Here are the studies that match your search criteria. If you are interested in participating, please reach out to the contact listed for the study. If no contact is listed, contact us and we'll help you find the right person.
Nivolumab in Treating Patients With Autoimmune Disorders and Advanced, Metastatic, or Unresectable Cancer
This phase Ib trial studies the side effects of nivolumab and to see how well it works in
treating patients with autoimmune disorders and cancer that has spread to other places in the
body or cannot removed by surgery. Immunotherapy with monoclonal antibodies, such as
nivolumab, may help the body's immune system attack the cancer, and may interfere with the
ability of tumor cells to grow and spread.
• Patients can have either histologically confirmed malignancy that is radiologically
evaluable and metastatic or unresectable, or have a malignancy for which a PD-1/PD-L1
inhibitor has been approved in the adjuvant setting. Eligible tumor types include
solid tumors and malignancies in which there is known evidence of clinical activity
for single agent PD-1 or PD-L1 antibodies. Nivolumab is Food and Drug Administration
(FDA)-approved for the treatment of melanoma, non-small cell lung cancer (NSCLC),
Merkel cell cancer, bladder cancer, renal cell carcinoma (RCC), gastric cancer,
hepatocellular carcinoma (HCC), cervical cancer, head and neck cancer, Hodgkin
lymphoma (HL), metastatic small cell lung cancer (SCLC), and any solid tumor with
microsatellite instability (MSI)-high status confirmed. Patients with HL are eligible
but must follow standard response criteria. Additional tumor types may be eligible on
a case by case basis upon discussion with principal investigator (PI). Patients
enrolling on the trial for adjuvant use will be restricted to those with histology for
which a PD-1/PD-L1 inhibitor has been approved in the adjuvant setting including but
not limited to NSCLC, melanoma, RCC, cervical cancer, and bladder cancer
• Patients who have previously received other forms of immunotherapy (high-dose [HD]
IL-2, IFN, CTLA-4) are allowed. Patients must not have received cytokine immunotherapy
for at least 4 weeks before nivolumab administration. Patients who have received prior
anti-CTLA4 will be allowed and the washout period is 6 weeks
• Age >= 18 years; children are excluded from this study but may be eligible for future
pediatric phase 1 combination trials
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 (Karnofsky >=
60)
• Life expectancy of greater than 12 weeks
• Leukocytes >= 1,000/mcL
• Absolute neutrophil count >= 500/mcL
• Platelets >= 50,000/mcL
• Total bilirubin =< 2 x institutional upper limit of normal (ULN)
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 5 x institutional ULN or < 8 x institutional ULN for patients with liver metastases
or an autoimmune disease that is contributing to the elevation of these values
• Creatinine ULN OR glomerular filtration rate (GFR) >= 30 mL/min (if using the
Cockcroft-Gault formula)
• Human immunodeficiency virus (HIV)-infected patients on effective antiretroviral
therapy with undetectable viral load within 6 months are eligible for this trial
• If evidence of chronic hepatitis B virus (HBV) infection, HBV viral load must be
undetectable on suppressive therapy if indicated
• If history of hepatitis C virus (HCV) infection, must be treated with undetectable HCV
viral load
• Patients with new or progressive brain metastases (active brain metastases) or
leptomeningeal disease are eligible if the treating physician determines that
immediate central nervous system (CNS) specific treatment is not required and is
unlikely to be required for at least 4 weeks (or scheduled assessment after the first
cycle of treatment), and a risk-benefit analysis (discussion) by the patient and the
investigator favors participation in the clinical trial
• The effects of nivolumab on the developing human fetus are unknown. For this reason,
women of child-bearing potential (WOCBP) and men must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) prior to study
entry and for the duration of study participation. WOCBP receiving nivolumab will be
instructed to adhere to contraception for a period of 5 months after the last dose of
investigational product. Men receiving nivolumab and who are sexually active with
WOCBP will be instructed to adhere to contraception for a period of 7 months after the
last dose of investigational product. Women of childbearing potential must have a
negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent
units of human chorionic gonadotropin [HCG]) within 24 hours prior to the start of
nivolumab. Women must not be breastfeeding. Women who are not of childbearing
potential (i.e., who are postmenopausal or surgically sterile as well as azoospermic
men) do not require contraception. WOCBP is defined as any female who has experienced
menarche and who has not undergone surgical sterilization (hysterectomy or bilateral
oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12
months of amenorrhea in a woman over 45 in the absence of other biological or
physiological causes. In addition, women under the age of 55 must have a documented
serum follicle stimulating hormone (FSH) level less than 40 mIU/mL. These durations
have been calculated using the upper limit of the half-life for nivolumab (25 days)
and are based on the protocol requirement that WOCBP use contraception for 5
half-lives plus 30 days, and men who are sexually active with WOCBP use contraception
for 5 half-lives plus 90 days. Should a woman become pregnant or suspect she is
pregnant while she or her partner is participating in this study, she (or the
participating partner) should inform the treating physician immediately
• Ability to understand and the willingness to sign a written informed consent document
• Patients with more than one autoimmune disease are eligible. The treating physician
would determine which autoimmune disease is dominant and the patient would be treated
under that specific cohort
Exclusion Criteria:
• Patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered from adverse events (AEs) due to agents administered more than 4 weeks
earlier have not resolved or stabilized. Palliative (limited-field) radiation therapy
(RT) is permitted (2 week washout from start of treatment), if all of the following
criteria are met:
• Repeat imaging demonstrates no new sites of bone metastases
• The lesion being considered for palliative radiation is not a target lesion
• Patients with prior therapy with an anti-PD-1 or anti-PD-L1
• Patients with prior allogeneic hematologic transplant
• Patients who are receiving any other anticancer investigational agents
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements
• Patients who have had evidence of active or acute diverticulitis, intra-abdominal
abscess, gastrointestinal (GI) bleeding, obstruction, and abdominal carcinomatosis
which are known risk factors for bowel perforation should be evaluated for the
potential need for additional treatment before coming on study. For the IBD (UC and
CD) cohort, an endoscopic assessment, disease activity index, and disease specific
inclusion/exclusion criteria will substitute for these factors in determining
eligibility with the exception of abdominal carcinomatosis, which should prompt
further evaluation
Olanzapine Versus Megestrol Acetate for the Treatment of Loss of Appetite Among Advanced Cancer Patients
This phase III trial compares the effects of olanzapine versus megestrol acetate in treating
loss of appetite in patients with cancer that has spread to other places in the body
(advanced). Olanzapine may stimulate and increase appetite. This study aims to find out if
olanzapine is better than the usual approach (megestrol acetate) for stimulating appetite and
preventing weight loss.
• Women and men of reproductive potential should agree to use an appropriate method of
birth control throughout their participation in this study due to the teratogenic
potential of the therapy utilized in this trial. Appropriate methods of birth control
include abstinence, oral contraceptives, implantable hormonal contraceptives or double
barrier method (diaphragm plus condom)
• Diagnosis of advanced cancer
• Patient-reported 2-month weight loss of at least 5 pounds (2.3 kilograms) and/or
physician-estimated caloric intake of less than 20 calories/kilogram of body weight
per day
• The patient must perceive loss of appetite and/or weight as a problem; and have an
appetite score of 4 or worse on the "Please rate your appetite…." question that
requires a patient response on a 0-10 numeric rating scale
• Not receiving ongoing tube feedings or parenteral nutrition at the time of
registration
• Not currently using systemic adrenal steroids (with the exception of short-term
dexamethasone within 3 days of chemotherapy for control of chemotherapy side effects)
• No use of androgens, progesterone analogs, or other appetite stimulants within the
past month
• Patient should not have poorly controlled hypertension or congestive heart failure at
registration
• Patient should not have an obstruction of the alimentary canal, malabsorption, or
intractable vomiting (defined as vomiting more than 3 times per day over the preceding
week)
• Not currently using olanzapine for another medical condition or had previously used
olanzapine for chronic nausea or for any pre-existing psychotic disorder
• Patient should not have had a previous blood clot at any time in the past
• No history of poorly controlled diabetes
• No symptomatic leptomeningeal disease or known brain metastases as these patients may
have difficulty taking oral medications
• No history of hypersensitivity to olanzapine or megestrol acetate
• No COVID-19 infection in the past that, in the opinion of the treating physician, had
left patients with compromised taste, which has not resolved at the time of
registration
• Not pregnant and not nursing, because this study involves an investigational agent
whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn
are unknown. Therefore, for women of childbearing potential only, a negative urine or
serum pregnancy test done =< 14 days prior to registration is required
• Age >= 18 years
• Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
• Estimated life expectancy of 3 months or longer
• Serum creatinine =< 2.0 mg/dL
• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 3 x upper limit
of normal (ULN)
• Fasting glucose > 1410 mg/dl
• Granulocytes > 1000/hpf
• No treatment with another antipsychotic agent, such as risperidone, quetiapine,
clozapine, butyrophenone within 30 days of enrollment
• In order to complete the mandatory patient-completed measures, participants must be
able to speak and/or read English or Spanish. Sites seeking to enroll Spanish-speaking
patients should have access to Spanish speaking staff on site or through the use of a
translation service to be able to conduct the informed consent discussion in Spanish,
and to conduct the weekly phone calls
Exclusion Criteria:
• Psychiatric illness which would prevent the patient from giving informed consent
• Medical condition such as uncontrolled infection (including human immunodeficiency
virus [HIV]), uncontrolled diabetes mellitus or cardiac disease which, in the opinion
of the treating physician, would make this protocol unreasonably hazardous for the
patient
• Patients who cannot swallow oral formulations of the agents
• Patients with impaired decision-making capacity (such as with a diagnosis of dementia
or memory loss) are not eligible for this study
• No presence of a hormone-sensitive tumor, such as breast, endometrial, or prostate
cancer (this exclusion criterion is intended to circumvent any confounding
antineoplastic effects of megestrol acetate)
Study of CLR 131 in Select B-Cell Malignancies (CLOVER-1) and Pivotal Expansion in Waldenstrom Macroglobulinemia (CLOVER-WaM)
Part A of this study evaluates CLR 131 in patients with select B-cell malignancies (multiple
myeloma( MM), indolent chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL),
lymphoplasmacytic lymphoma (LPL)/Waldenstrom Macroglobulinemia (WM), marginal zone lymphoma
(MZL), mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and central nervous
system lymphoma (CNSL) who have been previously treated with standard therapy for their
underlying malignancy. Part B (CLOVER-WaM) is a pivotal efficacy study evaluating IV
administration of CLR 131 in patients with WM that have received at least two prior lines of
therapy.
All Patients
• Histologically or cytologically confirmed MM; Patients with primary or secondary CNSL
may be enrolled.
• ECOG performance status of 0 to 2
• 18 years of age or older
• Life expectancy of at least 6 months
• Platelets ≥ 75,000/µL (if full-dose anticoagulation therapy is used, platelets ≥
100,000/µL are required)
• WBC count ≥ 3000/µL
• Absolute neutrophil count ≥ 1500/µL
• Hemoglobin ≥ 9 g/dL (last transfusion, if any, must be at least 1 week prior to study
registration, and no transfusions are allowed between registration and dosing)
• Estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
• Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 2.5 × upper
limit of normal (ULN)
• Bilirubin < 1.5 × ULN
• International normalized ratio (INR) < 2.5
• If patient is on full-dose anticoagulation therapy, the anticoagulation therapy must
be reversible and reversal of the anticoagulation therapy must not be
life-threatening, as judged by the Investigator
• Patients who have undergone stem cell transplant must be at least 100 days from
transplant
Patients with Multiple Myeloma
• At least 5 prior regimens, which must include at least 1 approved proteasome inhibitor
(bortezomib, carfilzomib, or ixazomib), at least 1 approved immunomodulatory agent
(thalidomide, lenalidomide, or pomalidomide), and at least 1 approved monoclonal
antibody (e.g., daratumumab or elotuzumab) with or without maintenance therapy, unless
patients are intolerable to such agents or ineligible to receive such agents.
• At least triple-class refractory (refractory to a proteasome inhibitor,
immunomodulatory agent, and a monoclonal antibody)
• Progressive disease defined by any of the following:
• 25% increase in serum M-protein from the lowest response value during (or after)
last therapy and/or absolute increase in serum M-protein of ≥ 0.5 g/dL
• 25% increase in urine M-protein from the lowest response value during (or after)
last therapy and/or absolute increase in urine M-protein of ≥ 200 mg/24 h
• 25% increase in bone marrow plasma cell percentage from the lowest response value
during (or after) last therapy. Absolute bone marrow plasma cell percentage must
be ≥ 10% unless prior CR when absolute bone marrow plasma cell percentage must be
≥ 5%.
• 25% increase in serum FLC level from the lowest response value during (or after)
last therapy; the absolute increase must be > 10 mg/dL
• New onset hypercalcemia > 11.5 mg/dL
• Failure to obtain a partial response or better to current treatment, or cannot
further improve their response to current treatment
• Appearance of new extramedullary disease
• Measurable disease defined by any of the following:
• Serum M-protein > 0.5 g/dL
• Urine M-protein > 200 mg/24 h
• Serum FLC assay: Involved FLC level ≥ 10 mg/dL provided serum FLC ratio is
abnormal.
[CLOSED] Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma,
Lymphoplasmacytic Lymphoma/Waldenstom Macroglobulinemia, or Marginal Zone Lymphoma
• Prior treatment with at least 2 prior regimens, which may include chemotherapy, an
approved anti-CD20 antibody with or without maintenance therapy, and an approved
targeted agent, unless patients are ineligible to receive such agents
• Patients with Helicobacter pylori+ mucosa-associated lymphoid tissue lymphoma must
have received 1 prior antibiotic regimen for H pylori
• At least 1 measurable nodal lesion with longest diameter > 15 mm or 1 measurable
extranodal lesion (eg, hepatic nodule) with longest diameter > 10 mm. Additional
parameters (e.g., measurable IgM for patients with Lymphoplasmacytic Lymphoma) may be
allowed if they meet current NCCN guidelines for symptomatic disease. Patients with
uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
[CLOSED] Patients with Mantle Cell Lymphoma
• Prior treatment with at least 1 prior regimen
• At least 1 measurable nodal lesion with longest diameter > 15 mm or 1 measurable
extranodal lesion (eg, hepatic nodule) with longest diameter > 10 mm. Patients with
uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
[CLOSED] Patients with Diffuse Large B-Cell Lymphoma
• Relapsed or refractory to combination chemotherapy for DLBCL that contains rituximab
and an anthracycline; or is intolerable to such agents. Relapsed disease is defined as
either recurrence of disease after a CR or PD after achieving a partial response (PR)
or SD. Refractory disease is defined as failure to achieve at least SD with any 1 line
of therapy or with PD ≤ 3 months of the most recent chemotherapy regimen.
• At least 1 measurable nodal lesion with longest diameter > 15 mm or 1 measurable
extranodal lesion (eg, hepatic nodule) with longest diameter > 10 mm. Patients with
uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
Patients with CNS Lymphoma
• Must have biopsy-proven disease and must have received at least one prior intervention
for their disease.
• Must be at least two weeks from CNS biopsy before administration of CLR 131.
• Must have at least one lesion with enhancement on brain imaging.
• Stable (or decreasing) dose of corticosteroids or anti-convulsant medication for at
least 7 days prior to dosing
[CLOVER-1]
Exclusion Criteria:
• Ongoing Grade 2 or greater toxicities due to previous therapies. Stable, tolerable
Grade 2 AEs (eg, neuropathy) may be allowed.
• Prior external-beam RT resulting in greater than 20% of total bone marrow receiving
greater than 20 Gy.
• Prior total body or hemi-body irradiation. Patients who have received prior low-dose
total body or hemi-body irradiation may be allowed on a case-by-case basis after
discussion with Sponsor (considerations may include factors such as time since
irradiation, total lifetime accumulated dose, etc.)
• Extradural tumor in contact with the spinal cord or tumor located where swelling in
response to therapy may impinge upon the spinal cord
• For patients with CLL/SLL, LPL, or MZL, transformation to a more aggressive form of
NHL
• Ongoing chronic immunosuppressive therapy
• Clinically significant bleeding event within prior 6 months
• Ongoing anti-platelet therapy (except low-dose aspirin [eg, 81 mg daily] for
cardioprotection)
• Anti-cancer therapy within two weeks of initial CLR 131 infusion. Low dose
dexamethasone for symptom management is allowed
• Radiation therapy, chemotherapy, immunotherapy, or investigational therapy within 2
weeks of eligibility-defining bone marrow biopsy.
• For patients with primary or secondary CNSL, active bleeding in the tumor bed and/or
uncontrolled seizure activity
[CLOVER-WaM] Inclusion Criteria
• Histologically or cytologically confirmed WM. Patients with a diagnosis of LPL may be
enrolled with prior Sponsor approval.
• Patient has an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0
to 2 (Appendix C)
• Patient is 18 years of age or older
• Life expectancy of at least 6 months
• Received at least two prior lines of therapy for WM
• Measurable IgM (above upper limit of normal) OR at least one measurable nodal lesion
with longest diameter > 15 mm or one measurable extranodal lesion (e.g., hepatic
nodule) with longest diameter > 10 mm
[CLOVER-WaM] Exclusion Criteria
• Ongoing Grade 2 or greater toxicities due to previous therapies, excluding alopecia.
• Prior external-beam RT resulting in greater than 20% of total bone marrow receiving
greater than 20 Gy.
• Prior total body or hemi-body irradiation. Patients who have received prior low-dose
total body or hemi-body irradiation may be allowed on a case-by-case basis after
discussion with Sponsor (considerations may include factors such as time since
irradiation, total lifetime accumulated dose, etc.)
• Patients with second malignancies in addition to WM, if the second malignancy has
required therapy in the last 2 years or is not in remission; exceptions to this
criterion include successfully treated non-metastatic basal cell or squamous cell skin
carcinoma, or prostate cancer that does not require therapy
• Anti-cancer therapy within two weeks of initial CLR 131 infusion.
• Need for acute treatment of WM (e.g., those with hyperviscosity)
Multiple Myeloma, Waldenström Macroglobulinemia, Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Marginal Zone Lymphoma, Mantle Cell Lymphoma, Diffuse Large B Cell Lymphoma, Non-Hodgkins Lymphoma, Central Nervous System Lymphoma, Lymphoplasmacytic Lymphoma
Phase 2 Study With Minimal Residual Disease (MRD) Driven Adaptive Strategy in Treatment for Newly Diagnosed Multiple Myeloma (MM) With Upfront Daratumumab-based Therapy
This phase 2 trial will test whether the combination of DaraRd (daratumumab + lenalidomide +
dexamethasone) as induction therapy, followed by DRVd (daratumumab + lenalidomide +
bortezomib + dexamethasone) consolidation therapy, if needed, will result in more patients
achieving minimal residual disease (MRD)-negative status, relative to the standard of care.
Consolidation therapy will be administered only to those patients with MRD-positive status
after induction therapy.
This is a study based on adaptive design for decision making of treatment options. Duration
of therapy (daratumumab cycles) will depend on individual approach, response, evidence of
disease progression and tolerance.
INCLUSION
1. Participants ≥18 years of age or legal age of consent per local regulations (whichever
is greater).
2. Voluntary written consent must be given before performance of any study-related
procedure not part of standard medical care, with the understanding that consent may
be withdrawn by the participant at any time without prejudice to future medical care.
3. ECOG status (Appendix A) of ≤2 and able to tolerate all applicable treatments per
investigator's evaluation and standard institutional criteria.
4. Both transplant eligible and ineligible myeloma patients can be included in this
study. If applicable, participant should be able to tolerate all treatments per
investigator's evaluation, including high-dose chemotherapy and autologous stem cell
transplant (ASCT) based on standard criteria at the institution where this treatment
will be administered.
5. Participant must have a diagnosis of active MM according to International Myeloma
Working Group (IMWG) diagnostic criteria.
6. Participant must also have measurable disease per protocol.
7. Participant agrees to refrain from blood donations during therapy on study and for 12
weeks after therapy is completed.
8. Participant must be registered in and must comply with all requirements of REMSTM
program for lenalidomide.
9. Female participant who:
• Is post-menopausal for at least one year prior to study enrollment, OR
• Is surgically sterile, OR
• If of childbearing potential, must have a negative urine or serum pregnancy test
within 10-14 days prior to and again within 24 hours of starting lenalidomide.
They must also be willing to use TWO effective forms of contraception
simultaneously from the time of signing the study consent until 90 days following
the administration of the last dose of lenalidomide and 7 months following the
administration of the last dose of bortezomib, OR
• Agree to practice true abstinence if that is aligned with their lifestyle, which
does not include periodic abstinence or withdrawal.
10. Male participant, even if surgically sterilized, must agree to one of the following:
• Agree to practice effective barrier contraception during the entire study
treatment period and through 90 days after the last dose of lenalidomide and 4
months following the administration of the last dose of bortezomib, OR
• Agree to practice true abstinence if that is aligned with their lifestyle, which
does not include periodic abstinence or withdrawal.
EXCLUSION:
1. Diagnoses of smoldering MM (SMM), monoclonal gammopathy of undetermined significance
(MGUS), non-secretory MM, plasma cell leukemia, AL amyloidosis, Waldenstrom's.
macroglobulinemia, POEMS syndrome. History of SMM and/or MGUS is not excluded.
2. Known disease involvement of the CNS.
3. History of prior hematopoietic stem cell transplant of any type.
4. Received more than one cycle of anti-myeloma therapy prior to enrollment. Up to one
cycle of myeloma therapy is allowed. Concomitant treatment is allowed with low-dose
corticosteroids and bisphosphonates. The dose of corticosteroids for myeloma treatment
should not exceed the equivalent of 160 mg of dexamethasone over a two-week period
before initiation of protocol. Prednisone up to but no more than 10 mg po daily or its
equivalent is allowed, for symptom management and comorbid conditions.
5. Significant renal insufficiency, defined as creatinine clearance <30ml/min per
Cockcroft-Gault formula.
6. Hepatic impairment, defined as bilirubin >1.5 x institutional upper limit of normal
(ULN) or AST (SGOT), ALT (SGPT), or alkaline phosphatase > 3x institutional ULN.
7. Absolute neutrophil count (ANC) < 1000 cells/mm3 within 14 days of enrollment. Growth
factor may not be used to meet ANC eligibility criteria.
8. Hemoglobin (Hgb) < 8g/dL within 14 days of enrollment. Transfusion may not be used to
meet Hgb eligibility criteria.
9. Platelet count < 75,000 cells/mm3 within 14 days of enrollment. Transfusion may not be
used to meet platelet eligibility criteria.
10. Any condition, including laboratory abnormalities, that in the opinion of the
investigator places the subject at unacceptable risk if subject were to participate in
the study.
11. Major surgery ≤ 4 weeks prior to starting study drug or who have not recovered from
complications of the surgery.
12. Clinically significant peripheral neuropathy not well controlled with treatment,
defined as symptoms limiting activities of daily living (basic ADLs).
13. Symptomatic uncontrolled cardiac disease including congestive heart failure with New
York Heart Association class III-IV symptoms, arrhythmia, unstable angina or
myocardial infarction within the past six months, or any other uncontrolled or severe
cardiovascular condition.
14. Known chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in
1 second (FEV1) <50% of predicted normal.
15. Clinically uncontrolled asthma of any classification or known moderate or severe
persistent asthma within the past two years (see asthma guidelines.
https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf).
16. Serious intercurrent illness including but not limited to clinically relevant
cerebrovascular disease, uncontrolled diabetes mellitus, cirrhosis, pulmonary disease.
17. Active autoimmune process or other disease requiring systemic immunosuppressive,
monoclonal antibody, small molecule, or radiation therapy.
18. Participant is:
• Seropositive for HIV
• Seropositive for Hepatitis B (defined by a positive test for hepatitis B surface
antigen [HBsAg]
• Subjects with resolved infection (i.e., subjects who are HBsAg negative but
positive for antibodies to hepatitis B core antigen [anti-HBc] and/or antibodies
to hepatitis B surface antigen [anti-HBs]) must be screened using real-time
polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) DNA
levels. Those who are PCR positive will be excluded.
• Participants with serologic findings suggestive of HBV vaccination (anti-HBs
positivity as the only serologic marker) AND a known history of prior HBV
vaccination, do not need to be tested for HBV DNA by PCR.
• Seropositive for Hepatitis C (except in the setting of a sustained virologic
response [SVR], defined as aviremia at least 12 weeks after completion of
antiviral therapy).
19. History of additional active malignancy in the past five years (not including squamous
cell or basal cell carcinoma of the skin or in situ cervical cancer). However,
malignancy treated with curative intent with <5% chance of disease relapse /
recurrence in the next two years is allowed.
20. Known drug allergy or intolerance to study medications (including steroids) or
appropriate prophylactic medications (e.g. acyclovir, aspirin, warfarin or
low-molecular weight heparin).
21. Women with a positive pregnancy test during the screening period prior to study
initiation or who are lactating.
22. Participation in other clinical trials, including those with other investigational
agents not included in this trial, within 30 days of the start of this trial and
throughout the duration of this trial.
23. Any significant history of non-compliance to medical regimens or unwilling or unable
to comply with the instructions given.
24. Participants using strong CYP3A4 inducers are excluded unless the inducer can be
switched to an alternative agent while receiving Bortezomib (per protocol).
A Study to Evaluate the Safety and Efficacy of JCAR017 in Pediatric Subjects With Relapsed/Refractory (r/r) B-cell Acute Lymphoblastic Leukemia (B-ALL) and B-cell Non-Hodgkin Lymphoma (B-NHL)
This is a Phase 1/2, open-label, single arm, multicohort study to evaluate the safety and
efficacy of JCAR017 in pediatric subjects aged ≤ 25 years with CD19+ r/r B-ALL and B-NHL.
Phase 1 will identify a recommended Phase 2 dose (RP2D). Phase 2 will evaluate the efficacy
of JCAR017 RP2D in the following three disease cohorts: Cohort 1 (r/r B-ALL), Cohort 2 (MRD+
B-ALL) and Cohort 3 (r/r B-NHL, [DLBCL, BL, or PMBCL]). A Simon's Optimal two-stage study
design will be applied to Cohort 1 and 2 in Phase 2.
Subjects must satisfy the following criteria to be enrolled in the study:
1. Phase 1: Subject < 18 years of age and weighs ≥ 6 kg at the time of signing the
informed consent form (ICF)/informed assent form (IAF).
Phase 2: Subject ≤ 25 years of age and weighs ≥ 6 kg at the time of signing the
ICF/IAF.
2. Subject (when applicable, parental/legal representative) must understand and
voluntarily provide permission to the ICF/IAF prior to conducting any study-related
assessments/procedures.
3. Subject is willing and able to adhere to the study visit schedule and other protocol
requirements.
4. Investigator considers the subject is appropriate for adoptive T cell therapy.
5. Evidence of CD19 expression via flow cytometry (peripheral blood or bone marrow) or
immunohistochemistry (bone marrow biopsy)
6. Subject has a Karnofsky score of ≥ 50 (subjects ≥ 16 years of age) or a Lansky score ≥
50 (subjects < 16 years of age).
7. Diagnosis of B-cell ALL or B-cell NHL as defined below:
Phase 1: Subjects with r/r B-ALL, defined as morphological evidence of disease in BM
(5% or greater lymphoblast by morphology) and either of the following:
• First or greater marrow relapse, or
• Any marrow relapse after allogeneic HSCT, or
• Primary refractory defined as not achieving a CR or a CRi after 2 or more
separate induction regimens (or chemo-refractory as not achieving CR/CRi after 1
cycle of standard chemotherapy for relapsed leukemia), or
• Ineligible for allogeneic HSCT Note: Subjects will be included regardless of MRD
status.
Phase 2: Subjects with one of the following:
• Cohort 1: r/r B-ALL, defined as morphological evidence of disease in BM (5% or
greater lymphoblast by morphology) and either:
• First or greater marrow relapse, or
• Any marrow relapse after allogeneic HSCT, or
• Primary refractory defined as not achieving a CR or a CRi after 2 or more
separate induction regimens (or chemo-refractory as not achieving CR/CRi
after 1 cycle of standard chemotherapy for relapsed leukemia), or
• Ineligible for allogeneic HSCT.
• Cohort 2: MRD+ B-ALL, defined as:
• < 5% lymphoblasts by morphology with,
• MRD detected by a validated assay at a frequency of 1 x10-4 or greater in BM
cells. Subjects eligible for enrollment in Cohort 2 are those with MRD
positive morphologic CR2 after re-induction when these subjects had
previously experienced an early relapse (< 36 months) after first-line
chemotherapy. Subjects who are in MRD+ morphologic CR3 and later, regardless
of time to relapse in earlier lines, are also eligible. Subjects who are in
morphologic relapse at screening (r/r B-ALL) and become MRD+ after bridging
chemotherapy are also eligible for treatment in Cohort 2.
• Cohort 3: r/r B-NHL (DLBCL, BL or PMBCL), defined as measurable disease after 1
or more lines of chemotherapy and/or having failed HSCT or being ineligible for
HSCT.
Note: B-NHL subjects with secondary CNS lymphoma involvement are eligible however
subject selection must consider clinical risk factors for severe neurological AEs and
alternative treatment options. Subjects should only be enrolled if the Investigator
considers the potential benefit outweighs the risk for the subject.
8. Subjects with Philadelphia chromosome positive ALL are eligible if they are intolerant
to or have failed one or more lines of tyrosine-kinase inhibitor (TKI) therapy or if
TKI therapy is contraindicated.
9. Adequate organ function, defined as:
• Adequate BM function to receive LD chemotherapy as assessed by the Investigator.
• Subject with adequate renal function, which is defined as:
Serum creatinine based on age/gender as described below. Subjects that do not meet the
criteria but who have a creatinine clearance or radioisotope glomerular filtration
rate (GFR) > 70 mL/min/1.73 m2 are eligible.• Alanine aminotransferase (ALT) ≤ 5 x
upper limit of normal (ULN) and total bilirubin < 2.0 mg/dL (or < 3.0 mg/dL for
subjects with Gilbert's syndrome or leukemic/lymphomatous infiltration of the liver).
• Adequate pulmonary function, defined as ≤ Grade 1 dyspnea according to Common
Toxicity Criteria for Adverse Events (CTCAE) and oxygen saturation (SaO2) ≥ 92%
on room air.
• Adequate cardiac function, defined as left ventricular ejection fraction (LVEF) ≥
40% as assessed by echocardiogram (ECHO) or multi-gated acquisition scan (MUGA)
within 4 weeks prior to leukapheresis.
10. Adequate vascular access for leukapheresis procedure.
11. Participants must agree to use effective contraception
Exclusion Criteria:
The presence of any of the following will exclude a subject from enrollment:
1. Subject has any significant medical condition, laboratory abnormality, or psychiatric
illness that would prevent the subject from participating in the study.
2. Subject has any condition including the presence of laboratory abnormalities, which
places the subject at unacceptable risk if he/she were to participate in the study.
3. Subject has any condition that confounds the ability to interpret data from the study.
4. Subject with a history of another primary malignancy that has not been in remission
for at least 2 years prior to enrollment.
5. Subjects who have received previous CD19-targeted therapy must have CD19-positive
disease confirmed since completing the prior CD19-targeted therapy.
6. Prior CAR T cell or other genetically-modified T cell therapy.
7. Subject with a previous history of or active hepatitis B, hepatitis C, or human
immunodeficiency virus (HIV) infection.
8. Subjects with uncontrolled systemic fungal, bacterial, viral or other infection
(including tuberculosis) despite appropriate antibiotics or other treatment at the
time of leukapheresis or JCAR017 infusion.
9. Subject has presence of acute or chronic graft-versus-host disease (GVHD).
10. Subject with active autoimmune disease requiring immunosuppressive therapy.
11. Subject has cardiac disorders (CTCAE version 4.03 Grade 3 or 4) within the past 6
months.
12. Subject with a concomitant genetic syndrome, with the exception of Down's syndrome.
13. Subject with active CNS disease and significant neurological deterioration. Subjects
with CNS-2 or CNS-3 involvement are eligible provided they are asymptomatic and do not
have significant neurological deterioration and, in the opinion of the study
investigator, the CNS disease burden can be controlled until JCAR017 infusion.
14. Subject with a history or presence of clinically relevant CNS pathology such as
epilepsy, seizure, paresis, aphasia, stroke, cerebral edema, severe brain injuries,
dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or
psychosis.
15. Subject is pregnant or nursing.
16. Subject has used the following:
• Therapeutic doses of corticosteroids (defined as > 0.4 mg/kg maximum 20 mg/day
prednisone or equivalent) within 7 days prior to leukapheresis or 72 hours prior
to JCAR017 infusion. Physiologic replacement, topical, and inhaled steroids are
permitted.
• Low-dose chemotherapy (eg, vincristine, rituximab, cyclophosphamide ≤ 300 mg/m2)
given after leukapheresis to maintain disease control must be stopped ≥ 7 days
prior to LD chemotherapy.
• Cytotoxic chemotherapeutic agents that are not considered lymphotoxic within 1
week prior to leukapheresis. Oral anticancer agents are allowed if at least 3
half-lives have elapsed prior to leukapheresis.
• Lymphotoxic chemotherapeutic agents (eg, cyclophosphamide, ifosfamide,
bendamustine) within 2 weeks prior to leukapheresis.
• Experimental agents within 4 weeks prior to leukapheresis unless no response or
PD is documented on the experimental therapy and at least 3 half-lives have
elapsed prior to leukapheresis.
• Immunosuppressive therapies within 4 weeks prior to leukapheresis and JCAR017
infusion (eg, calcineurin inhibitors, methotrexate or other chemotherapeutics,
mycophenolate, rapamycin, thalidomide, immunosuppressive antibodies such as
antitumor necrosis factor [TNF], anti-IL-6, or anti-IL-6R).
• Donor lymphocyte infusions (DLI) within 6 weeks prior to JCAR017 infusion.
• Radiation within 6 weeks prior to leukapheresis. Subjects must have PD in
irradiated lesions or have additional non-irradiated lesions to be eligible.
Radiation to a single lesion, if additional non-irradiated, measurable lesions
are present, is allowed up to 2 weeks prior to leukapheresis.
• Allogeneic HSCT within 90 days prior to leukapheresis.
17. Tumor invasion of venous or arterial vessels (B-NHL subjects only).
18. Deep Venous Thrombosis (DVT) or Pulmonary Embolism (PE) within 3 months prior to
leukapheresis. Subjects with DVT or PE that occurred longer than 3 months prior to
leukapheresis, who still require ongoing therapeutic levels of anti-coagulation
therapy, are also excluded.
19. Existence of CD19-negative clone(s) of leukemia cells
A Study of Pembrolizumab (MK-3475) in Pediatric Participants With an Advanced Solid Tumor or Lymphoma (MK-3475-051/KEYNOTE-051)
This is a two-part study of pembrolizumab (MK-3475) in pediatric participants who have any of
the following types of cancer:
- advanced melanoma (6 months to <18 years of age),
- advanced, relapsed or refractory programmed death-ligand 1 (PD-L1)-positive malignant
solid tumor or other lymphoma (6 months to <18 years of age),
- relapsed or refractory classical Hodgkin lymphoma (rrcHL) (3 years to <18 years of age),
or
- advanced relapsed or refractory microsatellite-instability-high (MSI-H) solid tumors (6
months to <18 years of age).
Part 1 will find the maximum tolerated dose (MTD)/maximum administered dose (MAD), confirm
the dose, and find the recommended Phase 2 dose (RP2D) for pembrolizumab therapy. Part 2 will
further evaluate the safety and efficacy at the pediatric RP2D.
The primary hypothesis of this study is that intravenous (IV) administration of pembrolizumab
to children with either advanced melanoma; a PD-L1 positive advanced, relapsed or refractory
solid tumor or other lymphoma; advanced, relapsed or refractory MSI-H solid tumor; or rrcHL,
will result in an Objective Response Rate (ORR) greater than 10% for at least one of these
types of cancer.
• Between 6 months and <18 years of age (or between 3 years and <18 years of age for
rrcHL participants) on day of signing informed consent/assent (the first 3
participants dosed in Part 1 are to be ≥ 6 years of age)
• Histologically- or cytologically-documented, locally-advanced, or metastatic solid
malignancy or lymphoma that is incurable and has failed prior standard therapy, or for
which no standard therapy exists, or for which no standard therapy is considered
appropriate
• Any number of prior treatment regimens
• Tissue (or lymph node biopsy for rrcHL participants) available from an archival tissue
sample or, if appropriate, a newly obtained core or excisional biopsy of a tumor
lesion not previously irradiated
• Advanced melanoma or PD-L1-positive advanced, relapsed, or refractory solid tumor or
lymphoma
• Measurable disease based on RECIST 1.1 (Or based on IWG [Cheson, 2007] [i.e.,
measurement must be >15 mm in longest diameter or >10 mm in short axis] for rrcHL
participants)
• Participants with neuroblastoma with only metaiodobenzylguanidine (MIBG)-positive
evaluable disease may be enrolled
• Lansky Play Scale ≥50 for participants from 6 months up to and including 16 years of
age; or Karnofsky score ≥50 for participants >16 years of age
• Adequate organ function
• Female participants of childbearing potential should have a negative urine or serum
pregnancy test within 72 hours prior to receiving the first dose of study medication
• Female participants of childbearing potential must be willing to use 2 methods of
contraception or be surgically sterile, or abstain from heterosexual activity for the
course of the study through 120 days after the last dose of study medication
• Male participants of reproductive potential must agree to use an adequate method of
contraception starting with the first dose of study medication through 120 days after
the last dose of study medication
Exclusion Criteria:
• Currently participating and receiving study therapy in, or has participated in a study
of an investigational agent and received study therapy or used an investigational
device within 4 weeks of the date of allocation/randomization
• Diagnosis of immunodeficiency or receiving systemic steroid therapy or any other form
of immunosuppressive therapy within 7 days prior to the date of
allocation/randomization
• Prior systemic anti-cancer therapy including investigational agent within 2 weeks
prior to study Day 1 or not recovered from adverse events due to a previously
administered agent
• Prior radiotherapy within 2 weeks of start of study treatment
• Known additional malignancy that is progressing or requires active treatment with the
exception of basal cell carcinoma of the skin, squamous cell carcinoma of the skin or
carcinoma in situ (eg, breast carcinoma, cervical carcinoma in situ) with potentially
curative therapy, or in situ cervical cancer
• Known active central nervous system (CNS) metastases and/or carcinomatous meningitis
• Tumor(s) involving the brain stem
• Severe hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients
• Active autoimmune disease that has required systemic treatment in past 2 years;
replacement therapy (such as thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal or pituitary insufficiency) is acceptable
• Has a history of (non-infectious) pneumonitis that required steroids or current
pneumonitis.
• Active infection requiring systemic therapy
• Pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the trial through 120 days after the last dose of study
medication
• Prior therapy with an anti-programmed cell death (PD)-1, anti-PD-ligand 1
(anti-PD-L1), anti-PD-L2 agent, or any agent directed to another stimulatory or
inhibitory T-cell receptor (eg, cytotoxic lymphocyte associated protein-4 [CTLA-4],
OX-40, CD137)
• Human immunodeficiency virus (HIV)
• Hepatitis B or C
• Known history of active tuberculosis (TB; Bacillus tuberculosis)
• Received a live vaccine within 30 days of planned start of study medication
• Has undergone solid organ transplant at any time, or prior allogeneic hematopoietic
stem cell transplantation within the last 5 years. (Participants who have had an
allogeneic hematopoietic transplant >5 years ago are eligible as long as there are no
symptoms of Graft Versus Host Disease [GVHD].)
• History or current evidence of any condition, therapy, or laboratory abnormality, or
known severe hypersensitivity to any component or analog of the trial treatment, that
might confound the results of the trial, or interfere with the participant's
participation for the full duration of the study
• Known psychiatric or substance abuse disorders that would interfere with the
requirements of the study
Imatinib Mesylate and Combination Chemotherapy in Treating Patients With Newly Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia
This randomized phase III trial studies how well imatinib mesylate works in combination with
two different chemotherapy regimens in treating patients with newly diagnosed Philadelphia
chromosome positive acute lymphoblastic leukemia (ALL). Imatinib mesylate has been shown to
improve outcomes in children and adolescents with Philadelphia chromosome positive (Ph+) ALL
when given with strong chemotherapy, but the combination has many side effects. This trial is
testing whether a different chemotherapy regimen may work as well as the stronger one but
have fewer side effects when given with imatinib. The trial is also testing how well the
combination of chemotherapy and imatinib works in another group of patients with a type of
ALL that is similar to Ph+ ALL. This type of ALL is called "ABL-class fusion positive ALL",
and because it is similar to Ph+ ALL, is thought it will respond well to the combination of
agents used to treat Ph+ ALL.
• For patients enrolled on APEC14B1 prior to enrollment on AALL1631, the required
diagnostic bone marrow sample has been fulfilled
• For patients who have not previously enrolled on APEC14B1 prior to enrollment on
AALL1631, a baseline diagnostic sample (or peripheral blood sample with blasts if
marrow sample unavailable) must be available to develop an MRD probe
• In addition, laboratory reports detailing evidence of BCR-ABL1 fusion or
ABL-class fusion must be submitted for rapid central review within 72 hours of
study enrollment
• >= 1 year (365 days) and =< 21 years at ALL diagnosis
• Ph+ (BCR-ABL1 fusion): newly diagnosed de novo ALL (B-ALL or T-ALL) or mixed
phenotypic acute leukemia (MPAL meeting 2016 World Health Organization [WHO]
definition) with definitive evidence of BCR-ABL1 fusion by karyotype, fluorescence in
situ hybridization (FISH) and/or molecular methodologies
• ABL-class fusion: newly diagnosed B-ALL with definitive evidence of ABL-class fusions.
ABL-class fusions are defined as those involving the following genes: ABL1, ABL2,
CSF1R, PDGFRB, PDGFRA. Methods of detection include fluorescence in-situ hybridization
(FISH, e.g. using break-apart or colocalization signals probes), multiplex or
singleplex reverse-transcription polymerase chain reaction (RT-PCR), whole
transcriptome or panel-based ribonucleic acid (RNA)-sequencing (e.g. TruSight RNA
Pan-Cancer Panel; Illumina, San Diego, CA, USA or similar)
• Ph+ patients must have previously started Induction therapy, which includes
vincristine, a corticosteroid, pegaspargase, with or without anthracycline, and/or
other standard cytotoxic chemotherapy
• Ph+ patients have not received more than 14 days of multiagent Induction therapy
beginning with the first dose of vinCRIStine
• Ph+ patients may have started imatinib prior to study entry but have not received more
than 14 days of imatinib
• ABL-class fusion patients must have previously completed the 4 or 5 weeks of
multiagent Induction chemotherapy (Induction IA phase)
• ABL-class fusion patients may have started imatinib during Induction IA, at the same
time of or after the first vinCRIStine dose
• Patients must have a performance status corresponding to Eastern Cooperative Oncology
Group (ECOG) scores of 0, 1, or 2
• Direct bilirubin =< 2.0 mg/dL
• Shortening fraction of >= 27% by echocardiogram
• Ejection fraction of >= 50% by radionuclide angiogram or echocardiogram
• Corrected QT interval, QTc < 480 msec
• Note: Repeat echocardiogram and electrocardiogram are not required if they were
performed at or after initial ALL diagnosis, before study enrollment
• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
mL/min/1.73 m^2 or serum creatinine within normal limits based on age/gender, as
follows:
• 1 to < 2 years: maximum serum creatinine 0.6 mg/dL (both male and female)
• 2 to < 6 years: maximum serum creatinine 0.8 mg/dL (both male and female)
• 6 to < 10 years: maximum serum creatinine 1 mg/dL (both male and female)
• 10 to < 13 years: maximum serum creatinine 1.2 mg/dL (both male and female)
• 13 to < 16 years: maximum serum creatinine 1.5 mg/dL (male), 1.4 mg/dL (female)
• >= 16 years: maximum serum creatinine 1.7 mg/dL (male), 1.4 mg/dL (female)
Exclusion Criteria:
• Known history of chronic myelogenous leukemia (CML)
• ALL developing after a previous cancer treated with cytotoxic chemotherapy
• Active, uncontrolled infection, or active systemic illness that requires ongoing
vasopressor support or mechanical ventilation
• Down syndrome
• Pregnancy and breast feeding
• Female patients who are pregnant since fetal toxicities and teratogenic effects
have been noted for several of the study drugs; a pregnancy test is required for
female patients of childbearing potential
• Lactating females who plan to breastfeed their infants
• Sexually active patients of reproductive potential who have not agreed to use an
effective contraceptive method for the duration of treatment according to
protocol
• Patients with congenital long QT syndrome, history of ventricular arrhythmias or heart
block
• Prior treatment with dasatinib, or any TKI other than imatinib
A Study of Repotrectinib in Pediatric and Young Adult Subjects Harboring ALK, ROS1, OR NTRK1-3 Alterations
Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib
in pediatric and young adult subjects with advanced or metastatic malignancies harboring
anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1),
or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to
estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the
Pediatric Recommended Phase 2 Dose (RP2D).
Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric subjects with
advanced or metastatic malignancies harboring ALK, ROS1, or NTRK1-3 alterations.
1. Documented genetic ALK, ROS1, or NTRK1-3 alteration (point mutation, fusion,
amplification) as identified by local testing in a Clinical Laboratory Improvement
Amendments (CLIA) laboratory in the US or equivalently accredited diagnostic lab
outside the United States (US) is required.
2. Phase 1: Age <12 years; Phase 2: Age 12- 25 years
3. Prior cytotoxic chemotherapy is allowed.
4. Prior immunotherapy is allowed.
5. Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer
therapy to National Cancer Institute Common Terminology Criteria for Adverse Events
(NCI CTCAE) Version 4.03 Grade less than or equal to 1.
6. All subjects must have measurable disease by RECIST v1.1 or Response Assessment in
Neuro-Oncology Criteria (RANO) criteria at time of enrollment.
7. Subjects with a primary CNS tumor or CNS metastases must be neurologically stable on a
stable or decreasing dose of steroids for at least 14 days prior to enrollment.
8. Subjects must have a Lansky (< 16 years) or Karnofsky (≥ 16 years) score of at least
50.
9. Life expectancy greater than or equal to 12 weeks.
10. Adequate hematologic, renal and hepatic function.
Phase 2
Inclusion Criteria:
1. Cohort Specific
Inclusion Criteria:
• Cohort 1: Subjects with NTRK fusion gene positive (NTRK+) advanced solid tumors
(including primary CNS tumors), that are tropomyosin receptor kinase (TRK) TKI
naïve;
• Cohort 2: subjects with NTRK+ advanced solid tumors (including primary CNS
tumors), that are TRK TKI pre-treated;
• Cohort 3: subjects with tumors or ALCL characterized by other ALK/ROS1/NTRK
alterations or NTRK fusions without centrally confirmed measurable disease or not
otherwise eligible for Cohort 1 or 2.
2. Subjects in Cohorts 1 and 2 must have prospectively confirmed measurable disease by
BICR prior to enrollment.
Key Exclusion Criteria (Phase 1 and Phase 2):
1. Subjects with neuroblastoma with only bone marrow disease evaluable by bone marrow
aspiration only.
2. Major surgery within 14 days (2 weeks) of start of repotrectinib treatment. Central
venous access (Broviac, Mediport, etc.) placement does not meet criteria for major
surgery.
3. Known active infections (bacterial, fungal, viral including HIV positivity).
4. Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut
syndrome) or other malabsorption syndromes that would impact drug absorption.
5. Any of the following cardiac criteria:
• Mean resting corrected QT interval (ECG interval measured from the onset of the
QRS complex to the end of the T wave) for heart rate (QTc) > 480 msec obtained
from three ECGs, using the screening clinic ECG machine-derived QTc value
• Any clinically important abnormalities in rhythm, conduction, or morphology of
resting ECG (e.g., complete left bundle branch block, third degree heart block,
second degree heart block, PR interval > 250 msec)
• Any factors that increase the risk of QTc prolongation or risk of arrhythmic
events such as heart failure, congenital long QT syndrome, family history of long
QT syndrome, or any concomitant medication known to prolong the QT interval
6. Peripheral neuropathy of CTCAE ≥grade 2.
7. Subjects being treated with or anticipating the need for treatment with strong CYP3A4
inhibitors or inducers.
Safety and Effectiveness of Quizartinib in Children and Young Adults With Acute Myeloid Leukemia (AML), a Cancer of the Blood
Quizartinib is an experimental drug. It is not approved for regular use. It can only be used
in medical research.
Children or young adults with a certain kind of blood cancer (FLT3-ITD AML) might be able to
join this study if it has come back after remission or is not responding to treatment.
• Has diagnosis of AML according to the World Health Organization (WHO) 2008
classification with ≥5% blasts in bone marrow, with or without extramedullary disease
• Is in first relapse or refractory to first-line high-dose chemotherapy with no more
than 1 attempt (1 to 2 cycles of induction chemotherapy) at remission induction -
prior HSCT is permitted
• Has presence of the FLT3-ITD activating mutation in bone marrow or peripheral blood as
defined in the protocol
• Is between 1 month and 21 years of age at the time the Informed Consent/Assent form is
signed
• Has protocol-defined adequate performance status score
• Has fully recovered from the acute clinically significant toxicity effects of all
prior chemotherapy, immunotherapy, or radiotherapy, per protocol guidelines
• Has protocol-defined adequate renal, hepatic and cardiac functions
• If of reproductive potential, is permanently sterile or agrees to use highly effective
birth control upon enrollment, during the period of therapy, and for 6 months
following the last dose of study drug or cytarabine, whichever is later
• If female of child-bearing potential, tests negative for pregnancy and agrees not to
breast feed
• Participant/legal representative is capable of understanding the investigational
nature of the study, potential risks, and benefits, and the patient (and/or legal
representative) signs a written assent/informed consent
• Meets protocol-specified guidelines before inclusion in the continuation therapy phase
Exclusion Criteria:
• Has been diagnosed with isolated central nervous system relapse, certain kinds of
leukemia, or with myeloid proliferations related to Down syndrome
• Has uncontrolled or pre-defined significant cardiovascular disease as detailed in the
protocol
• Has systemic fungal, bacterial, viral or other infection that is exhibiting ongoing
signs/symptoms related to the infection without improvement despite appropriate
antibiotics or other treatment. The patient must be off vasopressors and have negative
blood cultures for at least 48 hours prior to the start of systematic protocol
therapy.
• Has known active clinically relevant liver disease (e.g., active hepatitis B or active
hepatitis C)
• Has known history of human immunodeficiency virus (HIV)
• Has history of hypersensitivity to any of the study medications or their excipients
• Is receiving or is anticipated to receive concomitant chemotherapy, radiation, or
immunotherapy other than as specified in the protocol
• Has any significant concurrent disease, illness, psychiatric disorder or social issue
that would compromise subject safety or compliance, interfere with consent/assent,
study participation, follow up, or interpretation of study results
• Is currently participating in another investigative interventional procedure
(observational or long-term interventional follow-up is allowed)
• Is otherwise considered inappropriate for the study by the Investigator
A Study to Evaluate the Effectiveness and Safety of CAEL-101 in Patients With Mayo Stage IIIb AL Amyloidosis
AL (or light chain) amyloidosis begins in the bone marrow where abnormal proteins misfold and
create free light chains that cannot be broken down. These free light chains bind together to
form amyloid fibrils that build up in the extracellular space of organs, affecting the
kidneys, heart, liver, spleen, nervous system and digestive tract.
The primary purpose of this study is to determine if CAEL-101 improves the overall survival
in Patients with cardiac AL Amyloidosis.
• Each patient must meet the following criteria to be enrolled in this study.
1. Be able to and provide written informed consent and be willing and able to comply
with all study procedures
2. Adult, 18 years and older
3. AL amyloidosis Mayo stage IIIb based on the 2013 European Modification of the
2004 Standard Mayo Clinic Staging in patients with advanced cardiac involvement
at the time of Screening
4. Measurable hematologic disease at Screening as defined by at least one of the
following:
1. Involved/Uninvolved Free Light Chain Difference (dFLC) > 4 mg/dL or
2. Involved Free Light Chain (iFLC) > 4 mg/dL with abnormal ratio or
3. Serum Protein Electrophoresis (SPEP) m-spike > 0.5 g/dL
5. Histopathological diagnosis of amyloidosis AND confirmation of AL derived amyloid
deposits by at least one of the following:
1. Immunohistochemistry or
2. Mass spectrometry or
3. Characteristic electron microscopy appearance
6. Cardiac involvement as defined by:
a. Documented clinical signs and symptoms supportive of a diagnosis of heart
failure in the setting of a confirmed diagnosis of AL amyloidosis in the absence
of an alternative explanation for heart failure AND b. At least one of the
following: i. Endomyocardial biopsy demonstrating AL cardiac amyloidosis or
ii. Echocardiogram demonstrating a mean left ventricular wall thickness
(calculated as [IVSd+LPWd]/2) of > 12 mm at diastole in the absence of other
causes (e.g., severe hypertension, aortic stenosis), which would adequately
explain the degree of wall thickening or
iii. Cardiac MRI with gadolinium contrast agent diagnostic or cardiac amyloidosis
7. Planned first-line treatment for plasma cell disorder is a CyBorD-based regimen
administered as Standard of Care (SoC)
8. Adequate bone marrow reserve and hepatic function as demonstrated by:
1. Absolute neutrophil count ≥ 1.0 x 109/L
2. Platelet count ≥ 75 x 109/L
3. Hemoglobin ≥ 9 g/dL
4. Total direct bilirubin ≤ 2 times the upper limit of normal (x ULN) unless
due to Gilbert's syndrome.
5. Aspartate aminotransferase (AST) ≤ 3 x ULN
6. Alanine aminotransferase (ALT) ≤ 3 x ULN
7. Alkaline phosphatase (ALP) ≤ 5 x ULN (except for patients with hepatomegaly
and isozymes specific to liver, rather than bone)
9. Women of childbearing potential (WOCBP) must have a negative pregnancy test
during Screening and must agree to use highly effective physician approved
contraception from Screening to at least 5 months following the last study drug
administration or 12 months following the last dose of her PCD therapy, whichever
is longer
10. Men must be surgically sterile or must agree to use effective physician approved
contraception and refrain from donating sperm from Screening to at least 5 months
following the last study drug administration or 12 months following the last dose
of his PCD therapy, whichever is longer.
Exclusion Criteria:
• Patients who meet any of the following criteria will not be permitted entry to the
study.
1. Have any other form of amyloidosis other than AL amyloidosis
2. Received prior therapy for AL amyloidosis or multiple myeloma. A maximum exposure
of 2 weeks of a CyBorD-based PCD treatment after screening laboratory samples are
obtained and prior to randomization is allowed.
3. Has POEMS syndrome or multiple myeloma defined as clonal bone marrow plasma cells
> 10% or biopsy-proven bony or extramedullary plasmacytoma AND any one or more of
the following CRAB features:
a. Evidence of end organ damage that can be attributed to the underlying plasma
cell proliferative disorder, specifically:
i. Hypercalcemia: serum calcium > 0.25 mmol/L (> 1mg/dL) higher than the ULN or >
2.75 mmol/L (> 11mg/dL)
ii. Renal insufficiency: creatinine clearance < 40 mL per minute or serum
creatinine > 177mol/L (> 2mg/dL)
iii. Anemia: hemoglobin value of > 20g/L below the lowest limit of normal, or a
hemoglobin value < 100g/L
iv. Bone lesions: one or more osteolytic lesion on skeletal radiography, CT, or
PET/CT. If bone marrow has < 10% clonal plasma cells, more than one bone lesion
is required to distinguish from solitary plasmacytoma with minimal marrow
involvement
OR
b. Any one of the following biomarkers of malignancy:
i. 60% or greater clonal plasma cells on bone marrow examination
ii. More than one focal lesion on MRI that is at least 5mm or greater in size
4. Have supine systolic blood pressure < 90 mmHg or symptomatic orthostatic
hypotension, defined as a decrease in systolic blood pressure upon standing of >
30 mmHg despite medical management (e.g., midodrine, fludrocortisones) in the
absence of volume depletion
5. Taking prednisone or its equivalent > 10 mg/day
6. Taking doxycycline
7. Receiving dialysis
8. Planned stem cell transplant during the first 6 months of protocol therapy. Stem
cell collection during the protocol therapy is permitted.
9. Have had myocardial infarction, uncontrolled angina, severe uncontrolled
ventricular arrhythmias within 6 months prior to screening or percutaneous
cardiac intervention with recent stent or coronary artery bypass grafting within
4 months prior to screening. Exacerbation of chronic condition or new acute
condition will require discussion and approval by the Medical Monitor.
10. Left Ventricular Ejection Fraction (LVEF) is < 40% by echocardiogram at Screening
11. Have severe valvular stenosis (e.g., aortic or mitral stenosis with a valve area
< 1.0 cm2) or severe congenital heart disease
12. Have history of sustained ventricular tachycardia or aborted ventricular
fibrillation or a history of atrioventricular nodal or sinoatrial nodal
dysfunction for which a pacemaker/implantable cardioverter-defibrillator (ICD) is
indicated but not placed. (Participants who do have a pacemaker or ICD are
allowed in the study.)
13. QT corrected by Fridericia (QTcF) is > 550 msec. Participants who have a
pacemaker may be included regardless of calculated QTc interval.
14. There is evidence of acute ischemia or active conduction system abnormalities
with the exception of any of the following:
1. First degree Atrioventricular (AV)-block
2. Second degree AV-block Type 1 (Mobitz Type 1/Wenckebach type)
3. Right or left bundle branch block
4. Atrial fibrillation with a controlled ventricular rate. (An uncontrolled
ventricular rate [i.e., > 110 beats per minute] determined by an average of
three beats in lead II or representative beats in lead II is not allowed)
15. Have had major surgery within 4 weeks of randomization or is planning major
surgery during the study. Patients with surgical procedures conducted under local
anesthesia may participate
16. There is active malignancy (including lymphoma) with the exception of any of the
following:
1. Adequately treated basal cell carcinoma, squamous cell carcinoma, or in situ
cervical cancer
2. Adequately treated stage I cancer from which the patient is currently in
remission and has been in remission for > 2 years
3. Low-risk prostate cancer with Gleason score < 7 and prostate-specific
antigen < 10 mg/mL
4. Other localized and/or low risk malignancies may be permitted with Medical
Monitor approval.
17. Have received an investigational drug/device in another clinical investigational
study within 60 days before Screening
18. Hypersensitivity to the study drug
19. Have received a live vaccine within 4 weeks prior to first dose of CyBorD
20. Women who are breast feeding
21. Have any other medical, social or psychological factors that could affect the
patient's safety or ability to consent personally or comply with study
procedures.
Study of Orally Administered AG-120 in Subjects With Advanced Hematologic Malignancies With an IDH1 Mutation
The purpose of this Phase I, multicenter study is to evaluate the safety, pharmacokinetics,
pharmacodynamics and clinical activity of AG-120 in advanced hematologic malignancies that
harbor an IDH1 mutation. The first portion of the study is a dose escalation phase where
cohorts of patients will receive ascending oral doses of AG-120 to determine maximum
tolerated dose (MTD) and/or the recommended Phase II dose. The second portion of the study is
a dose expansion phase where four cohorts of patients will receive AG-120 to further evaluate
the safety, tolerability, and clinical activity of the recommended Phase II dose.
Additionally, the study includes a substudy evaluating the safety and tolerability, clinical
activity, pharmacokinetics, and pharmacodynamics of AG-120 in subjects with relapsed or
refractory myelodysplastic syndrome with an IDH1 mutation. Anticipated time on study
treatment is until disease progression or unacceptable toxicity occurs.
• Subject must be ≥18 years of age.
• Subjects must have documented IDH1 R132 gene-mutated advanced hematologic malignancy
based on local or central evaluation.
• Subjects must be amenable to serial bone marrow biopsies, peripheral blood sampling,
and urine sampling during the study.
• Subjects must have ECOG PS of 0 to 2.
• Platelet count ≥20,000/µL (Transfusions to achieve this level are allowed).
• Subjects must have adequate hepatic function as evidenced by: Aspartate
aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)
≤3.0 × ULN, unless considered due to leukemic disease and serum total bilirubin ≤1.5 x
upper limit of normal (ULN), unless considered due to Gilbert's disease or leukemic
disease
• Subjects must have adequate renal function as evidenced by a serum creatinine ≤2.0 ×
ULN or creatinine clearance >40mL/min based on Cockroft-Gault glomerular filtration
rate (GFR)
• Subjects must be recovered from any clinically relevant toxic effects of any prior
surgery, radiotherapy, or other therapy intended for the treatment of cancer.
• Female subjects with reproductive potential must have a negative serum pregnancy test
within 7 days prior to the start of therapy and on the first day of study drug
administration.
Key
Exclusion Criteria:
• Subjects who have undergone hematopoietic stem cell transplant (HSCT) within 60 days
of the first dose of AG-120, or subjects on immunosuppressive therapy post HSCT at the
time of screening, or with clinically significant graft-versus-host disease (GVHD).
(The use of a stable dose of oral steroids post HSCT and/or topical for ongoing skin
GVHD is permitted.)
• Subjects who received systemic anticancer therapy or radiotherapy <14 days prior to
their first day of study drug administration. (Hydroxyurea is allowed prior to
enrollment and after the start of AG-120).
• Subjects who received an investigational agent <14 days prior to their first day of
study drug administration.
• Subjects who are pregnant or breastfeeding.
• Subjects with an active severe infection or with an unexplained fever >38.5°C during
screening visits or on their first day of study drug administration (at the discretion
of the Investigator, subjects with tumor fever may be enrolled).
• Subjects with New York Heart Association (NYHA) Class III or IV congestive heart
failure or LVEF <40% by echocardiogram (ECHO) or multi-gated acquisition (MUGA) scan
within approximately 28 days of C1D1.
• Subjects with a history of myocardial infarction within the last 6 months of
screening.
• Subjects with a known unstable or uncontrolled angina pectoris.
• Subjects with a known history of severe and/or uncontrolled ventricular arrhythmias.
• Subjects with known unstable or uncontrolled angina pectoris.
• Subjects with heart-rate corrected QT (QTc) interval ≥450 ms or other factors that
increase the risk of QT prolongation or arrhythmic events.
• Patients taking medications that are known to prolong the QT interval
• Subjects with known infection with human immunodeficiency virus (HIV) or active
hepatitis B or C.
• Subjects with clinical symptoms suggesting active central nervous system (CNS)
leukemia or known CNS leukemia. Evaluation of cerebrospinal fluid is only required if
there is a clinical suspicion of CNS involvement by leukemia during screening.
• Subjects with immediately life-threatening, severe complications of leukemia such as
uncontrolled bleeding, pneumonia with hypoxia or shock, and/or disseminated
intravascular coagulation.
Drug: AG-120
Myelodysplastic Syndromes, Relapsed or Refractory Acute Myeloid Leukemia (AML), Untreated AML, Other IDH1-mutated Positive Hematologic Malignancies, Leukemia, Other, Myeloid and Monocytic Leukemia
'Re-Priming' RT After Incomplete Response to CAR-T in R/R NHL
This is a single-arm open-label phase I/II trial studying the safety and efficacy of focal
're-priming' radiation therapy (RT) to FDG-avid residual sites of disease in
relapsed/refractory non-Hodgkin lymphoma (R/R NHL) patients with incomplete response (IR) to
CAR T-cell therapy (CAR-T) by day 30 post-CAR-T PET/CT. We hypothesize that focal
're-priming' RT will be safe (phase I) and improve conversion to metabolic complete response
(CR) by day 90 post-CAR-T PET/CT from 29% (historical control) to 58% (phase II).
1. Age ≥ 18 years.
2. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 at screening (See
Section 13, Appendix A).
3. Biopsy-proven histological high-grade non-Hodgkin lymphoma, such as diffuse large
B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBCL), or transformed
follicular lymphoma.
4. Prior treatment with any CD19-directed CAR T-cell therapy, such as tisagenlecleucel
(tisa-cel, Kymriah), axicabtagene ciloleucel (axi-cel, Yescarta), or lisocabtagene
maraleucel (liso-cel).
5. Incomplete response noted on day 30 PET post-CAR-T, defined as not achieving CR per
Lugano 2014 classification37.
6. Ability to understand and the willingness to sign a written informed consent
7. All men, as well as women of child-bearing potential must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) prior to study
entry, for the duration of study participation, and for 90 days following completion
of therapy. Should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately.
7.1 A female of child-bearing potential is any woman (regardless of sexual orientation,
marital status, having undergone a tubal ligation, or remaining celibate by choice) who
meets the following criteria:
• Has not undergone a hysterectomy or bilateral oophorectomy; or
• Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has
had menses at any time in the preceding 12 consecutive months).
Exclusion Criteria:
1. Prior radiation therapy to one or more sites of incomplete response as noted on day 30
post-CAR-T PET/CT scan within the past one year.
2. Intracranial site of incomplete response as noted on day 30 post-CAR-T PET/CT scan or
any active central nervous system involvement by malignancy.
3. Active grade 3 or higher CRS or neurotoxicity related to CAR-T.
4. Patients with prior history of auto-immune disease or other contraindication to RT.
5. Patients with life expectancy < 3 months.
6. Psychiatric illness/social situations that would limit compliance with study
requirements.
7. Subjects must not be pregnant or nursing due to the potential for congenital
abnormalities and the potential of this regimen to harm nursing infants.
8. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that, in the opinion of the
investigator, would limit compliance with study requirements.
A Safety and Efficacy Study Evaluating CTX110 in Subjects With Relapsed or Refractory B-Cell Malignancies (CARBON)
This is an open-label, multicenter, Phase 1 study evaluating the safety and efficacy of
CTX110 in subjects with relapsed or refractory B-cell malignancies.
1. For NHL patients: Age ≥18 years. For B cell ALL patients: age ≥18 years to ≤70 years
2. Refractory or relapsed non-Hodgkin lymphoma, as evidenced by 2 or more lines of prior
therapy, or histologically confirmed B cell ALL, refractory or relapsed.
3. Eastern Cooperative Oncology Group performance status 0 or 1.
4. Adequate renal, liver, cardiac and pulmonary organ function
5. Female subjects of childbearing potential and male subjects must agree to use
acceptable method(s) of contraception from enrollment through at least 12 months after
CTX110 infusion.
6. Agree to participate in an additional long-term follow-up study after completion of
this study.
Key
Exclusion Criteria:
1. Treatment with any gene therapy or genetically modified cell therapy, including CAR T
cells.
2. For NHL patients: prior allogeneic HSCT. For B cell ALL patients: prior allogeneic
HSCT within 6 months, and/or any evidence of GvHD.
3. History of central nervous system (CNS) involvement by malignancy
4. History of a seizure disorder, cerebrovascular ischemia/hemorrhage, dementia,
cerebellar disease, or any autoimmune disease with CNS involvement.
5. Presence of bacterial, viral, or fungal infection that is uncontrolled or requires IV
anti-infectives.
6. Active HIV, hepatitis B virus or hepatitis C virus infection.
7. Previous or concurrent malignancy, except basal cell or squamous cell skin carcinoma,
adequately resected and in situ carcinoma of cervix, or a previous malignancy that was
completely resected and has been in remission for ≥5 years.
8. For NHL patients: Use of systemic anti-tumor therapy or investigational agent within
14 days or 5 half-lives, whichever is longer, of enrollment. For B cell ALL patients:
Use of systemic antitumor therapy within 7 days of enrollment.
9. Primary immunodeficiency disorder or active autoimmune disease requiring steroids
and/or other immunosuppressive therapy.
10. Women who are pregnant or breastfeeding.
Biological: CTX110
Non-hodgkin Lymphoma, Lymphoid Leukemia, Non-Hodgkins Lymphoma, B-cell Malignancy, B-cell Lymphoma, Adult B Cell ALL
CAR T, Non-Hodgkin Lymphoma, NHL, Lymphoma, Allogeneic, Leukemia
Safety, Tolerability and Pharmacokinetics of a Monoclonal Antibody Specific to B-and T-Lymphocyte Attenuator (BTLA) as Monotherapy and in Combination With an Anti-PD1 Monoclonal Antibody for Injection in Subjects With Advanced Malignancies
The primary objective is to assess the safety and tolerability of TAB004 as monotherapy and
in combination with toripalimab in subjects with selected advanced solid malignancies,
including lymphoma, and to evaluate the recommended Phase 2 dose.
The secondary objectives are to: 1) describe the pharmacokinetic (PK) profile of TAB004
monotherapy and in combination with toripalimab and to describe the PK profile of toripalimab
when administered with TAB004, 2) evaluate antitumor activity of TAB004 monotherapy and in
combination with toripalimab; and 3) determine the immunogenicity of TAB004 monotherapy and
in combination with toripalimab and to determine the immunogenicity of toripalimab when
administered with TAB004.
The exploratory objectives are to: 1) evaluate pharmacodynamic effects of TAB004 on its
target receptor BTLA, as well as effects on the immune system; 2) evaluate biomarkers that
may correlate with activity of TAB004 as monotherapy and in combination with toripalimab; 3)
evaluate the utility of BTLA ligand, herpesvirus-entry mediator (HVEM), and additional
exploratory biomarkers that could aid in selection of appropriate subjects for TAB004
monotherapy and in combination with toripalimab.
• 1. Able to understand and willing to sign the Informed Consent Form;
• 2. Male or female ≥ 18 years;
• 3. Subjects with histologically or cytologically confirmed advanced unresectable or
metastatic solid tumor, including lymphoma that have progressed following prior
treatment. In Part A, subjects must have received, or be ineligible for or intolerant
of all available approved or standard therapies known to confer clinical benefit
including immunotherapy, or for whom no standard therapy exists; in Part B, subjects
with advanced or metastatic solid tumors, including but not limited to lymphoma,
melanoma, NSCLC, or other tumors with agreement of the Sponsor, who must have received
at least one line of therapy for advanced or metastatic disease, but are not required
to have received all standard therapies known to confer clinical benefit; In Part C,
subjects must have received at least one line of therapy for advanced or metastatic
disease but are not required to have received all standard therapies known to confer
clinical benefit; In Part D, subjects with advanced or metastatic solid tumors that
may include but not limited to lymphoma, melanoma, NSCLC, RCC or UC who must have
received at least one line of therapy for advanced or metastatic disease, but are not
required to have received all standard therapies known to confer clinical benefit.
• 4. Measurable disease per RECISTv1.1 and iRECIST, or RECIL 2017 for lymphoma
• 5. ECOG performance status of 0 or 1 with life expectancy of 3 months in the opinion
of the investigator.
• 6. Adequate organ and marrow function, as defined below:
1. Hemoglobin 8.0 g/dL within first 2 weeks prior to first dose of TAB004 (are not
requiring a transfusion within 14 days prior to dosing)
2. Absolute neutrophil count (ANC) 1.0 x 109 /L (1,000 /mm3)
3. Absolute lymphocyte count ≥ 0.6 x 109/L (600/mm3)
4. Platelet count 75 x 109 /L (75,000 /mm3), and not requiring platelet transfusions
within the 5 days prior to dosing
5. Total bilirubin ≤ 1.5 x ULN except subjects with documented Gilbert's syndrome
who must have a baseline total bilirubin ≤ 3.0 mg/dL
6. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN;
for subjects with hepatic metastases, ALT and AST ≤ 5 x ULN
7. Serum creatinine ≤ 1.5 x ULN OR calculated creatinine clearance (CrCl) or 24 hour
urine CrCl ≥ 40 mL/minute Cockcroft-Gault formula will be used to calculate CrCl.
24-hour urine CrCl will be derived using the measured creatinine clearance
formula
8. International normalized ratio (INR) ≤ 2.0 and activated partial thromboplastin
time (aPTT) ≤ 1.5 x ULN; applies only to subjects who do not receive therapeutic
anticoagulation; subjects receiving therapeutic anticoagulation (such as
low-molecular weight heparin or warfarin) should be on a stable dose
• 7. Willingness to provide consent for biopsy samples (In Part A, fresh pre-treatment
biopsies will be requested from subjects with safely accessible lesions. For subjects
who cannot provide a fresh pre-treatment biopsy, request for the most recent
accessible archival specimen will be required. In Part B, C and D, fresh pre-treatment
biopsies will be required from subjects with safely accessible lesions. The most
recent archival specimens will also be requested).
• 8. Females of childbearing potential who are sexually active with a nonsterilized male
partner must use effective contraception from time of screening, and must agree to
continue using such precautions for 90 days after the final dose of TAB004 or
toripalimab; cessation of birth control after this point should be discussed with a
responsible physician. Periodic abstinence, the rhythm method, and the withdrawal
method are not acceptable methods of birth control.
• 9. Females of childbearing potential are defined as those who are not surgically
sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or complete
hysterectomy) or postmenopausal (defined as at least 12 months with no menses
confirmed by follicle-stimulating hormone [FSH] levels. FSH testing will be conducted
at the Screening visit to confirm post-menopausal status).
• 10. Subjects must use effective contraception. Nonsterilized males who are sexually
active with a female partner of childbearing potential must use effective
contraception from Day 1 and for 90 days after receipt of the final dose of TAB004 or
toripalimab.
Exclusion Criteria:
• 1. Concurrent enrollment in another clinical study, unless it is an observational (non
interventional) clinical study or the follow-up period of an interventional study.
• 2. Any concurrent anti-cancer therapy, such as but not limited to chemotherapy,
targeted therapy, radiotherapy, immunotherapy, or biologic therapy. Radiation
treatment for palliative intent is allowed provided that lesions other than those
receiving radiation are available to measure response. Concurrent use of hormones for
non-cancer-related conditions (e.g., insulin for type 2 diabetes and hormone
replacement therapy) is acceptable.
Note: Local treatment of isolated lesions for palliative intent is acceptable (e.g., by
local surgery or radiotherapy).
• 3. Receipt of any investigational anticancer therapy within 28 days prior to the first
dose of TAB004 or, provided documentable, 5 half lives whichever is shorter, except
for lymphoma in which the exclusionary period is 2 weeks for immune checkpoint
inhibitors only.
• 4. Current or prior use of immunosuppressive medication within 2 weeks prior to the
first dose of TAB004, with the exception of intranasal and inhaled corticosteroids or
systemic corticosteroids not to exceed 10 mg/day of prednisone or equivalent.
• 5. Prior exposure to anti-BTLA, or anti-HVEM antibodies for subjects enrolled into
Part A and B only; prior treatment with anti-PD-1 or anti-PDL-1is allowed,including
toripalimab for all subjects.
• 6. Prior allogeneic bone marrow transplantation or prior solid organ transplantation.
• 7. Subjects with another malignancy, or history or other malignancy within 3 years
that is not expected to relapse. Subjects with non-melanomatous skin cancer or
cervical cancer that has been curatively surgically resected are eligible.
• 8. Major surgery (as defined by the investigator) within 28 days prior to first dose
of TAB004 or has not recovered to at least Grade 1 from adverse effects from such
procedure, or anticipation of the need for major surgery during study treatment.
• 9. Unresolved toxicities from prior anticancer therapy, defined as having not resolved
to baseline or to NCI-CTCAE v5.0 Grade 0 or 1, or to levels dictated in the
inclusion/exclusion criteria with the exception of neuropathies that are stable or
improving and alopecia. Subjects with irreversible toxicity that is not reasonably
expected to be exacerbated by TAB004 may be included (e.g., hearing loss) after
consultation with the medical monitor.
• 10. Active or prior documented autoimmune disease, such as but not limited to systemic
lupus erythematosus, multiple sclerosis, inflammatory bowel diseases, rheumatoid
arthritis, autoimmune hepatitis, systemic sclerosis, autoimmune vasculitis, autoimmune
neuropathies or type 1 insulin-dependent diabetes mellitus.
Note: Subjects with the following are not excluded: vitiligo; alopecia; Grave's disease not
requiring systemic treatment other than thyroid hormone replacement (within the past 2
years) psoriasis not requiring systemic treatment; controlled celiac disease; subjects with
a history of autoimmune hypothyroidism requiring only thyroid hormone replacement therapy;
And type 2 diabetes, provided that it is adequately controlled.
• 11. Clinically significant (intracranial, gastrointestinal) bleeding within 2 weeks
prior to screening.
• 12. Known history of tuberculosis.
• 13. Subjects with history of or current drug-induced interstitial lung disease or
pneumonitis ≥ Grade 2.
• 14. Subjects who have discontinued prior immune therapy due to immune mediated adverse
reaction(s).
• 15. Subjects who are known to be human immunodeficiency virus positive.
• 16. Subjects with evidence of hepatitis B or C virus infection, unless their hepatitis
is considered to have been cured. (Note that subjects with prior hepatitis B virus
infection must have HBV viral load < 100 IU/mL before study enrollment, and must be
treated according to local standards; hepatitis C virus infection must have, before
study enrollment, no detectable viral load and must be treated according to local
standards).
• 17. Active or prior documented inflammatory bowel disease (e.g., Crohn's disease,
ulcerative colitis). Infection-related bowel inflammation, such as Clostridium
difficile colitis, is not excluded provided that it has been fully resolved for ≥ 6
weeks.
• 18. History of anaphylaxis, or eczema that cannot be controlled with topical
corticosteroids asthma.
• 19. Adult asthma that is moderate or severe, or asthma that has required:
hospitalization in the last 2 years; invasive mechanical ventilation ever; systemic
corticosteroids in the past year for exacerbations; or more than two short acting beta
agonist (e.g., albuterol) administrations per month for breakthrough asthma symptoms.
A history of childhood asthma or the presence of mild adult asthma that at baseline
has symptoms that can be controlled well with inhaled corticosteroids or short acting
beta agonists will not be excluded.
• 20. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure according to New York Heart
Association Functional Classification ≥ 3, uncontrolled hypertension, unstable angina
pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, or psychiatric
illness/social situations that would limit compliance with study requirements,
substantially increase risk of incurring adverse events from TAB004, or compromise the
ability of the subject to give written informed consent.
• 21. Untreated central nervous system and leptomeningeal metastases or requiring
ongoing treatment for these metastases, including corticosteroids. Subjects with
previously treated brain metastases may participate provided they are clinically
stable for at least 28 days prior to study entry, have no evidence of new or enlarging
metastases, and are off steroids.
• 22. Receipt of live attenuated vaccination within 28 days prior to study entry or
within 30 days of receiving TAB004.
• 23. Any condition or treatment or diagnostic test that, in the opinion of the
investigator or sponsor, would interfere with evaluation of TAB004 or interpretation
of subject safety or study results.
• 24. Pregnancy or breast feeding women.
A Study of Teclistamab in Combination With Daratumumab Subcutaneously (SC) (Tec-Dara) Versus Daratumumab SC, Pomalidomide, and Dexamethasone (DPd) or Daratumumab SC, Bortezomib, and Dexamethasone (DVd) in Participants With Relapsed or Refractory Multiple Myeloma (MajesTEC-3)
The purpose of this study is to compare the efficacy of teclistamab-daratumumab (Tec-Dara)
with daratumumab subcutaneously (SC) in combination with pomalidomide and dexamethasone (DPd)
or daratumumab SC in combination with bortezomib and dexamethasone (DVd) in Part 1 and to
evaluate the pharmacokinetics (PK), safety, and efficacy of the Tec-Dara regimen when
teclistamab is administered using a alternative dosing schedule in Part 2.
• Documented multiple myeloma as defined by the criteria: a. multiple myeloma diagnosis
according to the International Myeloma Working Group (IMWG) diagnostic criteria, b.
measurable disease at screening as defined by any of the following: 1) serum M-protein
level greater than or equal to (>=) 0.5 gram per deciliter (g/dL); or 2) urine
M-protein level >=200 milligrams (mg)/24 hours; or 3) serum immunoglobulin free light
chain >=10 mg/dL and abnormal serum immunoglobulin kappa lambda free light chain ratio
• Received 1 to 3 prior line(s) of antimyeloma therapy including a proteasome inhibitor
(PI) and lenalidomide; a. participants who have received only 1 line of prior line of
antimyeloma therapy must be lenalidomide refractory. Stable disease or progression on
or within 60 days of the last dose of lenalidomide given as maintenance will meet this
criterion
• Documented evidence of progressive disease based on investigator's determination of
response by IMWG criteria on or after their last regimen
• Have an eastern cooperative oncology group (ECOG) performance status score of 0, 1, or
2 at screening and prior to the start of administration of study treatment
• Have clinical laboratory values within the specified range
Exclusion Criteria:
• Contraindications or life-threatening allergies, hypersensitivity, or intolerance to
any study drug or its excipients. Additional exclusion criteria pertaining to specific
study drugs include:
1. A participant is not eligible to receive daratumumab subcutaneous (SC) in
combination with pomalidomide and dexamethasone (DPd) as control therapy if any
of the following are present: 1) Contraindications or life-threatening allergies,
hypersensitivity, or intolerance to pomalidomide, 2) Disease that is considered
refractory to pomalidomide per IMWG,
2. A participant is not eligible to receive daratumumab SC in combination with
bortezomib and dexamethasone (DVd) as control therapy if any of the following are
present: 1) Contraindications or life-threatening allergies, hypersensitivity, or
intolerance to bortezomib, 2) Grade 1 peripheral neuropathy with pain or Grade >=
2 peripheral neuropathy as defined by National Cancer Institute Common
Terminology Criteria for Adverse Events (NCI-CTCAE) Version 5.0, 3) Disease that
is considered refractory to bortezomib per IMWG, 4) Received a strong cytochromes
P450 (CYP3A4) inducer within 5 half-lives prior to randomization
• Received any prior B cell maturation antigen (BCMA)-directed therapy
• Has disease that is considered refractory to an anti-cluster of differentiation 38
(CD38) monoclonal antibody per IMWG
• Received a cumulative dose of corticosteroids equivalent to >=140 mg of prednisone
within 14 days before randomization
• Received a live, attenuated vaccine within 4 weeks before randomization
• Plasma cell leukemia at the time of screening, Waldenström's macroglobulinemia, POEMS
syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes),
or primary amyloid light chain amyloidosis
The OPAL Study: AVM0703 for Treatment of Lymphoid Malignancies (OPAL)
This is an open-label, Phase 1/2 study designed to characterize the safety, tolerability,
Pharmacokinetics(PK), and preliminary antitumor activity of AVM0703 administered as a single
intravenous (IV) infusion to patients with lymphoid malignancies.
• 1. Age ≥12 years and weight >40 kg;
2. Histologically confirmed diagnosis per 2016 World Health Organization (WHO)
classification of lymphoid neoplasms160 and per the 2016 WHO classification of acute
leukemia161 of the following indications:
• DLBCL, including arising from follicular lymphoma;
• High-grade B-cell lymphoma;
• MCL;
• Primary mediastinal large B-cell lymphoma;
• Primary DLBCL of the CNS;
• Burkitt or Burkitt-like lymphoma/leukemia;
• CLL/SLL; or
• B-lymphoblastic leukemia/lymphoma, T-lymphoblastic leukemia/lymphoma, acute
leukemia/lymphoma, acute leukemias of ambiguous lineage, or NK cell lymphoblastic
leukemia/lymphoma;
3. Patients must have R/R disease with prior therapies defined below:
• DLBCL and high-grade B-cell lymphoma:
1. R/R after autologous HCT; or
2. R/R after CAR T therapy; or
3. Ineligible for autologous HCT or CAR T therapy due to persistent disease,
co-morbidity, or social issues (eg, lack of insurance, lack of caregiver,
etc); or
4. R/R after ≥2 lines of therapy including anti-20 antibody. Patients must have
failed or are intolerant or ineligible for polatuzamab vedotin;
• MCL:
1. R/R after autologous HCT; or
2. Ineligible for autologous HCT due to persistent disease, co-morbidity, or
social issues (eg, lack of insurance, lack of caregiver, etc); or
3. R/R after ≥2 lines of therapy including at least 1 of the following: a BTK
inhibitor, bortezomib, or lenalidomide;
• Primary mediastinal large B-cell lymphoma:
a. R/R after ≥1 line of therapy; AVM Biotechnology, LLC. Clinical Study Protocol
AVM0703-001 Confidential & Proprietary Page 47 of 105 Version 1.0, 20 February
2020
• Primary DLBCL of the CNS:
a. R/R after ≥1 line of therapy including methotrexate (unless intolerant to
methotrexate);
• Burkitt or Burkitt-like lymphoma/leukemia:
1. R/R after autologous or allogeneic HCT; or
2. Ineligible for autologous or allogeneic HCT due to persistent disease,
co-morbidity, or social issues (eg, lack of insurance, lack of caregiver,
etc);
• CLL/SLL:
1. R/R after autologous or allogeneic HCT; or
2. Ineligible for autologous or allogeneic HCT due to persistent disease,
co-morbidity, or social issues (eg, lack of insurance, lack of caregiver,
etc); or
3. R/R after ≥2 lines of therapy including at least 1 of the following: a BTK
inhibitor, ventoclax, idelalisib, or duvelisib;
• ALL:
1. R/R after autologous or allogeneic HCT; or
2. Ineligible for allogeneic HCT due to persistent disease, co-morbidity, or
social issues (eg, lack of insurance, lack of caregiver, etc); or
3. R/R according to the following disease-specific specifications:
• B-cell lymphoblastic leukemia/lymphoma: ≥2 lines of therapy including approved
CAR T cell therapies, inotuzumab, ozogamicin, or blinatumomab; or
• T-cell lymphoblastic leukemia/lymphoma: Patients must have failed nelarabine; or
• NK cell lymphoblastic leukemia/lymphoma: R/R after ≥1 line of therapy;
4. Lansky (12 to 15 years of age) (Appendix G) or Karnofsky (≥16 years of age)
(Appendix H) performance status ≥50;
5. Screening laboratory values that meet all of the following criteria:
• Absolute neutrophil count ≥0.5 × 109/L;
• Platelet count >50 × 109/L;
• Hemoglobin ≥8.0 g/dL;
• Aspartate aminotransferase or alanine aminotransferase ≤2.5 × ULN, unless due to
the disease;
• Total bilirubin ≤1.5 × ULN (if secondary to Gilbert's syndrome, ≤3 × ULN is
permitted), unless due to the disease; and
• Serum creatinine ≤1.5 × ULN or glomerular filtration rate ≥50 mL/min (calculated
from a 24-hour urine collection);
6. Minimum level of pulmonary reserve defined as Exclusion Criteria:
• Patients who meet any of the following criteria will be excluded from participation in
the study:
1. History of another malignancy, except for the following:
• Adequately treated local basal cell or squamous cell carcinoma of the skin;
• Adequately treated carcinoma in situ without evidence of disease;
• Adequately treated papillary, noninvasive bladder cancer; or
• Other cancer that has been in complete remission for ≥2 years. Patients with
low-grade prostate cancer, on active surveillance, and not expected to
clinically progress over 2 years are allowed;
2. Significant cardiovascular disease (eg, myocardial infarction, arterial
thromboembolism, cerebrovascular thromboembolism) within 3 months prior to the
start of AVM0703 administration, angina requiring therapy, symptomatic peripheral
vascular disease, New York Heart Association Class III or IV congestive heart
failure, left ventricular ejection fraction <30%, left ventricular fractional
shortening <20%, or uncontrolled ≥Grade 3 hypertension (diastolic blood pressure
[DBP] ≥100 mmHg or systolic blood pressure [SBP] ≥150 mmHg) despite
antihypertensive therapy for patients ≥18 years of age, or uncontrolled stage 2
hypertension (DBP ≥90 mmHg or SBP ≥140 mmHg) despite antihypertensive therapy for
patients ≥12 years of age;
3. Significant screening electrocardiogram (ECG) abnormalities, including unstable
cardiac arrhythmia requiring medication, atrial fibrillation/flutter, left
bundle-branch block, second-degree atrioventricular (AV) block type 2,
third-degree AV block, ≥Grade 2 bradycardia, or heart rate corrected QT interval
using Fridericia's formula average of triplicate ECGs >450 msec;
4. Known gastric or duodenal ulcer;
5. Uncontrolled type 1 or type 2 diabetes;
6. Known hypersensitivity or allergy to the study drug or any of its excipients;
7. Untreated ongoing bacterial, fungal, or viral infection (including upper
respiratory tract infections) at the start of AVM0703 administration, including
the following:
• Positive hepatitis B surface antigen and/or hepatitis B core antibody test
plus a positive hepatitis B polymerase chain reaction (PCR) assay. Patients
with a negative PCR assay are permitted with appropriate antiviral
prophylaxis;
• Positive hepatitis C virus antibody (HCV Ab) test. Patients with a positive
HCV Ab test are eligible if they are negative for hepatitis C virus by PCR;
• Positive human immunodeficiency virus (HIV) antibody test with detectable
HIV load by PCR, or the patient is not able to tolerate antiretroviral
therapy; or
• Positive testing for tuberculosis during screening;
8. Received live vaccination within 8 weeks of screening;
9. Pregnant or breastfeeding;
10. Concurrent participation in another therapeutic clinical study; or
11. Manic-depressive disorder, schizophrenia, or a history of severe depression or
substance abuse.
• For all participants:
• Sign the informed consent form (ICF) and be willing and able to comply with the
protocol.
• Weigh ≥15 kg
• Agree to use a highly effective form of contraception.
• Participants may be eligible for the study whether they are on or off G-CSF
treatment.
1. Participants who are on granulocyte-colony stimulating factor (G-CSF) must
be on a stable dose for at least 14 days prior to enrollment and for the
duration of the study.
2. Participants who are not on G-CSF must be off for at least 14 days prior to
enrollment and for the duration of the study.
• Have an absolute neutrophil count (ANC) < 1000 cells/µL at the screening and
baseline visits. Participants on G-CSF are allowed if their screening and
baseline ANC is ≥1000 cells/microliter (uL). Participants with cyclical
neutropenia are required to have ANC <1000 cells/ µL only at the baseline visit.
• Have been diagnosed with chronic neutropenia for at least 6 months prior to
screening that is not attributable to medications, active or recent (within 3
months) infections, or malignant cause.
Key
Exclusion Criteria:
• Known systemic hypersensitivity to the mavorixafor drug substance or its inactive
ingredients.
• Is pregnant or nursing.
• Known history of a positive serology or viral load for human immunodeficiency virus
(HIV) or a known history of acquired immune deficiency syndrome.
• At screening, has laboratory test results meeting one or more of the following
criteria:
• Positive hepatitis C virus (HCV) antibodies with confirmation by HCV-ribonucleic
acid polymerase chain reaction reflex testing.
• Positive hepatitis B surface antigen (HBsAg) or hepatitis B core antibody
(HBcAb).
Note: If a participant tests negative for HBsAg but positive for HBcAb, the participant
would be considered eligible if the participant tests positive for antibody to HBsAg reflex
testing.
• At screening, has laboratory test results meeting one or more of the following
criteria:
• Hemoglobin <9.0 grams/deciliter (g/dL).
• Platelet count <30,000/μL with prior or current history of clinical bleeding
events or malignancy or other bone marrow pathologies (e.g., myelodysplastic
syndrome).
• Mild/moderate renal impairment, defined as 30 to 60 milliliter/minute (mL/min)
estimated glomerular filtration rate.
• Serum aspartate transaminase >2.5 * upper limit of normal (ULN).
• Serum alanine transaminase >2.5 * ULN.
• Total bilirubin >1.5 * ULN (unless due to Gilbert's syndrome, in which case total
bilirubin greater than or equal to (≥) 3.0 * ULN and direct bilirubin >1.5 *
ULN).
• Within 2 weeks before Day 1, received any of the following treatments:
• Glucocorticoids (>5 mg prednisone equivalent per day).
• Medication prohibited based on cytochrome P450 (CYP) and/or transporter-based
(such as, P-glycoprotein ([P-gp]) potential for drug-drug interaction.
• At the planned initiation of study drug, has an infection requiring use of antibiotics
(systemic or inhaled) or took systemic antibiotics within 4 weeks before Day 1.
• Has any other medical or personal condition that, in the opinion of the Investigator,
may potentially compromise the safety or compliance of the participant, or may
preclude the participant's successful completion of the clinical study.
• Inability to ingest capsules of study drug as presented.
• Has a history of hematologic malignancy.
• Diagnosed or have suspected congenital long QT syndrome. Any history of clinically
significant ventricular arrhythmias (such as ventricular tachycardia, ventricular
fibrillation, or torsades de pointes); any history of arrhythmia will be discussed
with the sponsor's medical monitor before participant's entry into the study.
• Prolonged corrected QT interval using Fridericia's formula on pre-entry
electrocardiogram (ECG) (>450 milliseconds [ms]).
Study to Evaluate the Efficacy & Safety of the INTERCEPT Blood System for RBCs in Complex Cardiac Surgery Patients (ReCePI)
The objective of this study is to evaluate the efficacy and safety of RBC transfusion for
support of acute anemia in cardiovascular surgery patients based on the clinical outcome of
renal impairment following transfusion of red blood cells (RBCs) treated with the INTERCEPT
Blood System (IBS) for Red Blood Cells compared to patients transfused with conventional
RBCs.
1. Age ≥ 11 years of age
2. Weight ≥ 40 kg
3. Scheduled complex cardiac surgery or thoracic aorta surgery. The procedure may be
performed either on or off cardiopulmonary bypass machine (CBP or "pump"). For the
purposes of this protocol "Repeat procedure" means that the subject had a previous
cardiac surgery. Procedures that qualify as complex cardiac surgery include but are
not limited to, the following:
• Single Vessel Coronary Artery Bypass Graft, first or repeat procedure
• Multiple Coronary Artery Bypass Grafts, first or repeat procedure
• Single Valve Repair or Replacement, first or repeat procedure
• Multiple Valve Repair or Replacement, first or repeat procedure
• Surgery involving both Coronary Artery Bypass Graft(s) and Valve Repair(s), first
or repeat procedure
• One or more of the following procedures, with or without Coronary Bypass
Graft(s):
• left ventricular aneurysm repair
• ventricular and/or atrial septal defect repairs
• Batista procedure (surgical ventricular remodeling)
• surgical ventricular restoration
• congenital cardiac defect repair
• aortic procedures
• other cardiac surgery or thoracic aorta surgery types with a high
probability of bleeding
4. TRUST probability score (Alghamdi, Davis et al. 2006) ≥ 3, or currently on a regimen
of aspirin (any dose), clopidogrel (or analogs) and/or GPIIb/IIIa inhibitors or at a
high probability for need of a transfusion during or after surgery at the discretion
of the Investigator
5. Female subjects of child-bearing potential must meet the 2 criteria below at
screening:
• Negative serum or urine pregnancy test
• Use at least one method of birth control that results in a low failure rate
(i.e., less than 1% per year) when used consistently and correctly such as
implants, injectables, combined oral contraceptives, some intrauterine devices
(IUDs), sexual abstinence or vasectomized partner
6. Signed and dated informed consent/assent form
Exclusion Criteria:
1. Confirmed positive baseline serum/plasma antibody specific to INTERCEPT RBCs (S-303
specific antibody) screening panel prior to randomization.
2. Pregnant or breast feeding
3. Refusal of blood products or other inability to comply with the protocol in the
opinion of the Investigator or the treating physician
4. Treatment with any medication that is known to adversely affect RBC viability, such
as, but not limited to dapsone, levodopa, methyldopa, nitrofurantoin, and its
derivatives, phenazopyridine and quinidine.
5. Planned cardiac transplantation
6. Active autoimmune hemolytic anemia
7. Left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO)
support pre operatively or planned need post-operatively
8. Cardiogenic shock requiring pre-operative placement of an intra-aortic balloon pump
(IABP) (NOTE: IABP done for unstable angina or prophylactically for low ejection
fraction is not excluded).
9. Planned use of autologous or directed donations.
10. RBC transfusion during current hospitalization prior to enrollment and randomization
(within 7 days).
11. Participation in an interventional clinical study concurrently or within the previous
28 days. This includes investigational blood products, pharmacologic agents, imaging
materials (including dyes), surgical techniques, or devices. Observational studies of
FDA cleared or approved products or nutrition, psychology, or socioeconomic issues are
not grounds for exclusion
12. Patients with a current diagnosis of either chronic kidney disease or acute kidney
injury and with sCr ≥1.8 mg/dL at screening and patients requiring RRT. (NOTE: If sCr
at screening is <1.8 mg/dL, a patient with a diagnosis of chronic or acute kidney
injury alone is not excluded).
13. Patients with a current diagnosis of either chronic or acute hepatic insufficiency and
with a total serum bilirubin ≥ 2.0 mg/dL (≥34.2 µmol/L). (NOTE: If total serum
bilirubin at screening is <2.0 mg/dL, a patient with a diagnosis of chronic or acute
hepatic failure alone is not excluded).
14. Pre-existing antibody(ies) to RBC antigens that may make the provision of compatible
study RBC components difficult.
15. History of TRs requiring washed RBCs, volume reduced RBC, or RBCs with additive
solution removed.
16. Patients with documented IgA deficiency or a history of severe allergic reactions to
blood products.
17. Patients who require gamma-irradiated RBC blood components.
18. Positive DAT as defined below:
A polyspecific DAT reaction strength > 2+, or
A polyspecific DAT (any strength) in conjunction with pan-reactivity with a commercial IAT
antibody screening panel that precludes the identification of underlying alloantibodies or
indicates the presence of autoantibody
Device: INTERCEPT, Device: Control
Anemia
INTERCEPT, Red Blood Cells, RBC, Pathogen Inactivation, Cerus, Pathogen Reduction, Cardiovascular surgery
• Ages 8 to ≤ 21 years
• Participant must be able to speak and understand English
• Be willing to participate and able to comply with the study protocol
• For participants with PE: Children with acute, radiologically confirmed pulmonary
embolism (PE) with our without DVT
• For control group: Children who are prescribed physical activity restrictions for 2 up
to 12 weeks following any minor outpatient surgery or, minor injury (surgery or injury
is referred to as "diagnosis" hereafter)
Exclusion Criteria:
• Congenital heart disease with abnormal pulmonary circulation or with in-situ pulmonary
artery thrombosis
• Chronic kidney disease
• Chronic inflammatory or an autoimmune disorder (such as systemic lupus erythematosus,
juvenile rheumatoid disorder, inflammatory bowel disease, and sickle cell disease)
• A metabolic or endocrinological disorder such as diabetes mellitus or thyroid disorder
• History of or active cancer
• Pregnant
• Musculoskeletal limitations to exercise expected to be present uptil 4 months
post-diagnosis
• Weight ≥ 300 lbs
• Contraindications to magnetic resonance imaging
• Frequent severe exacerbations of asthma defined by two or more bursts of systemic
glucocorticoids (more than three days each) in the previous year or at least one
hospitalization, intensive care unit stay or mechanical ventilation in the previous
year. Patients should also be excluded if there are daily symptoms of asthma requiring
daily use of short-acting bronchodilators such as albuterol or levalbuterol
administration. The use of controller medications such as daily inhaled
corticosteroids for mild persistent asthma is not exclusionary.
• Has any other medical condition, which in the opinion of the investigator may
potentially compromise the safety or compliance of the patient or may preclude the
patient's successful completion of the clinical study
Additional exclusion criteria for participants with PE:
• Prior history of DVT or PE (upper extremity, cerebral sinus venous thrombosis and
abdominal thromboses encountered as a neonate are not exclusion criteria)
• Lack of anticoagulant treatment for the acute VTE due to contraindications