Study on CD30 CAR Therapy for Relapsed or Hard-to-Treat CD30+ T Cell Lymphoma

Inclusion Criteria for the Study

1. Written informed consent and HIPAA authorization for release of personal health information explained to, understood by and signed by the subject or legally authorized representative.
2. Age ≥ 18 years at the time of consent.
3. Karnofsky score of >60%
4. Histological or cytological evidence/confirmation of CD30+ peripheral T-cell lymphoma per the 2017 World Health Organization Classification of Haematopoietic and Lymphoid Tissues.
5. CD30+ disease determined by biopsy after the subject's most recent anti-CD30 therapy prior to ATLCAR.CD30 (result can be pending at the time of cell procurement but must be confirmed prior to treatment with the first infusion of ATLCAR.CD30 cells). NOTE: CD30+ disease requires documented CD30 expression by immunohistochemistry based on the institutional hematopathology standard.
6. Any subjects who has received at least two prior lines of therapy for their lymphoma. If transplant is given as a preplanned consolidation in first remission, it will not be counted as a second line of therapy.
7. Any subject who has received one line of therapy who has primary refractory lymphoma or lymphoma that relapsed within 12 months of completing chemotherapy or receiving transplant as long as prior therapy included brentuximab vedotin unless they were not candidates for brentuximab vedotin.
8. Subjects relapsed after autologous stem cell transplant are eligible for this study.
9. Subjects relapsed after allogeneic stem cell transplantation are eligible provided the patient is ≥180 days from transplant, not on immunosuppresive therapy to treat/prevent graft-versus-host disease and has no evidence of active graft-versus-host disease.
10. Subjects with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
11. Female subjects of childbearing potential must have a negative serum pregnancy test within 72 hours prior to cell procurement. Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months. Documentation of postmenopausal status must be provided.
12. Female subjects of childbearing potential must be willing to abstain from heterosexual activity or to use 2 forms of effective methods of contraception from the time of informed consent until 6 months after study treatment discontinuation. The two contraception methods can be comprised of two barrier methods, or a barrier method plus a hormonal method or an intrauterine device that meets <1% failure rate for protection from pregnancy in the product label. Women of childbearing potential will also be instructed to tell their male partners to use a condom.
13. Subject is willing and able to comply with study procedures based on the judgement of the investigator or protocol designee.

Exclusion Criteria for the Study

1. Subject is pregnant or lactating (Note: Breast milk cannot be stored for future use while the mother is being treated on study ).
2. Current use of systemic corticosteroids at doses ≥10 mg prednisone daily or its equivalent; those receiving <10 mg daily may be enrolled at discretion of investigator. Inhaled steroids are allowed.
3. Active infection with HIV, HTLV, HCV (tests can be pending at the time of cell procurement; only those samples confirming lack of active infection will be used to generate transduced cells). Note: To meet eligibility subjects are required to be negative for HIV antibody, negative for HTLV1 and 2 antibody or PCR negative for HTLV1 and 2, negative for HCV antibody or HCV viral load.
4. Subjects who are positive for hepatitis B surface antigen (can be pending at the time of cell procurement; only those samples confirming lack of active infection will be used to generate transduced cells) are excluded. Subjects who are hepatitis B surface antigen negative but hepatitis B core antibody positive must have their hepatitis B viral load checked. These subjects will be excluded if their viral load is positive at baseline. Subjects who are core antibody positive and viral load negative at baseline will be considered eligible.

Eligibility Criteria Prior to Cell Procurement

1. Informed consent to undergo cell procurement understood by and signed by the subject or legally authorized representative; subject and/or legally authorized representative given a copy of informed consent form for cell procurement.

2. Subject has life expectancy ≥ 6 weeks.

3. Subject has evidence of adequate organ function within 7 days of procurement as defined by:

   • Hemoglobin ≥8.0 g/dL (transfusion is allowed prior to procurement)
   • Total bilirubin ≤ 2 × ULN, unless attributed to Gilbert's Syndrome
   • AST ≤ 3 × ULN
   • ALT < 3 x ULN
   • Creatinine ≤ 2 × ULN
   • Pulse oximetry of >90% on room air

4. Imaging results from within 90 days prior to procurement to assess presence of active disease.

5. Negative serum pregnancy test within 72 hours prior to procurement or documentation that the subject is post-menopausal. Post-menopausal status must be confirmed with documentation of absence of menses for >1 year, or documentation of surgical menopause (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.

Eligibility Criteria Prior to Lymphodepletion #1

1. Written informed consent explained to, understood by and signed by the subject or legally authorized representative; subject and/or legally authorized representative given a copy of informed consent form.

2. Imaging results from within 10 days prior to lymphodepletion. Imaging must occur at least 3 weeks after most recent therapy (used as baseline measure for documentation of progression before the lymphodepletion) to document measurable or assessable disease.

3. Subject must demonstrate adequate organ function prior to lymphodepletion as defined below. All tests must be obtained within 72 hours prior to lymphodepletion:

   • Absolute neutrophil count ≥ 1.0 × 10^9/L
   • Platelet count ≥ 50 × 10^9/L
   • Total bilirubin < 2 x ULN unless attributed to Gilbert's syndrome
   • AST ≤ 5 x ULN
   • ALT ≤ 5 x ULN
   • Creatinine ≤ 3 x ULN
   • Pulse Oximetry of >90% on room air

4. Subject must have available autologous transduced activated T cells product at a dose of 2x10^8 cells/m^2 and meets the Certificate of Analysis acceptance criteria.

5. No major surgery within 28 days prior to lymphodepletion.

6. Negative serum pregnancy test within 72 hours prior to lymphodepleting therapy for female participants of childbearing potential. Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.

7. Subject has not received any investigational agents or any tumor vaccines within the previous six weeks prior to lymphodepletion.

8. Subject has not received anti-CD30 antibody-based therapy within the previous 4 weeks prior to lymphodepletion.

9. Subject has not received chemotherapy within the previous 3 weeks prior to lymphodepletion.

10. Subject does not have rapidly progressive disease, per treating oncologist's discretion.

11. Subject is a good candidate for CAR T cell therapy, per treating oncologist's discretion.

12. Subjects on strong inhibitors of CYP1A2 (e.g., fluvoxamine, ciprofloxacin) as these may increase plasma concentrations of bendamustine, and decrease plasma concentrations of its metabolites. See http://medicine.iupui.edu/clinpharm/ddis/ for an updated list of strong inhibitors of CYP1A2. (This applies to subjects who receive bendamustine for lymphodepletion (required) up through 72 hours after the last dose of bendamustine.)

13. Subject is not taking a prohibited or contraindicated medication prior to lymphodepletion.

14. Current use of systemic corticosteroids at doses ≥10 mg prednisone daily or its equivalent; those receiving <10 mg daily may be enrolled at discretion of investigator. Inhaled steroids are allowed.

Eligibility Criteria Prior to Cell Product Administration #1

1. Subject has no evidence of uncontrolled infection or sepsis.

2. Negative serum pregnancy within 7 days of cell product administration for females of childbearing potential (does not need to be repeated if pre-lymphodepletion pregnancy test is within window). Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oopherectomy) or they are naturally postmenopausal for at least 12 consecutive months.

3. Evidence of adequate organ function as defined by:

   • Total bilirubin ≤ 2 × ULN, unless attributed to Gilbert's syndrome
   • AST ≤ 5 × ULN
   • ALT ≤ 5 × ULN
   • Creatinine ≤ 3 × ULN
   • Pulse Oximetry of >90% on room air

4. Subject has no clinical indication of rapidly progressing disease in the opinion of the clinical investigator.

5. Subject is a good candidate for treatment with ATLCAR.CD30 cell product per the clinical investigator's discretion.

Eligibility Criteria Prior to Lymphodepletion #2

1. Imaging results from within 21 days prior to lymphodepletion to confirm that the subject has derived clinical benefit from the initial infusion as assessed by the investigator. Clinical benefit will be defined as:

   1. Subject with stable disease or better after the first ATLCAR.CD30 infusion without subsequent progressive disease.
   2. Subjects that had a PR or CR and progressed after the first ATLCAR 30 infusion and prior to second lymphodepletion. A second infusion will be made available to the subject, if the subject chooses, if the treating investigator suspects the subject would obtain clinical benefit from a second infusion and all other eligibility criteria are met.

2. Subjects who experienced Grade 4 CRS or Grade 4 ICANS as a result of the initial ATLCAR.CD30 infusion are only eligible for a second round of lymphodepletion and infusion if they have partial response or better to the initial ATLCAR.CD30 infusion.

3. Subject must demonstrate adequate organ function prior to lymphodepletion as defined below. All tests must be obtained within 24 hours prior to lymphodepletion:

   • Absolute neutrophil count ≥ 1.0 × 10^9/L
   • Platelet count ≥ 50 × 10^9/L
   • Total bilirubin ≤ 2 × ULN, unless attributed to Gilbert's syndrome
   • AST ≤ 5 × ULN
   • ALT ≤ 5 × ULN
   • Creatinine ≤ 3 × ULN
   • Pulse Oximetry of >90% on room air

4. Subject must have available autologous transduced activated T cells product at a dose of 2x10^8 cells/m^2 and meets the Certificate of Analysis acceptance criteria.

5. Negative serum pregnancy test within 72 hours prior to lymphodepleting therapy for female participants of childbearing potential. Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.

6. Subject does not have evidence of uncontrolled infection or sepsis.

7. Subject is not receiving a prohibited medication at time of starting lymphodepletion up through 72 hours after the last dose of cyclophosphamide.

8. Subject is a good candidate for CAR T cell therapy, per treating oncologist's discretion.

9. Current use of systemic corticosteroids at doses ≥10 mg prednisone daily or its equivalent; those receiving <10 mg daily may be enrolled at discretion of investigator. Inhaled steroids are allowed.

Eligibility Criteria Prior to Cell Product Administration #2

1. Subject has no evidence of uncontrolled infection or sepsis.

2. Negative serum pregnancy within 7 days of cell product administration for females of childbearing potential (does not need to be repeated if pre-lymphodepletion pregnancy test is within window). Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months.

3. Evidence of adequate organ function as defined by:

   • Total bilirubin ≤ 2 × ULN, unless attributed to Gilbert's syndrome
   • AST ≤ 5 × ULN
   • ALT ≤ 5 × ULN
   • Creatinine ≤ 3 × ULN
   • Pulse Oximetry of >90% on room air

4. Subject has no clinical indication of rapidly progressing disease in the opinion of the clinical investigator.

5. Subject is a good candidate for treatment with ATLCAR.CD30 cell product per the clinical investigator's discretion.