Genetically Modified T cells for Leukemia and Lymphoma

Overseen By Kevin Curran

Age: Any Age

Sex: Any

Trial Phase: Phase 1

Sponsor: Memorial Sloan Kettering Cancer Center

Must not be taking: Glucocorticosteroids

Disqualifiers: HIV, Hepatitis B/C, Active malignancies, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new treatment using Modified T-cells, a type of immunotherapy, to determine their safety for people with certain blood cancers, such as B-cell leukemia or lymphoma. The trial focuses on patients whose cancer has returned after a transplant or who are at high risk of relapse. Participants may qualify if they have relapsed or are at high risk for relapse of B-cell leukemia or lymphoma, particularly after a stem cell or organ transplant. As a Phase 1 trial, the research aims to understand how the treatment works in people, offering participants the opportunity to be among the first to receive this new treatment.

Will I have to stop taking my current medications?

The trial protocol does not specify if you must stop taking your current medications. However, if you are on systematic chemotherapy, you need to stop it at least 2 weeks before the infusion, unless it's intrathecal chemotherapy, hydroxyurea, oral maintenance chemotherapy, or steroid therapy at replacement doses, which have specific conditions.

Is there any evidence suggesting that Modified T-cells are likely to be safe for humans?

Studies have shown that CAR T-cell therapies, which use modified T-cells, can help patients with certain blood cancers like leukemia and lymphoma. These treatments modify the patient's own T-cells to better combat cancer cells. Some patients have experienced long periods of remission.

However, there are risks to consider. The FDA is investigating serious risks, including a rare type of T-cell cancer that can require hospitalization or be life-threatening. Although these risks are uncommon, they are important to consider when deciding to join a trial. Overall, researchers continue to study these therapies to understand their safety for everyone. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatment?

Researchers are excited about genetically modified T cells for leukemia and lymphoma because they offer a targeted approach to fighting these cancers. Unlike traditional treatments like chemotherapy and radiation, which can affect healthy cells, genetically modified T cells are engineered to specifically recognize and attack cancer cells, minimizing damage to normal cells. This precision in targeting cancer cells allows for potentially more effective treatments with fewer side effects. Additionally, these T cells can be programmed to persist and provide ongoing surveillance against cancer recurrence, offering hope for long-term remission.

What evidence suggests that Modified T-cells might be an effective treatment for leukemia or lymphoma?

Research has shown that specially altered T-cells targeting the CD19 marker yield promising results in treating certain blood cancers. In this trial, participants will receive genetically modified T-cells as part of different expansion cohorts. Studies have found that these modified T-cells effectively combat difficult-to-treat B cell cancers, such as leukemia and lymphoma. In clinical trials, these treatments have led to significant improvements for patients with these diseases. For those with high-risk B cell cancers, these altered T-cells can locate and destroy cancer cells. While more research is needed to understand long-term effects, early results are hopeful for this type of treatment. ^{6 7 8 9 10}

Who Is on the Research Team?

Kevin Curran

Principal Investigator

Memorial Sloan Kettering Cancer Center

Are You a Good Fit for This Trial?

This trial is for patients with B-cell leukemia or lymphoma who have had a stem cell transplant or are at high risk of relapse. They must have proper kidney, liver, heart, and lung function. It's not for those with active HIV/hepatitis infections, other cancers needing treatment, pregnant women, severe heart conditions, uncontrolled illnesses that could worsen side effects from the therapy.

Inclusion Criteria

My cancer has returned and tests show more than 5% cancer cells in my bone marrow or any cancer presence detected by specific tests.

My cancer returned after a stem cell or organ transplant.

My age does not limit my participation.

Exclusion Criteria

I have health issues that make it hard for me to handle side effects.

I am an adult with a heart condition.

I have an active HIV, hepatitis B, or hepatitis C infection.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Conditioning Chemotherapy

Participants receive conditioning chemotherapy prior to T-cell infusion

2-3 weeks

Treatment

Participants receive genetically modified T-cells to assess safety and toxicities

6 weeks

Follow-up

Participants are monitored for safety and effectiveness after T-cell infusion

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Modified T-cells

Trial Overview

The study tests the safety of Modified T-cells from donors targeting CD19 antigen in patients with relapsed B-cell malignancies post-transplant or at high risk of relapse. The focus is on assessing toxicities related to these genetically modified cells after chemotherapy conditioning.

How Is the Trial Designed?

Group I: Biological/Genetically Modified T cells Experimental Treatment 2 Interventions

Utilizing our initial trial experience, it was amended to include three (3) expansion cohorts. Cohort 1: patients with CD19+ relapse/refractory (R/R) B cell malignancies occurring after allogeneic/autologous HSCT or solid organ transplant (SOT) infusion occurring following conditioning chemotherapy. Cohort 2:patients with CD10+ high risk B cell malignancies eligible for autologous HSCT followed by 19-28z CRA EBV-CTLs (auto-HSCT preparative regimen serves as conditioning chemotherapy. Cohort 3: patients with CD19+ high risk B cell malignancies eligible for allogeneic HSCT followed by consolidative 19-28z CAR EBV-CTLs (allo-HSCT preparative regimen serves as conditioning chemotherapy) Each expansion cohort has a target accrual of 6 patients treated with fixed CAR EBV-CTL dose (3x106 EBV-CTLs/kg) which has been demonstrated to be the ideal manufacturing dose.

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Published Research Related to This Trial

Genetic modification of T lymphocytes enhances their ability to recognize and attack tumor cells, which is crucial for improving cancer immunotherapy.

These modifications not only boost antitumor activity but also improve safety and allow for tracking of T cells using non-invasive imaging techniques, making them valuable for both research and treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting tumours with genetically enhanced T lymphocytes. Sadelain, M., Rivière, I., Brentjens, R.[2021]

The article discusses a clinical trial for a new adoptive immunotherapy using gene-modified T cells that target the Wilms Tumor 1 (WT1) antigen, showing promise for treating refractory acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS).

While this innovative approach has demonstrated clear and lasting clinical efficacy against tumors, it also poses risks of serious treatment-related adverse events, highlighting the need for careful management in developing powerful gene-modified T cell therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adoptive immunotherapy utilizing cancer antigen-specific T-cell receptors. Tanimoto, K., Fujiwara, H.[2017]

In a small trial, T cells modified to target the Wilms tumor antigen 1 were effective in preventing relapse in patients with acute myeloid leukemia after they underwent an allogeneic stem-cell transplant.

This approach highlights the potential of engineered T cell therapies in enhancing post-transplant outcomes for leukemia patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TCR Gene Therapy Improves AML Prognosis. [2020]

Recent advancements in T-lymphocyte based therapies, particularly through donor lymphocyte infusion and ex vivo expansion of antigen-specific cytotoxic T lymphocytes, have shown promising sustained antitumor effects in patients with virus-associated lymphomas, such as those related to Epstein-Barr virus.

The development of robust gene transfer methodologies to human T lymphocytes is rapidly evolving, providing new opportunities for enhancing the efficacy and specificity of T-cell based therapies in treating hematologic malignancies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Genetic modification of human T lymphocytes for the treatment of hematologic malignancies. Hoyos, V., Savoldo, B., Dotti, G.[2021]

Genetic modification of T cells to express receptors specific for tumor-associated antigens can redirect their function, enhancing their ability to target and eliminate tumor cells, which is crucial for treating common cancers.

Recent advances in gene design and cell production techniques have improved the clinical application of this adoptive immunotherapy, potentially leading to more effective treatments for patients with various types of cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Genetic redirection of T cells for cancer therapy. Westwood, JA., Kershaw, MH.[2010]

CAR-based therapies for T-cell malignancies show promising clinical responses above 50%, but most studies have short follow-up periods, making long-term efficacy unclear.

Specific toxicities, such as cytokine release syndrome (CRS) and graft-versus-host disease (GvHD), are associated with CAR-T treatments, with CRS being more common in antiCD7 CAR-T cells, though generally mild.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chimeric Antigen Receptor Based Cellular Therapy for Treatment Of T-Cell Malignancies. Polgárová, K., Otáhal, P., Šálek, C., et al.[2022]

Engineered T cell therapies, like CAR T cells and TCR T cell therapies, have shown remarkable efficacy in treating certain blood cancers, highlighting their potential as a powerful tool in cancer immunotherapy.

However, these therapies also pose unique safety challenges, such as cytokine release syndrome and neurotoxicity, which require careful nonclinical safety assessments to ensure patient safety during development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonclinical safety assessment of engineered T cell therapies. Lebrec, H., Maier, CC., Maki, K., et al.[2022]

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