This is a phase l, single arm, prospective open, dose-escalation study in patients with relapsed or refractory CD19-positive B cell malignancies (ALL, NHL, CLL). The trial will include adult and pediatric patients. There will be three individual cohorts, defined by disease biology: pediatric ALL and aggressive pediatric NHL (Cohort 1), adult ALL (Cohort 2) and adult NHL/CLL (Cohort 3).
The investigators will evaluate the safety of the MB-CART19.1 and determine the recommended dose levels for the Phase II clinical trial. Dose evaluation will start in Cohorts 1 and 2 with Dose Level 1 (5x10e5 CAR T cells/Kg) and in Cohort 3 with Dose Level 2 1x10e6 CAR T cells/Kg) , sparing Dose Level 1 . Each of the cohorts will evaluate the safety of the CAR-T cells. In each dose level of each of the three cohorts three 3 + 3 patients will be treated. A particular dose level will be expanded to 6 patients if one patient out of 3 patients treated at that particular dose level develops DLT. Once this occurs, further dose-escalations are halted until the dose has proven to be safe in the expanded cohort. If 2 or more in a cohort of 6 patients develop DLT no further dose escalation is allowed, and the next lower dose level will be expanded to 6 patients in total. The highest dose among the dose levels tested at which no more than one out of six patients experiences DLT will be considered the MTD. In Dose Level 3, three additional patients will be treated, if no DLT occurred. Dose Level 0 will be tested only if Dose Level 1 is not tolerable.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Cyclophosphamide 60mg/Kg on day -6
Fludarabine 25mg/m\^2 IV on days -5 to -3
Level -1 (1 x 105 cells/kg) Level 1 \[Starting dose\] (5 x 105 cells/kg) Level 2 (1 x 106 cells/kg) Level 3 (2 x 106 cells/kg)
Hospital Israelita Albert Einstein
São Paulo, São Paulo, Brazil
RECRUITINGDetermination of the recommended dose of CAR-T cells for a future phase II study
The RP2D will be the maximum tolerated dose (MTD) or the highest dose studied if an MTD is not obtained.
Time frame: Until day 28 after CAR-T cells infusion
Response to treatment for each timepoint.
ORR in ALL (Rate of CR/CRh)
Time frame: day 28
Response to treatment for each timepoint
ORR in NHL/CLL (Rate of CR/CRh)
Time frame: day 28, patients not in CR on day 28: month 3
Assess overall survival (OS), progression-free survival (PFS).
Overall survival (OS) and progression-free survival (PFS) will be assessed by dose cohort and in the first two groups at the MTD (or at the highest dose studied).
Time frame: at 1 year after CAR-T infusion
Phenotype and persistence of CAR-T
Blood samples for determination of persistence/phenotyping of infused CAR-T cells will be analysed.
Time frame: days 2, 7, 10, 14, 28, weeks 8, 12, months 6, 12, 24, 36, 48, 60
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