CD123-Directed Autologous T-Cell Therapy for Acute Myelogenous Leukemia (CATCHAML)
The CD123-CAR T-cell therapy is a new treatment that is being investigated for treatment of AML/myelodysplastic syndrome (MDS), T- or B- acute lymphoblastic leukemia (ALL) or blastic plasmacytoid dendritic cell neoplasia (BPDCN). The purpose of this study is to find the maximum (highest) dose of CD123-CAR T cells that is safe to give to these patients. This would include studying the side effects of the chemotherapy, as well as the CD123-CAR T-cell product on the recipient's body, disease and overall survival. Primary Objective To determine the safety of one intravenous infusion of escalating doses of autologous, CD123-CAR T cells in patients (≤21 years) with recurrent/refractory CD123+ disease (AML/MDS, B-ALL, T-ALL or BPDCN) after lymphodepleting chemotherapy. Secondary Objectives To evaluate the antileukemia activity of CD123-CAR T cells. Exploratory Objectives * To assess the immunophenotype, clonal structure and endogenous repertoire of CD123-CAR T cells and unmodified T cells * To characterize the cytokine profile in the peripheral blood and CSF after treatment with CD123-CAR T cells * To characterize tumor cells post CD123-CAR T-cell therapy
• Age ≤21 years old
• Relapsed/refractory CD123+ disease defined as follows:
∙ AML/MDS
• Relapsed disease: Patients developing recurrent disease after a first complete remission (CR)
• Refractory disease: Patients not achieving a CR after 2 cycles of induction chemotherapy
∙ B-cell ALL
• Relapsed disease that is CD123 positive and CD19 negative/dim or patients otherwise ineligible for CD19 directed therapies including
‣ Patients in 2nd or greater relapse
⁃ Patients with relapse after allogeneic HSCT
• Refractory disease that is CD123 positive and CD19 negative/dim or patients otherwise ineligible for CD19 directed therapies
∙ T-cell All • Relapsed refractory disease that is CD123 positive
∙ BPDCN
∙ • Relapsed/refractory disease that has failed front-line therapy
• Estimated life expectancy of \>12 weeks
• Karnofsky or Lansky (age-dependent) performance score ≥50
• Patients with a history of prior allogeneic HCT must be clinically recovered from prior HCT therapy, have no evidence of active GVHD and have not received a donor lymphocyte infusion (DLI) within the 28 days prior to apheresis
• Patient must have an identified, suitable HCT donor
• For females of child-bearing age:
• Not lactating with intent to breastfeed
• Not pregnant with negative serum pregnancy test within 7 days prior to enrollment
• Meets eligibility criteria to undergo autologous apheresis, or have previously undergone autologous apheresis
• Age≤21 years old
• Detectable disease that is CD123+ (at least MRD+ disease)
• Estimated life expectancy of \>8 weeks
• Karnofsky or Lansky (age-dependent) performance score≥50
• Patients with a history of prior allogeneic HCT must be clinically recovered from prior HCT therapy, have no evidence of active GVHD and have not received a donor lymphocyte infusion (DLI) within the 28 days prior to planned infusion
• Patient must have an identified, suitable HCT donor
• Adequate cardiac function defined as left ventricular ejection fraction \>40%, OR shortening fraction ≥25%
• EKG without evidence of clinically significant arrhythmia
• Adequate renal function defined as creatinine clearance or radioisotope GFR ≥50 ml/min/1.73m2 (GFR ≥40 ml/min/1.73m2 if \< 2 years of age)
• Adequate pulmonary function defined as forced vital capacity (FVC)≥50% of predicted value; or pulse oximetry≥92% on room air if patient is unable to perform pulmonary function testing
• Total Bilirubin≤3 times the upper limit of normal for age, except in subjects with Gilbert's syndrome
• Alanine aminotransferase (ALT) OR aspartate aminotransferase (AST) ≤5 times the upper limit of normal for age
• Has recovered from all NCI CTAE grade III-IV, non-hematologic acute toxicities from prior therapy
• For females of child-bearing age
‣ Not lactating with intent to breastfeed
⁃ Not pregnant with negative serum pregnancy test within 7 days prior to enrollment
• If sexually active, agreement to use birth control until 3 months after T- cell infusion. Male partners should use a condom.
• Available autologous transduced T-cell product that has met GMP release criteria