Autologous Cells Derived Anti-CD7 CAR-Engineered T Cells for T Lymphoid Malignancies

Overview

This is a single-center, open-label, single-arm study to evaluate the primary safety and efficacy of autologous anti-CD7 chimeric antigen receptor(CAR)-modified T cells(CAR7-Ts) in patients with relapsed or refractory T lymphoid malignancies.

Full Title of Study: “Safety and Efficacy of Autologous Cells Derived Anti-CD7 CAR-Engineered T Cells for Relapsed/Refractory T Lymphoid Malignancies: a Single-center, Open- Label, Non-randomized, Single-arm Clinical Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: April 7, 2023

Detailed Description

Chimeric antigen receptor-T cells (CAR-T) have made breakthroughs in the treatment of B-cell tumors, especially refractory/relapsed acute B lymphocytes. CD7 is a transmembrane glycoprotein expressed by T cells and natural killer cells and their precursors; it is also expressed in >95% of lymphoblastic T-cell leukemias and lymphomas . CD7 was previously evaluated as a target for immunotoxin-loaded antibodies in patients with T-cell malignancies, but tumor responses were limited. Enhancing the potency of CD7-directed cytotoxicity by substituting autologous CAR-T cells for a monoclonal antibody would augment the efficacy of CD7-targeted therapy in patients with T-cell malignancies. To prepare CAR7-T cells, CD7 expression is suppressed on autologous T cells by unique blocking technique, and CD7-negative T cells are transduced with a humanized anti-CD7-41BB-CD3ζ lentiviral vector. This is an investigational study. The objectives are to evaluate the safety and efficacy of CAR7-T cells in patients with CD7+ T-cell malignancies.

Interventions

  • Drug: Fludarabine + Cyclophosphamide + CAR7-T Cells
    • fludarabine 30 mg/kg on day -5, -4, and -3; cyclophosphamide 250 mg/kg on day -5, -4, and -3; CAR7-T Cells on day 0, 1, and 2.

Arms, Groups and Cohorts

  • Experimental: Fludarabine + Cyclophosphamide + anti-CD7 CAR-T Cells
    • Patients will received lymphodepletion with fludarabine (30 mg/kg) and cyclophosphamide (250 mg/kg) on day -5, -4, and -3, followed by the infusion of CAR7-T cells with the dose of 0.5×10^6/kg, 1×10^6/kg, 2×10^6/kg and 4×10^6/kg (with an allowance of ±20%) for 3 consecutive days. If no dose-limited toxicity (DLT) emerges in the group, then the subsequent higher dose will be used in the next group. If DLT emerges in a single subject in any dose level, 3 more subjects will be enrolled to the same dose level. The maximum dose could be extended.

Clinical Trial Outcome Measures

Primary Measures

  • Incidence of Treatment-related Adverse Events
    • Time Frame: within 2 years after infusion
    • Therapy-related adverse events will be recorded and assessed according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE, Version 5.0).

Secondary Measures

  • Overall response rate(ORR) of administering CAR7-T cells in Relapsed/Refractory CD7+ T-cell hematological malignancies.
    • Time Frame: within 2 years after infusion
    • ORR will be assessed from CAR T cell infusion to death or last follow-up (censored).
  • Complete response rate(CRR) of administering CAR7-T cells in Relapsed/Refractory CD7+ T-cell hematological malignancies.
    • Time Frame: within 2 years after infusion
    • CRR will be assessed from CAR T cell infusion to death or last follow-up (censored).
  • Progress-free survival(PFS) of administering CAR7-T cells in Relapsed/Refractory CD7+ T-cell hematological malignancies.
    • Time Frame: within 2 years after infusion
    • PFS will be assessed from CAR T cell infusion to death or last follow-up (censored).
  • Duration of Response(DOR) of administering CAR7-T cells in Relapsed/Refractory CD7+ T-cell hematological malignancies.
    • Time Frame: within 2 years after infusion
    • DOR will be assessed from CAR T cell infusion to death or last follow-up (censored).
  • Overall survival(OS) of administering CAR7-T cells in Relapsed/Refractory CD7+ T-cell hematological malignancies.
    • Time Frame: within 2 years after infusion
    • OS will be assessed from CAR T cell infusion to death or last follow-up (censored).

Participating in This Clinical Trial

Inclusion Criteria

1. Aged ≥ 18 years; 2. Expected survival over 60 days; 3. Eastern Cooperative Oncology Group score 0-2; 4. Diagnosed as T-cell hematologic malignancies (including leukemia and lymphoma) according to WHO2016 criteria; 5. Patients must relapse or be refractory after at least two lines of therapy. 6. CD7 were positive in bone marrow by immunohistochemistry or flow cytometry at screening, and one of the following conditions is satisfied: A. No remission was achieved after at least 2 lines of standard therapy; B. Relapse or progression after standard treatment; C. Relapse after autologous or allogeneic hematopoietic stem cell transplantation; 7. Have no fertility requirements or plans for one year since enrolment in this clinical trial; 8. Patient or his or her legal guardian voluntarily participates in and signs an informed consent form. Exclusion Criteria:

1. Complicated with central system leukemia/lymphoma; 2. Existing or preexisting CNS conditions, such as epileptic seizures, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, or any CNS related autoimmune disease; 3. Symptomatic heart failure or severe arrhythmias; 4. Symptoms of severe respiratory failure; 5. Complicated with other types of malignant tumors; 6. Serum creatinine and/or urea nitrogen ≥ 1.5 times of normal value; 7. Suffer from sepsis or other uncontrollable infections; 8. Intracranial hypertension or brain consciousness disorder; 9. Severe mental disorders; 10. Have received organ transplantation (excluding bone marrow transplantation); 11. Female patients (fertile patients) had positive blood HCG test; 12. Hepatitis (including hepatitis B and C), AIDS and syphilis were screened positive; 13. Patients with graft-versus-host disease (GVHD) or who require immunosuppressant treatment; 14. The absolute value of lymphocytes was too low to manufacture CART cells; 15. Other conditions considered inappropriate by the researcher.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Wuhan Union Hospital, China
  • Collaborator
    • Beijing GoBroad Hospital Management Co.,Ltd
  • Provider of Information About this Clinical Study
    • Principal Investigator: MEI HENG, Proferssor, Cheif Doctor – Wuhan Union Hospital, China
  • Overall Official(s)
    • Heng Mei, Principal Investigator, Wuhan Union Hospital, China
  • Overall Contact(s)
    • Heng Mei, 027-8572600, hmei@hust.edu.cn

References

Gomes-Silva D, Srinivasan M, Sharma S, Lee CM, Wagner DL, Davis TH, Rouce RH, Bao G, Brenner MK, Mamonkin M. CD7-edited T cells expressing a CD7-specific CAR for the therapy of T-cell malignancies. Blood. 2017 Jul 20;130(3):285-296. doi: 10.1182/blood-2017-01-761320. Epub 2017 May 24.

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