Adult patients with refractory or relapsed CD123+ hematologic malignancies, including acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia, or blastic plasmocytoid dentritic cell neoplasm will be recruited in the trial. CART123 cells will be manufatured from blood of each patient. During the production of CAR123 cells, patients may receive appropriate bridging therapy. After cells are produced, participants will undergo a single course of lymphodepleting chemotherapy and receive a single dose of CAR123 T cells. The trial will establish the recommended dose for further studies, either the Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD). Patients must be eligible for hematopoietic stem cell transplantation in order to participate in the trial.
This is an open-label, single arm study on up to 18 adult subjects with refractory or relapsed CD123+ AML, MDS, ALL or BPDCN. Following lymphodepleting conditioning regimen, the subjects will receive a single dose of autologous CAR123 T lymphocytes supplied by the sponsor´s manufacturing facility. CART123 dose will be increased in three predefined steps using the accelerated Bayesian optimal interval (BOIN) design in order to establish recommended CART123 dose for further study, which will be either Maximum Tolerated Dose (MTD) or Maximum Feasible Dose (MFD), whichever is reached first. Alternative dosing schedule will be adopted in case of dose limitation due to insufficient CART123 expansion during IMP manufacture. Due to concern for potentially prolonged or irreversible hematologic toxicity of CART123, all patients recruited in the study must be eligible for hematopoietic stem cell transplantation (HSCT) and have a donor of allogeneic hematopoietic stem cells identified and cleared by the transplant center. Decision to perform HSCT will be made on a case-by-case basis.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Anti-CD123 Chimeric Antigen Receptor (CAR) T-Cells (CART123)
Ustav hematologie a krevni transfuze / Institute of Hematology and Blood Transfusion
Prague, Czechia
RECRUITINGSafety and tolerability of autologous CART123 cells
Cumulative incidence of IMP-related adverse events (AEs) graded by ASTCT consensus grading criteria for Cytokine Release Syndrome (CRS) and Immune effector cell-associated neurotoxicity syndrome (ICANS) and by Common Terminology Criteria for Adverse Events (CTCAE) v 5.0 for other AEs
Time frame: 28 Days, Months 24
Rate of hematological recovery
Rate of hematological recovery, defined as absolute neutrophil count (ANC) \> 1x 10\^9/L and platelet count \> 20x10\^9/L without transfusion support. Hematological recovery before and after HSCT will be evaluated separately.
Time frame: 14 Days, 28 Days, 1Year, Months 12, Months 24
A dose of CART123 cells for further study
Incidence of dose-limiting toxicities (DLTs) and other safety data after IMP administration.
Time frame: 14 Days, 28 Days, 1year, Months 12, Months 24
Morphologic Leukemia Free State (MLFS).
Efficacy of IMP administration in patients with refractory or relapsed AML, MDS, BPDCN and ALL evaluated by rate of morphologic leukemia-free state (MLFS).
Time frame: at day 14 and 28 after IMP administration.
Complete Remission (CR) rate
Efficacy of IMP administration in patients with refractory or relapsed AML, MDS, BPDCN and ALL evaluated by Complete Remission (CR) rate.
Time frame: at 28 days and at any later point after IMP administration, before and after HSCT.
Median Overall Survival and Overall Survival
Efficacy of IMP administration in patients with refractory or relapsed AML, MDS, BPDCN and ALL evaluated by overall survival (OS)
Time frame: at one year after IMP administration.
Feasibility and need for allogeneic hematopoietic cell transplantation after IMP administration
Proportion of patients who did not recover blood counts within 28 days of IMP administration, proportion of patients who received allogeneic haematopoietic stem cell transplantation, and who engrafted after transplant.
Time frame: within 28 days of IMP administration
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