This phase I trial studies the side effects and best dose of BSB-2002 when given after cyclophosphamide and fludarabine and tests how well it works in treating NPM1-mutated acute myeloid leukemia (AML) that has come back after a period of improvement (relapsed) or that does not respond to treatment (refractory). BSB-2002 is a type of personalized autologous T cell receptor-modified T cell therapy. T cells are infection fighting blood cells that can kill cancer cells. The T cells given in this study come from the patient and have a new gene put in them that makes them able to recognize mutated NPM1, a protein on the surface of cancer cells. These NPM1 mutated-specific T cells may help the body's immune system identify and kill NPM1-mutated AML cells. Giving chemotherapy, such as cyclophosphamide and fludarabine, before BSB-2002 helps kill cancer cells in the body and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to grow. Giving BSB-2002 after cyclophosphamide and fludarabine may be safe, tolerable, and/or effective in treating relapsed or refractory AML in patients with NPM1 mutation.
PRIMARY OBJECTIVE: I. Evaluate the safety of BSB-2002. SECONDARY OBJECTIVES: I. Cellular kinetics of BSB-2002 in peripheral blood through day 365. II. Evaluate the efficacy of BSB-2002 based on IIa. Percentage of patients with complete remission (CR; including CR with measurable residual disease negative \[CRMRD-\], CR, CR with incomplete hematologic recovery \[CRi\], CR with partial hematologic recovery \[CRh\]) or partial remission (PR) as determined by the investigator according to the European LeukemiaNet (ELN) criteria for AML; IIb. Overall survival; IIc. Duration of response (time from first tumor assessment at which the overall response was recorded as CR/CRi / CRi, CRh \[AML\]) until documented relapse, or death from any cause, whichever occurred first. EXPLORATORY OBJECTIVES: I. Assess molecular minimal residual disease (MRD) as measured by mutation specific next generation sequencing (NGS). II. Evaluate inflammatory cytokines and other potential biomarkers. OUTLINE: This is a dose-escalation study of BSB-2002 in combination with cyclophosphamide and fludarabine. Patients undergo leukapheresis between days -45 and -21 for manufacturing of BSB-2002. Patients then receive cyclophosphamide intravenously (IV) and fludarabine IV on days -5 to -3 followed by BSB-2002 IV over 30 minutes on day 0 in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo blood sample collection as well as bone marrow aspiration and possible biopsy throughout the study. Patients also undergo echocardiography during screening. After completion of study treatment, patients are followed up at days 4, 7, 10, 14, 21, 28, 56, 90, 180, 270, and 365 and then yearly for up to 15 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
19
Undergo blood sample collection
Undergo bone marrow aspiration
Undergo bone marrow biopsy
Given IV
Undergo echocardiography
Given IV
Undergo leukapheresis
Given BSB-2002 IV
City of Hope Medical Center
Duarte, California, United States
Incidence of dose-limiting toxicity
Dose-limiting toxicity (DLT) will be assessed using the National Cancer Institute (NCI)'s Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Adverse events will be coded according to the Medical Dictionary for Regulatory Activities. Each adverse event will be counted once per patient. Separate tables and listings will present treatment-emergent adverse events (TEAEs), Serious Adverse Events (SAEs), Adverse Events of Special Interest (AESI), and dose-limiting toxicities (DLT). Tables will include system organ class, high-level term, and severity grade. Listings will also include treatment interruption or discontinuation, dose level, relevant severity scales, relationship to study intervention, expectedness, onset day, duration day, action taken, outcome, sex, age, and race.
Time frame: From the start of the infusion on day 0 through day 28
Frequency and severity of adverse events (AEs)
AEs will be graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) scale version (v) 5.0, cytokine release syndrome (CRS) and neurotoxicity (immune effector cell associated neurotoxicity syndrome \[ICANS\]) events will be graded by the American Society for Transplantation and Cellular Therapy (ASTCT) Consensus criteria scales for CRS and ICANS, respectively. Tables and listings will present AEs. Tables will include system organ class, high-level term, and severity grade. Listings will also include treatment interruption or discontinuation, dose level, relevant severity scales, relationship to study intervention, expectedness, onset day, duration day, action taken, outcome, sex, age, and race.
Time frame: Up to day +365
Frequency and severity of serious AEs
AEs will be graded by NCI CTCAE scale v 5.0, CRS and neurotoxicity (ICANS-Immune Effector Cell-Associated Neurotoxicity) events will be graded by the ASTCT Consensus criteria scales for CRS and ICANS, respectively. Tables and listings will present serious AEs. Tables will include system organ class, high-level term, and severity grade. Listings will also include treatment interruption or discontinuation, dose level, relevant severity scales, relationship to study intervention, expectedness, onset day, duration day, action taken, outcome, sex, age, and race.
Time frame: Up to day +365
Complete remission (CR)
Will assess the percentage of patients achieving CR (including CR with measurable residual disease negative, CR, CR with incomplete hematologic recovery \[CRi\], CR with partial hematologic recovery \[CRh\]) or partial remission as determined by the investigator according to the European LeukemiaNet criteria for acute myeloid leukemia. Will provide listings of patients who experience complete remission, including CR, CRi, and CRh, and partial remission.
Time frame: Up to day +365
Duration of response
Duration of response (time from first tumor assessment at which the overall response was recorded as CR/CRi / CRi, CRh (AML) until documented relapse, or death from any cause, whichever occurred first.
Time frame: From first tumor assessment at which the overall response was recorded as CR/CRi / CRi, CRh until documented relapse, or death from any cause, whichever occurred first, assessed up to 15 years
Overall survival
The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the overall survival is one way to see how well a new treatment works. Also called OS.
Time frame: Up to 15 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.