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.
FT516 in Subjects With Advanced Hematologic Malignancies
This is a Phase 1/1b dose-finding study of FT516 as monotherapy in acute myeloid leukemia
(AML) and in combination with CD20 directed monoclonal antibodies in B-cell lymphoma. The
study includes three stages: dose escalation, safety confirmation, and dose expansion.
KEY INCLUSION CRITERIA:
Diagnosis of the following:
Regimen A (FT516 monotherapy):
• Primary Refractory AML
• Relapsed AML defined as not in CR after 1 or more re-induction attempts; if >60 years
of age, prior re-induction therapy is not required
Regimen B (FT516 + rituximab or obinutuzumab):
• Histologically documented B-cell lymphoma expected to express CD20 who have relapsed
after or failed to respond to at least on prior treatment regimen and for whom there
is no available therapy expected to improve survival.
All subjects:
• Provision of signed and dated informed consent form (ICF)
• Age ≥18 years old
• Stated willingness to comply with study procedures and duration
• Presence of measurable disease
KEY EXCLUSION CRITERIA:
All subjects:
• Females of reproductive potential who are pregnant or lactating, and males or females
not willing to use a highly effective form of contraception from Screening through the
end of the study
• Eastern Cooperative Oncology Group (ECOG) Performance Status ≥2
• Evidence of insufficient organ function
• Receipt of therapy within 2 weeks prior to Cycle 1 Day 1 or within five half-lives,
whichever is shorter; or any investigational therapy within 28 days prior to Cycle 1
Day 1
• Currently receiving or likely to require systemic immunosuppressive therapy
• Prior allogeneic HSCT or allogeneic CAR-T within 6 months of Cycle 1 Day 1, or ongoing
requirement for systemic graft-versus-host therapy
• Receipt of an allograft organ transplant
• Known active central nervous system (CNS) involvement by malignancy.
• Clinically significant cardiovascular disease
• Clinically significant infections including: Known HIV infection; Known active
Hepatitis B (HBV) or Hepatitis C (HCV) infection
• Live vaccine <6 weeks prior to start of lympho-conditioning
• Known allergy to human albumin and DMSO
Additional Exclusion Criteria for FT516 monotherapy Regimen: Diagnosis of promyelocytic
leukemia with t(15:17) translocation
Additional Exclusion Criteria for FT516 plus monoclonal antibody Regimens: Diagnosis of
Waldenstrom macroglobulinemia
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
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.
'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.
This is an open label, single arm, phase II study to determine the efficacy, safety and PK
(persistence) of MBCART2019.1 cells in adults with relapsed or refractory DLBCL after
receiving at least two lines of therapy.
• Histologically confirmed DLBCL or associated subtype, defined by WHO 2016
classification
• Relapsed or Refractory disease after 2 or more lines of chemotherapy including
rituximab and anthracycline and either having failed autologous stem cell transplant
(ASCT), or being ineligible for or not consenting to ASCT
• Age > 18 years
• Eastern Cooperative Oncology Group (ECOG) performance status that is either 0 or 1 at
screening. ECOG performance status of 2 at screen is allowed if the decrease in
performance status is due to DLBCL
• Measurable disease according to Lugano 2014 criteria for assessing FDG PET/CT in
lymphoma (Cheson et al, 2014)
• Subject must have a tumor biopsy sample, per protocol specified slide availability
from the most recent relapse available prior to MBCART2019.1 Infusion. If medically
not feasible to obtain biopsy from the most recent relapse and for cases when amount
of tissue is limited, sponsor should be consulted, to confirm adequacy of sample for
study required analyses.
• No clinical suspicion of CNS lymphoma
• If the subject has history of CNS disease, then he/she must have no signs or symptoms
of CNS disease, have no active disease on magnetic resonance imaging (MRI) and have no
large cell lymphoma present in cerebral spinal fluid (CSF) on cytospin preparation and
flow cytometry, regardless of the number of white blood cells (WBCs)
• If has history of cerebral vascular accident (CVA), the CVA must be greater than 12
months prior to leukapheresis and any neurological deficits must be stable
• A creatinine clearance (as estimated either by a direct urine collection or
Cockcroft-Gault Equation) > 60mL/min
• Cardiac ejection fraction (EF) ≥ 45% as determined by an echocardiogram (ECHO) or
Multigated Radionuclide Angiography (MUGA)
• Resting O2 saturation >90% on room air
• Serum alanine aminotransferase (ALT) / aspartate aminotransferase (AST) <5 times the
Upper Limit of Normal (ULN) for age
• Total bilirubin <1.5 mg/dl, except in individuals with Gilbert's syndrome
• Absolute neutrophil count > 1000/μL
• Absolute lymphocyte count > 100/μL
• Platelet count > 50,000/μL
• Estimated life expectancy of more than 3 months other than primary disease
• Subjects of child-bearing or child-fathering potential must be willing to practice
birth control from the time of enrollment on this study until the follow-up period of
the study.
Exclusion Criteria:
• Primary CNS lymphoma
• Richter's transformed DLBCL arising from chronic lymphocytic leukemia (CLL)
• Unable to give informed consent
• Known history of infection with human immunodeficiency virus (HIV) or active hepatitis
B (HBsAg positive). If there is a history of treated hepatitis B or hepatitis C, the
viral load must be quantitative polymerase chain reaction (PCR) negative; antiviral
prophylaxis is required if HBsAg negative and anti-HBc positive.
• Known history of infection with hepatitis C virus (anti-HCV positive) unless viral
load is undetectable per quantitative PCR and/or nucleic acid testing
• Known history of active seizures or presence of seizure activities or on active,
anti-seizure medications within the prior 12 months
• Known history of CVA within prior 12 months.
• Known history or presence of autoimmune CNS disease, such as multiple sclerosis, optic
neuritis, or other immunologic or inflammatory disease
• Presence of CNS disorder that, in the judgment of the investigator, may impair the
ability to evaluate neurotoxicity
• Active systemic fungal, viral, or bacterial infection
• Pregnant or breast-feeding woman
• Previous or concurrent malignancy with the following exceptions:
• Adequately treated basal cell or squamous cell carcinoma (adequate wound healing
required prior to study entry)
• In situ carcinoma of the cervix or breast, treated curatively and without evidence of
recurrence for at least 2 years prior to the study
• Adequately treated breast or prostate carcinoma on hormonal therapies such as Lupron
or tamoxifen and in clinical remission of ≥ 2 years
• A primary malignancy which has been completely resected / treated with curative intent
and in complete remission of ≥ 2 years
• History of non-neurologic autoimmune disease (e.g. Crohn's disease, rheumatoid
arthritis, systemic lupus erythematosus)requiring systemic immunosuppressive or system
disease modifying agents within the last 2 years
• Medical condition requiring prolonged use of systemic corticosteroids equivalent to
prednisone >10 mg/day
• History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, or
other clinically significant cardiac disease within 6 months of enrollment
• Concurrent radiotherapy (normal tissue sparing palliative radiotherapy allowed up to
time of lymphodepletion). For systemic therapy, at least 2 weeks or 5 half-lives,
whichever is shorter, must have elapsed at the time of scheduled leukapheresis
• Baseline dementia that would interfere with therapy or monitoring, determined using
Immune Effector Cell-Associated Encephalopathy (ICE) Assessment at baseline
• History of severe immediate hypersensitivity reaction to any of the agents used in
this study
• Refusal to participate in additional lentiviral gene therapy LTFU protocol
• Prior CAR-T therapy for any indication or systemic gene modifying therapy for DLBCL
• Prior allogeneic stem cell transplant for any indication
• Prior BITE antibodies for cancer therapy
• Prior T cell receptor-engineered T cell therapy
Safety and Efficacy Trial of Epcoritamab Combinations in Subjects With B-cell Non-Hodgkin Lymphoma (B-NHL) (EPCORE™ NHL-2)
A phase 1b/2, open-label, multinational, interventional trial to evaluate the safety,
tolerability, pharmacokinetics (PK), pharmacodynamics/biomarkers, immunogenicity, and
preliminary efficacy of epcoritamab in combination with other standard of care (SOC) agents
in subjects with B-cell Non-Hodgkin Lymphoma (B-NHL).
Key Inclusion Criteria
1. Subject must sign an Informed Consent Form (ICF)
2. At least 18 years of age
3. Measurable disease defined as ≥1 measurable nodal lesion (long axis >1.5 cm and short
axis >1.0 cm) or ≥1 measurable extra-nodal lesion (long axis >1.0 cm) on computed
tomography (CT) or magnetic resonance imaging (MRI)
4. Eastern Cooperative Oncology Group (ECOG) PS score of 0, 1 or 2
5. Acceptable organ function at screening
6. CD20-positive non-Hodgkin lymphoma (NHL) at most recent representative tumor biopsy
7. If of childbearing potential subject must practicing a highly effective method of
birth control
8. A man who is sexually active with a woman of childbearing potential must agree to use
a barrier method of birth control
Arm 1:
• Newly Diagnosed Documented diffuse large B-cell lymphoma (DLBCL)
• DLBCL, NOS
• "double-hit" or "triple-hit" DLBCL
• FL Grade 3B
Arm 2: R/R FL
Arm 3: Newly diagnosed, previously untreated FL grade 1-3A
Arm 4:
• Documented DLBCL and eligible for HDT-ASCT
• DLBCL, NOS
• "double-hit" or "triple-hit" DLBCL
• FL Grade 3B
Arm 5:
• Relapsed or refractory documented DLBCL and ineligible for HDT-ASCT
• DLBCL, NOS
• "double-hit" or "triple-hit" DLBCL
• FL Grade 3B
Arm 6: Newly diagnosed, previously untreated FL grade 1-3A
Arm 7:
• FL Grade 1-3A
• If PR or CR per Lugano criteria following first-line or second-line treatment with SOC
regimen, and last dose of SOC within 6 months prior to enrollment.
Arm 8:
• DLBCL, NOS
• T-cell/histiocyte rich DLBCL
• "double-hit" or "triple-hit" DLBCL
• FL Grade 3B
Key Exclusion Criteria
1. Chemotherapy, radiation therapy, or major surgery within 4 weeks prior to the first
dose of epcoritamab
2. Any prior treatment with a bispecific antibody targeting CD3 and CD20.
3. Treatment with CAR-T therapy within 30 days prior to first dose of epcoritamab
4. Clinically significant cardiovascular disease
5. Evidence of significant, uncontrolled concomitant diseases that could affect
compliance with the protocol or interpretation of results
6. CNS lymphoma or known CNS involvement by lymphoma at screening as confirmed by MRI/CT
scan of the brain and, if clinically indicated, by lumbar puncture
7. Active positive tests for hepatitis B virus or hepatitis C virus indicating acute or
chronic infection
8. Known history of seropositivity of human immunodeficiency virus (HIV)
9. Active tuberculosis or history of completed treatment for active tuberculosis within
the past 12 months
10. Neuropathy > grade 1
11. Receiving immunostimulatory agent
12. Prior allogeneic HSCT
13. Current seizure disorder requiring anti-epileptic therapy
NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.
Drug: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, Drug: rituximab and lenalidomide, Drug: rituximab and bendamustine, Drug: rituximab, cytarabine, dexamethasone, and oxaliplatin/carboplatin, Drug: gemcitabine and oxaliplatin, Biological: Epcoritamab, Biological: Epcoritamab Maintenance, Drug: rituximab, cyclophosphamide, reduced dose of doxorubicin, vincristine, and prednisone
Diffuse Large B-Cell Lymphoma, Follicular Lymphoma, Non-Hodgkins Lymphoma
An Open-Label, Phase 2 Trial of Nanatinostat in Combination With Valganciclovir in Patients With Epstein-Barr Virus-Positive (EBV+) Relapsed/Refractory Lymphomas (NAVAL-1)
A Phase 2 study to evaluate the efficacy of nanatinostat in combination with valganciclovir
in patients with relapsed/refractory EBV-positive lymphomas
• EBV+ relapsed/refractory lymphoma following 2 or more prior systemic therapies
• EBV+ DLBCL, NOS: Must have received at least one course of an anti-CD20 immunotherapy,
and at least one course of anthracycline-based chemotherapy
• PTLD: Must have received immunotherapy with an anti-CD20 agent.
• Hodgkin lymphoma: Must have received at least one course of anthracycline-based
chemotherapy. Patients with classical Hodgkin lymphoma should have failed or be
ineligible for an anti-PD-1 agent and CD30-directed therapy.
• For ENKTL and PTCL patients only: Relapsed/refractory disease following 1 or more
prior systemic therapies. ENKTL patients must have failed an asparaginase-containing
regimen.
• No available therapies in the opinion of the Investigator
• Not eligible for high-dose chemotherapy with allogeneic/autologous stem cell
transplantation or CAR-T therapy
• Measurable disease per Lugano 2007
• ECOG performance status 0, 1, 2
• Adequate bone marrow function
Key
Exclusion Criteria:
• Presence or history of CNS involvement by lymphoma
• Systemic anticancer therapy or CAR-T within 21 days
• Antibody (anticancer) agents within 28 days
• Less than 60 days from prior autologous hematopoietic stem cell or solid organ
transplant
• Less than 90 days from prior allogeneic transplant.
• Daily corticosteroids (≥20 mg of prednisone or equivalent) within week prior to Cycle
1 Day 1
• Inability to take oral medication, malabsorption syndrome or any other
gastrointestinal condition (nausea, diarrhea, vomiting) that may impact the absorption
of nanatinostat and valganciclovir.
• Active infection requiring systemic therapy (excluding viral upper respiratory tract
infections).
Drug: Nanatinostat in combination with valganciclovir
Lymphoid Leukemia, Epstein-Barr Virus Associated Lymphoproliferative Disorder, EBV-Related PTLD, EBV Related Non-Hodgkin's Lymphoma, Extranodal NK/T-cell Lymphoma, EBV-Positive DLBCL, Nos, EBV Associated Lymphoma, EBV-Related Hodgkin Lymphoma, EBV Related PTCL, Nos
GEN3013, Epcoritamab Trial in Patients With Relapsed, Progressive or Refractory B-Cell Lymphoma EPCORE™ NHL-1
The trial is a global, multi-center safety trial of Epcoritamab, an antibody also known as
GEN3013 (DuoBody®-CD3xCD20). The trial consists of three parts: a dose-escalation part (Phase
1, first-in-human (FIH)), an expansion part (Phase 2a) and a dose optimization part (Phase
2a)
Main Inclusion Criteria Escalation Part (recruitment completed)
• Documented CD20+ mature B-cell neoplasm
1. Diffuse large B-cell lymphoma •de novo or transformed
2. High-grade B-cell lymphoma
3. Primary mediastinal large B-cell lymphoma
4. Follicular lymphoma
5. Mantle cell lymphoma
6. Small lymphocytic lymphoma
7. Marginal zone lymphoma (nodal, extranodal or mucosa associated)
• Relapsed, progressive and/or refractory disease following treatment with an anti-CD20
monoclonal antibody (e.g. rituximab) potentially in combination with chemotherapy
and/or relapsed after autologous stem cell rescue.
• ECOG performance status 0,1 or 2
• Patients must have measurable disease by CT, MRI or PET-CT scan
• Acceptable renal function
• Acceptable liver function
Main Inclusion Criteria Expansion and Optimization Parts
• Documented CD20 positive mature B cell neoplasm or CD20+ MCL
• Diffuse large B cell lymphoma, de novo or transformed (including double hit or triple
hit)
• Primary mediastinal large B cell lymphoma
• Follicular lymphoma grade 3B
• Histologic confirmed follicular lymphoma
• Marginal zone lymphomas
• Small lymphocytic lymphoma
• Mantle Cell Lymphoma (prior BTKi or intolerant to BTKi)
• At least 2 therapies including an anti CD20 monoclonal antibody containing
chemotherapy combination regimen
• Either failed prior autologous hematopoietic stem cell transplantation or ineligible
for autologous stem cell transplantation due to age or comorbidities
• At least 1 measurable site of disease based on CT, MRI or PET-CT scan with involvement
of 2 or more clearly demarcated lesions and or nodes
NOTE: Other protocol defined Inclusion criteria may apply.
Main Exclusion Criteria Escalation, Expansion and Optimization Parts
• Primary central nervous system (CNS) lymphoma or CNS involvement by lymphoma at
screening
• Known past or current malignancy other than inclusion diagnosis
• AST, and/or ALT >3 × upper limit of normal
• Total bilirubin >1.5 × upper limit of normal, unless bilirubin rise is due to
Gilbert's syndrome or of non-hepatic origin
• Estimated CrCl <45 mL/min
• Known clinically significant cardiovascular disease
• Ongoing active bacterial, viral, fungal, mycobacterial, parasitic, or other infection
requiring systemic treatment (excluding prophylactic treatment). Past COVID-19
infection may be a risk factor
• Confirmed history or current autoimmune disease or other diseases resulting in
permanent immunosuppression or requiring permanent immunosuppressive therapy
• Seizure disorder requiring therapy (such as steroids or anti-epileptics)
• Any prior therapy with an investigational bispecific antibody targeting CD3 and CD20
• Prior treatment with chimeric antigen receptor T-cell (CAR-T) therapy within 30 days
prior to first epcoritamab administration
• Eligible for curative intensive salvage therapy followed by high dose chemotherapy
with HSCT rescue
• Autologous HSCT within 100 days prior to first epcoritamab administration, or any
prior allogeneic HSCT or solid organ transplantation
• Active hepatitis B (DNA PCR-positive) or hepatitis C (RNA PCR-positive infection).
Subjects with evidence of prior HBV but who are PCR-negative are permitted in
• Known human immunodeficiency virus (HIV) infection
• Exposed to live or live attenuated vaccine within 4 weeks prior to signing ICF
• Pregnancy or breast feeding
• Patient is known or suspected of not being able to comply with the study protocol or
has any condition for which, participation would not be in the best interest of the
patient
• Contraindication to all uric acid lowering agents
Biological: Epcoritamab
Small Lymphocytic Lymphoma, Diffuse Large B-Cell Lymphoma, Follicular Lymphoma, Marginal Zone Lymphoma, Mantle Cell Lymphoma, Non-Hodgkins Lymphoma, High-grade B-cell Lymphoma, Primary Mediastinal Large B-cell Lymphoma
First-in-Human (FIH) Trial of GEN3009 in Subjects With Relapsed or Refractory B-Cell Non-Hodgkin Lymphomas
The drug that will be investigated in the study is an antibody, GEN3009. Since this is the
first study of GEN3009 in humans, the main purpose is to evaluate safety. Besides safety, the
study will determine the recommended GEN3009 dose to be tested in a larger group of patients
and assess preliminary clinical activity of GEN3009. GEN3009 will be studied in a broad group
of cancer patients, having different kinds of lymphomas. All patients will get GEN3009 either
as a single treatment (monotherapy) or in combination with another antibody-candidate for
treatment of cancer in the blood. The study consists of two parts: Part 1 tests increasing
doses of GEN3009 ("escalation"), followed by Part 2 which tests the recommended GEN3009 dose
from Part 1 ("expansion").
1. Be at least 18 years of age.
2. Must sign an informed consent form prior to any screening procedures.
3. Dose Escalation: Has histologically or cytologically confirmed relapsed and/or
refractory B-cell NHL with no available standard therapy or is not a candidate for
available standard therapy, and for whom, in the opinion of the investigator, the
experimental therapy may be beneficial. All subjects must have received at least two
prior lines of systemic therapy.
Dose Expansion: Has histologically or cytologically confirmed relapsed or refractory
B-cell NHL. All subjects must have received at least 2 prior lines of systemic
therapy, and,
1. For FL and DLBCL, at least 1 of the 2 prior lines of treatment must have been a
CD20 containing systemic regimen;
2. For CLL, subjects must have received at least one prior line of BTK inhibitor or
BCL 2 inhibitor.
4. Has one of the eligible subtypes of B-cell NHL :
Dose Escalation: (DLBCL, HGBCL, PMBCL, FL, MCL, MZL, SLL, or CLL). Dose Expansion:
(DLBCL, FL, CLL)
5. Has measurable disease for B-cell NHL or has active disease for Chronic Lymphocytic
Leukemia (CLL).
6. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
7. Has adequate hepatic, renal, and bone marrow functions.
8. Before the first dose of GEN3009, during the trial, and for 12 months after the last
dose of GEN3009 and/or the combination, a woman must be either not of childbearing
potential or of childbearing potential and practicing a highly effective method of
birth control, and must have a negative serum beta-human chorionic gonadotropin
(beta-hCG) and urine pregnancy test at screening.
9. A man who is sexually active with a woman of childbearing potential and has not had a
vasectomy must agree to use a barrier method of birth control.
10. Subjects must have a life expectancy of at least 3 months.
Key
Exclusion Criteria:
1. Prior treatment with a CD37-targeting agent.
2. Prior allogeneic Hematopoietic Stem Cell Transplantation (HSCT).
3. Prior treatment with a CD3xCD20 bispecific antibody (Combination Expansion cohort
only).
4. Autologous HSCT within 3 months before the first dose of GEN3009.
5. Lymphomas leukemic phase: high absolute lymphocyte count or the presence of abnormal
cells in the peripheral blood indicating circulating lymphoma cells.
6. Treatment with an anti-cancer biologic including anti-CD20 therapy, radio-conjugated
or toxin-conjugated antibody or chimeric antigen receptor (CAR) T-cell therapy within
4 weeks or 5 half-lives, whichever is shorter, before the first dose of GEN3009.
Treatment with small molecules such as BTK inhibitors, BCL2 inhibitors, or PI3K
inhibitors within 5 half-lives prior to the first dose of GEN3009.
7. Chemotherapy or radiation therapy within 2 weeks of the first dose of GEN3009.
8. Treatment with an investigational drug or an invasive investigational medical device
within 4 weeks or 5 half-lives, whichever is shorter, prior to the first dose of
GEN3009, and at any time during the study treatment period.
9. Autoimmune disease or other diseases that require permanent or high-dose
immunosuppressive therapy.
10. Received a cumulative dose of corticosteroids more than the equivalent of 250 mg of
prednisone within the 2-week period before the first dose of GEN3009.
11. Has uncontrolled intercurrent illness.
12. Seizure disorder requiring therapy (such as steroids or anti-epileptics) (Combination
Expansion cohort only).
13. Toxicities from previous anti-cancer therapies have not resolved to baseline levels or
to Grade 1 or less except for alopecia and peripheral neuropathy.
14. Primary central nervous system (CNS) lymphoma or known CNS involvement at screening.
15. Known past or current malignancy other than inclusion diagnosis.
16. Had allergic reactions to anti-CD20 or anti-CD37 monoclonal antibody treatment or
intolerant to GEN3009 or to the combination therapy excipients.
17. Has had major surgery within 4 weeks before screening or will not have fully recovered
from surgery, or has major surgery planned during the time the subject is expected to
participate in the trial (or within 4 weeks after the last dose of GEN3009 and/or the
combination therapy).
18. Known history/positive serology for hepatitis B.
19. Known medical history or ongoing hepatitis C infection that has not been cured.
20. Known history of seropositivity for HIV infection.
21. Is a woman who is pregnant or breast-feeding, or who is planning to become pregnant
while enrolled in this trial or within 12 months after the last dose of GEN3009 and/or
the combination therapy.
22. Is a man who plans to father a child while enrolled in this trial or within 12 months
after the last dose of GEN3009 and/or the combination therapy.
23. Has any condition for which, in the opinion of the investigator, participation would
not be in the best interest of the subject (eg, compromise the well-being) or that
could prevent, limit, or confound the protocol-specified assessments. Additionally,
vulnerable subjects or subjects under guardianship, curatorship, judicial protection
or deprived of liberty), are excluded from participation in this trial.
24. Exposed to live/live attenuated vaccine within 4 weeks prior to initiation of GEN3009
treatment.
NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.
Biological: GEN3009, Biological: Epcoritamab
Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Diffuse Large B-Cell Lymphoma, Follicular Lymphoma, Marginal Zone Lymphoma, Mantle Cell Lymphoma, Non-Hodgkins Lymphoma, High-grade B-cell Lymphoma, Primary Mediastinal Large B-cell Lymphoma
Safety and Efficacy of KRT-232 in Combination With Acalabrutinib in Subjects With R/R DLBCL or R/R CLL
This study evaluates KRT-232, a novel oral small molecule inhibitor of MDM2, combined with
acalabrutinib for the treatment of adults with Diffuse Large B-Cell Lymphoma and Chronic
Lymphocytic Leukemia. Participants must be relapsed/refractory (having failed prior therapy)
• Cohort 1: Confirmed diagnosis of TP53wt DLBCL (WHO); R/R DLBCL after at least 2 prior
lines of treatment or 1 prior for patients who are ineligible for stem cell transplant
• Cohort 2: Confirmed diagnosis of TP53wt CLL (iwCLL); R/R CLL after at least 1 prior
line of treatment
• ECOG 0 to 2
• Adequate hematologic, hepatic, and renal functions.
Exclusion Criteria:
• Prior treatment with any MDM2 inhibitor
• Prior treatment with any BTK inhibitor
Drug: KRT-232, Drug: acalabrutinib
Chronic Lymphocytic Leukemia, Non Hodgkin Lymphoma, Diffuse Large B Cell Lymphoma, Leukemia, Other, Non-Hodgkins Lymphoma
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
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.
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
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
Testing the Addition of Lenalidomide and Nivolumab to the Usual Treatment for Primary CNS Lymphoma
This phase I trial is to find out the best dose, possible benefits and/or side effects of
lenalidomide when added to nivolumab and the usual drugs (rituximab and methotrexate) in
patients with primary central nervous system (CNS) lymphoma. Lenalidomide may stop or slow
primary CNS lymphoma by blocking the growth of new blood vessels necessary for tumor growth.
Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune
system attack the cancer, and may interfere with the ability of cancer cells to grow and
spread. Rituximab is a monoclonal antibody that may interfere with the ability of cancer
cells to grow and spread. Methotrexate is frequently combined with other chemotherapy agents
to improve response. This study may help increase the understanding of lenalidomide and
nivolumab use in primary CNS lymphoma treatment. In addition, it may help researchers see
whether the control of CNS lymphoma can be extended by using these study drugs as maintenance
(prolonged therapy) after control is achieved with the initial chemotherapy regimen
(induction).
• Histologically proven primary CNS diffuse large b-cell lymphoma confirmed by one of
the following:
• Brain biopsy or resection
• Cerebrospinal fluid
• Vitreous fluid
• At least one measurable, contrast-enhancing lesion in the brain (>= 1 cm in length),
CSF or vitreous (intraocular lymphoma)
• No prior organ transplantation to exclude post-transplant lymphoproliferative
disorders
• No prior chemotherapy or radiation therapy for lymphoma
• No prior allogeneic stem cell transplantation
• Use of systemic corticosteroids (dexamethasone up to 24 mg/day or equivalent) for
disease control or improvement of performance status to be tapered as fast as
clinically safe after initiation of therapy is permissible
• 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 and an agent that has known genotoxic, mutagenic and teratogenic effects.
Therefore, female of childbearing potential (FCBP) must have a negative serum or urine
pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic
gonadotropin [HCG]) =< 7 days prior to registration
• Karnofsky performance scale (KPS) >= 40 (>= 50 for patients older than 60 unless
related to lymphoma on investigator's opinion)
• Absolute neutrophil count (ANC) >= 1,500/mm^3
• Platelet count >= 100,000/mm^3
• Calculated creatinine clearance >= 50 mL/min by Cockcroft-Gault formula
• Total Bilirubin =< 1.5 x upper limit of normal (ULN)
• Aspartate aminotransferase (AST) / alanine aminotransferase (ALT) =< 2.5 x upper limit
of normal (ULN)
• No evidence of non-Hodgkin's lymphoma (NHL) outside CNS
• No prior history of NHL
• No history of autoimmune disorder. Patients with active autoimmune disease or history
of autoimmune disease that might recur, which may affect vital organ function or
require immune suppressive treatment including systemic corticosteroids, should be
excluded. These include but are not limited to patients with a history of immune
related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy,
Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as
Systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma,
inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients
with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or
phospholipid syndrome should be excluded because of the risk of recurrence or
exacerbation of disease. Patients with vitiligo, endocrine deficiencies including
thyroiditis managed with replacement hormones including physiologic corticosteroids
are eligible. Patients with rheumatoid arthritis and other arthropathies, Sjogren's
syndrome and psoriasis controlled with topical medication and patients with positive
serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be
evaluated for the presence of target organ involvement and potential need for systemic
treatment but should otherwise be eligible
• Patients are permitted to enroll if they have vitiligo, type I diabetes mellitus,
residual hypothyroidism due to autoimmune condition only requiring hormone
replacement, psoriasis not requiring systemic treatment, or conditions not expected to
recur in the absence of an external trigger (precipitating event)
• Patients should be excluded if they have a condition requiring systemic treatment with
either corticosteroids (except short course of systemic corticosteroids for disease
control or improvement of performance status or other immunosuppressive medications
within 14 days prior to registration. Inhaled or topical steroids and adrenal
replacement doses < 10 mg daily prednisone equivalents are permitted in the absence of
active autoimmune disease. Patients are permitted to use topical, ocular,
intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic
absorption). Physiologic replacement doses of systemic corticosteroids are permitted,
even if < 10 mg/day prednisone equivalents. A brief course of corticosteroids for
prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions
(e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted
• Patients who have had evidence of active or acute diverticulitis, intra-abdominal
abscess, gastrointestinal (GI) 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
• No prior or concurrent malignancies with exception of surgically cured carcinoma in
situ (CIS) of the uterus, carcinoma of the skin without evidence of disease for >= 5
years
• No concurrent malignancy requiring active therapy
• No untreated hepatitis C virus (HCV) infection with detectable HCV viral load
• No untreated chronic hepatitis B virus (HBV) infection with detectable HBV viral load
• No untreated human immunodeficiency virus (HIV) infection or with detectable viral
load or with CD4+T-cell count of less than 500/mm^3
• No history of HIV infection and evidence of Epstein Barr virus (EBV)-related primary
central nervous system lymphoma (PCNSL)
• Inability to tolerate anticoagulation with acetylsalicylic acid, warfarin, or direct
oral anticoagulants
• No other investigational agent
• No history of severe hypersensitivity reaction to any monoclonal antibody
• No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to or other agents used in study
• Sulfonamide drugs, trimethoprim, salicylates, nonsteroidal anti-inflammatory drugs,
penicillin, vitamin C, ciprofloxacin, and proton pump inhibitors should be held at
least 48 hours prior to methotrexate administration
Tagraxofusp in Pediatric Patients With Relapsed or Refractory CD123 Expressing Hematologic Malignancies
Tagraxofusp is a protein-drug conjugate consisting of a diphtheria toxin redirected to target
CD123 has been approved for treatment in pediatric and adult patients with blastic
plasmacytoid dendritic cell neoplasm (BPDCN). This trial aims to examine the safety of this
novel agent in pediatric patients with relapsed/refractory hematologic malignancies.
The mechanism by which tagraxofusp kills cells is distinct from that of conventional
chemotherapy. Tagraxofusp directly targets CD123 that is present on tumor cells, but is
expressed at lower or levels or absent on normal hematopoietic stem cells. Tagraxofusp also
utilizes a payload that is not cell cycle dependent, making it effective against both highly
proliferative tumor cells and also quiescent tumor cells.
The rationale for clinical development of tagraxofusp for pediatric patients with hematologic
malignancies is based on the ubiquitous and high expression of CD123 on many of these
diseases, as well as the highly potent preclinical activity and robust clinical
responsiveness in adults observed to date.
This trial includes two parts: a monotherapy phase and a combination chemotherapy phase. This
design will provide further monotherapy safety data and confirm the FDA approved pediatric
dose, as well as provide safety data when combined with chemotherapy.
The goal of this study is to improve survival rates in children and young adults with
relapsed hematological malignancies, determine the recommended phase 2 dose (RP2D) of
tagraxofusp given alone and in combination with chemotherapy, as well as to describe the
toxicities, pharmacokinetics, and pharmacodynamic properties of tagraxofusp in pediatric
patients.
About 54 children and young adults will participate in this study. Patients with Down
syndrome will be included in part 1 of the study.
Age
• Patients must be ≥ 1 and ≤21 years of age at the time of study enrollment.
Diagnosis
• Relapsed and/or refractory hematologic malignancy (including, but not limited to,
acute lymphoblastic leukemia, acute myeloid leukemia, myelodysplastic syndrome, mixed
phenotype acute leukemia, acute undifferentiated leukemia, blastic plasmacytoid
dendritic cell neoplasm, Hodgkin lymphoma, and non-Hodgkin lymphoma).
• Tumor cells must demonstrate surface expression of CD123 at the time of enrollment by
flow cytometry or immunohistochemistry, as defined by the local institution.
Disease Status:
Monotherapy, Part 1
• Second or greater relapse; or
• Refractory after 2 or more chemotherapy cycles; or
• First relapse after primary chemotherapy-refractory disease; or
• BPDCN in first relapse or refractory after 1 or more chemotherapy cycles
Combination therapy, Part 2
• First or greater relapse; or
• Refractory after 2 or more chemotherapy cycles; or
• BPDCN in first relapse or refractory after 1 or more chemotherapy cycles
For relapsed/refractory leukemia, patients must have:
• >5% blasts in the bone marrow aspirate by morphology or flow cytometry
• Patients with 1% •5% blasts are eligible for Part 2, Cohort C (only), if A single
bone marrow sample with flow cytometry and at least one other test (e.g. karyotype,
FISH, PCR, or NGS) shows ≥ 1% leukemic blasts and/or flow cytometry demonstrates a
stable or rising level of disease on two serial bone marrows.
For relapsed/refractory non-Hodgkin or Hodgkin lymphoma, patients must have:
• Histologic verification of relapse
• Measurable disease documented by radiographic criteria or bone marrow
• Patients in Part 1 may have sites of non-CNS extramedullary disease, but no CNS
disease. Patients in Part 2 may have CNS disease and/or other non-CNS extramedullary
disease. No cranial irradiation is allowed during the protocol therapy.
• Patients with Down syndrome are eligible.
Performance Level
• Karnofsky > 50% for patients > 16 years of age and Lansky > 50% for patients ≤ 16
years of age (See Appendix I for Performance Scales). Patients who are unable to walk
because of paralysis, but who are up in a wheelchair, will be considered ambulatory
for the purpose of assessing the performance score.
Prior Therapy
• Patients must have fully recovered from the acute toxic effects of all prior
chemotherapy, immunotherapy, or radiotherapy, defined as resolution of all such
toxicities to ≤ Grade 2 or lower per the inclusion/exclusion criteria.
Myelosuppressive chemotherapy: Patients must have fully recovered from the acute toxic
effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this
study. At least 14 day must have elapsed since the completion of myelosuppressive therapy.
However, individuals may receive any of the following medications within 14 days without a
"wash-out period":
• Hydroxyurea: Hydroxyurea can be initiated and/or continued for up to 24 hours prior to
the start of protocol therapy.
• "Maintenance-style" therapy: therapy including vincristine (dosed a maximum of
one-time weekly), oral 6-mercaptopurine, oral methotrexate (dosed a maximum of
one-time weekly), intrathecal therapy (dosed a maximum of one-time weekly) and/or
dexamethasone (dosed at ≤3 mg/m2/dose twice daily) or prednisone (dosed at ≤20
mg/m2/dose twice daily) can be continued for up to 24 hours prior to entering the
study.
• Hematopoietic stem cell transplant: Patients who have experienced their relapse after
a HSCT are eligible, provided they have no evidence of acute or chronic
Graft-versus-Host Disease (GVHD) and are at least 100 days post-transplant at the time
of enrollment.
• Hematopoietic growth factors: It must have been at least 7 days since the completion
of therapy with granulocyte colony stimulating factor (GCSF) or other growth factors
at the time of enrollment. It must have been at least 14 days since the completion of
therapy with pegfilgrastim (Neulasta®).
• Biologic (anti-neoplastic agent): At least 7 days after the last dose of a biologic
agent. For agents that have known adverse events occurring beyond 7 days after
administration, this period must be extended beyond the time during which adverse
events are known to occur. The duration of this interval must be discussed with the
study chair.
• Monoclonal antibodies: Maximum of 3 half-lives of the antibody or 21 days (whichever
is shorter) must have elapsed after the last dose of monoclonal antibody.
• Immunotherapy: At least 30 days from last infusion of chimeric antigen receptor T cell
(CART) therapy or tumor vaccine.
• XRT: Craniospinal XRT is prohibited during protocol therapy. No washout period is
necessary for radiation given to any extramedullary site other than CNS chloromas; ≥
90 days must have elapsed if prior TBI or craniospinal XRT.
• Patients that have received other non-tagraxofusp CD123 targeting agents are eligible.
Patients that have previously received tagraxofusp are not eligible.
Organ Function Requirements
Adequate Bone Marrow Function Defined as:
• Patients should not be known to be refractory to red blood cell or platelet
transfusions.
• Blood counts are not required to be normal prior to enrollment on trial. However,
platelet count must be ≥20,000/mm3 to initiate therapy (may receive platelet
transfusions).
Adequate Renal Function Defined as:
• Patient must have a calculated creatinine clearance or radioisotope GFR ≥
70ml/min/1.73m2 OR a normal serum creatinine based on age/gender in the chart below:
Maximum Serum Creatinine (mg/dL):
• 1 to < 2 years old •Male: 0.6, Female: 0.6
• 2 to < 6 years old •Male:0.8, Female: 0.8
• 6 to < 10 years old •Male: 1, Female: 1
• 10 to < 13 years old •Male: 1.2, Female: 1.2
• 13 to < 16 years old •Male: 1.5, Female: 1.4
• ≥ 16 years old •Male: 1.7, Female: 1.4
The threshold creatinine values in this Table were derived from the Schwartz formula for
estimating GFR (Schwartz et al. J. Peds, 106:522, 1985) utilizing child length and stature
data published by the CDC.
Adequate Liver Function Defined as:
• Total bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x institutional upper limit
of normal for age
• SGPT (ALT) and SGOT (AST) must be less than 3x institutional upper limit of normal.
• Serum albumin ≥3.2 g/dL (albumin infusion independent).
Adequate Cardiac Function Defined as:
• Shortening fraction of ≥27% by echocardiogram, or
• Ejection fraction of ≥ 50% by gated radionuclide study/echocardiogram.
Adequate Pulmonary Function Defined as:
• Pulse oximetry > 94% on room air (> 90% if at high altitude)
• No evidence of dyspnea at rest and no exercise intolerance.
Reproductive Function
• Female patients of childbearing potential must have a negative urine or serum
pregnancy test confirmed within 2 weeks prior to enrollment.
• Female patients with infants must agree not to breastfeed their infants while on this
study.
• Male and female patients of child-bearing potential must agree to use an effective
method of contraception approved by the investigator during the study and for 12 weeks
after the last dose of tagraxofusp.
Exclusion Criteria
Disease Status:
• Patients with CNS disease are not eligible for Part 1.
• Patients with isolated CNS disease are not eligible for Part 1 or Part 2.
• Patients with isolated non-CNS disease are eligible for Part 1 and Part 2.
Concomitant Medications
• Corticosteroids •Patients receiving corticosteroids for disease control who have not
been on a stable or decreasing dose of corticosteroid for at least 7 days prior to
enrollment are not eligible.
• Investigational Drugs •Patients who are currently receiving another investigational
drug are not eligible. The definition of "investigational" for use in this protocol
means any drug that is not licensed by the FDA, Health Canada or the Therapeutic Goods
Administration to be sold in the countries they govern. (United States, Canada and
Australia)
• Anti-cancer Agents •Patients who are currently receiving or may receive while on
therapy, other anti-cancer agents, radiation therapy or immunotherapy are not eligible
[except hydroxyurea, which may be continued until 24 hours prior to start of protocol
therapy]. Intrathecal chemotherapy (at the discretion of the primary oncologist) may
be given up to one week prior to the initiation of study treatment (day 1 therapy).
• Anti-GVHD or agents to prevent organ rejection post-transplant •Patients who are
receiving cyclosporine, tacrolimus or other agents to prevent either graft-versus-host
disease post bone marrow transplant or organ rejection post-transplant are not
eligible for this trial. At least 4 weeks must have elapsed after the last dose of
GVHD meds.
Infection Criteria •Patients are excluded if they have:
• Positive blood culture within 48 hours of study enrollment;
• Fever above 38.2 within 48 hours of study enrollment with clinical signs of infection.
Fever that is determined to be due to tumor burden is allowed if patients have
documented negative blood cultures for at least 48 hours prior to enrollment and no
concurrent signs or symptoms of active infection or hemodynamic instability.
• A positive fungal culture within 30 days of study enrollment.
• Active fungal, viral, bacterial, or protozoal infection requiring IV treatment.
Chronic prophylaxis therapy to prevent infections is allowed.
• Patients will be excluded if they have a known allergy to any of the drugs used in the
study.
• Patients will be excluded if they have significant concurrent disease, illness,
psychiatric disorder or social issue that would compromise patient safety or
compliance with the protocol treatment or procedures, interfere with consent, study
participation, follow up, or interpretation of study results.
• Patients with DNA fragility syndromes (such as Fanconi anemia, Bloom syndrome) are
excluded.
Nivolumab in Combination With Chemo-Immunotherapy for the Treatment of Newly Diagnosed Primary Mediastinal B-Cell Lymphoma
This phase III trial compares the effects of nivolumab with chemo-immunotherapy versus
chemo-immunotherapy alone in treating patients with newly diagnosed primary mediastinal
B-cell lymphoma (PMBCL). Immunotherapy with monoclonal antibodies, such as nivolumab, may
help the body's immune system attack the cancer, and may interfere with the ability of cancer
cells to grow and spread. Treatment for PMBCL involves chemotherapy combined with an
immunotherapy called rituximab. Chemotherapy drugs work in different ways to stop the growth
of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping
them from spreading. Rituximab is a monoclonal antibody. It binds to a protein called CD20,
which is found on B cells (a type of white blood cell) and some types of cancer cells. This
may help the immune system kill cancer cells. Giving nivolumab with chemo-immunotherapy may
help treat patients with PMBCL.
• Age >= 2 years
• Patient must have histologically confirmed primary mediastinal B-cell lymphoma (PMBCL)
as defined by World Health Organization (WHO) criteria
• Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 or ECOG
performance status of 3 if poor performance is related to lymphoma
• Children's Oncology Group (COG) Institutions: Use Karnofsky for patients >= 17
and < 18 years of age and Lansky for patients < 17 years of age
• Adults (age 18 or older): Creatinine clearance >= 30 mL/min, as estimated by the
Cockcroft and Gault formula. The creatinine value used in the calculation must have
been obtained within 28 days prior to registration. Estimated creatinine clearance is
based on actual body weight
• Pediatric Patients (age < 18 years): The following must have been obtained within 14
days prior to registration:
• Measured or calculated (based on institutional standard) creatinine clearance or
radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2, or
• Serum creatinine =< 1.5 x institutional upper limit of normal (IULN), or a serum
creatinine based on age/gender as follows:
• Age : 2 to < 6 year; Maximum serum creatinine (mg/dL): 0.8 (male; 0.8
(female)
• Age : 6 to < 10 years; Maximum serum creatinine (mg/dL): 1 (male); 1
(female)
• Age : 10 to < 13 years; Maximum serum creatinine (mg/dL): 1.2 (male); 1.2
(female)
• Age : 13 to < 16 years; Maximum serum creatinine (mg/dL): 1.5 (male); 1.4
(female)
• Age : >= 16 years to < 18 years; Maximum serum creatinine (mg/dL): 1.7
(male); 1.4 (female)
• Patients with abnormal liver function will be eligible to enroll if the lab
abnormality is thought to be due to the lymphoma or Gilbert's syndrome
• Age >= 18 years: Ejection fraction of >= 50% by echocardiogram
• Age < 18 years: Shortening fraction of >= 27% by echocardiogram, or ejection fraction
of >= 50% by radionuclide angiogram
• Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
therapy with undetectable viral load within 6 months are eligible for this trial
• For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral
load must be undetectable on suppressive therapy, if indicated
• Patients with a history of hepatitis C virus (HCV) infection must have been treated
and cured. For patients with HCV infection who are currently on treatment, they are
eligible if they have an undetectable HCV viral load
• All patients and/or their parents or legal guardians must sign a written informed
consent
• All institutional, Food and Drug Administration (FDA), and National Cancer Institute
(NCI) requirements for human studies must be met
Exclusion Criteria:
• Administration of prior anti-cancer therapy except as outlined below:
• A short course (=< 2 weeks) of corticosteroids for the relief of lymphoma-related
symptoms
• A single course of COP (cyclophosphamide, vincristine, and prednisone)
• One cycle of chemo-immunotherapy including R-CHOP, DA-EPOCH-R, a pediatric mature
B-cell non-Hodgkin lymphoma (B-NHL) induction therapy (such as ANHL1131), or
intrathecal chemotherapy that has not started more than 21 days prior to
enrollment
• Active ischemic heart disease or heart failure
• Active uncontrolled infection
• Central nervous system (CNS) involvement of lymphoma
• Previous cancer that required systemic chemotherapy and/or thoracic radiation. Other
cancers will be permitted if in remission x 3 years
• Active autoimmune disease that has required systemic treatment (such as disease
modifying agents, corticosteroids, or immunosuppressive agents) in the past 2 years.
Replacement therapy such as thyroxine, insulin or physiologic corticosteroid for
adrenal or pituitary insufficiency is not considered a form of systemic treatment
• In patients < 18 years of age hepatitis B serologies consistent with past or current
infections
• Patients with severe hepatic impairment (Child-Pugh class C or serum total bilirubin >
5.0 mg/dL) unless thought to be due to lymphoma or Gilbert's syndrome
• 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
• Sexually active patients of reproductive potential who have not agreed to use a highly
effective contraceptive method (failure rate of < 1% per year when used consistently
and correctly) for the duration of their study participation
• Lactating females are not eligible unless they have agreed not to breastfeed their
infants starting with the first dose of study therapy and for at least 6 months after
the last dose of rituximab
Safety Study of Cord Blood Units for Stem Cell Transplants
Background:
- Cord blood is blood that is taken from the umbilical cord and placenta of healthy newborns
after childbirth. The cord blood collected from a baby is called a cord blood unit. Cord
blood units are stored frozen in public cord blood banks. About 10,000 cord blood
transplants have been performed in children and adults for blood cancers and other diseases
in the world. These transplants have helped save lives and improve treatments. However, not
all available units of cord blood have been collected, stored, and licensed according to
specific government requirements. These unlicensed units can still be used in transplant,
but they can only be given as part of specific research studies. This study will evaluate
the safety of giving these unlicensed units by recording any problems that may occur during
and after giving the cord blood.
Objectives:
- To test the safety and effectiveness of unlicensed cord blood units in people who need
stem cell transplants.
Eligibility:
- Individuals who are scheduled to have a stem cell transplant.
Design:
- Participants will be screened with a medical history and physical exam.
- Participants will receive the cord blood unit as part of their stem cell transplant
procedure. The transplant will be performed according to the current standard of care
for the procedure.
- After the transplant, participants will be monitored for up to 1 year. Any problems or
side effects from the transplant will be treated as necessary. All outcomes will be
reported to the National Cord Blood Program and to the Center for International Blood
and Marrow Transplant.
• INCLUSION CRITERIA:
• Patients of any age or either gender with indications for receipt of investigational
HPC-CORD BLOOD who are participating in an NIH-IRB approved clinical trial for
unrelated hematopoietic stem cell transplantation.
• Signed informed consent (and assent when applicable).
EXCLUSION CRITERIA:
• Patients who are receiving licensed CB products (only)
• Patients who are receiving unlicensed CB products from other CB banks (i.e. NMDP)
Inotuzumab Ozogamicin in Treating Younger Patients With B-Lymphoblastic Lymphoma or Relapsed or Refractory CD22 Positive B Acute Lymphoblastic Leukemia
This phase II trial studies how well inotuzumab ozogamicin works in treating younger patients
with B-lymphoblastic lymphoma or CD22 positive B acute lymphoblastic leukemia that has come
back (relapsed) or does not respond to treatment (refractory). Inotuzumab ozogamicin is a
monoclonal antibody, called inotuzumab, linked to a toxic agent called ozogamicin. Inotuzumab
attaches to CD22 positive cancer cells in a targeted way and delivers ozogamicin to kill
them.
• Patients must be >= 1 year and < 22 years of age at the time of enrollment
• Patients must have B-ALL, or previously diagnosed B lymphoblastic lymphoma (B-LL),
with >= 5% (M2 or M3) bone marrow blasts with or without extramedullary disease
• NOTE: Relapsed patients previously diagnosed with B-lymphoblastic lymphoma (B-LL)
are eligible if they have an M2 or M3 marrow at the time of enrollment on this
study
• Patients with ALL or B-LL who have M2 morphology must have local confirmatory testing
showing >= 5% blasts by flow cytometry, fluorescence in situ hybridization (FISH)
testing or other molecular method
• Leukemic blasts must demonstrate surface expression of CD22 at the time of relapse by
local/institutional flow cytometry of a bone marrow aspirate sample; (assessment of
CD22 using a bright fluorophore such as phycoerythrin [PE] is strongly recommended)
• In the case of an inadequate aspirate sample (dry tap) or if bone marrow aspirate
is unable to be performed due to patient clinical status, flow cytometry of
peripheral blood specimen may be substituted if the patient has at least 1,000/uL
circulating blasts; alternatively, CD22 expression may be documented by
immunohistochemistry of a bone marrow biopsy specimen
• Patients with one of the following:
• Second or greater relapse;
• Primary refractory disease with at least 2 prior induction attempts;
• First relapse refractory to at least one prior re-induction attempt
• Any relapse after HSCT (Cohort 1 ONLY)
Patients with Down syndrome are eligible ONLY for Cohort 1 with:
• Any of above disease status, OR
• First relapse with no prior re-induction attempt NOTE: Patients with Down syndrome or
prior HSCT are NOT eligible for Cohort 2 combination therapy
• Patients with Philadelphia chromosome (Ph)+ ALL must have had two prior therapy
attempts including two different tyrosine kinase inhibitors (TKIs)
• Patients must have fully recovered from the acute toxic effects of all prior
anti-cancer therapy, defined as resolution of all such toxicities to =< grade 2
or lower per the inclusion/exclusion criteria prior to entering this study. Apply
to Cohort 2:
• Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive. For
agents not listed, the duration of this interval must be discussed with the study
chair and the study-assigned Research Coordinator prior to enrollment.
• A waiting period prior to enrollment is not required for patients receiving
standard cytotoxic maintenance chemotherapy (i.e., corticosteroid, vincristine,
6MP, and/or methotrexate).
• A waiting period is not required for patients receiving a single dose of
intrathecal methotrexate, hydrocortisone, and/or cytarabine within 7 days prior
to enrollment
• >= 14 days must have elapsed after the completion of other cytotoxic therapy,
with the exception of hydroxyurea, for patients not receiving standard
maintenance therapy. For patients who previously received calaspargase pegol, >=
21 days must have elapsed after the last dose. Additionally, patients must have
fully recovered from all acute toxic effects of prior therapy.
• Note: Cytoreduction with hydroxyurea must be discontinued >= 24 hours prior
to the start of protocol therapy.
• Anti-cancer agents not known to be myelosuppressive (e.g., not associated with reduced
platelet or absolute neutrophil count [ANC] counts): >= 7 days after the last dose of
agent. For agents not listed, the duration of this interval must be discussed with the
study chair and the study-assigned research coordinator prior to enrollment.
• Anti-cancer agents that are antibodies: >= 21 days must have elapsed from infusion of
last dose of antibody, and toxicity related to prior antibody therapy must be
recovered to grade =< 1. There is an exception for blinatumomab infusions, for which
patients must have been off for at least 3 days and all drug related toxicity must
have resolved to grade 2 or lower as outlined in the inclusion/exclusion criteria.
• Corticosteroids: If used to modify immune adverse events related to prior therapy, >=
14 days must have elapsed since last dose of corticosteroid. A waiting period prior to
enrollment is not required for patients receiving corticosteroid for leukemia
therapy/cytoreduction.
• Radiotherapy: >= 2 weeks must have elapsed since local palliative radiation therapy
(XRT) (small port); >= 3 months must have elapsed if prior cranial or craniospinal XRT
was received, if >= 50% of the pelvis was irradiated, or if total body irradiation
(TBI) was received; >= 6 weeks must have elapsed if other substantial bone marrow
irradiation was given.
• Stem cell transplant or rescue without TBI: For Cohort 1, at least 90 days must have
elapsed since stem cell transplant and at least 30 days from donor lymphocyte
infusion. Patient must have had no more than one previous HSCT and currently have no
evidence of active graft vs. host disease (GVHD). For Cohort 2, no prior HSCT is
allowed.
• Chimeric antigen receptor (CAR) T cell therapy: At least 30 days must have elapsed
from the last CAR-T cell infusion
• Patients must have a performance status corresponding to Eastern Cooperative
Oncology Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years
of age and Lansky for patients =< 16 years of age; patients who are unable to
walk because of paralysis, but who are up in a wheelchair, will be considered
ambulatory for the purpose of assessing the performance score
• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
mL/min/1.73 m^2 or
• A serum creatinine 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)
• Direct bilirubin =< 1.5 x upper limit of normal (ULN) for age, and
• Serum glutamic pyruvic transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5
x ULN for age; for the purpose of this study, the ULN for ALT will be 45 U/L
Exclusion Criteria:
• Patients with any prior history of SOS irrespective of severity
• Patients with isolated central nervous system (CNS), testicular, or any other
extramedullary site of relapse
• Patients who have been previously treated with inotuzumab ozogamicin
• Patients who have previously received HSCT (Cohort 2 only)
• Patients with Down syndrome (Cohort 2 only)
• History of allergic reaction attributed to compounds of similar or biologic
composition to inotuzumab ozogamicin or other agents in the study
• Note: Patients with history of allergy to pegaspargase/calaspargase pegol are
eligible for enrollment on Cohort 2 (dose levels 1 and -1) if Erwinia formulation
of asparaginase can be obtained
• If Cohort 2 is enrolling at dose level -2, then patients who cannot receive
asparaginase due to prior allergy, toxicity, or lack of access may enroll
• NOTE: patients on AALL1621 are not eligible to co-enroll on AALL1931
• Patients with active optic nerve and/or retinal involvement are not eligible; patients
who are presenting with visual disturbances should have an ophthalmologic exam and, if
indicated, a magnetic resonance imaging (MRI) to assess optic nerve or retinal
involvement
• Patients who are currently receiving another investigational drug
• Patients who are currently receiving or plan to receive other anti-cancer agents
(except hydroxyurea, which may be continued until 24 hours prior to start of protocol
therapy, and intrathecal chemotherapy)
• Anti-GVHD or agents to prevent organ rejection post-transplant; patients who are
receiving cyclosporine, tacrolimus, or other agents to prevent either
graft-versus-host disease post bone marrow transplant or organ rejection
post-transplant are not eligible for this trial; at least 3 half-lives must have
elapsed after the last dose of GVHD or anti-rejection medications
• Patients who are currently receiving or plan to receive corticosteroids except as
described below
• Systemic corticosteroids may be administered for cytoreduction up to 24 hours
prior to the start of protocol therapy, (Cohort 1 only) for all patients,
corticosteroids may be administered as a premedication for inotuzumab ozogamicin
and as treatment for allergic reactions or for physiologic replacement/stress
dosing of hydrocortisone for documented adrenal insufficiency; corticosteroids
are not allowed for other indications
• Patients with known human immunodeficiency virus (HIV), hepatitis B or C infections;
testing to prove negative status is not required for enrollment unless it is deemed
necessary for usual medical care of the patient
• Patients who have an active uncontrolled infection defined as:
• Positive bacterial blood culture within 48 hours of study enrollment;
• Fever above 38.2 degree Celsius (C) within 48 hours of study enrollment with
clinical signs of infection; fever that is determined to be due to tumor burden
is allowed if patients have documented negative blood cultures for at least 48
hours prior to enrollment and no concurrent signs or symptoms of active infection
or hemodynamic instability
• A positive fungal culture within 30 days of study enrollment or active therapy
for presumed invasive fungal infection
• Patients may be receiving IV or oral antibiotics to complete a course of therapy
for a prior documented infection as long as cultures have been negative for at
least 48 hours and signs or symptoms of active infection have resolved; for
patients with clostridium (C.) difficile diarrhea, at least 72 hours of
antibacterial therapy must have elapsed and stools must have normalized to
baseline
• Active viral or protozoal infection requiring IV treatment
• Patients known to have one of the following concomitant genetic syndromes: Bloom
syndrome, ataxia-telangiectasia, Fanconi anemia, Kostmann syndrome, Schwachman
(Schwachman-Diamond-Blackfan) syndrome or any other known bone marrow failure syndrome
• There have been no human studies of inotuzumab ozogamicin in pregnant women and no
reports of exposure in utero; based on nonclinical safety studies, inotuzumab
ozogamicin has the potential to impair human male and female fertility and to
adversely affect human embryo fetal development; women of childbearing potential
should be advised to avoid becoming pregnant while receiving inotuzumab ozogamicin;
there is no information regarding the presence of inotuzumab ozogamicin in human milk,
the effects on the breast-fed infant, or the effects on milk production; because of
the potential for adverse reactions in breast-fed infants, women should not
breast-feed during treatment with inotuzumab ozogamicin and for at least 2 months
after the final dose
• Female patients of childbearing potential are not eligible unless a negative
pregnancy test result has been obtained within 7 days prior to enrollment
• Female patients who are sexually active and of reproductive potential are not
eligible unless they agree to use an effective contraceptive method for the
duration of their study participation and for 8 months after the last dose of
inotuzumab ozogamicin
• Men with female partners of childbearing potential should use effective
contraception during treatment with inotuzumab ozogamicin and for at least 5
months after the last dose of inotuzumab ozogamicin
• Lactating females are not eligible unless they agree not to breastfeed their
infants
Recurrent B Acute Lymphoblastic Leukemia, Recurrent B Lymphoblastic Lymphoma, Refractory B Acute Lymphoblastic Leukemia, Refractory B Lymphoblastic Lymphoma
Study of ONO-4685 in Patients With Relapsed or Refractory T Cell Lymphoma
This study will investigate the safety, tolerability, pharmacokinetics, and preliminary
efficacy of ONO-4685 in patients with relapsed or refractory T cell Lymphoma
Inclusion Criteria
1. Patients aged ≥ 18 years at time of screening
2. Written informed consent by the patient or the patients' legally authorized
representative prior to screening
3. Patients with histologically or cytologically confirmed diagnosis of one of the
following subtypes of T-cell lymphoma:
1. Peripheral T-cell lymphoma (PTCL): Angioimmunoblastic T-cell lymphoma (AITL),
PTCL, not otherwise specified (PTCL-NOS), nodal PTCL with T-follicular helper
(TFH) and follicular T-cell lymphoma (FTCL)
2. Cutaneous T-cell lymphoma (CTCL) (stages II-B, III, and IV): Mycosis fungoides
(MF) and Sezary syndrome (SS)
4. Patients must have received at least 2 prior systemic therapies.
5. Patients with PTCL must have at least 1 measurable lesion
6. Patients with CTCL must have assessable disease by response criteria for CTCL (Olsen
EA, 2011)
7. Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 0-2
8. Life expectancy of at least 3 months
9. Adequate bone marrow, renal and hepatic functions
Exclusion Criteria:
1. Patients with central nervous system (CNS) involvement
2. Patients with Adult T-cell leukemia/lymphoma (ATLL)
3. Prior allogeneic stem cell transplant
4. Prior treatment with ONO-4685, anti-PD-1, anti-PD-L1, anticytotoxic T lymphocyte
associated protein 4 (CTLA-4) antibody, or any other antibody or drug specifically
targeting T-cell co-stimulation or checkpoint pathways
5. Patients with malignancies (other than T-cell lymphoma) except for completely resected
basal cell carcinoma, stage I squamous cell carcinoma, carcinoma in situ, or any other
malignancies that has not relapsed for at least 2 years
6. History of severe allergy or hypersensitivity to any monoclonal antibodies, other
therapeutic proteins or corticosteroid (e.g., dexamethasone)
7. History of infection with Mycobacterium tuberculosis within 2 years prior to the first
dose of study treatment
8. Patients with systemic and active infection including human immunodeficiency virus
(HIV), hepatitis B or C virus infection
9. Patients not recovered to Grade 1 or stabilized from the adverse effects (excluding
alopecia) of any prior therapy for their malignancies
10. Women who are pregnant or lactating
Drug: ONO-4685
Lymphoid Leukemia, Relapsed or Refractory T Cell Lymphoma
ONO-4685, PD-1, CD3, Bispecific antibody, PTCL, AITL, PTCL-NOS, nodal PTCL with TFH, FTCL, CTCL, MF, SS
Heparin Versus Normal Saline in Peripherally Inserted Central Catheter Lines
The study team will be performing a study comparing the use of Heparin Flushes vs. Normal
Saline Flushes in making sure central lines stay open. The participants will be placed in a
group to receive the University of Texas Southwestern Medical Center (UTSW) Standard of Care
(control group) for maintaining central lines, or a group to receive Normal Saline Flushes
only (experimental group) to keep their central line open. The participants electronic
medical record will be reviewed by study team members for the inclusion/exclusion criteria,
the participants central line will be assessed by an 11 Blue BMT nurse every 12 hours, and
they may be asked questions regarding their medical history during their stay on 11 Blue BMT.
If a participant is discharged or transferred off of the 11 Blue BMT unit, they will no
longer be included in the study and their central line maintenance will return to the UTSW
Standard of Care. Participants in this study may be at risk for central line occlusion (a
blood clot) which could require intervention to regain the free flow of fluids and use of the
central line. The study team predicts there will be no increase in the rate of line occlusion
when using Normal Saline Flushes only to maintain the free flow of fluids through
participants central line. The study team also hopes the results of this study will help to
improve patient outcomes by decreasing risk of infection, heparin associated complications,
and costs.
• Oncology patients
• Admitted to 11Blue Bone Marrow Transplant Unit at Clements University Hospital
University of Texas Southwestern Medical Center
• Ages 18-80 years
• Pre-existing or newly placed PICC line
• PICC line with good blood return (defined as: "brisk blood return of 3cc")
• Flushes without difficulty
Exclusion Criteria:
• Patient less than 18 years of age or greater than 80 years of age
• Refused or unable to give consent to the study
• Patient admitted to the 11Blue BMT unit with any line other than a PICC line, or
multiple lines
• Patient admitted to 11Blue BMT for active transplant
• Patient with a coagulopathy diagnosis
• Patient on therapeutic dose of anticoagulants for documented Deep Vein Thrombosis or
Pulmonary Embolism
• Patient on inpatient hospice/comfort care
• Patient transferred off 11B BMT unit onto another floor
Drug: Normal Saline Group, Drug: Heparin Group
Lymphoma, Cancer, Multiple Myeloma, Leukemia, Other, Leukemia, Not Otherwise Specified, Lymphoid Leukemia, Myeloid and Monocytic Leukemia
Peripherally Inserted Central Lines, Heparin Flush
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.
Targeted Therapy Directed by Genetic Testing in Treating Pediatric Patients With Relapsed or Refractory Advanced Solid Tumors, Non-Hodgkin Lymphomas, or Histiocytic Disorders (The Pediatric MATCH Screening Trial)
This Pediatric MATCH screening and multi-sub-study phase II trial studies how well treatment
that is directed by genetic testing works in pediatric patients with solid tumors,
non-Hodgkin lymphomas, or histiocytic disorders that have progressed following at least one
line of standard systemic therapy and/or for which no standard treatment exists that has been
shown to prolong survival. Genetic tests look at the unique genetic material (genes) of
patients' tumor cells. Patients with genetic changes or abnormalities (mutations) may benefit
more from treatment which targets their tumor's particular genetic mutation, and may help
doctors plan better treatment for patients with solid tumors or non-Hodgkin lymphomas.
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients must be >= 12 months and
=< 21 years of age at the time of study enrollment
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients with recurrent or
refractory solid tumors, including non-Hodgkin lymphomas, histiocytoses (e.g.
langerhans cell histiocytosis [LCH], juvenile xanthogranuloma [JXG], histiocytic
sarcoma), and central nervous system (CNS) tumors are eligible; patients must have had
histologic verification of malignancy at original diagnosis or relapse except in
patients with intrinsic brain stem tumors, optic pathway gliomas, or patients with
pineal tumors and elevations of cerebrospinal fluid (CSF) or serum tumor markers
including alpha-fetoprotein or beta-human chorionic gonadotropin (HCG); in cases where
patient enrolls prior to histologic confirmation of recurrent disease, patient is
ineligible and should be withdrawn from study if histology fails to confirm
recurrence; please note: Patients with Hodgkin lymphoma and plexiform neurofibroma are
not eligible
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Tumor Testing Requirement: Tumor
sample availability requirement for stage 1 of Pediatric MATCH (patients enrolled from
start of study in July 2017 through 12/31/21); Patients must have an formalin-fixed
paraffin-embedded (FFPE) tumor sample available for MATCH study testing from a biopsy
or surgery that was performed at any point after initial tumor recurrence/progression,
or be planned to have a procedure to obtain such a sample that is considered to be of
potential benefit by the treating clinicians; a tumor sample from a clinically
performed diagnostic (pre-treatment) biopsy will be acceptable for enrollment onto
Pediatric MATCH only for children with high-grade gliomas of the brainstem (diffuse
intrinsic pontine gliomas) or thalamus
• Please note: Samples that have been decalcified using standardly utilized
acid-based decalcification methods are not generally suitable for MATCH study
testing; the nucleic acids will have been degraded in the decalcification process
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Tumor molecular profiling report
availability requirement for Stage 2 of Pediatric MATCH (patients enrolled starting
2022): In stage 2 of the study, no tumor samples will be submitted for centralized
clinical tumor profiling; instead, a tumor molecular profiling report from a College
of American Pathologists (CAP)/ Clinical Laboratory Improvements Amendments
(CLIA)-approved testing laboratory must be submitted for review by the Molecular
Review Committee (MRC)
• This molecular profiling must have been performed on a tumor sample that was
obtained at any point after initial tumor recurrence/progression and must be
accompanied by a pathology report for the same tumor specimen; a molecular
profiling report for a diagnostic (pre-treatment) tumor sample will be acceptable
for enrollment onto Pediatric MATCH only for children with high-grade gliomas of
the brainstem (diffuse intrinsic pontine gliomas) or thalamus. In the event that
molecular profiling reports are available from multiple timepoints, the most
recent report should be prioritized for study submission
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Karnofsky >= 50% for patients >
16 years of age and Lansky >= 50 for patients =< 16 years of age); note: neurologic
deficits in patients with central nervous system (CNS) tumors must have been stable
for at least 7 days prior to study enrollment; patients who are unable to walk because
of paralysis, but who are up in a wheelchair, will be considered ambulatory for the
purpose of assessing the performance score
• ELIGIBILITY CRITERIA FOR ENROLLMENT ONTO APEC1621SC: Patients must have
radiographically measurable disease; measurable disease based on imaging obtained less
than or equal to 56 days prior to enrollment; patients with neuroblastoma who do not
have measurable disease but have metaiodobenzylguanidine (MIBG) positive (+) evaluable
disease are eligible; measurable disease in patients with CNS involvement is defined
as any lesion that is at minimum 10 mm in one dimension on standard magnetic resonance
imaging (MRI) or computed tomography (CT)
• Note: The following do not qualify as measurable disease:
• Malignant fluid collections (e.g., ascites, pleural effusions)
• Bone marrow infiltration except that detected by MIBG scan for neuroblastoma
• Lesions only detected by nuclear medicine studies (e.g., bone, gallium or
positron emission tomography [PET] scans) except as noted for neuroblastoma
• Elevated tumor markers in plasma or CSF
• Previously radiated lesions that have not demonstrated clear progression
post radiation
• Leptomeningeal lesions that do not meet the measurement requirements for
Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: NOTE: patient does not need to meet all
subprotocol criteria at time of enrollment onto the APEC1621SC screening protocol, but
will need to meet all criteria prior to enrollment on any assigned treatment
subprotocol. Patients must be enrolled onto a subprotocol within 2 weeks (14 days) of
treatment assignment
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Karnofsky >= 50% for patients > 16 years
of age and Lansky >= 50 for patients =< 16 years of age); Note: neurologic deficits in
patients with CNS tumors must have been stable for at least 7 days prior to study
enrollment; patients who are unable to walk because of paralysis, but who are up in a
wheelchair, will be considered ambulatory for the purpose of assessing the performance
score
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: At the time of treatment with subprotocol
specified therapy, the patients must have radiographically measurable disease;
patients with neuroblastoma who do not have measurable disease but have MIBG+
evaluable are eligible; measurable disease in patients with CNS involvement is defined
as any lesion that is at minimum 10 mm in one dimension on standard MRI or CT
• Note: The following do not qualify as measurable disease:
• Malignant fluid collections (e.g., ascites, pleural effusions)
• Bone marrow infiltration except that detected by MIBG scan for neuroblastoma
• Lesions only detected by nuclear medicine studies (e.g., bone, gallium or
positron emission tomography [PET] scans) except as noted for neuroblastoma
• Elevated tumor markers in plasma or CSF
• Previously radiated lesions that have not demonstrated clear progression
post radiation
• Leptomeningeal lesions that do not meet the measurement requirements for
RECIST 1.1
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: At the time of enrollment onto a
subprotocol, the following general criteria for initiation of therapy will be
required:
• Patients must have fully recovered from the acute toxic effects of all prior
anticancer therapy and must meet the following minimum duration from prior
anticancer directed therapy prior to enrollment to the subprotocol; if after the
required timeframe, the numerical eligibility criteria are met, e.g. blood count
criteria, the patient is considered to have recovered adequately
• Cytotoxic chemotherapy or other anticancer agents known to be
myelosuppressive: for agents not listed, the duration of this interval must
be discussed with the study chair and the study-assigned research
coordinator prior to enrollment >= 21 days after the last dose of cytotoxic
or myelosuppressive chemotherapy (42 days if prior nitrosourea)
• Anticancer agents not known to be myelosuppressive (e.g. not associated with
reduced platelet or absolute neutrophil counts [ANC]): >= 7 days after the
last dose of agent; for agents not listed, the duration of this interval
must be discussed with the study chair and the study-assigned research
coordinator prior to enrollment
• Antibodies: >= 21 days must have elapsed from infusion of last dose of
antibody, and toxicity related to prior antibody therapy must be recovered
to grade =< 1
• Corticosteroids: If used to modify immune adverse events related to prior
therapy, >= 14 days must have elapsed since last dose of corticosteroid
• Hematopoietic growth factors: >= 14 days after the last dose of a
long-acting growth factor (e.g. Neulasta) or 7 days for short-acting growth
factor; for agents that have known adverse events occurring beyond 7 days
after administration, this period must be extended beyond the time during
which adverse events are known to occur; the duration of this interval must
be discussed with the study chair and the study-assigned research
coordinator
• Interleukins, interferons and cytokines (other than hematopoietic growth
factors): >= 21 days after the completion of interleukins, interferon or
cytokines (other than hematopoietic growth factors)
• Stem cell infusions (with or without total-body irradiation [TBI]):
• Allogeneic (non-autologous) bone marrow or stem cell transplant, or any
stem cell infusion including donor lymphocyte infusion (DLI) or boost
infusion: >= 84 days after infusion and no evidence of graft versus
host disease (GVHD)
• Autologous stem cell infusion including boost infusion: >= 42 days
• Cellular therapy: >= 42 days after the completion of any type of cellular
therapy (e.g. modified T cells, natural killer (NK) cells, dendritic cells,
etc.)
• X-ray therapy (XRT)/External Beam Irradiation including Protons: >= 14 days
after local XRT; >= 150 days after TBI, craniospinal XRT or if radiation to
>= 50% of the pelvis; >= 42 days if other substantial bone marrow (BM)
radiation; note: radiation may not be delivered to "measurable disease"
tumor site(s) being used to follow response to subprotocol treatment
• Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131I-MIBG): >= 42
days after systemically administered radiopharmaceutical therapy
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: For patients with solid tumors without
known bone marrow involvement:
• Peripheral absolute neutrophil count (ANC) >= 1000/mm^3
• Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving
platelet transfusions for at least 7 days prior to enrollment)
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Patients with known bone marrow
metastatic disease will be eligible for study provided they meet the blood counts (may
receive transfusions provided they are not known to be refractory to red cell or
platelet transfusions); these patients will not be evaluable for hematologic toxicity
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Creatinine clearance or radioisotope
glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or a serum creatinine based on
age/gender as follows:
• Age: 1 to < 2 years; maximum serum creatinine (mg/dL): male 0.6; female 0.6
• Age: 2 to < 6 years; maximum serum creatinine (mg/dL): male 0.8; female 0.8
• Age: 6 to < 10 years; maximum serum creatinine (mg/dL): male 1; female 1
• Age: 10 to < 13 years; maximum serum creatinine (mg/dL): male 1.2; female 1.2
• Age: 13 to < 16 years; maximum serum creatinine (mg/dL): male 1.5; female 1.4
• Age: >= 16 years; maximum serum creatinine (mg/dL): male 1.7; female 1.4
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Bilirubin (sum of conjugated +
unconjugated) =< 1.5 x upper limit of normal (ULN) for age
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Serum glutamate pyruvate transaminase
(SGPT) (alanine transferase [ALT]) =< 135 U/L (for the purpose of this study, the ULN
for SGPT is 45 U/L)
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Patients must be able to swallow intact
capsules/tablets, unless otherwise specified in the subprotocol to which they are
assigned
• GENERAL INCLUSION CRITERIA FOR SUBPROTOCOLS: Agent specific limitations on prior
therapy will be included with specific treatment subprotocols
Exclusion Criteria:
• GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Pregnant or breast-feeding women will not
be entered on this study due to risks of fetal and teratogenic adverse events as seen
in animal/human studies, or because there is currently no available information
regarding human fetal or teratogenic toxicities; pregnancy tests must be obtained in
females who are post-menarchal; males or females of reproductive potential may not
participate unless they have agreed to use an effective contraceptive method
• GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Concomitant medications
• Corticosteroids: at the time of consent and enrollment to regimen specific
subprotocols, patients receiving corticosteroids who have not been on a stable or
decreasing dose of corticosteroid for at least 7 days prior to enrollment to the
subprotocol will not be eligible; if used to modify immune adverse events related
to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid
• Investigational drugs: patients must meet criteria for prior therapy at the time
of consent and enrollment to a subprotocol; other investigational agents may not
be administered to patients while they are receiving study drug as part of a
subprotocol
• Anticancer agents: patients must meet criteria for prior therapy at the time of
consent and enrollment to a subprotocol; other investigational agents may not be
administered to patients while they are receiving study drug as part of a
subprotocol
• Anti-GVHD agents post-transplant: patients who are receiving cyclosporine,
tacrolimus or other agents to prevent graft-versus-host disease post bone marrow
transplant are not eligible
• GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Patients who have an uncontrolled
infection are not eligible
• GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Patients who have had a prior solid organ
transplant are not eligible
• GENERAL EXCLUSION CRITERIA FOR SUBPROTOCOLS: Additional agent specific criteria will
be included with specific treatment subprotocols
PO Ixazomib in Combination With Chemotherapy for Childhood Relapsed or Refractory Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma
This is a phase 1/2 study of a drug called Ixazomib in combination with cytotoxic
chemotherapy consisting of Vincristine, Dexamethasone, Asparaginase, and Doxorubicin (VXLD).
• Age Patients must be ≤21 years of age at the time of enrollment.
1. Phase 1 •Initial enrollment will be restricted to patients < 18 years of age
until 9 such patients are enrolled
2. Phase 2 •Initial enrollment will be restricted to patients < 18 years of age
until 6 such patients are enrolled
• Diagnosis Patients must have a diagnosis of relapsed/refractory ALL or LLy with or
without extramedullary disease (including CNS2 and CNS3). Patient with mixed phenotype
ALL or mature B (Burkitt-like) leukemia are not eligible.
1. Patients with ALL must have ≥ 5% blasts by morphology.
2. Patients with LLy must have measurable disease documented by clinical, radiologic
or histologic criteria
• Performance Level Karnofsky ≥ 50% for patients > 16 years of age and Lansky ≥ 50% for
patients ≤ 16 years of age.
• Prior Therapy A. Prior therapeutic attempts
• Phase 1 •Any patients with relapsed/refractory ALL or LLy
• Phase 2
1. B-cell ALL/LLy: all patients must have failed two or more therapeutic
attempts.
2. T-cell ALL/LLy: all patients must have failed one or more therapeutic
attempts. B. Recent prior chemotherapy Patients must have fully recovered
from the acute toxic effects of all prior chemotherapy, immunotherapy, or
radiotherapy prior to entering this study.
• Cytoreduction with hydroxyurea Hydroxyurea can be initiated and continued for up
to 24 hours prior to the start of protocol therapy.
• Patients who relapsed while they are receiving cytotoxic therapy At least 14 days
must have elapsed since the completion of the last dose of chemotherapy,except
Intrathecal chemotherapy, and/or maintenance therapy such as vincristine,
mercaptopurine, methotrexate or glucocorticoids. There is no waiting period for
those relapsing on maintenance therapy.
C. Hematopoietic stem cell transplant: Patients who have experienced their relapse after a
HSCT are eligible, provided they have no evidence of acute or chronic Graft-versus-Host
Disease (GVHD), are not receiving GVHD prophylaxis or treatment, and are at least 90 days
post-transplant at the time of enrollment.
D. Hematopoietic growth factors: It must have been at least 7 days since the completion of
therapy with G-CSF or other growth factors at the time of enrollment. It must have been at
least 14 days since the completion of therapy with pegfilgrastim (Neulasta®).
E. Biologic (anti-neoplastic agent): At least 7 days since the last dose of a biologic
agent. For agents that have known adverse events occurring beyond 7 days after
administration, this period must be extended beyond the time during which adverse events
are known to occur. The duration of this interval must be discussed with the study chair
1. Monoclonal antibodies: At least 3 half-lives of the antibody must have elapsed after
the last dose of monoclonal antibody. (i.e., blinatumomab = 6 hours,44 inotuzumab = 37
days, rituximab = 66 days)
2. Immunotherapy: At least 30 days after the completion of any type of immunotherapy,
e.g., tumor vaccines, CAR T cells.
F. XRT: Craniospinal XRT is prohibited during protocol therapy. No washout period is
necessary for radiation given to any extramedullary site other than CNS; ≥90 days must have
elapsed if prior total body irradiation (TBI) or craniospinal XRT.
G. Anthracyclines: Patients must have had a lifetime exposure of <400 mg/m2 of doxorubicin
equivalents of anthracyclines.
H. Proteasome inhibitors: Patients with a prior exposure to proteasome inhibitors (e.g.,
bortezomib, carfilzomib) are eligible as long as the patient demonstrated at least a
partial response to a proteasome inhibitor with chemotherapy combination.
-Renal and hepatic function
Patients must have adequate renal and hepatic functions as indicated by the following
laboratory values:
A. Adequate renal function defined as: Patient must have a calculated creatinine clearance
or radioisotope GFR 70ml/min/1.73m2 OR a normal serum creatinine based on age/gender
B. Adequate Liver Function Defined as: Direct bilirubin ≤ 1.5 x upper limit of normal (ULN)
for age or normal (except in the presence of Gilbert's syndrome), AND alanine transaminase
(ALT) ≤ 5 x ULN for age. The hepatic requirements are waived for patients with known or
suspected liver involvement by leukemia or lymphoma. This must be reviewed by and approved
by the study chair or vice chair.
• Adequate Cardiac Function Defined as: Shortening fraction of more than or equal to 27%
by echocardiogram, OR ejection fraction of equal to or more than 50% by radionuclide
angiogram (MUGA).
• Reproductive Function A. Female patients of childbearing potential must have a
negative urine or serum pregnancy test confirmed within 2 weeks prior to enrollment.
B. Female patients with infants must agree not to breastfeed their infants while on this
study.
C. Male and female patients of child-bearing potential must agree to use an effective
method of contraception approved by the investigator during the study and for a minimum of
6 months after study treatment.
• Informed Consent Patients and/or their parents or legal guardians must be capable of
understanding the investigational nature, potential risks and benefits of the study.
All patients and/or their parents or legal guardians must sign a written informed
consent. Age appropriate assent will be obtained per institutional guidelines. To
allow non-English speaking patients to participate in this study, bilingual health
services will be provided in the appropriate language when feasible.
• All institutional, FDA, and OHRP requirements for human studies must be met.
Exclusion Criteria:
Patients will be excluded if they have isolated CNS or testicular disease.
Patients will be excluded if they have ≥grade 2 peripheral sensory or motor neuropathy
(defined by the Modified "Balis" Pediatric Scale of Pediatric Neuropathies) at the time of
enrollment (see section 4.7.1.1).
Patients will be excluded if they have a known allergy or intolerance to any of the drugs
used in the study •except for PEG-asparaginase for which erwinia asparaginase may be
substituted
Patients will be excluded if they have a 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 needs to be off
pressors and have negative blood cultures for 48 hours.
Patients will be excluded if there is a plan to administer non-protocol chemotherapy,
radiation therapy, or immunotherapy during the study period.
Patients will be excluded if they have significant concurrent disease, illness, psychiatric
disorder or social issue that would compromise patient safety or compliance with the
protocol treatment or procedures, interfere with consent, study participation, follow up,
or interpretation of study results.
Patients with DNA fragility syndromes (such as Fanconi anemia, Bloom syndrome) are
excluded.
Patients will be excluded if they have had a lifetime exposure of ≥400 mg/m2 doxorubicin
equivolents of anthracyclines (anthracycline equivalence to doxorubicin conversion see
appendix iv) .
Concomitant medications Investigational drugs: Patients currently receiving another
investigational drug are not eligible.
Anti-GVHD agents post transplant: patients who are receiving cyclosporine, tacrolimus or
other agents to prevent graft-versus-host disease post hematopoetic stem cell transplant
are not eligible.
CYP3A4 agents: patients who are currently receiving drugs that are strong inducers of
CYP3A4 are not eligible. Strong inducers of CYP3A4 should be avoided from 14 days prior to
enrollment to the end of the study. See appendix ii for a list of agents which fall into
this category.
Patients with Ph+ALL and Ph-like ALL who are currently receiving TKI therapy
Infants or Patients with Down Syndrome will be excluded in phase 2 of the study
Study of Ravulizumab in Pediatric Participants With HSCT-TMA
This study will evaluate the safety, efficacy, pharmacokinetics, and pharmacodynamics of
ravulizumab administered by intravenous infusion to pediatric participants, from 1 month to <
18 years of age, with HSCT-TMA. The treatment period is 26 weeks, followed by a 26-week
off-treatment follow-up period.
1. 1 month of age up to < 18 years of age at the time of signing the informed consent.
2. Received HSCT within the past 6 months.
3. Diagnosis of TMA that persists despite initial management of any triggering condition.
4. Body weight ≥ 5 kilograms.
5. Female participants of childbearing potential and male participants with female
partners of childbearing potential must use highly effective contraception starting at
Screening and continuing until at least 8 months after the last dose of ravulizumab.
6. Participants must be vaccinated against meningococcal infections if clinically
feasible, according to institutional guidelines for immune reconstitution after HSCT.
Participants must be re-vaccinated against Haemophilus influenzae type b and
Streptococcus pneumoniae if clinically feasible, according to institutional guidelines
for immune reconstitution after HSCT. All participants should be administered coverage
with prophylactic antibiotics according to institutional post-transplant infection
prophylaxis guidances, including coverage against Neisseria meningitidis for at least
2 weeks after meningococcal vaccination. Participants who cannot receive meningococcal
vaccine should receive antibiotic prophylaxis coverage against Neisseria meningitidis
the entire Treatment Period and for 8 months following the final dose of ravulizumab.
Exclusion Criteria:
1. Known familial or acquired 'a disintegrin and metalloproteinase with a thrombospondin
type 1 motif, member 13' deficiency (activity < 5%).
2. Known Shiga toxin-related hemolytic uremic syndrome.
3. Positive direct Coombs test.
4. Diagnosis or suspicion of disseminated intravascular coagulation.
5. Known bone marrow/graft failure.
6. Diagnosis of veno-occlusive disease.
7. Human immunodeficiency virus (HIV) infection (evidenced by HIV-1 or HIV-2 antibody
titer).
8. Unresolved meningococcal disease.
9. Presence or suspicion of sepsis (treated or untreated) within 7 days prior to
Screening.
10. Pregnancy or breastfeeding.
11. Hypersensitivity to murine proteins or to 1 of the excipients of ravulizumab.
12. Previously or currently treated with a complement inhibitor.
Drug: Ravulizumab, Other: Best Supportive Care
Brain and Nervous System, Kidney, Leukemia, Other, Hodgkins Lymphoma, Leukemia, Not Otherwise Specified, Lymphoid Leukemia, Myeloid and Monocytic Leukemia, Non-Hodgkins Lymphoma, Other Hematopoietic, Thrombotic Microangiopathy
Efficacy and Safety of KD025 in Subjects With cGVHD After At Least 2 Prior Lines of Systemic Therapy
This is a Phase 2, randomized, multicenter study to evaluate the efficacy and safety of KD025
in subjects with Chronic Graft Versus Host Disease (cGVHD) after at least 2 prior lines of
systemic therapy
1. Male and female subjects at least 12 years of age who have had allogenic hematopoietic
cell transplant (HCT).
2. Previously received at least 2 and not more than 5 lines of systemic therapy for cGVHD
3. Receiving glucocorticoid therapy with a stable dose over the 2 weeks prior to
screening
4. Have persistent cGVHD manifestations and systemic therapy is indicated
5. Karnofsky Performance Score of ≥ 60 (if aged 16 years or older); Lansky Performance
Score of ≥ 60 (if aged < 16 years)
6. Weight ≥ 40kg
Exclusion Criteria:
1. Subject has not been on a stable dose / regimen of systemic cGVHD treatments for at
least 2 weeks prior to screening. (Note: Concomitant corticosteroids, calcineurin
inhibitors, sirolimus, MMF, methotrexate, rituximab, and extracorporeal photophoresis
(ECP) are acceptable. Systemic investigational GVHD treatments are not permitted).
2. Histological relapse of the underlying cancer or post-transplant lymphoproliferative
disease at the time of screening.
3. Current treatment with ibrutinib. Prior treatment with ibrutinib is allowed with a
washout of at least 28 days prior to randomization.
Drug: Belumosudil (KD025)
Leukemia, Other, Hodgkins Lymphoma, Leukemia, Not Otherwise Specified, Lymphoid Leukemia, Other Hematopoietic, Chronic Graft-versus-host-disease
Inotuzumab Ozogamicin and Post-Induction Chemotherapy in Treating Patients With High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and B-LLy
This phase III trial studies whether inotuzumab ozogamicin added to post-induction
chemotherapy for patients with High-Risk B-cell Acute Lymphoblastic Leukemia (B-ALL) improves
outcomes. This trial also studies the outcomes of patients with mixed phenotype acute
leukemia (MPAL), and B-lymphoblastic lymphoma (B-LLy) when treated with ALL therapy without
inotuzumab ozogamicin. Inotuzumab ozogamicin is a monoclonal antibody, called inotuzumab,
linked to a type of chemotherapy called calicheamicin. Inotuzumab attaches to cancer cells in
a targeted way and delivers calicheamicin to kill them. Other drugs used in the chemotherapy
regimen, such as cyclophosphamide, cytarabine, dexamethasone, doxorubicin, daunorubicin,
methotrexate, leucovorin, mercaptopurine, prednisone, thioguanine, vincristine, and
pegaspargase or calaspargase pegol work in different ways to stop the growth of cancer cells,
either by killing the cells, by stopping them from dividing, or by stopping them from
spreading. This trial will also study the outcomes of patients with mixed phenotype acute
leukemia (MPAL) and disseminated B lymphoblastic lymphoma (B-LLy) when treated with high-risk
ALL chemotherapy.
The overall goal of this study is to understand if adding inotuzumab ozogamicin to standard
of care chemotherapy maintains or improves outcomes in High Risk B-cell Acute Lymphoblastic
Leukemia (HR B-ALL). The first part of the study includes the first two phases of therapy:
Induction and Consolidation. This part will collect information on the leukemia, as well as
the effects of the initial treatment, in order to classify patients into post-consolidation
treatment groups. On the second part of this study, patients will receive the remainder of
the chemotherapy cycles (interim maintenance I, delayed intensification, interim maintenance
II, maintenance), with some patients randomized to receive inotuzumab. Other aims of this
study include investigating whether treating both males and females with the same duration of
chemotherapy maintains outcomes for males who have previously been treated for an additional
year compared to girls, as well as to evaluate the best ways to help patients adhere to oral
chemotherapy regimens. Finally, this study will be the first to track the outcomes of
subjects with disseminated B-cell Lymphoblastic Leukemia (B-LLy) or Mixed Phenotype Acute
Leukemia (MPAL) when treated with B-ALL chemotherapy.
• B-ALL and MPAL patients must be enrolled on APEC14B1 and consented to eligibility
studies (Part A) prior to treatment and enrollment on AALL1732. Note that central
confirmation of MPAL diagnosis must occur within 22 business days after enrollment for
MPAL patients. If not performed within this time frame, patients will be taken off
protocol.
• APEC14B1 is not a requirement for B-LLy patients but for institutional compliance
every patient should be offered participation in APEC14B1. B-LLy patients may directly
enroll on AALL1732.
• Patients must be > 365 days and < 25 years of age
• White blood cell count (WBC) criteria for patients with B-ALL (within 7 days prior to
the start of protocol-directed systemic therapy):
• Age 1-9.99 years: WBC >= 50,000/uL
• Age 10-24.99 years: Any WBC
• Age 1-9.99 years: WBC < 50,000/uL with:
• Testicular leukemia
• CNS leukemia (CNS3)
• Steroid pretreatment.
• White blood cell count (WBC) criteria for patients with MPAL (within 7 days prior to
the start of protocol-directed systemic therapy):
• Age 1-24.99 years: any WBC.
• Patient has newly diagnosed B-ALL or MPAL (by World Health Organization [WHO] 2016
criteria) with >= 25% blasts on a bone marrow (BM) aspirate;
• OR If a BM aspirate is not obtained or is not diagnostic of acute leukemia, the
diagnosis can be established by a pathologic diagnosis of acute leukemia on a BM
biopsy;
• OR A complete blood count (CBC) documenting the presence of at least 1,000/uL
circulating leukemic cells if a bone marrow aspirate or biopsy cannot be
performed.
• Patient has newly diagnosed B-LLy Murphy stages III or IV.
• Patient has newly diagnosed B-LLy Murphy stages I or II with steroid pretreatment.
• Note: For B-LLy patients with tissue available for flow cytometry, the criterion for
diagnosis should be analogous to B-ALL. For tissue processed by other means (i.e.,
paraffin blocks), the methodology and criteria for immunophenotypic analysis to
establish the diagnosis of B-LLy defined by the submitting institution will be
accepted.
• All patients and/or their parents or legal guardians must sign a written informed
consent.
• All institutional, Food and Drug Administration (FDA), and NCI requirements for human
studies must be met.
Exclusion Criteria:
• Patients with Down syndrome are not eligible (patients with Down syndrome and B-ALL
are eligible for AALL1731, regardless of NCI risk group).
• With the exception of steroid pretreatment or the administration of intrathecal
cytarabine, patients must not have received any prior cytotoxic chemotherapy for the
current diagnosis of B-ALL, MPAL, or B-LLy or for any cancer diagnosed prior to
initiation of protocol therapy on AALL1732.
• Patients who have received > 72 hours of hydroxyurea within one week prior to start of
systemic protocol therapy.
• Patients with B-ALL or MPAL who do not have sufficient diagnostic bone marrow
submitted for APEC14B1 testing and who do not have a peripheral blood sample submitted
containing > 1,000/uL circulating leukemia cells.
• Patients with acute undifferentiated leukemia (AUL) are not eligible.
• For Murphy stage III/IV B-LLy patients, or stage I/II patients with steroid
pretreatment, the following additional exclusion criteria apply:
• T-lymphoblastic lymphoma.
• Morphologically unclassifiable lymphoma.
• Absence of both B-cell and T-cell phenotype markers in a case submitted as
lymphoblastic lymphoma.
• Patients with known Charcot-Marie-Tooth disease.
• Patients with known MYC translocation associated with mature (Burkitt) B-cell ALL,
regardless of blast immunophenotype.
• Patients requiring radiation at diagnosis.
• 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 women who plan to breastfeed their infants while on study and for 2 months
after the last dose of inotuzumab ozogamicin.
• Sexually active patients of reproductive potential who have not agreed to use an
effective contraceptive method for the duration of study participation. For those
patients randomized to inotuzumab ozogamicin, there is a minimum of 8 months after the
last dose of inotuzumab ozogamicin for females and 5 months after the last dose of
inotuzumab ozogamicin for males.
Tabelecleucel for Solid Organ or Allogeneic Hematopoietic Cell Transplant Participants With Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disease (EBV+ PTLD) After Failure of Rituximab or Rituximab and Chemotherapy (ALLELE)
The purpose of this study is to determine the clinical benefit and characterize the safety
profile of tabelecleucel for the treatment of Epstein-Barr virus-associated post-transplant
lymphoproliferative disease (EBV+ PTLD) in the setting of (1) solid organ transplant (SOT)
after failure of rituximab and rituximab plus chemotherapy or (2) allogeneic hematopoietic
cell transplant (HCT) after failure of rituximab.
1. Prior SOT of kidney, liver, heart, lung, pancreas, small bowel, or any combination of
these (SOT cohort); or prior allogeneic HCT (HCT cohort)
2. A diagnosis of locally-assessed, biopsy-proven EBV+ PTLD
3. Availability of appropriate partially HLA-matched and restricted tabelecleucel has
been confirmed by the sponsor
4. Measurable, 18F-deoxyglucose (FDG)-avid (Deauville score ≥ 3) systemic disease using
Lugano Classification response criteria by positron emission tomography
(PET)-diagnostic computed tomography (CT), except when contraindicated or mandated by
local practice, then magnetic resonance imaging (MRI) may be used.For subjects with
treated central nervous system (CNS) disease, a head CT and/or brain/spinal MRI as
clinically appropriate will be required to follow CNS disease response per Lugano
Classification response criteria.
5. Treatment failure of rituximab or interchangeable commercially available biosimilar
monotherapy (SOT subgroup A or HCT cohort) or rituximab plus any concurrent or
sequentially administered chemotherapy regimen (SOT subgroup B) for treatment of PTLD.
6. Eastern Cooperative Oncology Group performance status ≤ 3 for subjects aged ≥ 16
years; Lansky score ≥ 20 for subjects < 16 years
7. For HCT cohort only: If allogeneic HCT was performed as treatment for an acute
lymphoid or myeloid malignancy, the underlying primary disease for which the subject
underwent transplant must be in morphologic remission
8. Adequate organ function
1. Absolute neutrophil count ≥ 1000/μL, (SOT cohort) or ≥ 500/μL (HCT cohort), with
or without cytokine support
2. Platelet count ≥ 50,000/μL, with or without transfusion or cytokine support. For
HCT cohort, platelet count < 50,000/μL but ≥ 20,000/μL, with or without
transfusion support, is permissible if the subject has not had grade ≥ 2 bleeding
in the prior 4 weeks (where grading of the bleeding is determined per the
National Cancer Institute's Common Terminology Criteria for Adverse Events
[CTCAE], version 5.0)
3. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total
bilirubin each < 5 × the upper limit of normal; however, ALT, AST, and total
bilirubin each ≤ 10 × upper limit of normal is acceptable if the elevation is
considered by the investigator to be due to EBV and/or PTLD involvement of the
liver as long as there is no known evidence of significant liver dysfunction
9. Subject or subject's representative is willing and able to provide written informed
consent
Exclusion Criteria:
1. Burkitt lymphoma, classical Hodgkin lymphoma, or any T cell lymphoma
2. Daily steroids of > 0.5 mg/kg prednisone or glucocorticoid equivalent, ongoing
methotrexate, or extracorporeal photopheresis
3. Untreated CNS PTLD or CNS PTLD for which the subject is actively receiving
CNS-directed chemotherapy (systemic or intrathecal) or radiotherapy at enrollment.
NOTE:Subjects with previously treated CNS PTLD may enroll if CNS-directed therapy is
complete.
4. Suspected or confirmed grade ≥ 2 graft-versus-host disease (GvHD) per the Center for
International Blood and Marrow Transplant Research consensus grading system at
enrollment
5. Ongoing or recent use of a checkpoint inhibitor agent (eg, ipilimumab, pembrolizumab,
nivolumab) within 3 drug half-lives from the most recent dose to enrollment
6. For HCT cohort: active adenovirus viremia
7. Need for vasopressor or ventilatory support
8. Antithymocyte globulin or similar anti-T cell antibody therapy ≤ 4 weeks prior to
enrollment
9. Treatment with Epstein-Barr virus cytotoxic T lymphocytes or chimeric antigen receptor
T cells directed against B cells within 8 weeks of enrollment (SOT or HCT cohorts), or
unselected donor lymphocyte infusion within 8 weeks of enrollment (HCT cohort only)
10. Female who is breastfeeding or pregnant or female of childbearing potential or male
with a female partner of childbearing potential unwilling to use a highly effective
method of contraception
11. Inability to comply with study-related procedures
Testicular Tissue Cryopreservation for Fertility Preservation
Testicular tissue cryopreservation is an experimental procedure where a young boy's
testicular tissue is retrieved and frozen. This technique is reserved for young male patients
who are not yet producing mature sperm, with the ultimate goal that their tissue may be used
in the future to restore fertility when experimental techniques emerge from the research
pipeline.
• Be male at any age.
• Be scheduled to undergo surgery, chemotherapy, drug treatment and/or radiation for the
treatment or prevention of a medical condition or malignancy with risk of causing
permanent and complete loss of subsequent testicular function.
• Or, have a medical condition or malignancy that requires removal of all or part of one
or both testicles.
• Have newly diagnosed or recurrent disease. Those who were not enrolled at the time of
initial diagnosis (i.e., patients with recurrent disease) are eligible if they have
not previously received therapy that is viewed as likely to result in complete and
permanent loss of testicular function.
• Have two testicles if undergoing elective removal of all or part of a testicle for
fertility preservation only. Note: removal of both testicles will limit fertility
preservation options.
• Sign an approved informed consent and authorization permitting the release of personal
health information. The patient and/or the patient's legally authorized guardian must
acknowledge in writing that consent for specimen collection has been obtained, in
accordance with institutional policies approved by the U.S. Department of Health and
• Consent for serum screening tests for infectious diseases [HIV-1, HIV-2, Hepatitis B,
Hepatitis C], to be performed at the time of testicular tissue harvesting.
• Undergo a full history and physical examination and obtain standard pre-operative
clearance (based on the most recent ACC/AHA Guideline for Perioperative Cardiovascular
Evaluation for Noncardiac Surgery) as determined by their primary surgeon.
• Participating in long term follow-up is a requirement of the protocol.
Exclusion Criteria:
• Diagnosed with psychological, psychiatric, or other conditions which prevent giving
fully informed consent.
• Diagnosed with an underlying medical condition that significantly increases their risk
of complications from anesthesia and surgery.
Procedure: Testicular biopsy
Lymphoma, Sarcoma, Cancer, Mycosis Fungoides, Brain and Nervous System, Other, Eye and Orbit, Anklylosing Spondylitis, Anus, Bones and Joints, Breast - Male, Carcinoid Tumor, Cardiovascular, Colon, Esophagus, Gall Bladder, Head and Neck, Kidney, Larynx, Lip, Oral Cavity and Pharynx, Liver, Lung/Thoracic, Nose, Other Digestive Organ, Other Endocrine System, Other Male Genital, Other Respiratory and Intrathoracic Organs, Other Skin, Other Urinary, Pancreas, Prostate, Rectum, Stomach, Throat, Thyroid, Urinary Bladder, Leukemia, Other, Hodgkins Lymphoma, Heart, Leukemia, Not Otherwise Specified, Lymphoid Leukemia, Myeloid and Monocytic Leukemia, Non-Hodgkins Lymphoma, Other Hematopoietic, Small Intestine, Soft Tissue, Unknown Sites, Ill - Defined Sites, Autoimmune Disorders
A Study of Selpercatinib (LOXO-292) in Participants With Advanced Solid Tumors, RET Fusion-Positive Solid Tumors, and Medullary Thyroid Cancer (LIBRETTO-001) (LIBRETTO-001)
This is an open-label, first-in-human study designed to evaluate the safety, tolerability,
pharmacokinetics (PK) and preliminary anti-tumor activity of selpercatinib (also known as
LOXO-292) administered orally to participants with advanced solid tumors, including
rearranged during transfection (RET)-fusion-positive solid tumors, medullary thyroid cancer
(MTC) and other tumors with RET activation.
For Phase 1:
• Participants with a locally advanced or metastatic solid tumor that:
• Has progressed on or is intolerant to standard therapy, or
• For which no standard therapy exists, or in the opinion of the Investigator, are not
candidates for or would be unlikely to tolerate or derive significant clinical benefit
from standard therapy, or
• Decline standard therapy
• Prior multikinase inhibitors (MKIs) with anti-RET activity are allowed
• A RET gene alteration is not required initially. Once adequate PK exposure is
achieved, evidence of RET gene alteration in tumor and/or blood is required as
identified through molecular assays, as performed for clinical evaluation
• Measurable or non-measurable disease as determined by RECIST 1.1 or RANO as
appropriate to tumor type
• Eastern Cooperative Oncology Group (ECOG) score of 0, 1, or 2 or Lansky Performance
Score (LPS) greater than or equal to (≥) 40 percent (%) (age less than [<] 16 years)
with no sudden deterioration 2 weeks prior to the first dose of study treatment
• Adequate hematologic, hepatic and renal function
• Life expectancy of at least 3 months
For Phase 2: As for phase 1 with the following modifications:
• For Cohort 1: Participants must have received prior standard therapy appropriate for
their tumor type and stage of disease, or in the opinion of the Investigator, would be
unlikely to tolerate or derive clinical benefit from appropriate standard of care
therapy
• Cohorts 1 and 2:
• Enrollment will be restricted to participants with evidence of a RET gene
alteration in tumor
• At least one measurable lesion as defined by RECIST 1.1 or RANO, as appropriate
to tumor type and not previously irradiated
• Cohorts 3 and 4: Enrollment closed
• Cohort 5:
• Cohorts 1-4 without measurable disease
• MCT not meeting the requirements for Cohorts 3 or 4
• MTC syndrome spectrum cancers (e.g., MTC, pheochromocytoma), cancers with
neuroendocrine features/differentiation, or poorly differentiated thyroid cancers
with other RET alteration/activation may be allowed with prior Sponsor approval
• cfDNA positive for a RET gene alteration not known to be present in a tumor
sample
• Cohort 6: Participants who otherwise are eligible for Cohorts 1, 2 or 5 who
discontinued another RET inhibitor may be eligible with prior Sponsor approval
• Cohort 7: Participants with a histologically confirmed stage IB-IIIA NSCLC and a RET
fusion; determined to be medically operable and tumor deemed resectable by a thoracic
surgical oncologist, without prior systemic treatment for NSCLC
Key Exclusion Criteria (Phase 1 and Phase 2):
• Phase 2 Cohorts 1 and 2: an additional known oncogenic driver
• Cohorts 3 and 4: Enrollment closed
• Cohorts 1, 2 and 5: prior treatment with a selective RET inhibitor Notes: Participants
otherwise eligible for Cohorts 1, 2, and 5 who discontinued another selective RET
inhibitor may be eligible for Phase 2 Cohort 6 with prior Sponsor approval
• Investigational agent or anticancer therapy (including chemotherapy, biologic therapy,
immunotherapy, anticancer Chinese medicine or other anticancer herbal remedy) within 5
half-lives or 2 weeks (whichever is shorter) prior to planned start of LOXO-292
(selpercatinib). In addition, no concurrent investigational anti-cancer therapy is
permitted Note: Potential exception for this exclusion criterion will require a valid
scientific justification and approval from the Sponsor
• Major surgery (excluding placement of vascular access) within 2 weeks prior to planned
start of LOXO-292 (selpercatinib)
• Radiotherapy with a limited field of radiation for palliation within 1 week of planned
start of LOXO-292 (selpercatinib), with the exception of participants receiving
radiation to more than 30% of the bone marrow or with a wide field of radiation, which
must be completed at least 4 weeks prior to the first dose of study treatment
• Any unresolved toxicities from prior therapy greater than Common Terminology Criteria
for Adverse Events (CTCAE) Grade 1 at the time of starting study treatment with the
exception of alopecia and Grade 2, prior platinum-therapy related neuropathy
• Symptomatic primary CNS tumor, metastases, leptomeningeal carcinomatosis, or untreated
spinal cord compression. Participants are eligible if neurological symptoms and CNS
imaging are stable and steroid dose is stable for 14 days prior to the first dose of
LOXO-292 (selpercatinib) and no CNS surgery or radiation has been performed for 28
days, 14 days if stereotactic radiosurgery (SRS)
• Clinically significant active cardiovascular disease or history of myocardial
infarction within 6 months prior to planned start of LOXO-292 (selpercatinib) or
prolongation of the QT interval corrected (QTcF) greater than (>) 470 milliseconds
(msec)
• Participants with implanted pacemakers may enter the study without meeting QTc
criteria due to nonevaluable measurement if it is possible to monitor for QT
changes.
• Participants with bundle branch block may be considered for study entry if QTc is
appropriate by a formula other than Fridericia's and if it is possible to monitor
for QT changes.
• Required treatment with certain strong cytochrome P450 3A4 (CYP3A4) inhibitors or
inducers and certain prohibited concomitant medications
• Phase 2 Cohort 7 (neoadjuvant treatment): Participant must not have received prior
systemic therapy for NSCLC.
Drug: LOXO-292
Lymphoma, Non-Small Cell Lung Cancer, Colon Cancer, Medullary Thyroid Cancer, Any Solid Tumor, Brain and Nervous System, Eye and Orbit, Anus, Bones and Joints, Breast - Female, Breast - Male, Cervix, Colon, Corpus Uteri, Esophagus, Kidney, Larynx, Lip, Oral Cavity and Pharynx, Liver, Lung/Thoracic, Melanoma, skin, Other Digestive Organ, Other Endocrine System, Other Female Genital, Other Male Genital, Other Respiratory and Intrathoracic Organs, Other Skin, Other Urinary, Ovary, Pancreas, Prostate, Stomach, Thyroid, Urinary Bladder, Hodgkins Lymphoma, Small Intestine, Soft Tissue
LOXO-292, KIF5B-RET, M918T, CCDC6-RET, RET-PTC1, NCOA4-RET, RET-PTC, RET-PTC3, RET-PTC4, PRKAR1A-RET, RET-PTC2, GOLGA5-RET, RET-PTC5, ERC1-RET, KTN1-RET, RET-PTC8, HOOK3-RET, PCM1-RET, TRIM24-RET, RET-PTC6, TRIM27-RET, TRIM33-RET, RET-PTC7, AKAP13-RET, FKBP15-RET, SPECC1L-RET, TBL1XR1-RET, BCR-RET, FGRF1OP-RET, RFG8-RET, RET-PTC9, ACBD5-RET, MYH13-RET, CUX1-RET, KIAA1468-RET, FRMD4A-RET, SQSTM1-RET, AFAP1L2-RET, PPFIBP2-RET, EML4-RET, PARD3-RET, G533C, C609F, C609G, C609R, C609S, C609Y, C611F, C611G, C611S, C611Y, C611W, C618F, C618R, C618S, C620F, C620R, C620S, C630R, C630Y, D631Y, C634F, C634G, C634R, C634S, C634W, C634Y, K666E, E768D, L790F, V804L, V804M, A883F, S891A, R912P, CLIP1-RET, Y806C, RET fusion, RET alteration, RET mutation, RET rearrangement, RET translocation, Neoplasms by Site, Neoplasms, Non-Small Cell Lung Cancer, Lung Neoplasms, Carcinoma, Non-Small-Cell Lung, Cancer of Lung, Cancer of the Lung, Lung Cancer, Neoplasms, Lung, Neoplasms, Pulmonary, Pulmonary Cancer, Pulmonary Neoplasms, Respiratory Tract Neoplasms, Lung Diseases, Respiratory Tract Diseases, Carcinoma, Bronchogenic, Bronchial Neoplasms, Medullary Thyroid Cancer, Papillary Thyroid Cancer, Thyroid Diseases, Thyroid Neoplasms, Cancer of the Thyroid, Cancer of Thyroid, Neoplasms, Thyroid, Thyroid Ademona, Thyroid Cancer, Thyroid Carcinoma, Endocrine System Diseases, Endocrine Gland Neoplasms, Head and Neck Neoplasms, Thoracic Neoplasms, CNS tumor, Primary CNS tumor, Cancer of Colon, Cancer of the Colon, Colon Cancer, Colon Neoplasms, Colonic Cancer, Neoplasms, Colonic, Malignant tumor of Breast, Mammary Cancer, Mammary Carcinoma, Human, Mammary Neoplasm, Human, Neoplasms, Breast, Tumors, Breast, Human Mammary Carcinoma, Malignant Neoplasm of Breast, Breast Carcinoma, Breast Tumors, Cancer of the Breast, Breast Neoplasms, Breast Cancer, RET Inhibitor, MTC, NSCLC, selpercatinib, neo-adjuvant treatment in early stage NSCLC