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B Acute Lymphoblastic LeukemiaPhase 1/2CAPTiRALLNCT05310591

Combination of an Anti-PD1 Antibody With Tisagenlecleucel Reinfusion in Children, Adolescents and Young Adults With Acute Lymphoblastic Leukemia After Loss of Persistence

A Phase 1/2 study testing Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) ) and Nivolumab starting at day -1 in people with B Acute Lymphoblastic Leukemia and Acute Lymphoblastic Leukemia, in Relapse, run by Assistance Publique - Hôpitaux de Paris at 13 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Tisagenlecleucel (CTL019) is an anti-CD19 autologous Chimeric Antigen Receptor (CAR) T-cell therapy, which has shown dramatic early results in advanced ALLs. Early loss of B-cell aplasia (recovery of B-cells in marrow/ peripheral blood within 6 months after infusion), a marker of the loss or non-functionality of the… Read more about this study

Who is it for?
Ages 1 year to 25 years
What is being tested?
Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) ) and Nivolumab starting at day -1
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
26 participants
Where
13 sitesFrance
Study dates
15 Mar 2023to Mar 2027
Phase
Phase 1/2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Patients aged from 1 to 25 years (pediatric and young adults) with a history of CD19+ relapsed or refractory B-ALL (any relapse after HSCT, 2nd relapse or later, refractory ALL).
  • Patient must have a second tisagenlecleucel (Kymriah ®) product available
  • Cohort 1: previously treated by tisagenlecleucel (Kymriah ®), and who present an early loss of B-cell aplasia defined by blood B lymphocytes < 10 /mm3 and/ or < 3% of total lymphocytes (< 6 months after infusion) while still being in CR with undetectable MRD
  • Cohort 2: previously treated by tisagenlecleucel (Kymriah ®), who present a loss of B-cell aplasia defined by blood B lymphocytes < 10 /mm3 and/ or < 3% of total lymphocytes and a CD19+ ALL detectable disease in the marrow and/or Blood
  • Life expectancy > 12 weeks.
  • Karnofsky (age > 16) Lansky (age < 16) > 70 at screening.
Show all 9Show fewer
  • No organ dysfunction
  • Who have signed an informed consent
  • Affiliation to social security or any health insurance (as a beneficiary or assignee)

Who cannot join

  • Patient has received intervening therapy for leukemia after first tisagenlecleucel infusion (chemotherapy, anti leukemic immunotherapy, ITK, allogeneic HSCT).
  • Patient has an active autoimmune disease requiring systemic treatment within the past 2 years.
  • Patient has known history of, or any evidence of active, non-infectious pneumonitis.
  • Patient has a history of non-infectious pneumonitis that required steroid or has current pneumonitis.
  • Had receive prior therapy with an anti-PD1, Anti- PDL1 or anti-PDL2 agent.
  • Patient has hypersensivity to pembrolizumab/ nivolumab or one of its excipients
Show all 25Show fewer
  • Patient has received a live vaccine injection within 45 days of planned start of study therapy.
  • Patients with concomitant genetic syndromes associated with bone marrow failure states: such as patients with Fanconi anemia, Kostmann syndrome, Shwachman syndrome or any other known bone marrow failure syndrome. Patients with Down syndrome will not be excluded.
  • Patients with Burkitt's lymphoma/leukemia
  • Prior malignancy, except carcinoma in situ of the skin or cervix treated with curative intent and with no evidence of active disease.
  • Prior treatment with any gene therapy product except first tisagenlecleucel (Kymriah ®) injection.
  • Prior treatment with any anti-CD19/anti-CD3 therapy, or any other anti-CD19 therapy, except for patients pre-treated with blinatumomab and/or tisagenlecleucel (Kymriah®)
  • Prior anti-cancer monoclonal antibody within 4 weeks before starting the study.
  • Prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 or who has not recovered (i.e., ≤ Grade1 or at baseline) from adverse events due to a previously administered agent.
  • Active or latent hepatitis B or active hepatitis C (test within 8 weeks of Screening), or any uncontrolled infection at Screening.
  • Human immunodeficiency virus (HIV) positive test within 8 weeks of Screening.
  • Presence of grade 2 to 4 acute or extensive chronic GVHD.
  • Active CNS involvement by malignancy, defined as CNS-3 per NCCN guidelines. Note: Patients with history of CNS disease that has been effectively treated will be eligible.
  • Uncontrolled acute life threatening bacterial, viral or fungal infection at Screening.
  • Previous or concurrent malignancy with the following exceptions:
  • Adequately treated basal cell or squamous cell carcinoma
  • in situ carcinoma of the cervix or breast, treated curatively and without evidence of recurrence for at least 3 years prior to the study.
  • A primary malignancy completely resected and in CR for ≥ 5 years
  • Pregnant or lactating women (female study participants of reproductive potential must have a negative serum or urine pregnancy test performed within 48 hours before infusion)
  • Patient with hypersensivity to Fludarabine and/or cyclophosphamide and/or tisagenlecleucel and/or nivolumab or one of their excipients.

Trial locations and contacts

13 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Andre Baruchel, Pr contact

+331 40 03 53 88

andre.baruchel@aphp.fr

Jérôme Lambert, Pr contact

+33142499742

jerome.lambert@u-paris.fr

13 sites in 1 country

France13 sites, 13 recruiting
  • CHRU Bordeaux

    Bordeaux

    Marie Angoso

    Recruiting
  • CHRU Lille

    Lille

    Brigitte Nelken

    Recruiting
  • HCL - Lyon Sud

    Lyon

    Marie Balsat

    Recruiting
  • HCL

    Lyon

    Carine Halfan Domenech

    Recruiting
  • HCL

    Lyon

    Solene Remy

    Recruiting
  • Hôpital pour enfants - La Timone

    Marseille

    Michel Gerard

    Recruiting
  • CHU Montpellier - Hopital Arnaud de Villeneuve

    Montpellier

    Anne Sirvent

    Recruiting
  • CHU Nancy

    Nancy

    Cécile Pochon

    Recruiting
  • CHU Nantes - Hopital Mère-enfants

    Nantes

    Fanny Rialland

    Recruiting
  • Robert Debre hospital

    Paris

    André Baruchel

    Recruiting
  • Saint Louis hospital

    Paris

    Nicolas Boissel

    Recruiting
  • CHU Rouen

    Rouen

    Nimrod Buchbinder

    Recruiting
  • CHRU Strasbourg

    Strasbourg

    Catherine Paillard

    Recruiting

Other trials in France

About this study

Tisagenlecleucel (CTL019) is an anti-CD19 autologous Chimeric Antigen Receptor (CAR) T-cell therapy, which has shown dramatic early results in advanced ALLs. Early loss of B-cell aplasia (recovery of B-cells in marrow/ peripheral blood within 6 months after infusion), a marker of the loss or non-functionality of the CAR T-cells, is associated to a very high risk of relapse. A reinfusion of CTL019, even after Fludarabine-Cyclophosphamide reconditioning, frequently fails to induce further expansion as observed in UPENN studies and in the Robert Debré Hospital experience.

Non-persistence of CAR T-cells may be due to immune- mediated rejection or environment-mediated suppression of their growth. Evidence for increased PD-1 expression in CAR T-cells between infusion and peak expansion has been demonstrated in clinical samples.

Read more

Preclinical data and few clinical data support a role of PD- 1-PD-L1 blockade in improving the effectiveness of CAR T-cell therapy.

The objectives of this phase I/II study is to determine the safety, efficacy and feasibility of Nivolumab (Opdivo®)- an anti-PD1 treatment- combined to tisagenlecleucel in a cohort of relapsed or refractory B-ALL patients, aged 1-25 years old, previously treated by tisagenlecleucel (Kymriah®), with a demonstrated early loss of B-cell aplasia (within 6 months), a surrogate marker of the loss of CAR T-cells or their non- functionality.

More specifically, the main objectives are:

  • In cohort 1 that includes patients with a MRD negative disease status combined to an early loss (within 6 months) of B-cell aplasia :

To determine the optimal starting time of Nivolumab (Opdivo®) in terms of safety and efficacy among 4 candidate time points (day 14, day 11, day 5, and day - 1).

  • In cohort 2 that includes relapsed patients with an early loss (within 6 months) of B-cell aplasia :

To estimate the feasibility in terms of safety and efficacy of a very early start of nivolumab (day-1), prior to the reinfusion of tisagenlecleucel

Being tested
Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) ), Nivolumab starting at day -1
Medical subject headings
Burkitt Lymphoma, Precursor Cell Lymphoblastic Leukemia-Lymphoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) )Drug

    Patients included first receive a lympho-depleting chemotherapy by Fludarabine / Cyclophosphamide. tisagenlecleucel infusion should then be administered 2 to 14 days after completion of chemotherapy.

    Nivolumab (Opdivo®) will be given intravenously at 3mg/kg every 2 weeks. It will include patients with MRD negative disease status.

    1. Four decreasing starting times for beginning nivolumab (day 14, day 11, day 5 and day -1) will be available for testing
    2. Patients will be enrolled sequentially by cohorts of 3 with escalation between cohorts based only on the limiting toxicities between infusion and D28

    Nivolumab will be given until 12 months after tisagenlecleucel infusion in case of response.

  • Nivolumab starting at day -1Drug

    It will include relapsed patients. Patients included first receive a lympho-depleting chemotherapy by Fludarabine / Cyclophosphamide. tisagenlecleucel infusion should then be administered 2 to 14 days after completion of chemotherapy.

    Nivolumab (Opdivo®) will be given intravenously at 3mg/kg every 2 weeks.

    -nivolumab starting at day -1.

    Nivolumab will be given until 12 months after tisagenlecleucel infusion in case of response.

Study groups in NCT05310591
Study groupRoleWhat they receive
Patients with MRD negative disease status: Time to Event Continual Reassessment Method (TITE-CRM)ExperimentalNot described
Receives: Drug: Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) )
For relapsed patientsExperimentalNot described
Receives: Drug: Nivolumab starting at day -1

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of patients with limiting-toxicities

    Limiting toxicities are defined by the occurrence of either

    • Related to CAR-T cells infusion: CRS or aGVH: limiting toxicity will be defined as toxicity ≥ 4 ICANs: limiting toxicity will be defined as toxicity ≥ 3 (excepted grade 3 seizure, ie focal, generalized seizure that resolves rapidly)
    • Related to nivolumab: immune related myocarditis, pneumonitis, encephalitis: limiting toxicity will be defined as toxicity ≥ 4

    Measured: at day 28

  2. Efficacy assessed by Minimal residual disease (MRD) negative Complete remission (CR) and B cell aplasia.

    MRD negative CR is defined by undetectable disease at a 10-4 sensitivity threshold B cell aplasia is defined by blood B lymphocytes < 10 /mm3 and/or < 3% of total lymphocytes

    Measured: at 3 months

Secondary outcomes (18)
  1. Incidence of B cell aplasia

    Measured: at 6 months

  2. Increase of B cell aplasia duration compared to the previous one observed

    Measured: up to 24 months

  3. Proportion of patients with Disease best response

    Measured: up to three months

  4. Proportion of patients with Complete remission

    Measured: at 1 month

  5. Proportion of patients with Complete remission

    Measured: at 3 months

  6. Proportion of patients with Complete remission

    Measured: at 6 months

  7. Proportion of patients with Complete remission

    Measured: at 12 months

  8. Proportion of patients with Minimal residual disease

    Measured: at 1 month

  9. Proportion of patients with Minimal residual disease

    Measured: at 3 months

  10. Proportion of patients with Minimal residual disease

    Measured: at 6 months

  11. Proportion of patients with Minimal residual disease

    Measured: at 12 months

  12. Overall survival

    Measured: at one year

  13. Overall survival

    Measured: at 2 years

  14. Event Free Survival (EFS)

    Measured: at 1 year

  15. Event Free Survival (EFS)

    Measured: at 2 years

  16. Incidence of Grade 3 adverse events

    Measured: up to 2 years

  17. Incidence of Grade 3, 4 or 5 nivolumab-related adverse events

    Measured: up to 2 years

  18. Incidence of GVHD

    Measured: up to one year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Apr 2022
  2. Study start15 Mar 2023
  3. Primary completionMar 2027 (estimated)
  4. Study completionMar 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
26 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05310591
Sponsor's protocol ID
APHP200132
Acronym
CAPTiRALL
Status last verified
Feb 2024
First submitted
9 Mar 2022
Last updated
29 May 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Davis KL, Yao CC, Zimmerman JAO, Rau RE. Immunotherapy in B-Cell Acute Lymphoblastic Leukemia. J Natl Compr Canc Netw. 2025 Dec;23(12):e257067. doi: 10.6004/jnccn.2025.7067.

    PubMed 41671463

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Decreasing starting times for beginning nivolumab (Time to Event Continual Reassessment Method (TITE-CRM) ) and Nivolumab starting at day -1 in people with B Acute Lymphoblastic Leukemia and Acute Lymphoblastic Leukemia, in Relapse, run by Assistance Publique - Hôpitaux de Paris at 13 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 29 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Andre Baruchel, Pr (+331 40 03 53 88, andre.baruchel@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of patients with limiting-toxicities (time frame: at day 28). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05310591, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2024.

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