CAR T-cell Therapy Directed to CD70 for Pediatric Patients With Hematological Malignancies

Phase 1RecruitingNCT06326463

St. Jude Children's Research Hospital18 enrolled

Overview

The study participant has one of the following blood cancers: acute myelogenous leukemia (AML)/myelodysplastic syndrome (MDS), acute lymphoblastic leukemia (B-ALL, T-ALL) or Lymphoma. Your cancer has been difficult to treat (refractory) or has come back after treatment (relapse). Primary Objective To determine the safety and maximum tolerated dose of intravenous infusions of escalating doses of CD70-CAR T cells in patients (≤21 years) with recurrent/refractory CD70+ hematological malignancies after lymphodepleting chemotherapy. Secondary Objectives To evaluate the antileukemic activity of CD70-CAR T cells. We will determine the anti- leukemic activity of the CD70-CAR T cells in the bone marrow and in the treatment of extramedullary disease.

The primary interventions are a lymphodepleting chemotherapy regimen (fludarabine and cyclophosphamide), followed by a single autologous infusion of CD70-CAR T cells. Phase I study evaluating three (3) dose levels of CD70-CAR T cells.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Hematologic Malignancy ALL, Childhood AML, Childhood

Interventions

FludarabineDRUG

40mg/m2, Day -4, -3 and -2

CyclophosphamideDRUG

Day -3 and Day-2 REST DAY, -1

CD70-CAR T cell infusion (Autologous)DRUG

Day 0 or +1

MesnaDRUG

Mesna is generally dosed at approximately 25% of the cyclophosphamide dose. It is generally given intravenously prior to and again at 3, 6 and 9 hours following each dose of cyclophosphamide

Eligibility

Sex: ALLMax age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria Age ≤21 years old Relapsed/refractory CD70+ hematological malignancy Relapsed disease: Patients developing recurrent disease after a prior complete remission (CR) Refractory disease: Patients with persistent disease despite 3 cycles of induction chemotherapy. * Relapsed/refractory CD70+ AML or MDS: * Relapsed disease that is CD70 positive * Refractory disease that is persistent despite 3 cycles of chemotherapy * Relapsed/refractory CD70+ B-cell ALL: * Relapsed disease that is CD70 positive and CD19 negative/dim or patients otherwise ineligible for CD19-directed therapies including: * Patients in 2nd or greater relapse * Patients with relapse after allogeneic HSCT * Relapsed/refractory CD70+ T-cell ALL: * Relapsed /refractory disease that is CD70 positive * Mixed Phenotype Acute Leukemia (MPAL): * Relapsed/refractory that is CD70 positive * Relapsed/refractory CD70+ lymphoma: * Relapsed disease that is CD70 positive and CD19 negative/dim or patients otherwise ineligible for CD19-directed therapies including: * Patients in 2nd or greater relapse * Patients with relapse after allogeneic HSCT Estimated life expectancy of \>12 weeks Karnofsky or Lansky (age- dependent) performance score ≥50 Patients with a history of prior allogeneic HCT must be clinically recovered from prior HCT therapy, have no evidence of active GVHD and have not received a donor lymphocyte infusion (DLI) within the 28 days prior to apheresis Patient must have an identified HCT donor For females of childbearing age: i. Not lactating with intent to breastfeed ii. Not pregnant with negative serum or urine pregnancy test within 7 days prior to enrollment Exclusion Criteria * Known primary immunodeficiency * Known history of HIV positivity * Severe intercurrent bacterial, viral or fungal infection * History of hypersensitivity to cornstarch or hydroxyethyl starch * Patients with acute promyelocytic leukemia (APL) * Known contraindication to protocol defined lymphodepleting * chemotherapy regimen of Fludarabine/cyclophosphamide

Outcomes

Primary Outcomes

Maximum tolerated dose of CD70-CAR T cells

Phase I design to determine the maximum tolerated dose (MTD) of autologous, CD70-CAR T cells. Three (3) dose levels will be evaluated (1x10e6, 3x10e6, and 1x10e7 cells/kg).

Time frame: 28 days after CD70-CAR T-cell infusion