Second Infusion of Tisagenlecleucel for Acute Lymphoblastic Leukemia

Recruiting at 5 trial locations

Overseen By Kavitha Ramaswamy

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Waitlist Available

Sponsor: Memorial Sloan Kettering Cancer Center

Must not be taking: Non-standard chemotherapy

Disqualifiers: Infection, Pregnancy, Severe toxicities, others

No Placebo Group

Prior Safety Data

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing if using the body's own immune system can help patients with a specific type of leukemia stay in a stable condition. It also looks at the safety and effectiveness of this approach. The treatment works by boosting the body's own immune system to better fight cancer.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial team or your doctor.

What data supports the effectiveness of the treatment Tisagenlecleucel for Acute Lymphoblastic Leukemia?

Tisagenlecleucel has shown high initial response rates in children and young adults with relapsed or refractory B-cell acute lymphoblastic leukemia, with 83.3% of patients experiencing a complete response. However, nearly half of these patients experienced a relapse, indicating that while the treatment is initially effective, long-term outcomes may vary. ^{1 2 3 4 5}

Is Tisagenlecleucel generally safe for humans?

Tisagenlecleucel has been used in various conditions and has shown a manageable safety profile, but it can cause serious side effects. Common issues include cytokine release syndrome (a severe immune reaction), fever, and low blood pressure. Some cases have resulted in hospitalization or even death, mainly due to disease progression, but further studies are needed to understand long-term safety. ^{1 2 3 6 7}

How is the treatment Tisagenlecleucel unique for acute lymphoblastic leukemia?

Tisagenlecleucel is a unique treatment for acute lymphoblastic leukemia because it uses the patient's own T-cells, which are genetically modified to target and destroy cancer cells, offering a personalized approach for those who have not responded to other treatments. ^{1 2 8 9 10}

Research Team

Kevin Curran

Principal Investigator

Memorial Sloan Kettering Cancer Center

Eligibility Criteria

This trial is for children and young adults under 26 with B-cell Acute Lymphoblastic Leukemia who've had a previous tisagenlecleucel infusion. They must have normal organ function, no severe ongoing side effects from the first treatment, and not be pregnant or breastfeeding. Participants need to agree to use contraception if applicable.

Inclusion Criteria

Peripheral blood B-cell aplasia within 14 days prior to reinfusion

My recent tests show no cancer signs in my bone marrow.

My CAR T cell therapy is considered out of specification but is not expected to affect its safety or effectiveness.

Exclusion Criteria

I am a sexually active male unwilling to use a condom.

It has been over 60 days since my first tisagenlecleucel infusion.

Pregnant or lactating women or women of child-bearing potential not using highly effective contraception

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Lymphodepleting Chemotherapy

Participants receive lymphodepleting chemotherapy with cyclophosphamide and fludarabine prior to the initial tisagenlecleucel infusion

2-14 days

Initial Tisagenlecleucel Infusion

Participants receive the initial infusion of tisagenlecleucel

1 day

Early Reinfusion of Tisagenlecleucel

Participants receive a second infusion of tisagenlecleucel on day +30-60 after their initial infusion if meeting eligibility criteria

30-60 days post-initial infusion

Follow-up

Participants are monitored for safety and effectiveness after treatment, including the assessment of B-Cell Aplasia and toxicities

6 months

Long-term Follow-up

Participants are monitored for long-term safety and effectiveness, including the evaluation of toxicities

1 year

Treatment Details

Interventions

• Tisagenlecleucel (CAR T-cell Therapy)

Trial Overview The study tests whether an early second dose of tisagenlecleucel can maintain cancer remission at six months post-first infusion in patients with B-ALL. It also evaluates the safety and effectiveness of this reinfusion strategy.

Participant Groups

Group I: Tisagenlecleucel Experimental Treatment 1 Intervention

Patients will receive reinfusion of tisagenlecleucel on day +30-60 after their initial infusion if meeting eligibility criteria. Tisagenlecleucel is an autologous cellular immunotherapy product that is comprised of CD3+T cells that have undergone ex vivo T cell activation, gene modification, expansion, and formulation in infusible cryomedia.

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Novartis Pharmaceuticals

Industry Sponsor

Trials

2,963

Recruited

4,275,000+

Founded

1996

Headquarters

Basel, Switzerland

Known For

Precision medicine

Top Products

Gleevec, Cosentyx, Entresto, Kisqali

Dr. Vas Narasimhan

Novartis Pharmaceuticals

Chief Executive Officer since 2018

MD from Harvard Medical School

Dr. Shreeram Aradhye

Novartis Pharmaceuticals

Chief Medical Officer since 2021

MD

Findings from Research

Tisagenlecleucel (tisa-cel) is an effective CAR-T therapy for patients with relapsed/refractory follicular lymphoma (R/R FL), showing durable remissions even in high-risk patients, as confirmed by the pivotal ELARA study.

The therapy has a manageable toxicity profile, making it a viable option for patients who have undergone two lines of systemic therapies, leading to its FDA approval for this indication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel: CAR-T cell therapy for adult patients with relapsed or refractory follicular lymphoma. Saha, A., Jhaveri, K., Sarfraz, H., et al.[2023]

In a study of 79 pediatric patients with relapsed/refractory B-cell acute lymphoblastic leukemia, those who responded to the CAR T-cell therapy tisagenlecleucel showed approximately double the expansion of the therapy in their blood compared to nonresponders, indicating a strong correlation between cellular expansion and treatment efficacy.

The therapy demonstrated persistence in responders for over two years, and its expansion continued even after treatment with tocilizumab, which is used to manage cytokine release syndrome, suggesting that tisagenlecleucel can remain effective despite potential side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Pharmacology of Tisagenlecleucel in B-cell Acute Lymphoblastic Leukemia. Mueller, KT., Waldron, E., Grupp, SA., et al.[2020]

Tisagenlecleucel, a CAR-T cell therapy, shows high overall remission rates of 69% to 93% in patients with relapsed/refractory B-cell acute lymphoblastic leukemia, with durable 12-month relapse-free survival rates of 55% to 59%.

However, the treatment is associated with significant risks, including potentially life-threatening cytokine release syndrome in 77% to 100% of patients and neurotoxicity in 31% to 45%, highlighting the need for careful patient selection and management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel in Acute Lymphoblastic Leukemia: A Review of the Literature and Practical Considerations. Halford, Z., Anderson, MK., Bennett, LL., et al.[2021]

In a study of 31 pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) treated with tisagenlecleucel, 83.3% achieved a complete response, but 48% experienced disease relapse, indicating a significant challenge in long-term management.

High pretreatment leukemic burden (≥5% bone marrow blasts) was identified as a critical risk factor for poorer event-free survival (EFS) and overall survival (OS), suggesting that reducing this burden before CAR T-cell therapy could enhance treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of High Disease Burden on Survival in Pediatric Patients with B-ALL Treated with Tisagenlecleucel. Ravich, JW., Huang, S., Zhou, Y., et al.[2023]

The total estimated cost for treating pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia using tisagenlecleucel is $612,779, which includes significant additional costs beyond the drug's list price of $475,000.

Adverse event management and inpatient admissions were the main contributors to the additional costs, highlighting the importance of considering these factors in the overall economic evaluation of tisagenlecleucel treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimation of Total Costs in Pediatric and Young Adult Patients with Relapsed or Refractory Acute Lymphoblastic Leukemia Receiving Tisagenlecleucel from a U.S. Hospital's Perspective. Yang, H., Hao, Y., Qi, CZ., et al.[2023]

A post-marketing evaluation of tisagenlecleucel in pediatric patients revealed that 92% of the 638 reported adverse events were serious, often leading to hospitalization, with 55 cases resulting in fatal outcomes primarily due to leukemia progression or recurrence.

Cytokine release syndrome was the most common adverse event following tisagenlecleucel infusion, highlighting the need for ongoing monitoring of safety, especially since this analysis confirms the previously established safety profile but emphasizes the necessity for longer-term studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel in Children and Young Adults: Reverse Translational Research by Using Real-World Safety Data. Rafaniello, C., Ferrajolo, C., Gaio, M., et al.[2020]

In a study of 91 patients with relapsed/refractory large B-cell lymphoma (LBCL), treatment with the CAR T-cell therapy tisagenlecleucel (tisa-cel) resulted in a best overall response rate of 60% and a complete response rate of 32%, indicating its efficacy in a real-world setting.

The safety profile of tisa-cel was manageable, with only 5% of patients experiencing severe cytokine release syndrome and 1% experiencing neurotoxicity, suggesting that it can be safely administered in standard-of-care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-world evidence of tisagenlecleucel for the treatment of relapsed or refractory large B-cell lymphoma. Iacoboni, G., Villacampa, G., Martinez-Cibrian, N., et al.[2021]

Tisagenlecleucel, a genetically modified T cell therapy, showed a high overall remission rate of 66.7% in a small group of Japanese patients with relapsed/refractory B-cell acute lymphoblastic leukemia, with some patients achieving long-lasting complete remission.

The treatment was associated with manageable side effects, including cytokine release syndrome in 83% of patients, which resolved with appropriate care, indicating a favorable safety profile for this therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of tisagenlecleucel in Japanese pediatric and young adult patients with relapsed/refractory B cell acute lymphoblastic leukemia. Hiramatsu, H., Adachi, S., Umeda, K., et al.[2022]

In a study of 32 patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) and diffuse large B-cell lymphoma (DLBCL) treated with tisagenlecleucel (tisa-cel), the level of CAR-T cell expansion in the body after treatment was found to be a key predictor of therapy success, rather than the specific characteristics of the CAR-T cells themselves.

Patients who had a higher percentage of certain T cell types (CD8+CD45RA+CD27+) before treatment were more likely to respond positively to the therapy, while those with primary refractory aggressive B-cell lymphomas showed poor outcomes, indicating that tumor biology plays a significant role in treatment efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Characterization of the input material quality for the production of tisagenlecleucel by multiparameter flow cytometry and its relation to the clinical outcome. Štach, M., Pytlík, R., Šmilauerová, K., et al.[2023]

Tisagenlecleucel, a CAR T cell therapy for relapsed/refractory B cell acute lymphoblastic leukemia, showed a high incidence of grade 3/4 adverse events (77% of patients), including cytokine-release syndrome (79%) and prolonged cytopenias (40%).

Despite the significant adverse events, the therapy led to complete remission in patients, with effective management of complications such as CRS using tocilizumab and corticosteroids, and a low incidence of severe infections after one year due to immunoglobulin replacement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pooled safety analysis of tisagenlecleucel in children and young adults with B cell acute lymphoblastic leukemia. Levine, JE., Grupp, SA., Pulsipher, MA., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel: CAR-T cell therapy for adult patients with relapsed or refractory follicular lymphoma. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Clinical Pharmacology of Tisagenlecleucel in B-cell Acute Lymphoblastic Leukemia. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel in Acute Lymphoblastic Leukemia: A Review of the Literature and Practical Considerations. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Impact of High Disease Burden on Survival in Pediatric Patients with B-ALL Treated with Tisagenlecleucel. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Estimation of Total Costs in Pediatric and Young Adult Patients with Relapsed or Refractory Acute Lymphoblastic Leukemia Receiving Tisagenlecleucel from a U.S. Hospital's Perspective. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Tisagenlecleucel in Children and Young Adults: Reverse Translational Research by Using Real-World Safety Data. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Real-world evidence of tisagenlecleucel for the treatment of relapsed or refractory large B-cell lymphoma. [2021]

8. Japan pubmed.ncbi.nlm.nih.gov

Efficacy and safety of tisagenlecleucel in Japanese pediatric and young adult patients with relapsed/refractory B cell acute lymphoblastic leukemia. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Characterization of the input material quality for the production of tisagenlecleucel by multiparameter flow cytometry and its relation to the clinical outcome. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Pooled safety analysis of tisagenlecleucel in children and young adults with B cell acute lymphoblastic leukemia. [2022]