This phase I trial tests the safety, side effects, and best dose of allogeneic CD6 chimeric antigen receptor T regulatory cells (CD6-CAR Tregs) in treating patients who have chronic graft versus host disease (cGVHD) after an allogeneic hematopoietic cell transplantation (HCT). An allogeneic HCT is an established treatment for benign or malignant blood and marrow conditions where healthy stem cells from a donor are infused into a patient to help the patient's bone marrow make more healthy cells and platelets. GVHD is a systemic disorder that occurs when the graft's immune cells recognize the host as foreign and attack the recipient's body cells. "Graft" refers to transplanted, or donated tissues, and "host" refers to the tissues of the recipient. It is a common complication after allogeneic HCT. The onset of cGVHD is usually within three years of transplantation and has some features of autoimmune diseases. A strategy that minimizes the incidence and severity of cGVHD, without other adverse effects, is needed to improve survival after allogeneic HCT. T regulatory cells are critical for controlling autoimmunity and maintaining immune homeostasis. Patients with active cGVHD have reduced numbers of T regulatory cells compared to patients without GVHD, suggesting that restoration of T regulatory cells in patients with active cGCHD is impaired and insufficient numbers may contribute to cGVHD. Therefore, therapies that augment numbers and function of T regulatory cells may promote tolerance and control of cGVHD. CAR T-cell therapy is a type of treatment in which T cells (a type of immune system cell) are taken from the blood and changed in the laboratory. The gene for a special receptor that binds to a certain protein, CD6, on the patient's cells is added to the T cells in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion. CD6-CAR Tregs combines the CD6-targeted anti-inflammatory response with the immune regulatory properties of T regulatory cells which could generate a more potent and stable T regulatory cell population to promote immune tolerance and long-term disease control in cGVHD.
PRIMARY OBJECTIVES: I. Determine if CD6-CAR Tregs administration is safe and tolerable in patients who developed chronic graft-versus-host disease (cGVHD), by evaluation of toxicities, including: type, frequency, severity, attribution, time course and duration. II. To evaluate the feasibility to produce donor derived CD6-CAR Tregs. SECONDARY OBJECTIVES: I. Obtain preliminary evidence of CD6-CAR Tregs activity against cGVHD by estimating the response rate (as defined by 2014 National Institute of Health \[NIH\] consensus development project on clinical trials in cGVHD). II. Evaluate changes in cGVHD severity using physician -reported cGVHD activity assessment form. III. Evaluate changes in symptom activity using cGVHD activity assessment patient self-report. IV. Evaluate failure-free survival (FFS). V. Quantify CD6-CAR Treg cells in peripheral blood. VI. Characterize and assess changes in immune biomarkers over time in blood samples. EXPLORATORY OBJECTIVES: I. Percent and counts from peripheral blood T cell subsets in hematopoietic stem/progenitor cell compartments to assess ability of CD6-CAR Tregs to suppress pathogenic T cell activity and proliferation. II. Profile cytokine levels over time and changes to assess the ability of CD6-CAR Tregs to down-regulate proinflammatory cytokine production (IFNgamma, IL-6, TNFalpha) and adhesion molecules that promote pathogenic T cell. III. For subjects who receive tafasitamab-cxix for CAR Treg ablation, describe the activity of infusional tafasitamab-cxix to eliminate transferred CD6 CAR Treg cells. OUTLINE: This is a dose-escalation study of CD6-CAR Treg cells followed by a dose-expansion study. Donors undergo leukapheresis over 2-4 hours for collection of peripheral blood mononuclear cells (PBMSc) and the manufacturing of CD6-CAR Treg cells over 2 weeks. Patients then receive CD6-CAR Treg intravenously on day 0. Patients may also receive ablation tafasitamab IV post Treg cell infusion on days 1, 4, 8, 15, 22 for 1 cycle. If ablation is not complete by day 28, patients may receive an additional 1-2 cycles per investigator's discretion. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO), computed tomography (CT), and x-ray imaging during screening and as clinically indicated. Patients undergo blood specimen collection on study and during follow-up. Patients may undergo a biopsy on study as well as a lumbar puncture and magnetic resonance imaging (MRI)/CT as clinically indicated on study. After completion of study treatment, patients are followed up to 28 days, monthly for 1 year, and then yearly for 15 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
27
Undergo biopsy
Undergo blood sample collection
Given CD6-CAR Tregs IV
Undergo CT
Undergo ECHO
Ancillary studies
Undergo leukapheresis
Undergo lumbar puncture
Undergo MRI/CT
Ancillary studies
Given IV
Undergo x-ray imaging
City of Hope Medical Center
Duarte, California, United States
Dose-limiting toxicity
Toxicity will be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0; cytokine release syndrome and immune effector cell associated neurotoxicity syndrome will be assessed per American Society for Transplantation and Cellular Therapy consensus criteria. Observed toxicities will be summarized by type, severity, date of onset, duration, reversibility, and attribution.
Time frame: From infusion of Allogeneic CD6 chimeric antigen receptor T regulatory cells (CD6-CAR Tregs) to day +28
Feasibility as the ability to met at least 80% of the required cell dose at the assigned dose level
Will be estimated with 90% confidence interval (CI) overall and by dose level.
Time frame: From infusion of CD6-CAR Tregs to day +28
Feasibility as the ability to meet the required produce release criteria
Will be estimated with 90% CI overall and by dose level.
Time frame: From infusion of CD6-CAR Tregs to day +28
CD6-CAR Treg activity
As measured by changes in chronic graft versus host disease (cGVHD) severity.
Time frame: Up to 15 years
Changes in cGVHD severity
Will be evaluated using cGVHD activity assessment patient self-report. Various graphical methods will be used to explore the association between immune response measures (at different time points and the changes over time) with changes in cGVHD severity.
Time frame: Baseline up to 15 years
Failure-free survival (FFS)
Kaplan-Meier curve will be used to estimate FFS.
Time frame: From infusion of CD6-CAR Tregs to start of new treatment for cGVHD, recurrence of malignancy, or death, whichever comes first, assessed at week 12 and 1-year follow-up
Relapse-free survival
Time frame: From the start of treatment to the date of death, disease relapse, or last follow-up whichever occurs first, assessed up to 15 years
CD6-CAR Treg persistence
Immunophenotyping (CD19t, CD3, CD4, CD8) (fluorescence-activated cell sorting/ co-detection by indexing), cytokine release syndrome (including TNF-alpha, IL-2, IL-6, IL-10 and IFN-gamma) (multiplex assay), immunogenicity (anti-CAR antibodies) (enzyme-linked immunosorbent assay)
Time frame: Up to 15 years
Changes in immune biomarkers over time
Descriptive statistics and graphics will be used to characterize and plot the specific time trend for each marker of the immune response. Various graphical methods will be used to explore the association between these immune response measures (at different time points and the changes over time) with changes in cGVHD severity.
Time frame: Baseline up to 15 years
Infectious complications
Microbiologically documented infections will be reported by site of disease, date of onset, severity and resolution, if any. This data will be captured via case report form and will be collected from day 1 to day 28 of alloCD6-CAR Treg infusion and will follow the same data collection intervals as the toxicity and adverse event data. Severity of the infections will be graded by CTCAE v5.0 and Blood and Marrow Clinical Trials Network.
Time frame: From day 1 to day 28 of CD6-CAR Treg infusion, up to 15 years
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