United Kingdom
Percentage of patients starting lymphodepletion on the planned start date without delay
To evaluate whether there is any delay in patients starting lymphodepletion
Time frame: From planned start date of lymphodepletion until actual start date of lymphodepletion, assessed up to 2 weeks
Best overall response after Tisagenlecleucel infusion as per International Working Group 2014 criteria
Proportion of patients achieving a Complete Response (CR) or Partial Response (PR)
Time frame: After Tisagenlecleucel infusion through to study completion, an average of 24 months
Overall response rate at 3 months and 6 months after Tisagenlecleucel infusion
Overall response rate after Tisagenlecleucel infusion
Time frame: At 3 and 6 months after Tisagenlecleucel infusion
Complete metabolic response at 3 months and 6 months after Tisagenlecleucel infusion
Complete metabolic response after Tisagenlecleucel infusion
Time frame: At 3 and 6 months after Tisagenlecleucel infusion
Duration of response
Time from date of first response confirmation to the first date of progressive disease confirmation
Time frame: From initial response until the date of first documented disease progression, assessed up to 24 months
Median progression free survival and progression free survival at 12 months
Progression Free Survival after Tisagenlecleucel infusion
Time frame: 12 months after Tisagenlecleucel infusion
Median event-free survival and event-free survival at 12 months
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Event-free survival after Tisagenlecleucel infusion
Time frame: 12 months after Tisagenlecleucel infusion
Median overall survival and overall survival at 12 months
Overall Survival after Tisagenlecleucel infusion
Time frame: 12 months after Tisagenlecleucel infusion
Treatment emergent adverse events
Adverse events being reported during and after treatment
Time frame: From start of Tisagenlecleucel infusion until 30 days post Tisagenlecleucel infusion
Incidence of grade 3 or higher cytokine release syndrome and immune effector cell associated neurotoxicity syndrome
Percentage of grade 3 or higher cytokine relapse syndrome and immune effector cell associated neurotoxicity syndrome events
Time frame: From start of Tisagenlecleucel infusion through to study completion, an average of 24 months
Neutrophil levels at 1, 3, 6 months after Tisagenlecleucel infusion
Neutrophil counts to be reported after Tisagenlecleucel infusion
Time frame: At 1, 3 and 6 months after Tisagenlecleucel infusion
Platelet levels at 1, 3, 6 months after Tisagenlecleucel infusion
Platelet counts to be reported after Tisagenlecleucel infusion
Time frame: At 1, 3 and 6 months after Tisagenlecleucel infusion