Phase 1 Trial of Autologous CD123-Directed CAR T-Cells (CART123) as Monotherapy or in Combination With Ruxolitinib in Relapsed/Refractory Acute Myeloid Leukemia
Summary
This study is designed to evaluate the safety and effectiveness of CART123 cells either alone or when combined with ruxolitinib in pediatric and young adult subjects with relapsed or refractory AML. Subjects will be enrolled into one of two treatment cohorts: subjects who will receive CART123 alone (Cohort A) or subjects who will receive CART123 in combination with ruxolitinib (Cohort B).
Detailed description
This trial will be conducted at the Children's Hospital of Philadelphia with CART123 infusions occurring in an outpatient setting with close follow-up. Approximately 18 subjects will be treated on Cohort A and 12 patients treated on Cohort B. Cohort A will consist of a dose escalation of CART123 cells administered intravenously on Day 0 after lymphodepleting chemotherapy. Subjects enrolled on Cohort A will receive a standard regimen of fludarabine (30 mg/m2/day x 4 days) and cyclophosphamide (500 mg/m2/day x 2 days). There is the most experience with the use of this regimen in facilitating adoptive immunotherapy in completed and ongoing pediatric CART trials. Cohort B will consist of a fixed dose of CART123 cells (2x10\^6 CART123 cells/kg) to be administered intravenously on Day 0 in combination with age and BSA-based dosing of ruxolitinib given orally from the start of lymphodepleting chemotherapy until Day -2 and again from Day+7 to Day+13. Subjects enrolled on Cohort B will receive the regimen fludarabine (30 mg/m2/day x 4 days) and cyclophosphamide (1000 mg/m2/day x 3 days). This regimen of enhanced lymphodepletion has been employed with other investigational CAR T-cell therapies with the goal of improving CAR T-cell expansion. There is no dose escalation of CART123 cells or ruxolitinib on this cohort, but a dose de-escalation of ruxolitinib is planned in the event of unacceptable toxicity defined by dose de-escalation rules.
Arms & interventions
- BiologicalAnti-CD123 LV redirected T cells (CART123)
CART123 cells: lentivirally transduced T cells expressing anti-CD123 chimeric antigen receptors expressing tandem TCRζ and 4-1BB (TCRζ /4-1BB) costimulatory domains.
- DrugRuxolitinib (JAKAVI®)
Ruxolitinib: an orally administered janus-activated kinase (JAK) inhibitor that selectively inhibits JAK1 and JAK2.
Outcome measures
Primary
Evaluate the Safety of CART123
Frequency of Adverse events will be measured by evaluating the frequency and severity of treatment related adverse events following administration of CART123
Time frame: 5 years
Safety of CART123 in combination with Ruxolitinib
Frequency of Adverse events will be measured by evaluating the frequency and severity of treatment related adverse events following administration of CART123 and Ruxolitinib
Time frame: 5 Years
Determine Maximum Tolerated Dose of CART123
The Maximum Tolerated Dose will be determined by measuring the incidence of dose limiting toxicities following administration of the CART123 product.
Time frame: 5 years
Secondary
Determine Feasibility of CART123 Treatment
Time frame: 5 years
Determine feasibility of combination treatment with CART123 and ruxolitinib
Time frame: 5 years
Determine the Preliminary Efficacy of CART123
Time frame: 5 years
Determine the Preliminary Efficacy of CART123 + Ruxolitinib
Time frame: 5 years
Evaluate the need for rescue stem cell transplant following treatment with CART123 or CART123 with Ruxolitinib
Time frame: 5 years
Eligibility criteria
Study locations (1)
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104