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    Summary
    EudraCT Number:2020-003452-32
    Sponsor's Protocol Code Number:CD19-CAR_Lenti
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-05-24
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-003452-32
    A.3Full title of the trial
    Phase I/II study of anti-CD19 Chimeric Antigen Receptor-Expressing T cells in pediatric patients affected by relapsed/refractory CD19+ Acute Lymphoblastic Leukemia and Diffuse Large B Cell Lymphoma (DLBCL) or Primary Mediastinal B Cell Lymphoma (PML)
    Studio di fase I/II sull’espressione in cellule T di un recettore chimerico anti-CD19 in pazienti pediatrici affetti da Leucemia Linfoblastica Acuta CD19+ recidivata/refrattaria e Linfoma a Grandi Cellule B (DLCBL) o Linfoma Primitivo del Mediastino a Cellule B (PML)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    CD19-CAR_Lenti in pediatric patients affected by relapsed/refractory B-ALL or aggressive B-NHL
    CD19-CAR_Lenti in pazienti pediatrici affetti da B-ALL recidivata/refrattaria o con Linfoma a Grandi Cellule B (DLCBL) o Linfoma Primitivo del Mediastino a Cellule B (PML)
    A.3.2Name or abbreviated title of the trial where available
    CD19-CAR_Lenti
    CD19-CAR_Lenti
    A.4.1Sponsor's protocol code numberCD19-CAR_Lenti
    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 SponsorIRCCS, OSPEDALE PEDIATRICO BAMBINO GESÙ DI ROMA
    B.1.3.4CountryItaly
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMiltenyi Biotec GmbH
    B.4.2CountryGermany
    B.4.1Name of organisation providing supportFONTE DI COPERTURA DEI COSTI codice: 201987_TRIAL_LOCAT (Prof. Franco Locatelli)
    B.4.2CountryItaly
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationIRCCS OSPEDALE PEDIATRICO BAMBINO GESU'
    B.5.2Functional name of contact pointCO-PRINCIPAL INVESTIGATOR
    B.5.3 Address:
    B.5.3.1Street AddressPiazza Sant’Onofrio, 4
    B.5.3.2Town/ cityRoma
    B.5.3.3Post code00165
    B.5.3.4CountryItaly
    B.5.4Telephone number+390668594664
    B.5.5Fax number+390668594664
    B.5.6E-mailfrancesca.delbufalo@opbg.net
    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 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 nameCiclofosfamide monoidrata
    D.3.2Product code [N.A.]
    D.3.4Pharmaceutical form Powder and solvent for solution for infusion
    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 INNN,N-Bis(2-chloroethyl)tetrahydro-2H-1 ,3,2-oxazaphosphorin-2-amine 2-oxide
    D.3.9.1CAS number 50-18-0
    D.3.9.2Current sponsor codeN.A.
    D.3.9.3Other descriptive nameCyclophosphamide
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 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: 2
    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 No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCD19-CAR_Lenti
    D.3.2Product code [N.A.]
    D.3.4Pharmaceutical form Solution for infusion
    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 INNCD19-CAR_Lenti
    D.3.9.2Current sponsor codeCD19-CAR_Lenti
    D.3.10 Strength
    D.3.10.1Concentration unit billion organisms/g billion organisms/gram
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number1 to 3
    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 No
    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: 3
    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 Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameFludarabina Fosfato
    D.3.2Product code [N.A.]
    D.3.4Pharmaceutical form Powder and solvent for solution for infusion
    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 INN(2R,3S,4S,5R)-2-(6-amino-2-fluoro-9H-purin-9-yl)-5-(hydroxymethyl)oxolane-3,4-diol
    D.3.9.1CAS number 21679-14-1
    D.3.9.2Current sponsor codeN.A.
    D.3.9.3Other descriptive nameFludarabine
    D.3.10 Strength
    D.3.10.1Concentration unit mg/m2 milligram(s)/square meter
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 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
    relapsed/refractory CD19+ Acute Lymphoblastic Leukemia and Diffuse Large B Cell Lymphoma or Primary Mediastinal B Cell Lymphoma
    B-ALL recidivata/refrattaria o con Linfoma a Grandi Cellule B (DLCBL) o Linfoma Primitivo del Mediastino a Cellule B (PML)
    E.1.1.1Medical condition in easily understood language
    Hematological disorders
    Patologie neoplastiche ematologiche
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level SOC
    E.1.2Classification code 10005329
    E.1.2Term Blood and lymphatic system disorders
    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 phase I portion of the study is to evaluate the safety and to establish the recommended dose of CD19-CAR_Lenti infused in pediatric patients affected by relapsed/refractory B-ALL or aggressive B-NHL, starting from a minimum target dose of 1.0 x 106 cells/kilogram recipient total body weight, using the Miltenyi CliniMACS Prodigy® automated system. The primary objective of the phase II extension is to test the efficacy of the treatment at the optimal dose defined in the phase I, by determining BM morphological complete remission (CR) and minimal residual disease (MRD), at day 28, in patients with CD19-positive ALL. In patients with B-cell aggressive lymphoma, we will evaluate the Overall Response Rate (ORR), which includes Complete Remission (CR), CR with incomplete blood count recovery (CRi), Partial Response (PR) and Stable Disease (SD), at day 28, day 90 and 180 after CD19-CAR_Lenti infusion.
    L’obiettivo primario di questo studio di fase I è valutare la sicurezza e stabilire la dose raccomandata di CD19-CAR_Lenti infuse in pazienti pediatrici affetti da B-ALL recidivata/refrattaria o con Linfoma a Grandi Cellule B (DLCBL) o Linfoma Primitivo del Mediastino a Cellule B (PML). L’estensione della fase II è finalizzata a testare l’efficacia del trattamento alla dose ottimale definita nella fase. Inoltre, testeremo la fattibilità, in questa popolazione di pazienti, di produrre con successo la dose terapeutica target di 3.0x106 cellule/Kg di peso del paziente utilizzando il sistema di produzione automatizzato Miltenyi CliniMACS Prodigy®.
    E.2.2Secondary objectives of the trial
    To assess long-term response variables, including relapse rate (RR), overall survival (OS), and disease-free survival (DFS) at 1 and 2 years. To describe the in vivo expansion and persistence of CD19-CAR_Lenti, in blood and BM, measured by flow cytometry and qPCR. To characterize the T-cell subpopulations of the CD19-CAR_Lenti cells before and after infusion, including the exhaustion profile, and to describe the changes in CD19-CAR_Lenti cells after infusion and their correlation with disease response and adverse events. To characterize the cytokine profile after infusion and its correlation with cytokine release syndrome (CRS) in order to define a possible predictive profile.
    Determinare la risposta a lungo termine, il RR, la OS e la DFS a 1 e 2 anni
    Valutare persistenza e espansione in vivo delle cellule T infuse nel PB e BM
    Caratterizzare sottopopolazioni T di cellule CD19-CAR_Lenti prima/dopo infusione e il profilo di esaurimento e descrivere modifiche in cellule CD19-CAR_Lenti dopo infusione e la correlazione con la risposta di malattia e con la tossicità
    Definire profilo di citochine sieriche e correlazione con la CRS al fine di definire un possibile profilo predittivo
    Valutare l’outcome di malattia in pazienti trattati con steroide e/o tocilizumab per CRS/neurotossicità
    Valutare la risposta di pazienti trattati prima con immunoterapia anticorpo-mediata diretta vs CD19
    Valutare l'incidenza e la durata della linfopenia B e dell'ipogammaglobulinemia e la correlazione con il mantenimento della CR
    Valutare l'outcome di pazienti trattati in presenza HAMA pre-esistenti al trattamento o rilevati dopo l'infusione di CD19-CAR_Lenti
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Procurement eligibility
    1. Diagnosis of CD19 expressing B acute lymphoblastic leukemia (ALL) or diffuse large B-cell lymphoma (DLBCL) or primary mediastinal lymphoma (PML) and one of the following:
    a. Patients in 1st relapse, with High-Risk (HR) features including: MLL-rearrangements, E2A/TCF3-PBX1 [t(1;19)], TCF3-HLF [t(17;19)], hypodiploidy (i.e., <44 chromosomes), TP53 alterations, early (i.e., <30 months from diagnosis)/very early (i.e.,
    <18 months from diagnosis) isolated or combined bone marrow relapse
    b. MRD > 0.1% after either reinduction therapy or any course of consolidation for relapsed ALL
    c. Patients with DLBCL or PML in 1st or subsequent relapse, after at least one standard frontline chemotherapy
    2. Age: 1 year – 25 years for BCP-ALL and 1-35 years for B-NHL.
    3. Adequate venous access for apheresis or eligible for appropriate catheter placement, and no other contraindications for leukapheresis
    4. Voluntary informed consent is given. For subjects < 18 year-old their legal guardian must give informed consent. Pediatric subjects will be included in age-appropriate discussion and verbal assent will be obtained for those greater than or equal to 12 years of age, when appropriate.
    5. Clinical performance status: Patients > 16 years of age: Karnofsky greater than or equal to 60%; Patients < 16 years of age: Lansky scale greater than or equal to 60%.

    Treatment eligibility (i.e., eligibility to drug product infusion)
    1. Diagnosis of CD19 expressing B-ALL or DLBCL or PML and one of the following:
    a. Patients in 1st relapse, with High-Risk (HR) features including: MLL-rearrangements, E2A/TCF3-PBX1, TCF3-HLF [t(17;19)], hypodiploidy (i.e., <44 chromosomes), TP53 alterations, early (i.e., <30 months from diagnosis)/very early (i.e., <18 months from diagnosis) isolated or combined bone marrow relapse
    b. MRD > 0.1% after either reinduction therapy or any course of consolidation for relapsed
    c. Patients with DLBCL or PML in 1st or subsequent relapse, after at least one standard frontline chemotherapy
    2. Age: 1 year – 25 years for Bcp-ALL and 1-35 years for B-NHL.
    3. Voluntary informed consent is given. For subjects < 18 year-old their legal guardian must give informed consent. Pediatric subjects will be included in age-appropriate discussion and verbal assent will be obtained for those greater than or equal to 12 years of age, when appropriate.
    4. Clinical performance status: Patients > 16 years of age: Karnofsky greater than or equal to 60%; Patients < 16 years of age: Lansky scale greater than or equal to 60%.
    5. Patients of child-bearing or child-fathering potential must be willing to practice birth control from the time of enrollment on this study and for four months after receiving the preparative regimen.
    6. Females of child-bearing potential must have a negative pregnancy test because of the potentially dangerous effects on the fetus.
    Eleggibilità all’aferesi
    1. Diagnosi di Leucemia Linfoblastica acuta a cellule B (ALL) o DLBCL o PML, esprimenti CD19, ed uno dei seguenti:
    a. Pazienti in prima recidiva di malattia con caratteristiche di alto rischio, quali: riarrangiamenti di MLL, E2A/TCF3-PBX1 [t(1;19)], TCF3-HLF [t(17;19)], ipodiploidia (<44 cromosomi), alterazioni di TP53, recidiva midollare isolata o combinata precoce
    (<30 mesi dalla diagnosi)/molto precoce (<18 mesi dalla diagnosi)
    b. MRD > 0.1% dopo una terapia di reinduzione o dopo qualunque ciclo di consolidamento per ALL recidivata
    c. Pazienti con DLBCL o PML in prima o successive recidive, dopo la terapia di prima linea convenzionale
    2. Età: 1– 25 anni per BCP_ALL e 1 – 35 anni per DLBCL e PML.
    3. Accesso venoso adeguato per l’aferesi o che sia idoneo ad un appropriato posizionamento del catetere e assenza di altre controindicazione per la leucoaferesi
    4. Fornire il consenso informato volontario. Per soggetti di età < 18 anni il loro tutore legale deve fornire il consenso informato.
    5. Stato delle prestazioni cliniche: pazienti di età > 16 anni: Karnofsky superiore o uguale al 60%; Pazienti di età <16 anni: scala Lansky superiore o pari al 60%.

    Eleggibilità al trattamento

    1. Diagnosi di Leucemia Linfoblastica acuta a cellule B (ALL) o DLBCL o PML, esprimenti CD19, ed uno dei seguenti:
    a. Pazienti in prima recidiva di malattia con caratteristiche di alto rischio, quali: riarrangiamenti di MLL, E2A/TCF3-PBX1 [t(1;19)], TCF3-HLF [t(17;19)], ipodiploidia (<44 cromosomi), alterazioni di TP53, recidiva midollare isolata o combinata precoce
    (<30 mesi dalla diagnosi)/molto precoce (<18 mesi dalla diagnosi)
    b. MRD > 0.1% dopo una terapia di reinduzione o dopo qualunque ciclo di consolidamento per ALL recidivata
    c. Pazienti con DLBCL o PML in prima o successive recidive, dopo la terapia di prima linea convenzionale
    2. Età: 1– 25 anni per BCP_ALL e 1 – 35 anni per DLBCL e PML.
    3. Fornire il consenso informato volontario. Per soggetti di età < 18 anni il loro tutore legale deve fornire il consenso informato. I soggetti pediatrici saranno inclusi
    4. Stato delle prestazioni cliniche: pazienti di età > 16 anni: Karnofsky superiore o uguale al 60%; Pazienti di età <16 anni: scala Lansky superiore o pari al 60%.
    5. Soggetti di sesso maschile e femminile in età fertile devono essere disposti a praticare il controllo delle nascite dal momento dell’arruolamento in questo studio e per 4 mesi dopo aver ricevuto il trattamento.
    6. Soggetti di sesso femminile in età fertile non devono essere in stato di gravidanza a causa degli effetti potenzialmente dannosi sul feto.
    E.4Principal exclusion criteria
    Procurement eligibility
    1. Severe, uncontrolled active infections
    2. HIV, or active HCV and/or HBV infection (detection of viral RNA/DNA in blood)
    3. Previous allogeneic HSCT in the preceding 100 days before apheresis
    4. Concurrent or recent prior therapies, before apheresis:
    a) Systemic steroids (at a dose equivalent to or greater 2 mg/kg prednisone) in the 2 weeks before apheresis collection. Recent or current use of inhaled/topical/non-absorbable steroids is not exclusionary.
    b) Systemic chemotherapy in the 2 weeks preceding apheresis collection.
    c) Anti-thymocyte globulin (ATG) in the 4 weeks preceding apheresis collection.
    d) Immunosuppressive agents in the 2 weeks preceding apheresis collection.
    e) Radiation therapy must have been completed at least 1 week prior to apheresis.
    f) Other anti-neoplastic investigational agents currently administered or within 30 days prior to apheresis (i.e., start of protocol therapy);

    Treatment eligibility
    1. Pregnant or lactating women
    2. Severe, uncontrolled active infections
    3. HIV, or active HCV and/or HBV infection (detection of viral RNA/DNA in blood)
    4. Life-expectancy < 6 weeks
    5. Hepatic function: Inadequate liver function defined as total bilirubin > 4x upper limit of normal (ULN) or transaminase (ALT and AST) > 6 x ULN
    6. Renal function: serum creatinine > 3x ULN for age.
    7. Blood oxygen saturation < 90%.
    8. Cardiac function: Left ventricular ejection fraction lower than 45% by ECHO.
    9. Congestive heart failure, cardiac arrhythmia, psychiatric illness, or social situations that would limit compliance with study requirements or in the opinion of the PI would pose an unacceptable risk to the subject.
    10. BM blasts > 50% pre-infusion.
    11. Hyperleukocytosis (greater than or equal to 20,000 blasts/microliter) or rapidly progressive disease that in the evaluation of the investigator would compromise ability to complete study therapy
    12. Presence of active, grade 2-4 acute or moderate-severe chronic GvHD
    13. Recurrent or refractory ALL with testicular involvement
    14. Concurrent or recent prior therapies, before infusion:
    a) Systemic steroids (at a dose > 2 mg/kg prednisone) in the 2 weeks before infusion. Recent or current use of inhaled/topical/non-absorbable steroids is not exclusionary.
    b) Systemic chemotherapy in the week preceding infusion.
    c) Anti-thymocyte globulin (ATG) in the 4 weeks preceding infusion.
    d) Immunosuppressive agents in the 1 week preceding infusion.
    e) Radiation therapy must have been completed at least 3 weeks prior to enrollment.
    f) Other anti-neoplastic investigational agents currently administered or within 30 days prior to infusion (i.e. start of protocol therapy);
    15. Patient-derived CD19-CAR_Lenti production failure: vitality of the fresh product <80%, CD3+ cells <80%, CD3+ CAR+ cells <10%, non-sterility in IPC at day 5, endotoxin contamination (> 5 EU/ml) in IPC at day 5, mycoplasma contamination in IPC at day 5, failure of the visual inspection.
    Eleggibilità all’aferesi

    1. Infezioni attive non controllate, severe
    2. HIV o infezione attiva da HCV e/o HBV (riscontro di DNA/RNA virale in circolo)
    3. Precedenti terapie concomitanti o recenti, prima dell’aferesi:
    i. Steroidi sistemici (a una dose equivalente o superiore a 2 mg/kg di prednisone) nelle due settimane precedenti la raccolta aferetica. Non è escluso l’uso recente o concomitante di steroidi inalatori/topici/non assorbibili.
    ii. Chemioterapia sistemica nelle 2 settimane precedenti la raccolta aferetica. iii. Globulina Antitimocitica (ATG) nelle 4 settimane precedenti la raccolta aferetica.
    iv. Agenti Immunosoppressivi nelle 2 settimane precedenti la raccolta aferetica
    v. La radioterapia deve essere completata almeno 1 settimana prima dell’aferesi.
    vi. Altri agenti anti-neoplastici di ricerca attualmente somministrati o entro 30 giorni precedenti l’aferesi;

    Eleggibilità al trattamento
    1. Soggetto in stato di gravidanza o allattamento
    2. Infezioni attive non controllate, severe
    3. HIV o infezione attiva da HCV e/o HBV (riscontro di DNA/RNA virale in circolo)
    4. Aspettativa di vita < 6 settimane
    5. Funzione epatica: Funzionalità epatica inadeguata definita come bilirubina totale > 4x sopra il limite del normale (LSN) o transaminasi (ALT and AST) > 6 x LSN
    6. Funzione renale: creatinine sierica > 3x LSN per l’età
    7. Saturazione di ossigeno nel sangue < 90%.
    8. Funzione cardiaca: frazione di eiezione del ventricolo sinistro minore del 45% da ECHO
    9. Insufficienza cardiaca congestizia, aritmia cardiaca, malattie psichiatriche o condizioni sociali che potrebbero limitare la compliance con le richieste dello studio o che secondo il parere del PI potrebbe comportare un rischio inaccettabile per il soggetto.
    10. Blasti in midollo osseo > 50% pre-infusione.
    11. Iperleucocitosi (maggiore o uguale a 20,000 blasti/microlitro) o progressione rapida della malattia che, secondo la valutazione dell’investigatore, potrebbe compromettere il completamento della terapia prevista dallo studio.
    12. Presenza di GvHD attiva acuta di grado 2-4 o di GvHD cronica moderata-severa
    13. ALL ricorrente o refrattaria con coinvolgimento testicolare
    14. Terapie concomitanti o recenti, prima dell’infusione:
    i. Steroidi sistemici (a una dose equivalente o superiore a 2 mg/kg di prednisone) due settimane precedenti la raccolta aferetica. Non è escluso l’uso recente o concomitante di steroidi inalatori/topici/non assorbibili.
    ii. Chemioterapia sistemica nella settimana precedente l’infusione.
    iii. Globulina Antitimocitica (ATG) nelle 4 settimane precedenti l’infusione.
    iv. Agenti immunosoppressivi nella settimana precedente l’infusione.
    v. La radioterapia deve essere completata almeno 3 settimane prima dell’arruolamento.
    vi. Altri agenti anti-neoplastici di ricerca attualmente somministrati o entro 30 giorni precedenti l’inizio della terapia del protocollo;
    15. Il fallimento della produzione di CD19-CAR_Lenti derivato dal paziente si manifesta con i seguenti criteri: vitalità del prodotto a fresco <80%, cellule CD3+ <80%, cellule CD3+ CAR+ <10%, non sterilità in IPC al giorno 5, contaminazione da endotossine (> 1 EU/ml) in IPC al giorno 5, contaminazione da micoplasma in IPC al giorno 5, fallimento dell’ispezione visiva.
    E.5 End points
    E.5.1Primary end point(s)
    PHASE I
    The safety and tolerability of CD19-CAR_Lenti will be assessed by:
    - Suspected adverse events, and
    - Suspected serious adverse events
    As evidenced by clinically relevant:
    - Changes in clinical laboratory tests (clinical chemistry, hematology, etc).
    - Changes in vital signs (blood pressure, pulse, respiratory rate and body temperature).
    - Changes in physical examination. Signs and symptoms assessed may require additional testing as clinically indicated such as ECG, PFT, radiographic studies, etc.
    - Subject reported signs and symptoms
    The dose-limiting toxicity (DLT) of the cellular product will be established, defined as any of the following that is not pre-existing, due to infection or to underlying malignancy and that may be considered possibly, probably or definitely related to the study cellular products. (1) Death related to CD19-CAR_Lenti; (2) Non-hematologic DLT, defined as any grade 4 non-hematologic toxicity; (3) Grade 4 reactions related to the drug product infusion.
    The recommended dose of CD19-CAR_Lenti will be defined as the maximum tolerated dose (MTD) or the highest dose studied, if an MTD is not reached.

    PHASE II
    The response will be assessed using standard response criteria for ALL or for lymphoma
    End-points primari della fase I
    1. Valutare la sicurezza dell’infusione di CD19-CAR_Lenti a 3 dosi crescenti (1,0 x 106, 2,0 x 106 e 3,0 x 106 cellule/kg per peso corporeo del ricevente di cellule T CAR+) e stabilire la dose raccomandata(RD)/dose limitante la tossicità (DLT) del prodotto cellulare ottenuto utilizzando il sistema di produzione automatizzato Miltenyi CliniMACS Prodigy®. La DLT sarà definita come una delle seguenti che non è pre-esistente, dovuta a infezioni o alla malignità intrinseca e che può essere considerate possibile, probabile o connessa al prodotto cellulare di studio. (1) Morte in relazione all’infusione di CD19-CAR_Lenti; (2) DLT Non-ematologica è la tossicità non ematologica di grado 3 o 4; (3) Reazioni di grado 4 connesse all’infusione.

    End-points primari della fase II
    1. Confermare la sicurezza dell’approccio, utilizzando la dose raccomandata definite nella Fase I dello studio.
    2. Valutare l’effetto antitumorale di CD19-CAR_Lenti, alla RD definita nella Fase I dello studio, al 28° giorno post-infusione tramite valutazione della risposta morfologica e della malattia residua minima (MRD).
    In particolare, l’end-point primario sarà valutare la proporzione di pazienti che raggiungeranno la remissione morfologica completa (CR) con MRD negativa al giorno 28 in pazienti con ALL CD19-positiva. Nei pazienti con linfomi a cellule B, valuteremo il tasso di risposta globale (ORR) che include la CR, la CR senza recupero ematologico (CRi), la risposta parziale (PR) e la malattia stabile (SD) al giorno 28, 90 e 180 dopo l’infusione di CD19-CAR_Lenti.
    E.5.1.1Timepoint(s) of evaluation of this end point
    At day 28 post infusion
    28° giorno dopo l'infusione
    E.5.2Secondary end point(s)
    Secondary Endpoints phase I and II
    Relapse rate (RR), overall survival (OS), and disease-free survival (DFS) will be evaluated at 1 and 2 years.
    - The expansion and persistence of CD19-CAR_Lenti will be measured by flow cytometry and qPCR.
    - The T cell subpopulations of the CD19-CAR_Lenti cells before and after infusion and the exhaustion profile will be measured by flow cytometry
    - Disease outcome will be correlated with: a) use of either steroids and/or tocilizumab for CRS/Neurotoxicity; b) previous CD19-directed antibody-mediated immunotherapy; c) incidence and duration of B-cell lymphopenia and hypogammaglobulinemia; d) presence of HAMA either pre-existing to the treatment, or detected after CD19-CAR_Lenti infusion.
    End-points secondari della fase I e della fase II
    1. Determinare la risposta a lungo termine, incluso il tasso di recidive (RR), la sopravvivenza globale (OS) e la sopravvivenza libera da malattia (DFS) a 1 e 2 anni.
    2. Valutare la persistenza e l’espansione in vivo delle cellule T infuse nel sangue periferico (PB) e nel midollo osseo (BM).
    3. Caratterizzare le sottopopolazioni T delle cellule CD19-CAR_Lenti prima/dopo infusione e il profilo di esaurimento e descrivere le modifiche nelle cellule CD19-CAR_Lenti dopo infusione e la loro correlazione con la risposta di malattia e con l’occorrenza di tossicità.
    4. Definire il profilo delle citochine sieriche e la correlazione con la sindrome da rilascio citochinico (CRS) al fine di definire un possibile profilo predittivo.
    5. Valutare l'outcome della malattia nei pazienti trattati con steroide e/o tocilizumab per CRS/neurotossicità.
    6. Valutare la risposta di pazienti precedentemente trattati con immunoterapia anticorpo-mediata diretta verso CD19.
    7. Valutare l'incidenza e la durata della linfopenia B e dell'ipogammaglobulinemia e la correlazione con il mantenimento della CR.
    8. Valutare l'outcome dei pazienti trattati in presenza di anticorpi umani antimurini (HAMA) pre-esistenti al trattamento o rilevati dopo l'infusione di CD19-CAR_Lenti.
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. At 1 and 2 years old
    2. Pre-infusion; on day 0; per day 3-4; at weeks 1, 2, 4; every 2 weeks until week 12; every 3 months up to month 12; every 6 months up to month 24; annually for 15 years.
    3. Screening; on day 0; on day 3-4, at weeks 1,2,4; every 2 weeks until week 12, every 3 months up to month 12; every 6 months up to month 24; annually for 15 years.
    4. Pre-infusion; daily from day 3 to day 10; every 48h until normalization in patients who develop CRS
    5. at week 4 and, for long-term response, 1 and 2 years
    6. at week 4
    1. A 1 e 2 anni
    2. Pre-infusione; al giorno 0; al giorno 3-4; alle settimane 1, 2, 4; ogni 2 settimane fino alla settimana 12; ogni 3 mesi fino al mese 12; ogni 6 mesi fino al mese 24; annualmente per 15 anni.
    3. Allo Screening; al giorno 0; al giorno 3-4, settimanalmente fino alla settimana 4; ogni 2 settimane fino alla settimana 12,ogni 3 mesi fino al mese 12; ogni 6 mesi fino al mese 24; annualmente per 15 anni.
    4. Pre-infusione; quotidianamente dal giorno 3 al giorno 10; ogni 48h fino a normalizzazione nei pz che sviluppano CRS
    5. Alla settimana 4 e, per risposta a lungo termine, 1 e 2 anni
    6. Alla settimana 4
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans Yes
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Therapeutic exploratory (Phase II)
    Valutazione terapeutica (Fase II)
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    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 No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.4.1Number of sites anticipated in Member State concerned1
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial has a data monitoring committee No
    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 the study is defined as completion of the last visit or procedure shown in the SOA in the trial. After the last subject completes the 2-year follow up period, all subjects will be enrolled in post-therapy long term follow up for patients who have undergone gene therapy. Per EMA recommendations, patients will be followed for potential gene-therapy related adverse events for a 15-year period under this protocol.
    La fine dello studio è definita come il completamento dell'ultima visita o procedura mostrata nella nello studio. Dopo che l'ultimo soggetto ha completato il periodo di follow-up di 2 anni, tutti i soggetti saranno arruolati nel follow-up a lungo termine post-terapia per i pazienti sottoposti a terapia genica. Secondo le raccomandazioni EMA, i pazienti saranno seguiti per potenziali eventi avversi correlati alla terapia genica per un periodo di 15 anni secondo questo protocollo.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years15
    E.8.9.1In the Member State concerned months180
    E.8.9.1In the Member State concerned days54
    E.8.9.2In all countries concerned by the trial years15
    E.8.9.2In all countries concerned by the trial months180
    E.8.9.2In all countries concerned by the trial days54
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    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) Yes
    F.1.1.4.1Number of subjects for this age range: 1
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 19
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 9
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 3
    F.1.3Elderly (>=65 years) No
    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 Yes
    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 state32
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 32
    F.4.2.2In the whole clinical trial 32
    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)
    None
    Nessuno
    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 Decision2021-01-08
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-01-13
    P. End of Trial
    P.End of Trial StatusOngoing
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