iCaspase9-transduced T cells + AP1903 for Blood Cancers

(DOTTI Trial)

Recruiting at1 trial location

Overseen by Malcolm K Brenner, MB, PhD

Age: Any Age

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Waitlist Available

Sponsor: Baylor College of Medicine

No Placebo Group

Trial Summary

What is the purpose of this trial?

Patients will be receiving a stem cell transplant as treatment for their disease. As part of the stem cell transplant, patients will be given very strong doses of chemotherapy, which will kill all their existing stem cells. A close relative of the patient will be identified, whose stem cells are not a perfect match for the patient's, but can be used. This type of transplant is called "allogeneic", meaning that the cells are from a donor. With this type of donor who is not a perfect match, there is typically an increased risk of developing GvHD, and a longer delay in the recovery of the immune system. GvHD is a serious and sometimes fatal side-effect of stem cell transplant. GvHD occurs when the new donor cells (graft) recognize that the body tissues of the patient (host) are different from those of the donor. In this study, investigators are trying to see whether they can make special T cells in the laboratory that can be given to the patient to help their immune system recover faster. As a safety measure, we want to "program" the T cells so that if, after they have been given to the patient, they start to cause GvHD, we can destroy them ("suicide gene"). Investigators will obtain T cells from a donor, culture them in the laboratory, and then introduce the "suicide gene" which makes the cells sensitive to a specific drug called AP1903. If the specially modified T cells begin to cause GvHD, the investigators can kill the cells by administering AP1903 to the patient. We have had encouraging results in a previous study regarding the effective elimination of T cells causing GvHD, while sparing a sufficient number of T cells to fight infection and potentially cancer. More specifically, T cells made to carry a gene called iCasp9 can be killed when they encounter the drug AP1903. To get the iCasp9 gene into T cells, we insert it using a virus called a retrovirus that has been made for this study. The AP1903 that will be used to "activate" the iCasp9 is an experimental drug that has been tested in a study in normal donors with no bad side-effects. We hope we can use this drug to kill the T cells. The major purpose of this study is to find a safe and effective dose of "iCasp9" T cells that can be given to patients who receive an allogeneic stem cell transplant. Another important purpose of this study is to find out whether these special T cells can help the patient's immune system recover faster after the transplant than they would have otherwise.

Research Team

Malcolm K Brenner, MB, PhD

Principal Investigator

Baylor College of Medicine

Eligibility Criteria

This trial is for patients with certain blood disorders or immune system conditions like Non-Hodgkin's Lymphoma, Myelodysplastic Syndrome, and various forms of Leukemia. Participants must have a life expectancy over 30 days, stable organ function, and no severe infections. Pregnant individuals or those on other investigational drugs within the last 30 days cannot join.

Inclusion Criteria

My kidney function is normal, with creatinine levels not exceeding twice the upper limit.

Engrafted with an absolute neutrophil count > 500 cells/µL

My transplant shows at least 50% donor cells in blood or bone marrow, or my original disease has returned.

Exclusion Criteria

Other investigational drugs in the prior 30 days

Pregnancy*

Pregnancy test only required for at-risk individuals, defined as female patients of childbearing potential who have received a reduced-intensity conditioning regimen.

Treatment Details

Interventions

• iCaspase9-transduced T cells (CAR T-cell Therapy)

Trial Overview The study tests genetically modified T cells with a 'suicide gene' (iCasp9) in patients undergoing allogeneic stem cell transplants. If these T cells cause GvHD—a serious transplant complication—the drug AP1903 can be used to destroy them. The goal is to find a safe dose that helps immune recovery without causing harm.

Participant Groups

Group I: iCaspase9-transduced T cells Experimental Treatment 2 Interventions

The 5 dose levels are: 1. 1 x 10\^4 T cells/kg 2. 1 x 10\^5 T cells/kg 3. 5 x 10\^5 T cells/kg 4. 1 x 10\^6 T cells/kg 5. 5 x 10\^6 T cells/kg AP1903 will be administered if there is development of Grade 1 or greater GvHD.

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials

1,044

Recruited

6,031,000+

Paul Klotman

Baylor College of Medicine

Chief Executive Officer since 2010

MD, PhD

James Versalovic

Baylor College of Medicine

Chief Medical Officer since 2020

MD from Baylor College of Medicine

The Methodist Hospital Research Institute

Collaborator

Trials

299

Recruited

82,500+

Dr. John P. Cooke

The Methodist Hospital Research Institute

Chief Medical Officer since 2013

MD, PhD

Dr. Jenny Chang

The Methodist Hospital Research Institute

Chief Executive Officer

MBBChir from University of Cambridge, MHCM from Johns Hopkins University

Center for Cell and Gene Therapy, Baylor College of Medicine

Collaborator

Trials

114

Recruited

2,900+

Dr. Helen E. Heslop

Center for Cell and Gene Therapy, Baylor College of Medicine

Chief Executive Officer since 2017

M.D. from University of Otago, New Zealand

Dr. Chrystal U. Louis

Center for Cell and Gene Therapy, Baylor College of Medicine

Chief Medical Officer since 2024

M.D. from Tulane University School of Medicine