Dose Optimization Trial of CD19 Redirected Autologous T Cells

Inclusion Criteria

Documented CD19+ CLL or SLL
Successful test expansion of T-cells
At least 2 prior chemotherapy regimens, not including single agent monoclonal antibody (rituxan) therapy. Single agent ofatumumab will be counted as a regimen. -Patients with high risk disease manifested by deletion chromosome 17p will be eligible if they fail to achieve a CR to initial therapy or progress within 2 years of 1 prior regimen.
Patients who progress within 2 years after the second or higher line of therapy will be eligible. For instance, patients who had progression < 2 years after second or greater line therapy, but who have responded to their most recent treatment (3rd line or higher) will be eligible.
Subject is not appropriate candidate for a potentially curative allogeneic SCT due to the state of disease, co-morbid illness, lack of an available donor, or patient declines Performance status (ECOG) 0 or 1
Age >/= 18 years

Adequate organ system function including:

Creatinine < 1.6 mg/dl
ALT/AST < 3x upper limit of normal
Total Bilirubin <2.0 mg/dl
Any relapse after prior autologous SCT will make patient eligible regardless of other prior therapy

Patients with relapsed disease after prior allogeneic SCT (myeloablative or nonmyeloablative) will be eligible if they meet all other inclusion criteria and:

Have no active GVHD and require no immunosuppression
Are more than 6 months from transplant
No contraindications for leukapheresis
Left Ventricular Ejection fraction >40%
Gives voluntary informed consent

Retreatment Inclusion Criteria

Performance Status 0-1

Adequate organ system function including:

Creatinine < 1.6 mg/dl
ALT/AST < 3x upper limit of normal
Total Bilirubin < 2.0 mg/dl
Subject is not an appropriate candidate for a potentially curative allogeneic SCT due to the state of disease, co-morbid illness, lack of an available donor, or patient declines.
Left Ventricular Ejection Fraction > 40%
No contraindications for leukapheresis (if required for retreatment)
Gives voluntary informed consent for retreatment

Exclusion Criteria

Pregnant or lactating women. The safety of this therapy on unborn children is not known. Female study participants of reproductive potential must have a negative serum or urine pregnancy test performed within 48 hours before infusion.
Uncontrolled active infection
Active hepatitis B or hepatitis C infection
Concurrent use of systemic steroids or chronic use of immunosuppressant medications. Recent or current use of inhaled steroids is not exclusionary. For additional details regarding use of steroid and immunosuppressant medications.
Any uncontrolled active medical disorder that would preclude participation as outlined
HIV infection
Patients with active CNS involvement with malignancy. Patients with prior CNS disease that has been effectively treated will be eligible providing treatment was >4 weeks before enrollment.
Class III/IV cardiovascular disability according to the New York Heart Association Classification

Retreatment Exclusion Criteria

Pregnant or lactating women. Female study participants must have a negative serum or urine pregnancy test performed within 48 hours before infusion.
Uncontrolled active infection
Active hepatitis or hepatitis infection
Concurrent use of systemic steroids. Recent or current use of inhaled steroids is not exclusionary.
Any uncontrolled active medical disorder that would preclude participation as outlined.
HIV infection
Patients with active CNS involvement with malignancy. Patients with prior CNS disease that has been effectively treated will be eligible providing treatment was >4 weeks before enrollment on the retreatment cohort.
Class III/IV cardiovascular disability according to the New York Heart Association Classification