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    Clinical Trial Results:
    A phase II, open label, multi-center trial to determine the efficacy and safety of tisagenlecleucel re-infusion in Pediatric and Adolescent Young Adult (AYA) patients with acute lymphoblastic leukemia experiencing loss of B cell aplasia

    Summary
    EudraCT number
    2021-001535-99
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    19 Oct 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    30 Apr 2022
    First version publication date
    30 Apr 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CCTL019BUS03
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04225676
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma  AG
    Sponsor organisation address
    Novartis Campus, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG  , 41 613241111, Novartis.email@novartis.com
    Scientific contact
    Clinical Disclosure Office, Novartis Pharma AG  , 41 613241111, Novartis.email@novartis.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    19 Oct 2021
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Oct 2021
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of the trial was to evaluate the incidence of B-cell aplasia after re-infusion of tisageniecleucel.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Oct 2020
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 5
    Worldwide total number of subjects
    5
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    2
    Adolescents (12-17 years)
    2
    Adults (18-64 years)
    1
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    There were 7 participants screened.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Tisagenlecleucel
    Arm description
    Tisagenlecleucel Cell Dispersion for Infusion given once during the study. The approved dose range for tisagenlecleucel is: 0.2 to 5.0×10^6 CAR positive viable T cells / kg for patients’ ≤ 50 kg body weight or 0.1 to 2.5×10^8 CAR-positive viable T cells for patients > 50 kg body weight.
    Arm type
    Experimental

    Investigational medicinal product name
    Tisagenlecleucel
    Investigational medicinal product code
    CTL019
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    A second dose (for reinfusion) of commercial tisagenlecleucel was not considered investigation treatment because it was released commercially when prescribed by the treating physician in the course of medical practice.

    Number of subjects in period 1
    Tisagenlecleucel
    Started
    5
    Full analysis, safety and enrolled sets
    5
    Completed
    0
    Not completed
    5
         Physician decision
    1
         Study terminated by sponsor
    3
         Lack of efficacy
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Tisagenlecleucel
    Reporting group description
    Tisagenlecleucel Cell Dispersion for Infusion given once during the study. The approved dose range for tisagenlecleucel is: 0.2 to 5.0×10^6 CAR positive viable T cells / kg for patients’ ≤ 50 kg body weight or 0.1 to 2.5×10^8 CAR-positive viable T cells for patients > 50 kg body weight.

    Reporting group values
    Tisagenlecleucel Total
    Number of subjects
    5 5
    Age Categorical
    Units: Participants
        < 10 years
    2 2
        >=10 to <18 years
    2 2
        >=18 years
    1 1
    Sex: Female, Male
    Units: participants
        Female
    1 1
        Male
    4 4
    Race
    Units: Subjects
        White
    5 5
    Subject analysis sets

    Subject analysis set title
    Best responses reported
    Subject analysis set type
    Full analysis
    Subject analysis set description
    1 = CR = Complete remission and 2 = CRi = Complete remission without complete blood count recovery

    Subject analysis sets values
    Best responses reported
    Number of subjects
    5
    Age Categorical
    Units: Participants
        < 10 years
        >=10 to <18 years
        >=18 years
    Age continuous
    Units:
        
    ±
    Sex: Female, Male
    Units: participants
        Female
        Male
    Race
    Units: Subjects
        White
    5

    End points

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    End points reporting groups
    Reporting group title
    Tisagenlecleucel
    Reporting group description
    Tisagenlecleucel Cell Dispersion for Infusion given once during the study. The approved dose range for tisagenlecleucel is: 0.2 to 5.0×10^6 CAR positive viable T cells / kg for patients’ ≤ 50 kg body weight or 0.1 to 2.5×10^8 CAR-positive viable T cells for patients > 50 kg body weight.

    Subject analysis set title
    Best responses reported
    Subject analysis set type
    Full analysis
    Subject analysis set description
    1 = CR = Complete remission and 2 = CRi = Complete remission without complete blood count recovery

    Primary: Percentage of patients who establish B cell aplasia within 9 months of reinfusion

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    End point title
    Percentage of patients who establish B cell aplasia within 9 months of reinfusion [1]
    End point description
    Percentage of patients who establish B-cell aplasia at any visit following re-infusion with tisagenlecleucel. B-cell aplasia is defined as peripheral blood (PB) absolute B lymphocyte count <50/μL. Planned timeframe was 12 months but actual timeframe was approximately 9 months due to early termination of the trial. Day 1 is post lymphodepleting chemotherapy and pre-reinfusion of tisagenlecleucel.
    End point type
    Primary
    End point timeframe
    Post-reinfusion up to 9 months (Day 1 is excluded)
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analysis was done
    End point values
    Tisagenlecleucel
    Number of subjects analysed
    5
    Units: Participants
    2
    No statistical analyses for this end point

    Secondary: Overall remission rate (ORR)

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    End point title
    Overall remission rate (ORR)
    End point description
    ORR is defined as the percentage of participants with a best overall disease response of complete remission (CR) or CR with incomplete blood count recovery (CRi). However, the rate was not calculated due to low enrollment. Participants' best responses have been listed by day in study with 1=Complete response (CR) and 2= CRi = CR with incomplete blood count recovery.
    End point type
    Secondary
    End point timeframe
    Post-reinfusion up to 9 months
    End point values
    Best responses reported
    Number of subjects analysed
    5
    Units: Day
        Participant A - Day 34
    1
        Participant A - Day 67
    1
        Participant B - Day 24
    2
        Participant C - Day 32
    1
        Participant C - Day 91
    2
        Participant C - Day 182
    1
        Participant C - Day 274
    2
        Participant D - Day 29
    1
        Participant D - Day 84
    2
        Participant D - Day 177
    2
        Participant D - Day 211
    2
        Participant E - Day 28
    1
    No statistical analyses for this end point

    Secondary: Event free survival (EFS)

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    End point title
    Event free survival (EFS)
    End point description
    Time from reinfusion to the earliest of the following: death from any cause after remission, relapse, treatment failure (defined as no response in the study or discontinuation from the study for death, adverse event, lack of efficacy or progressive disease or new cancer therapy).
    End point type
    Secondary
    End point timeframe
    Reinfusion up to 9 months
    End point values
    Tisagenlecleucel
    Number of subjects analysed
    5
    Units: Days
    1
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    Time from date of re-infusion to the date of death due to any reason.
    End point type
    Secondary
    End point timeframe
    Reinfusion up to 9 months
    End point values
    Tisagenlecleucel
    Number of subjects analysed
    5
    Units: Days
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were reported from first dose of study treatment until end of study for a duration of 274 days. .
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.1
    Reporting groups
    Reporting group title
    All@subjects
    Reporting group description
    All@subjects

    Serious adverse events
    All@subjects
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 5 (60.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Paraesthesia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Cytokine release syndrome
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    All@subjects
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 5 (80.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Cancer fatigue
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    3
    General disorders and administration site conditions
    Catheter site erythema
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Chills
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Fatigue
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Pain
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Pyrexia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Hypoxia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Rhinitis allergic
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Investigations
    Enterovirus test positive
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Platelet count decreased
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    3
    Neutrophil count decreased
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    2
    Human rhinovirus test positive
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Respirovirus test positive
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    4
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    3
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    2
    Eye disorders
    Vision blurred
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Constipation
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    2
    Dental caries
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    3
    Tooth development disorder
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Stomatitis
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Vomiting
         subjects affected / exposed
    2 / 5 (40.00%)
         occurrences all number
    4
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Dermatitis acneiform
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Back pain
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    4
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    HCoV-OC43 infection
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Paronychia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    2
    Polyomavirus viraemia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Hypoalbuminaemia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Decreased appetite
         subjects affected / exposed
    3 / 5 (60.00%)
         occurrences all number
    4
    Hypokalaemia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    1
    Hypomagnesaemia
         subjects affected / exposed
    1 / 5 (20.00%)
         occurrences all number
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    23 Jun 2020
    The amendment was implemented prior to first patient screened or enrolled. It was amended to clarify that tisagenlecleucel would not be supplied as an investigational product. Participants in the study, who had an additional commercial dose available, were to be prescribed commercial tisagenlecleucel by a physician and it was to be administered in the course of medical practice.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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