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    Summary
    EudraCT Number:2018-000929-32
    Sponsor's Protocol Code Number:JCAR017-BCM-003
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-04-06
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedFrance - ANSM
    A.2EudraCT number2018-000929-32
    A.3Full title of the trial
    A global randomized multicenter Phase 3 trial to compare the efficacy and safety of JCAR017 to standard of care in adult subjects with high-risk, transplant-eligible relapsed or refractory aggressive B-cell non-Hodgkin lymphomas (TRANSFORM)
    Étude multicentrique internationale randomisée de phase III comparant l’efficacité et la tolérance de JCAR017 au traitement de référence chez des patients adultes atteints d’un lymphome non hodgkinien à lymphocytes B agressif, réfractaire ou récidivant, à haut risque, éligibles à une greffe (TRANSFORM)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A phase 3 study to assess the efficacy and safety of JCAR017, a CAR-T cell therapy, in adults with aggressive B-Cell non-Hodgkin lymphoma
    Étude de phase III visant à déterminer l’efficacité et la tolérance de JCAR017, un traitement par cellules CAR-T, chez des patients adultes atteints d’un lymphome non hodgkinien à lymphocytes B agressif
    A.4.1Sponsor's protocol code numberJCAR017-BCM-003
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorCelgene Corporation
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportCelgene Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCelgene Corporation
    B.5.2Functional name of contact pointClinicalTrialDisclosure
    B.5.3 Address:
    B.5.3.1Street Address9225 Indian Creek Parkway, Suite 900
    B.5.3.2Town/ cityOverland Park, Kansas
    B.5.3.3Post code66210
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1888260 1599
    B.5.5Fax number+1913266 0394
    B.5.6E-mailClinicalTrialDisclosure@celgene.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/17/1890
    D.3 Description of the IMP
    D.3.1Product nameJCAR017
    D.3.2Product code JCAR017
    D.3.4Pharmaceutical form Suspension for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAutologous CD4+ and CD8+ T cells expressing a CD19-specific chimeric antigen receptor (CAR)
    D.3.9.2Current sponsor codeJCAR017
    D.3.10 Strength
    D.3.10.1Concentration unit Other
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Yes
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product Yes
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms Yes
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCARMUSTINE
    D.3.4Pharmaceutical form Injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCARMUSTINE
    D.3.9.1CAS number 154-93-8
    D.3.9.3Other descriptive nameBCNU
    D.3.9.4EV Substance CodeSUB06132MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number300
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product Yes
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameETOPOSIDE
    D.3.4Pharmaceutical form Injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNETOPOSIDE
    D.3.9.1CAS number 33419-42-0
    D.3.9.3Other descriptive nameETOPOSIDE
    D.3.9.4EV Substance CodeSUB07337MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product Yes
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCytarabine
    D.3.4Pharmaceutical form Injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCYTARABINE
    D.3.9.1CAS number 147-94-4
    D.3.9.3Other descriptive nameCYTARABINE, Ara-C, cytosine arabinoside
    D.3.9.4EV Substance CodeSUB06880MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product Yes
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameMELPHALAN
    D.3.4Pharmaceutical form Injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMELPHALAN
    D.3.9.1CAS number 148-82-3
    D.3.9.4EV Substance CodeSUB08728MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number140
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product Yes
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Transplant-eligible relapsed or refractory (R/R) aggressive B-cell Non Hodgkin Lymphoma (B-NHL)
    Lymphome non hodgkinien (LNH) à lymphocytes B agressif, réfractaire ou récidivant (R/R), éligible à une greffe
    E.1.1.1Medical condition in easily understood language
    A cancer of B-cells, a type of white blood cell responsible for producing Antibodies
    Cancer des lymphocytes B, un type de globules blancs responsables de la production d’anticorps
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10029593
    E.1.2Term Non-Hodgkin's lymphoma NOS
    E.1.2System Organ Class 100000004864
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level HLGT
    E.1.2Classification code 10025320
    E.1.2Term Lymphomas non-Hodgkin's B-cell
    E.1.2System Organ Class 10005329 - Blood and lymphatic system disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to compare the efficacy in subjects treated with JCAR017 versus subjects treated according to standard of care (SOC) defined as event-free survival (EFS).
    L'objectif principal est de comparer l’efficacité chez les patients traités par JCAR017 par rapport aux patients recevant un traitement de référence (SOC), définie comme la survie sans événement (SSE).
    E.2.2Secondary objectives of the trial
    The key secondary objectives are to compare the efficacy in subjects treated with JCAR017 versus subjects treated according to SOC defined as complete response rate (CRR), progression-free survival (PFS) and overall survival (OS).

    - To compare other parameters of efficacy, defined as duration of response (DOR), overall response rate (ORR), PFS on next line of treatment (PFS-2)

    - To compare efficacy rates (EFS, PFS, OS) at 6, 12 and 24 months after randomization

    - To compare the safety defined as type and frequency of adverse events (AEs), serious adverse events (SAEs), and laboratory abnormalities

    - To compare the safety and efficacy in clinical, histological and molecular subgroups

    - To compare health-related quality of life (HRQoL)

    - To compare hospital resource utilization (HRU)

    - To describe the rate of completion of high dose chemotherapy (HDCT) and hematopoietic stem cell transplant (HSCT)

    - To assess the response 3 months after-HSCT
    Les objectifs secondaires principaux sont
    • Comparaison d’autres paramètres d’efficacité, définis comme la durée de la réponse (DR), le taux de réponse globale (RG) et la SSP sous la ligne de traitement suivante (SSP-2).
    • Comparaison des taux d’efficacité (SSE, SSP, SG) 6, 12 et 24 mois après la randomisation.
    • Comparaison de la tolérance, définie comme le type et la fréquence des événements indésirables (EI), des événements indésirables graves (EIG) et des anomalies biologiques.
    • Comparaison de la tolérance et de l’efficacité dans les sous-groupes cliniques, histologiques et moléculaires.
    • Comparaison de la qualité de vie liée à la santé (HRQoL).
    • Comparaison de l’utilisation des ressources hospitalières (URH).
    • Description du taux d’administration complète d’une chimiothérapie à haute dose (CTHD) et de greffes de cellules souches hématopoïétiques (GCSH).
    • Évaluation de la réponse 3 mois après la GCSH.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Subject is ≥ 18 years and ≤ 75 years of age at the time of signing the informed consent form (ICF).

    2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.

    3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements.

    4. ECOG performance status ≤ 2.

    5. Histologically proven diffuse large B-cell lymphoma (DLBCL) NOS (de novo or transformed FL), high grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (double/triple-hit lymphoma [DHL/THL]) or follicular lymphoma grade 3B. Enough tumor material must be available for confirmation by central pathology. If archival sample is before most recent relapse or no or insufficient archival sample is available, a new tumor biopsy is mandated to confirm diagnosis.
    Note: Subjects with secondary CNS involvement are eligible.

    6. Refractory (SD, PD, PR or CR with relapse before 3 months) or relapsed (CR with relapse on or after 3 months) within 12 months from CD20 antibody and anthracycline containing first line therapy.

    7. [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET) positive lesion at screening.

    8. Adequate organ function, defined as:
    - Adequate bone marrow function as assessed by the Investigator
    - Serum creatinine < 1.5 x age-adjusted upper limit of normal (ULN) or creatinine clearance > 30 mL/min (estimated glomerular filtration rate [eGFR] by Cockcroft Gault see Appendix D for calculation)
    - Alanine aminotransferase (ALT) ≤ 5 x ULN and total bilirubin < 2.0 mg/dL (or < 3.0 mg/dL for subjects with Gilbert's syndrome or lymphomatous infiltration of the liver)
    - Adequate pulmonary function, defined as ≤ Grade 1 dyspnea according to Common Terminology 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) performed within 4 weeks of randomization

    9. Adequate vascular access for leukapheresis

    10. Subjects must agree to not donate blood, organs, sperm or semen, and egg cells for usage in other individuals while receiving as well as within 12 months after the JCAR017 infusion and until CAR T cells are no longer present by quantitative polymerase chain reaction (qPCR) on 2 consecutive tests, whichever occurs last.

    11. Females of childbearing potential (FCBP) must:
    - Have a negative pregnancy test as verified by the Investigator prior to starting study therapy. She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence* from heterosexual contact.
    - Either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use, and be able to comply with, effective contraception without interruption. Contraception methods must include 1 highly effective and 1 additional effective (barrier) method of contraception from screening until at least 12 months after the JCAR017 infusion and until CAR T cells are no longer present by qPCR on 2 consecutive tests, whichever is later (Arm B) and until 12 months after the last chemotherapy (Arm A),
    - Agree to abstain from breastfeeding during study participation and for at least 3 months after the last dose of JCAR017 or until CAR T cells are no longer present by qPCR on 2 consecutive tests, whichever is later.
    Note: Highly effective methods are defined as those that result in a low failure rate (ie, less than 1% per year) when used consistently and correctly. The following are examples of highly effective and additional effective methods of contraception:
    Intrauterine device (IUD)
    Hormonal (birth control pill, injections, implants)
    Tubal ligation
    Partner's vasectomy
    Male condom (additional effective method)
    Diaphragm (additional effective method)
    Cervical cap (additional effective method)

    12. Male subjects must:
    - Practice true abstinence* (which must be reviewed on a monthly basis) or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for 12 months after the JCAR017 infusion even if he has undergone a successful vasectomy and until CAR T cells are no longer present by qPCR on 2 consecutive tests, whichever occurs last (Arm B) and for 12 months after the last chemotherapy (Arm A).
    * True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. In contrast, periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.
    1. Patient≥18 ans et ≤75 ans au moment de la signature FCE
    2. Le patient doit comprendre et signer volontairement le FCE avant la réalisation de toute évaluation ou procédure de l’étude.
    3. Le patient accepte et est capable de respecter le calendrier des visites d’étude et les autres exigences du protocole.
    4. Indice de performance ECOG≤2.
    5. Lymphome diffus à grandes cellules B (LDGCB) sans autre spécificité (NOS) (de novo ou lymphome folliculaire [LF] transformé) confirmé par examen histologique, lymphome à cellules B de haut grade avec réarrangements de MYC et BCL2 et/ou BCL6 à histologie LDGCB (lymphome « double hit »/« triple hit » [LDH/LTH]) ou lymphome folliculaire de grade 3B. Une quantité suffisante de matériel tumoral doit être disponible pour confirmation par un examen de pathologie centralisé. Si l’échantillon archivé a été prélevé avant la récidive la plus récente, si aucun échantillon archivé n’est disponible ou si l’échantillon archivé est insuffisant, une nouvelle biopsie tumorale est obligatoire pour confirmer le diagnostic
    Remarque : les patients présentant une atteinte secondaire du SNC pourront être inclus.
    6. Réfractaire (maladie stable, progression de la maladie, réponse partielle ou réponse complète avec récidive avant 3 mois) ou récidivant (réponse complète avec récidive au bout de 3 mois ou plus) dans les 12 mois qui suivent le traitement de première ligne comprenant un anticorps anti-CD20 et une anthracycline.
    7. Lésion observée par tomographie par émission de positons (TEP) au fluorodésoxyglucose (FDG) [18F] à la sélection.
    8. Bonne fonction organique définie comme suit :
    - Bonne fonction médullaire d’après l’évaluation de l’investigateur
    - Créatinine sérique < 1,5 x LSN ajustée pour l’âge ou clairance de la créatinine > 30 ml/min (TFGe selon la formule de Cockroft-Gault ; voir Annexe D)
    - ALAT ≤ 5 × LSN et bilirubine totale < 2,0 mg/dl (ou < 3,0 mg/dl pour les patients atteints du syndrome de Gilbert ou d’infiltration lymphomateuse du foie)
    - Bonne fonction pulmonaire définie par une dyspnée de grade ≤ 1 selon les critères CTCAE et une SaO2 ≥ 92 % à l’air ambiant
    - Bonne fonction cardiaque définie par une FEVG ≥ 40 % évaluée par écho cardiaque ou MUGA dans les 4 semaines qui précèdent la randomisation
    9. Bon accès vasculaire pour la leucaphérèse.
    10. Les patients doivent accepter de ne pas faire de don de sang, d’organes, de sperme ou d’ovules pour une utilisation par d’autres personnes au moment de la perfusion de JCAR017, au cours des 12 mois suivants et jusqu’à ce que les cellules CAR-T ne soient plus présentes à deux évaluations consécutives par amplification qPCR, l'échéance la plus longue prévalant.
    11. Les femmes en âge de procréer (FAP) doivent :
    - Avoir un résultat négatif au test de grossesse vérifié par l’investigateur avant le début du traitement de l’étude. Elles doivent accepter de faire des tests de grossesse répétés pendant l’étude et après la fin du traitement de l’étude. Cette règle s’applique même si la patiente pratique l’abstinence réelle*.
    - S’engager à une abstinence réelle* de contact hétérosexuel (contrôlée et documentée tous les mois) ou accepter d’utiliser et être capables de suivre une contraception efficace et ininterrompue. Les méthodes de contraception doivent comprendre une méthode hautement efficace et une méthode efficace supplémentaire (méthode « barrière ») à compter de la sélection, pendant au moins 12 mois après la perfusion de JCAR017 et jusqu’à ce que les cellules CAR-T ne soient plus présentes à deux évaluations consécutives par qPCR, l'échéance la plus longue prévalant (bras B) ou pendant les 12 mois qui suivent la dernière chimiothérapie (bras A).
    - Accepter de ne pas allaiter pendant la participation à l’étude et pendant au moins les 3 mois qui suivent la dernière perfusion de JCAR017 ou jusqu’à ce que les cellules CAR-T ne soient plus présentes à deux évaluations consécutives par qPCR, l'échéance la plus longue prévalant.
    Remarque : Quelques ex de méthodes de contraception hautement efficaces et de méthodes de contraception efficaces supplémentaires :
    DIU
    Contraception hormonale (pilules contraceptives, injections, implants)
    Ligature des trompes
    Vasectomie du partenaire
    Préservatif masculin (méthode efficace supplémentaire)
    Diaphragme (méthode efficace supplémentaire)
    Cape cervicale (méthode efficace supplémentaire)
    12. Les patients masculins doivent :
    - Pratiquer une abstinence réelle* (vérifiée tous les mois) ou accepter d’utiliser un préservatif lors des relations sexuelles avec une femme enceinte ou une femme en âge de procréer pendant la participation à l’étude, pendant les interruptions de dose et pendant les 12 mois qui suivent la perfusion de JCAR017, même s’ils sont vasectomisés, et jusqu’à ce que les cellules CAR-T ne soient plus présentes à deux évaluations consécutives par qPCR, l'échéance la plus longue prévalant (bras B) et pendant les 12 mois qui suivent la dernière chimiothérapie (bras A).
    E.4Principal exclusion criteria
    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 would place the subject at unacceptable risk if participating in the study.

    3. Subject has any condition that confounds the ability to interpret data from the study.

    4. Subjects not eligible for hematopoietic stem cell transplantation (HSCT).

    5. Subjects planned to undergo allogeneic stem cell transplantation.

    6. Subjects with T cell rich/histiocyte rich large B-cell lymphoma (THRBCL), primary cutaneous large B-cell lymphoma, primary mediastinal B-cell lymphoma (PMBCL), EBV (Epstein-Barr virus) positive DLBCL of the elderly and Burkitt lymphoma, transformed indolent NHL except transformed FL.

    7. Subjects with prior history of malignancies, other than aggressive R/R NHL, unless the subject has been free of the disease for ≥ 2 years with the exception of the following noninvasive malignancies:
    - Basal cell carcinoma of the skin
    - Squamous cell carcinoma of the skin
    - Carcinoma in situ of the cervix
    - Carcinoma in situ of the breast
    - Incidental histologic finding of prostate cancer (T1a or T1b using the TNM [tumor, nodes, metastasis] clinical staging system) or prostate cancer that is curative.
    - Other completely resected stage 1 solid tumor with low risk for recurrence

    8. Treatment with any prior gene therapy product

    9. Subjects who have received previous CD19-targeted therapy.

    10. History of or active hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) infection.

    11. Subjects with uncontrolled systemic fungal, bacterial, viral or other infection (including tuberculosis) despite appropriate antibiotics or other treatment.

    12. Active autoimmune disease requiring immunosuppressive therapy.

    13. History of any one of the following cardiovascular conditions within the past 6 months prior to signing the ICF: Class III or IV heart failure as defined by the New York Heart Association (NYHA), cardiac angioplasty or stenting, myocardial infarction, unstable angina, or other clinically significant cardiac disease.

    14. History or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis.

    15. Pregnant or nursing (lactating) women.

    16. Use of the following:
    - Therapeutic doses of corticosteroids (defined as > 20 mg/day prednisone or equivalent) within 7 days prior to unstimulated leukapheresis. Physiologic replacement, topical, and inhaled steroids are permitted.
    - Cytotoxic chemotherapeutic agents that are not considered lymphotoxic (see below) must be stopped ≥ 7 days prior to unstimulated leukapheresis.
    - Lymphotoxic chemotherapeutic agents (eg, cyclophosphamide, ifosfamide, bendamustine) prior to unstimulated leukapheresis.
    - Experimental agents within 4 weeks prior to signing the ICF unless no response or progressive disease (PD) is documented on the experimental therapy and at least 3 half-lives have elapsed prior to unstimulated leukapheresis.
    - Immunosuppressive therapies within 4 weeks prior to unstimulated leukapheresis (eg, calcineurin inhibitors, methotrexate or other chemotherapeutics, mycophenolate, rapamycin, thalidomide, immunosuppressive antibodies such as anti-tumor necrosis factor [TNF], anti-IL-6, or anti-IL-6R).
    - Radiation within 4 weeks prior to signing the ICF. Subjects must have progressive disease in irradiated lesions or have additional non-irradiated, PET-positive lesions to be eligible. Radiation to a single lesion, if additional non-irradiated, measurable PETpositive lesions are present, is allowed up to 2 weeks prior to unstimulated leukapheresis.

    1. Le patient présente une affection, une anomalie biologique ou une maladie psychiatrique significative incompatible avec la participation à l’étude.
    2. Le patient présente une affection, y compris des anomalies biologiques, susceptible de l’exposer à un risque inacceptable s’il participe à l’étude.
    3. Le patient présente une affection qui pourrait fausser l’interprétation des données de l’étude.
    4. Patients non candidats à une greffe de cellules souches hématopoïétiques (GCSH).
    5. Patients prévoyant de subir une greffe allogénique de cellules souches.
    6. Patients présentant un lymphome à grandes cellules B riche en lymphocytes T/histiocytes (LGCBTH), un lymphome cutané primitif à grandes cellules B, un lymphome médiastinal primitif à grandes cellules B (LMPGCB), un LDGCB positif au virus d’Epstein-Barr (VEB) du sujet âgé, un lymphome de Burkitt ou un LNH indolent transformé à l’exception du LF transformé.
    7. Patients ayant des antécédents de tumeurs malignes, autres qu’un LNH R/R agressif, sauf rémission complète d’une durée de 2 ans ou plus, à l’exception des cancers non invasifs suivants :
    - Carcinome basocellulaire cutané
    - Carcinome épidermoïde cutané
    - Carcinome in situ du col de l’utérus
    - Carcinome in situ du sein
    - Découverte histologique fortuite d’un cancer de la prostate (de stade T1a ou T1b selon la classification TNM [tumeur, envahissement ganglionnaire, métastases]) ou cancer de la prostate curable.
    - Autre tumeur solide de stade 1 complètement réséquée à faible risque de récidive
    8. Traitement antérieur par un produit de thérapie génique.
    9. Patients ayant reçu un traitement antérieur ciblant CD19.
    10. Antécédents d’infection ou infection active par le virus de l’hépatite B, de l’hépatite C ou de l’immunodéficience humaine (VIH).
    11. Patients présentant une infection fongique, bactérienne, virale ou autre (y compris tuberculose) systémique non contrôlée malgré une antibiothérapie ou un autre traitement adapté.
    12. Maladie auto-immune active nécessitant un traitement immunosuppresseur.
    13. Antécédents de l’une quelconque des pathologies cardiovasculaires suivantes au cours des 6 mois précédant la signature du FCE : insuffisance cardiaque de classe III ou IV selon la définition de la New York Heart Association (NYHA), angioplastie ou endoprothèse cardiaque, infarctus du myocarde, angor instable ou toute autre maladie cardiaque cliniquement significative.
    14. Antécédents ou présence d’une pathologie du système nerveux central (SNC) cliniquement pertinente, notamment : épilepsie, convulsions, parésie, aphasie, AVC, lésions cérébrales importantes, démence, maladie de Parkinson, maladie affectant le cervelet, syndrome organique du cerveau ou psychose.
    15. Femmes enceintes ou qui allaitent.
    16. Recours aux produits suivants :
    - Doses thérapeutiques de corticoïdes (définies comme > 20 mg/jour de prednisone ou équivalent) dans les 7 jours qui précèdent la leucaphérèse non stimulée. Les corticothérapies substitutives à dose physiologique et les corticoïdes topiques et inhalés sont autorisés.
    - Les agents chimiothérapeutiques cytotoxiques qui ne sont pas considérés lymphotoxiques (voir ci-après) doivent être arrêtés au moins 7 jours avant la leucaphérèse non stimulée.
    - Agents chimiothérapeutiques lymphotoxiques (par ex., cyclophosphamide, ifosfamide, bendamustine) avant la leucaphérèse non stimulée.
    - Agents expérimentaux au cours des 4 semaines qui précèdent la signature du FCE, sauf si aucune réponse ou progression de la maladie (PM) n’est documentée sous traitement expérimental et si au moins 3 demi-vies se sont écoulées avant la leucaphérèse non stimulée.
    - Traitements immunosuppresseurs au cours des 4 semaines qui précèdent la leucaphérèse non stimulée (par ex., inhibiteurs de la calcineurine, méthotrexate ou autres agents de chimiothérapie, mycophénolate, rapamycine, thalidomide, anticorps immunosuppresseurs tels que les inhibiteurs du facteur de nécrose tumorale [TNF],
    anti-IL-6 ou anti-IL-6R).
    - Radiothérapie au cours des 4 semaines qui précèdent la signature du FCE. Pour pouvoir participer à l'étude, les patients doivent présenter une progression de la maladie au niveau des lésions irradiées ou présenter d’autres lésions non irradiées observées par TEP. Une radiothérapie d’une seule lésion, en cas de présence d’autres lésions non irradiées, mesurables et observées par TEP, est autorisée jusqu’à 2 semaines avant la leucaphérèse non stimulée.

    E.5 End points
    E.5.1Primary end point(s)
    Primary Efficacy:

    Event-free survival (EFS):
    Time from randomization to death from any cause, progressive disease (PD), as assessed by the independent review committee (IRC) or start of new antineoplastic therapy, whichever occurs first.
    Critère d’efficacité principal :
    Survie sans événement (SSE) :
    Délai entre la randomisation et le décès toutes causes confondues, la progression de la maladie (PM) évaluée par le comité de protection des personnes (CPP) ou le début d’un nouveau traitement antinéoplasique, l'échéance la plus courte prévalant.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Up to 3 years post-randomization
    Jusque 3 ans après randomisation
    E.5.2Secondary end point(s)
    Key Secondary Efficacy:

    1. Complete response rate (CRR):
    Percentage of subjects achieving a complete response (CR) according to the Lugano Classification (Cheson, 2014) assessed by the IRC.

    2. Progression-free survival (PFS):
    Time from randomization to PD, SD at 1st response assessment as per protocol schedule, as per IRC review or death from any cause, whichever occurs first.

    3. Overall survival (OS):
    Time from randomization to time of death due to any cause.

    Secondary Efficacy:

    1. Overall response rate (ORR):
    Percentage of subjects achieving an objective response of partial response (PR) or better according to the Lugano Classification (Cheson, 2014) as assessed by IRC review.

    2. Duration of response (DOR):
    Time from first response to disease progression, start of new antineoplastic therapy or death from any cause.

    3. PFS-2:
    Time from randomization to second objective disease progression or death from any cause, whichever is first.

    4. EFS rate

    5. PFS rate

    6. OS rate

    See protocol for additional study endpoints
    Principaux critères d’efficacité secondaires :
    1. Taux de réponse complète (TRC) :
    Pourcentage de patients qui obtiennent une réponse complète (RC) évaluée par le CPP d’après la classification de Lugano (Cheson, 2014).
    2. Survie sans progression (SSP) :
    Délai entre la randomisation et la progression de la maladie, la stabilisation de la maladie lors de la première évaluation de la réponse du calendrier du protocole, d’après l’évaluation du CPP ou le décès toutes causes confondues, l'échéance la plus courte prévalant.
    3. Survie globale (SG) :
    Délai entre la randomisation et le décès toutes causes confondues.

    Critères d’efficacité secondaires :
    1. Taux de réponse globale (TRG) :
    Pourcentage de patients qui obtiennent au moins une réponse partielle (RP) objective évaluée par le CPP d’après la classification de Lugano (Cheson, 2014).
    2. Durée de la réponse (DR) :
    Délai entre la première réponse et la progression de la maladie, le début d’un nouveau traitement antinéoplasique ou le décès toutes causes confondues.
    3. SSP-2 :
    Délai entre la randomisation et la deuxième progression objective de la maladie ou le décès toutes causes confondues, l'échéance la plus courte prévalant.
    4. Taux de SSE
    5. Taux de SSP
    6. Taux de SG
    Voir le protocole pour les autres critères d’évaluation de l’étude
    E.5.2.1Timepoint(s) of evaluation of this end point
    Key Secondary Efficacy:
    1 and 2 - Up to 3 years post-randomization
    3 - Up to last subject last visit

    Secondary Efficacy:
    1, 2, 3 - Up to 3 years post-randomization
    4, 5, 6 - At 6, 12 and 24 months post-randomization
    Efficacité secondaire Principale:
    1 et 2 - Jusque 3 ans après randomisation
    3 - Jusque dernière visite du dernier patient

    Efficacité secondaire
    1, 2, 3 - Jusque 3 ans après randomisation
    4, 5, 6 - 6, 12 et 24 mois après la randomisation
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    Immunochemotherapy followed by HDCT and HSCT
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA16
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Belgium
    Canada
    France
    Germany
    Italy
    Japan
    Netherlands
    Spain
    Sweden
    Switzerland
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The End of Trial is defined as either the date of the last visit of the last subject to complete the post-treatment follow-up, or the date when the last subject enters the LTFU study, or the date of receipt of the last data point from the last subject that is required for primary, secondary and/or exploratory analysis, as pre-specified in the protocol, whichever is the later date.
    La fin de l’étude est définie soit comme la date de la dernière visite du dernier patient à l’issue de la période de suivi post-traitement, soit comme la date à laquelle le dernier patient entre dans l’étude de suivi à long terme, soit comme la date de réception du dernier point de données du dernier patient requis pour l’analyse principale, secondaire et/ou exploratoire, tel que prédéterminé dans le protocole, l'échéance la plus longue prévalant.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 91
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 91
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state21
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 150
    F.4.2.2In the whole clinical trial 182
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Because this protocol involves gene transfer, long-term follow-up for lentiviral vector safety, disease status, and survival will continue after EOS under a separate LTFU protocol thereafter for up to 15 years after the JCAR017 infusion. All subjects who either complete the follow-up period specified in the protocol or who prematurely withdraw after JCAR017 infusion will be asked to enroll in the LTFU protocol at the EOS visit or at the time of withdrawal, respectively.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-08-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-07-10
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2023-10-23
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