Recurrent Diffuse Large B-Cell LymphomaPhase 2NCT07042438
Fecal Microbiome Transplant to Remodel Intestinal Microbiota for Patients With Relapsed or Refractory Lymphoma With Exposure to High-Risk Antibiotics Who Are Receiving Chimeric Antigen Receptor T Cells
A Phase 2 study testing Axicabtagene Ciloleucel, Biospecimen Collection and Chemotherapy in people with Recurrent Diffuse Large B-Cell Lymphoma and Recurrent High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements, run by City of Hope Medical Center at 1 site in United States.
Trial summary
This phase II trial tests how well fecal microbiome transplantation works to remodel intestinal microbiota for patients with lymphoma that has come back after a period of improvement (relapsed) or that does not respond to treatment (refractory) with exposure to high-risk antibiotics who are receiving chimeric antigen… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Recurrent Diffuse Large B-Cell Lymphoma, Recurrent High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements, Recurrent Transformed Follicular Lymphoma to Diffuse Large B-Cell Lymphoma
- What is being tested?
- Axicabtagene Ciloleucel, Biospecimen Collection and Chemotherapy
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 56 participants
- Where
- 1 siteUnited States
- Study dates
- 11 Feb 2026to 23 Jan 2029
- Phase
- Phase 2
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 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Documented informed consent of the participant and/or legally authorized representative.
- Assent, when appropriate, will be obtained per institutional guidelines
- Agreement to allow the use of archival tissue from diagnostic tumor biopsies
- If unavailable, exceptions may be granted with study principal investigator (PI) approval
- Age: ≥ 18 years
- Karnofsky performance status (KPS) ≥ 60
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- Confirmed diagnosis of relapsed/refractory CD19 B-cell lymphomas of diffuse large B cell lymphoma (DLBCL), transformed follicular lymphoma (tFL), or double-hit lymphoma (DHL) and scheduled to receive commercial CAR T treatment of YESCARTA ® for their diagnosis
- Fully recovered from the acute toxic effects (except alopecia) to ≤ grade 1 to prior anti-cancer therapy
- Exposure to high-risk antibiotics within 90 days of consent. High-risk broad-spectrum antibiotics include carbapenems (meropenem, imipenem, doripenem), anti-pseudomonal antibiotics (cefepime, piperacillin-tazobactam, ceftazidime) or anaerobic antibiotics including metronidazole, clindamycin, amoxicillin-sulbactam, and vancomycin
- Clinical laboratory and organ function criteria per standard of care to CAR T patients at City of hope: (To be performed within 30 days prior to leukapheresis)
- Seronegative for HIV antigen (Ag)/antibody (Ab) combo, hepatitis C virus (HCV), active hepatitis B virus (HBV) (surface antigen negative)
- HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
- Meets other institutional and federal requirements for infectious disease titer requirements
- Note: Infectious disease testing to be performed within 28 days prior to day 1 of protocol therapy
- Women of childbearing potential (WOCBP): negative urine or serum pregnancy test
- If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
- Agreement by females and males of childbearing potential* to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 12 months after the last dose of protocol therapy.
- Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
Who cannot join
- Major surgery in 4 months preceding enrollment
- No live vaccine in 30 days prior to enrollment
- Inability to swallow capsules or history of disorder with Inability to swallow FMT capsules
- History of inflammatory bowel disorder, irritable bowel disorder
- Severe food allergies
- History of chronic aspiration
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- History of behavioral disorders including substance abuse disorders which per discretion of primary investigator will interfere with safe conduct and compliance to study treatment
- History neurocognitive disorder which per discretion of primary investigator will interfere with safe conduct and compliance to study treatment
- Diagnosis of primary immunodeficiency
- Active second malignancy requiring treatment except non-melanoma skin cancer or carcinoma in situ-cervix, bladder or to non-metastatic prostate cancer which does not require treatment
- Uncontrolled bacterial, fungal, or viral infection confirmed using clinical, laboratory and radiological findings requiring administration of intravenously (IV) antimicrobials
- Any clinical, laboratory or radiologic findings per discretion of primary investigator will interfere with safe conduct of study treatment and compliance with study procedures
- Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site, 1 recruiting
- Recruiting
City of Hope Medical Center
Duarte, California, 91010
Karamjeet S. Sandhu, 626-218-2405, ksandhu@coh.org
Karamjeet S. Sandhu
About this study
Official title: A Phase 2 Randomized Trial of Remodeling Intestinal Microbiota Using Fecal Microbiome Transplant (FMT) Among Recipients of Chimeric Antigen Receptor T Cells (CAR T)
This phase II trial tests how well fecal microbiome transplantation works to remodel intestinal microbiota for patients with lymphoma that has come back after a period of improvement (relapsed) or that does not respond to treatment (refractory) with exposure to high-risk antibiotics who are receiving chimeric antigen receptor (CAR) T cells. Fecal microbiome transplantation consists of fecal microbiota from healthy donors with healthy gut microbiota that allows re-population of the patient's microbiome with diverse protective microorganisms. CAR T-cell therapy is a type of treatment in which a patient's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells. T cells are taken from a patient's blood. Then the gene for a special receptor that binds to a certain protein on the patient's cancer cells is added to the T cells in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion for treatment of certain cancers. Part of the treatment for CAR T therapy involves high doses of chemotherapy. This, along with prior exposure to high strength antibiotics, can damage patient's intestinal microbiota. Giving fecal microbiome transplantation may improve clinical response by repairing intestinal microbiota for patients with relapsed or refractory lymphoma who had exposure to high-risk antibiotics.
Read the detailed description
PRIMARY OBJECTIVE:
- Evaluate the efficacy of fecal microbiome transplant (FMT) by measuring changes in gut microbiome diversity (as assessed by Shannon alpha diversity Index) at day 0 (day of CAR T infusion).
SECONDARY OBJECTIVES:
- Estimate rates of complete response (CR) at days +30, +90 or 1 year after CAR T therapy in each arm. (Key secondary objective) II. Determine the safety and tolerability/feasibility of fecal microbiota transplant (FMT) until 28 days post last dose by adverse events: type, frequency, severity, attribution, time course, duration.
III. Quantify engraftment of bacterial strains that are definitely attributable to FMT product.
IV. Estimate incidence and severity of cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) in each arm.
- Shannon index at each fecal sampling timepoint after day 0 to assess overtime changes in microbiome diversity in each cohort after CAR T infusion.
VII. Estimate rates of overall response (ORR) at 30 days, 90 days and 1 year after CAR T therapy in each arm.
VIII. Determine the number of bacterial infection rate post 30 days of last FMT last dose.
IX. Estimate rate of overall survival (OS), relapse/progression and non-relapse mortality (NRM) at 30 days, 90 days and 1 year after CAR T therapy in each arm.
- Estimate time to neutropenia recovery at each arm.
EXPLORATORY OBJECTIVES:
- Compare quality of manufactured CAR T products in patients treated or not treated with FMT.
II. Characterize and correlate FMT treatment with the following biologic endpoints.
IIa. Plasma and stool metabolites with a focus on butyrate-related pathways (metabolomics analysis); IIb. T cell phenotype (multicolor flow cytometry at Immuno-Oncology Core) and cytokines assay (30-multiplex plate using Luminex); IIc. CAR T cell persistence (using standard polymerase chain reaction [PCR] assays) on days +30, +90, 6 months and 1 year after CAR T therapy.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients undergo standard of care leukapheresis and receive standard of care chemotherapy and CAR T cells. Patients receive FMT orally (PO) once daily (QD) on day -10 and -7 before leukapheresis, day -10 and -7 before CAR T cell infusion, within 3 days of neutrophil recovery and 2 days after first neutrophil recovery dose. Treatment given in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection throughout the study.
ARM II: Patients undergo standard of care leukapheresis and receive standard of care chemotherapy and CAR T cells. Patients receive placebo PO QD on day -10 and -7 before leukapheresis, day -10 and -7 before CAR T cell infusion, within 3 days of neutrophil recovery and 2 days after first neutrophil recovery dose. Treatment given in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection throughout the study.
After completion of study treatment, patients are followed up at day 28, 90 and 1 year post CAR T cell therapy.
- Conditions
- Recurrent Diffuse Large B-Cell Lymphoma, Recurrent High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements, Recurrent Transformed Follicular Lymphoma to Diffuse Large B-Cell Lymphoma, Refractory Diffuse Large B-Cell Lymphoma, Refractory High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements, Refractory Transformed Follicular Lymphoma to Diffuse Large B-Cell Lymphoma
- Being tested
- Axicabtagene Ciloleucel, Biospecimen Collection, Chemotherapy, Fecal Microbiota Transplantation, Leukapheresis
- Medical subject headings
- Lymphoma, Large B-Cell, Diffuse
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Axicabtagene CiloleucelBiological
Also called Axi-cel, Axicel, KTE C19, KTE-C19
Given CAR-T cells
Biospecimen CollectionProcedure or surgery
Also called Biological Sample Collection, Biospecimen Collected, Specimen Collection
Undergo blood sample collection
ChemotherapyDrug
Also called Chemo, Chemotherapy (NOS), Chemotherapy, Cancer, General
Receive chemotherapy
Fecal Microbiota TransplantationProcedure or surgery
Also called Fecal Material Transplantation, Fecal Transplantation, FMT, Poo Transplant
Given PO
LeukapheresisProcedure or surgery
Also called Leukocyte Adsorptive Apheresis, Leukocytopheresis, Therapeutic Leukopheresis, White Blood Cell Reduction Apheresis
Undergo leukapheresis
Placebo AdministrationDrug
Given PO
| Study group | Role | What they receive |
|---|---|---|
| Arm I (FMT) | Experimental | Patients undergo standard of care leukapheresis and receive standard of care chemotherapy and CAR T cells. Patients receive FMT PO QD on day -10 and -7 before leukapheresis, day -10 and -7 before CAR T cell infusion, within 3 days of neutrophil recovery and 2 days after first neutrophil recovery dose. Treatment given in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection throughout the study. Receives: Biological: Axicabtagene Ciloleucel; Procedure: Biospecimen Collection; Drug: Chemotherapy; Procedure: Fecal Microbiota Transplantation; Procedure: Leukapheresis |
| Arm II (Placebo) | Placebo comparator | Patients undergo standard of care leukapheresis and receive standard of care chemotherapy and CAR T cells. Patients receive placebo PO QD on day -10 and -7 before leukapheresis, day -10 and -7 before CAR T cell infusion, within 3 days of neutrophil recovery and 2 days after first neutrophil recovery dose. Treatment given in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection throughout the study. Receives: Procedure: Biospecimen Collection; Drug: Chemotherapy; Procedure: Fecal Microbiota Transplantation; Procedure: Leukapheresis; Drug: Placebo Administration |
What is being measured
The primary outcome is the main question the study is designed to answer.
Changes in gut microbiome diversity
Assessed using the Shannon alpha diversity index. For comparisons at a timepoint of most interest, a t-test (or Wilcoxon rank-sum test if assumptions are not met) will be used to compare the Shannon index between the fecal microbiome transplant (FMT) and placebo groups. For over-time comparisons, linear mixed models will be used to assess longitudinal changes in microbiome diversity between treatment (FMT) and control (placebo) groups, accounting for within-subject correlations over multiple measurement points.
Measured: From baseline to day 0
Secondary outcomes (11)
Rate of complete response
Measured: At day +30, +90 and 1 year after chimeric antigen receptor t cell (CAR T) therapy
Incidence of adverse events
Scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 scale. Will summarize adverse events by type, severity, attribution, time of onset, duration, and association with study treatment. All observed toxicities will be tabulated and summarized by grade and frequency.
Measured: Up to 1 year post CAR T cell therapy
Feasibility of Rx administration
Evaluated by assessment of patient's ability to take at least 2 of the first 4 doses of Rx (4 capsules of FMT or placebo) before CAR T infusion.
Measured: Up to 30 days before CAR T cell infusion
Quantify engraftment of bacterial strains that are definitely attributable to FMT product
Donor microbiota engraftment will be determined by SourceTracker. SourceTracker estimates the attribution of microbiota in a post-treatment sample to donor microbiota. In choosing the donor source for each post-FMT sample, only the specific donor whose product was administered to the patient was used as donor. By contrast, because placebo capsules did not contain any donor material, the calculated engraftment rates from all four presumptive donors were averaged to derive donor attribution of post-placebo microbiota.
Measured: Up to 1 year post CAR T cell therapy
Incidence and severity of Cytokine Release Syndrome
Measured: Up to 1 year post CAR T cell therapy
Incidence and severity of immune effector cell associated neurotoxicity syndrome
Measured: Up to 1 year post CAR T cell therapy
Overall response rate
The binomial exact 95% confidence interval will be estimated at each post-treatment assessment timepoint and compared between FMT and placebo by Pearson Chi-square test or Fisher exact test.
Measured: At day +30, +90 and 1 year after CAR T therapy
Bacterial infection rate
Measured: Post 30 days of last FMT last dose
Rate of overall survival
Measured: At day +30, +90 and 1 year after CAR T therapy
Rate of relapse/progression
Measured: At day +30, +90 and 1 year after CAR T therapy
Rate of non-relapse mortality
The binomial exact 95% confidence interval will be estimated at each post-treatment assessment timepoint and compared between FMT and placebo by Pearson Chi-square test or Fisher exact test.
Measured: At day +30, +90 and 1 year after CAR T therapy
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jun 2025
- Study start11 Feb 2026
- Primary completion23 Jan 2029 (estimated)
- Study completion23 Jan 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Recurrent Diffuse Large B-Cell LymphomaStudies of the same condition, open and under way.
- More trials run by City of Hope Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 56 participants (estimated)
Sponsor and investigators
- Lead sponsor
- City of Hope Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Responsible party
- Sponsor
- Investigators
- Karamjeet S Sandhu, Principal investigator, City of Hope Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07042438
- Sponsor's protocol ID
- 24910
- Other IDs
- NCI-2025-03771, 24910, P30CA033572
- Status last verified
- Mar 2026
- First submitted
- 6 Jun 2025
- Last updated
- 5 Mar 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No