Non Hodgkin Lymphoma Clinical Trial
BAFFR-targeting CAR T Cells for Patients With Relapsed or Refractory B-NHL
A Phase 1 Study Evaluating BAFFR-targeting CAR T Cells for Patients with Relapsed or Refractory B-cell Non-Hodgkin's Lymphoma (B-NHL)
This phase I trial evaluates the side effects and best dose of BAFFR-CAR T cells in treating patients with B-cell Non-Hodgkin's Lymphoma (B-NHL) that has come back (recurrent) or does not respond to treatment (refractory). T cells are infection fighting blood cells that can kill cancer cells. The T cells given in this study will come from the patient and will have a new gene put in them that makes them able to recognize BAFFR, a protein on the surface of cancer cells. These BAFFR-specific T cells may help the body's immune system identify and kill BAFFR+ cancer cells.
1. Documented informed consent of the participant and/or legally authorized representative.
2. Agreement to allow the use of archival tissue from diagnostic tumor biopsies If unavailable, exceptions may be granted with Study PI approval.
3. Age: ≥ 18 years
4. ECOG ≤ 2
5. Histologically confirmed Mantle Cell Lymphoma (MCL)
Evidence of positive BAFF-R expression on the MCL cells at the time of enrollment is required. Archival tissue is allowed if there is a significant safety risk for a repeat biopsy or if the lymphoma site is not accessible.
Subjects with other relapsed or refractory BAFFR+ B cell lymphoma with no standard of care options are allowed during initial dose escalation phase, not the dose expansion phase.
6. Relapsed/refractory disease after failure of at least 1 prior regimen.
Participants who have primary refractory MCL (with or without prior BTK inhibitor) defined as lymphoma did not respond to a first line therapy or the response did not last longer than 6 months from an initial response, or
Participants who have relapsed MCL defined as recurrence of disease after an initial response lasting longer than 6 months, must have had at least 1 prior regimen that must include a BTK inhibitor, or
Participants with newly diagnosed MCL without standard of care (SOC) options (e.g., TP53 mutation, ineligible for intensive chemotherapy) are eligible after discussion with PI.
7. Measurable disease by CT scan (≥1.5 cm) or evidence of blood, gastrointestinal, skin, bone marrow or spleen involvement
8. Prior CAR T cell therapy is allowed if at least 90 days has elapsed prior to leukapheresis procedure
9. Fully recovered from the acute toxic effects (except alopecia) to ≤ Grade 1 to prior anti-cancer therapy
10. No known contraindications to leukapheresis, steroids or tocilizumab.
11. Total bilirubin ≤ 1.5 X ULN (unless has Gilbert's disease), then ≥ 3.0 x ULN and direct bilirubin ≤ 1.5 x ULN)
12. AST < 3 x ULN
13. ALT < 3 x ULN
14. Creatinine clearance of ≥ 50 mL/min per 24 hour urine test or the Cockcroft-Gault formula
15. Left ventricular ejection fraction (LVEF) ≥ 45% Note: To be performed within 28 days prior to start of protocol therapy.
16. QTc ≤ 480 ms Note: To be performed within 28 days prior to start of protocol therapy.
17. O2 saturation > 91% on room air.
18. Seronegative for HIV Ag/Ab combo, HCV*, active HBV (Surface Antigen Negative)
*If seropositive for HIV, HCV or HBV (surface antigen or core antibody positive), nucleic acid quantitation must be performed. Viral load must be undetectable.
19. Women of childbearing potential (WOCBP): negative urine or serum pregnancy test.
*If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
20. Agreement by females and males of childbearing potential* to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy.
Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only).
1. Prior allogeneic stem cell transplant.
2. Autologous stem cell transplant within 90 days at the time of enrollment.
3. Concurrent use of systemic steroids or chronic use of immunosuppressant medications. Recent or current use of inhaled steroids is not exclusionary. Physiologic replacement of steroids (i.e., prednisone ≤ 7.5 mg/day or hydrocortisone ≤ 20 mg/day) is allowed. During study participation, participants may receive systemic corticosteroids as needed for treatment-emergent comorbid conditions.
4. Cardiac lymphoma involvement
5. Requirement for urgent therapy due to tumor mass effects such as bowel obstruction or blood vessel compression
6. Auto-immune disease or condition requiring systemic immunosuppressant therapy, including uncontrolled autoimmune hemolytic anemia (AIHA) or idiopathic thrombocytopenic purpura (ITP).
7. Primary immunodeficiency
8. Class III/IV cardiovascular disability according to the New York Heart Association (NYHA) Classification.
9. History of clinically significant arrhythmia. Paroxysmal atrial fibrillation or flutter that is stable on medical management at least 2 weeks prior to enrollment is allowed.
10. History or prior diagnosis of optic neuritis or other immunologic or inflammatory disease affecting the central nervous system, including seizure disorder.
11. History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent, including lymphodepletion agents and tocilizumab.
12. History of stroke or intracranial hemorrhage within 6 months of enrollment.
13. History of venous thrombotic embolism (VTE) within 6 months of enrollment with exception of central line associated VTE.
14. History of other malignancies, except for malignancy surgically resected (or treated with other modalities) with curative intent, basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin; non-muscle invasive bladder cancer; malignancy treated with curative intent with no known active disease present for ≥ 3 years.
15. Clinically significant uncontrolled illness.
16. Active systemic uncontrolled infection requiring antimicrobials.
17. Active CNS MCL or History of CNS MCL within 3 months prior to screening
18. Females only: Pregnant or breastfeeding i. Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures.
19. Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).
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