The goal of this clinical trial is to learn if a new type of chimeric antigen receptor (CAR) T-cell therapy called WZTL-002 is effective and safe for the treatment large B-cell lymphomas (LBCL) that have not responded to or have come back after standard chemotherapy. The main questions this trial aims to answer are: * What is the likelihood of complete response of the lymphoma after WZTL-002 treatment? * What is the risk of altered brain function (neurotoxicity) after WZTL-002? All eligible participants will receive WZTL-002; the researchers will compare the complete response rate and neurotoxicity rate with historical groups of patients who were treated with similar therapies. Participants will: * Have a procedure to gather white blood cells * Receive chemotherapy to prepare for the CAR T-cells * Receive WZTL-002 CAR T-cells through a vein * Be monitored closely for the first 14 days for certain side effects * Have scans 28 days and 3, 6, 12 and 24 months after WZTL-002 CAR T-cells to check if the treatment has worked
WZTL-002 is a third-generation CAR T-cell product comprising autologous T-cells transduced to express a CAR directed against CD19 and incorporating a Toll-like receptor 2 (TLR2) co-stimulatory domain interposed between CD28 and CD3ζ signalling domains. The trial will screen up to 80 patients in order to enrol and treat approximately 60 participants with WZTL-002. This is a single arm open-label phase 2 trial designed to evaluate the efficacy, safety, cellular kinetics and pharmacodynamic properties of WZTL-002 for the second- or third-line treatment of r/r LBCL. Eligible participants will undergo leukapheresis to harvest peripheral blood mononuclear cells, the starting material for the manufacture of the autologous third generation anti-CD19 CAR T-cell product, WZTL-002. After WZTL-002 manufacture and confirmation that product release criteria are met, participants will receive lymphodepleting chemotherapy comprising fludarabine and cyclophosphamide on days -5 to day -3, inclusive. WZTL-002 will be administered intravenously on day 0 as a single dose. After WZTL-002 administration, participants will be monitored closely for 14 days including targeted assessments for the specific CAR T-cell related toxicities Cytokine Release Syndrome (CRS) and Immune Effector Cell Neurotoxicity Syndrome (ICANS). CRS, ICANS and grade 3 or higher neutropenia, thrombocytopenia or anemia persisting beyond day 30 will be recorded as adverse events of special interest. PET/CT scans to assess treatment response will take place at screening, pre-lymphodepletion and at 28 days, 3 months and 6 months after WZTL-002 infusion, and CT scans to assess duration of response at 12 and 24 months after WZTL-002 infusion. Samples will be taken to determine WZTL-002 cellular kinetics and the depth and duration of B-cell aplasia (pharmacodynamic analysis). Follow-up beyond month 24 will take place within the Center for International Blood and Marrow Transplant Research (CIBMT) Cellular Therapies Registry or the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), and in a subsequent long-term follow-up study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
30 mg/m\^2/day IV for three consecutive days
500 mg/m\^2/day IV for three consecutive days
WZTL-002 comprises autologous T-cells transduced to express the third-generation 1928T2z chimeric antigen receptor, which recognises the CD19 antigen present on malignant and normal B-cells. The chimeric antigen receptor (CAR) incorporates an extracellular scFv specific for CD19, the intracellular signalling domains of CD28 and CD3ζ, and an intracellular co-stimulatory domain derived from TLR2 interposed between CD28 and CD3ζ. On Day 0, the WZTL-002 CAR T-cell product is administered intravenously two days after completing lymphodepleting chemotherapy.
Christchurch Hospital
Christchurch, Christchurch Central, New Zealand
RECRUITINGWellington Hospital
Newtown, Wellington Region, New Zealand
RECRUITINGAuckland City Hospital
Auckland, New Zealand
RECRUITINGComplete response (CR) rate per Investigator assessment
Investigator-assessed CR rate according to Lugano Response Criteria
Time frame: 3 months after WZTL-002 administration
Immune effector cell-associated neurotoxicity syndrome (ICANS) rate
Proportion of participants with ICANS (any grade) as assessed by American Society for Transplantation and Cellular Therapy (ASTCT) criteria
Time frame: 3 months after WZTL-002 administration
Complete response (CR) rate per central assessment
Complete response (CR) rate per central assessment according to Lugano Response criteria
Time frame: 3 months after WZTL-002 administration
Objective response rate (ORR) per investigator and per central assessment
Objective response rate comprising CR rate plus partial response (PR) rate, according to Lugano Response Criteria
Time frame: At 3 and at 6 months after WZTL-002 administration
Progression free survival (PFS), Event-free survival (EFS), Overall survival (OS) and Duration of Response (DOR)
To estimate the progression-free, event-free, overall survival and duration of response after treatment with WZTL-002
Time frame: At Months 3, 6, 9, 12, 18, and 24 after WZTL-002 administration
Cytokine release syndrome (CRS) rate and grade
CRS rate and grade, as assessed by ASTCT consensus criteria
Time frame: 3 months after WZTL-002 administration
Number and severity of adverse effects
Adverse events will be graded by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria (except for CRS and ICANS; see separate endpoints)
Time frame: From screening until 24 months after WZTL-002 administration
Hospitalisation (inpatient) days
Number of intensive care unit (ICU) inpatient days and non-ICU inpatient days and reason for hospitalisation
Time frame: 3 months after WZTL-002 administration
Health-related quality of life (HRQoL) as Assessed by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)
EORTC QLQ-C30 is a 30-item participant self-reported questionnaire composed of multi-item and single scales. Participants rate items and a score from 0 to 100 for the global health status scale and for each functional scale is calculated. A higher score indicates a better level of quality of life or function, and positive changes from baseline indicate improvement
Time frame: Upto 24 months after WZTL-002 administration
European Quality of Life 5-Dimensions 5-Levels Health Questionnaire (EQ-5D-5L)
The EQ-5D-5L measures health outcomes using a visual analogue score (VAS) to record a participant's self-rated health on a scale from 0 to 100, where 100 is 'the best health you can imagine' and 0 is 'the worst health you can imagine.' A higher score indicates a better health outcome.
Time frame: Upto 24 months after WZTL-002 administration
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