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This is a single-center, single-arm, open-label phase 1/2 study of CART19 in children and young adults with refractory Systemic lupus erythematosus (SLE), including both patients diagnosed with lupus nephritis (LN) and patients with non-renal Systemic lupus erythematosus (SLE).
Phase 1 will evaluate the safety of CART19 in 6-12 patients with Systemic lupus erythematosus (SLE). There is no planned dose escalation, but a dose de-escalation will be made based on the incidence of Dose Limiting Toxicities. Phase 2 will evaluate the efficacy and further evaluate the safety of CART19 in this population.
Lupus disease activity is associated with increased numbers of activated naïve B cells and polyclonal expansion of antibody secreting cells, indicating a central role for B cells in the pathogenesis of SLE. While traditional anti-CD19 antibody therapies have been utilized with varying success in the treatment of Systemic lupus erythematosus (SLE), CD19 directed cellular therapies have emerged as an attractive therapeutic option that may lead to immunosuppression-free remission in this population given the ability of CD19 directed CAR T cells to more deeply deplete the B cell compartment. Previous clinical experience utilizing CD19 directed CAR T cells in patients diagnosed with Systemic lupus erythematosus (SLE) have exceeded any other Systemic lupus erythematosus (SLE) therapeutic available; although, those clinical trials have treated a limited number of subjects. During this trial the test article will be CART19 cells transduced with a lentiviral vector to express anti-CD19 scFv:41-BB:TCRζ, administered by IV injection.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CART19 | Experimental | Participants will receive the study product. CART19 cells transduced with a lentiviral vector to express anti-CD19 scFv:41-BB:TCRζ, administered by IV injection. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CART19 | Biological | CART19 cells transduced with a lentiviral vector to express anti-CD19 scFv:41-BB:TCRζ, administered by IV injection. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of the dose limiting toxicities of CART19 | Frequency of the dose limiting toxicities of CART19 | up to 24 months post infusion |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of childhood SLE Clinical Remission off steroids (cCR-0) at 3 months | 3 months post treatment | |
| 2-year overall survival rate | 24 months post infusion | |
| 2-year flare free survival rate |
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Inclusion Criteria:
Signed informed consent form must be obtained prior to any study procedure. Labs or other procedures obtained during routine clinical care may be used for eligibility if obtained within the protocol required window.
Patient age must be 12-29 years, inclusive, at time of enrollment.
Meeting ACR/EULAR Classification Criteria for SLE
ANA positive > 1:80 and/or double-stranded DNA (dsDNA) positive
Active (refractory) disease, defined as follows:
a. Lupus nephritis subjects must meet both the following criteria: i. ISN/RPS active nephritis Class III/IV +/- V lupus nephritis diagnosed by biopsy within past 12 months.
ii. Persistent and clinically significant: ≥2 measurements with urine protein with either of the following:
6. Patients must have had at least 3 months of cumulative conventional therapy defined as:
i. B-cell directed biologic therapy (e.g., rituximab, belimumab, ofatumumab, obinutuzumab) ii. Calcineurin inhibitor (e.g., tacrolimus, cyclosporine, voclosporin) iii. Other immunosuppressive medication for SLE (e.g., anifrolumab, abatacept, JAK inhibitor) 7. Adequate organ function status
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Caitlin Elgarten, MD | Contact | 267-425-7964 | elgartenc@chop.edu | |
| Melissa Varghese | Contact | 845-553-5358 | verghesem@chop.edu |
| Name | Affiliation | Role |
|---|---|---|
| Caitlin Elgarten, MD | Children's Hospital of Philadelphia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's Hospital of Philadelphia | Recruiting | Philadelphia | Pennsylvania | 19104 | United States |
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| ID | Term |
|---|---|
| D008180 | Lupus Erythematosus, Systemic |
| D008181 | Lupus Nephritis |
| ID | Term |
|---|---|
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| C000598123 | CTL019 chimeric antigen receptor |
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| up to 24 months post infusion |
| Feasibility of manufacturing CART19 for participants with SLE | Feasibility of manufacturing CART19 measured by the percentage of manufactured products that do not meet release criteria for vector transduction efficiency, T cell product purity, viability, or sterility | up to 24 months post infusion |
| Proportion of patients achieving a complete renal response | renal response will be measured by urine protein/creatinine ratio of < 0.5, normal renal function (serum creatinine ≤ULN) without worsening of baseline serum creatinine by more than 15%, and inactive urinary sediment (<10 red blood cells (RBCs)/high-power field (HPF) without RBC casts) | up to 24 months post infusion |
| Proportion of patients achieving a partial renal response | partial renal response will be measured by urine protein/creatinine ratio of < 0.5, normal renal function (serum creatinine ≤ULN) without worsening of baseline serum creatinine by more than 15%, and inactive urinary sediment (<10 red blood cells (RBCs)/high-power field (HPF) without RBC casts) | up to 24 months post infusion |
| Rate of CART19 expansion, persistence or B cell aplasia | Rate of CART19 expansion, persistence and B cell aplasia will be measured by qPCR and flow cytometry | up to 24 months post infusion |
| Survival of CART19 cells | CART19 cell survival will be measured by utilizing polymerase chain reaction analysis of whole blood to detect and quantify number of cells over time. | up to 24 months post infusion |
| Elevations in cytokines in serum | to assess bioreactivity and biological response following CART cell infusion, systemic soluble immune and inflammatory factors will be measured by assessing any change in elevations in cytokines in serum prior to infusion and after. | up to 24 months post infusion |
| D005921 | Glomerulonephritis |
| D009393 | Nephritis |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |