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NCT03394365PHASE3Recruiting

A Phase 3 Study of Tabelecleucel for Participants With Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disease After Failure With Rituximab or Rituximab and Chemotherapy

Pierre Fabre Medicament

Start Date

12/29/2017

Completion Date

8/1/2030

Summary

The purpose of this study is to determine the clinical benefit and characterize the safety profile of tabelecleucel for the treatment of Epstein-Barr virus-associated post-transplant lymphoproliferative disease (EBV+ PTLD) in the setting of (1) solid organ transplant (SOT) after failure of rituximab (SOT-R) and rituximab plus chemotherapy (SOT-R+C) or (2) allogeneic hematopoietic cell transplant (HCT) after failure of rituximab.

Detailed Description

This is a multicenter, open-label, phase 3 study to assess the efficacy and safety of tabelecleucel for the treatment of EBV+ PTLD in the setting of SOT-R and SOT-R+C (Cohort \[C\]-SOT) or HCT after failure of rituximab (C-HCT). SOT-R further included participants: 1. who did not receive chemotherapy and did not have a documented medical reason not to receive chemotherapy (SOT-Ro) or 2. who were considered chemotherapy ineligible/inappropriate (SOT-R-Ci) Combined population (SOT-R-Ci, SOT-R+C, and HCT) and (SOT-R-Ci and SOT-R+C) who received commercial product, or a product manufactured using a comparable process version (PV) were also used for analysis of outcomes. Enrollment will be preceded by confirmation of availability of partially human leukocyte antigen (HLA) matched and restricted tabelecleucel for the participant. Study procedures and product administration will be the same for each cohort. Tabelecleucel will be administered in cycles lasting 5 weeks (35 days). During each cycle, participants will receive intravenous tabelecleucel at a dose of 2 × 10\^6 cells/kg on Days 1, 8, and 15, followed by observation through Day 35. Treatment will continue until maximal response, unacceptable toxicity, initiation of non protocol therapy, or failure of tabelecleucel with up to 2 different HLA restrictions (C-SOT) or up to 4 different HLA restrictions (C-HCT). The study includes a total of 5 years of follow-up for disease and survival status for participants enrolled before or after 09 October 2023 to reach the initial sample size of 33 participants in both cohorts. For all other participants enrolled after 09 October 2023 and after the initial sample of 33 participants in both cohorts has been reached in both cohorts, the follow-up will be every 3 months, up to 12 months, as assessed on anniversary of Cycle 1 Day 1. For responders, the follow-up will be 12 months from the date of initial response.

Eligibility Criteria

Age Range: No minimum to No maximum

Inclusion Criteria: 1. Prior SOT of kidney, liver, heart, lung, pancreas, small bowel, or any combination of these (C-SOT); or prior allogeneic HCT (C-HCT). 2. A diagnosis of locally assessed, biopsy-proven EBV+ PTLD. 3. Availability of appropriate partially HLA-matched and restricted tabelecleucel has been confirmed by the sponsor. 4. Measurable, 18F-deoxyglucose (FDG)-avid (Deauville score ≥ 3) systemic disease using Lugano Classification response criteria by positron emission tomography (PET)-diagnostic computed tomography (CT), except when contraindicated or mandated by local practice, then magnetic resonance imaging (MRI) may be used. For participants with treated central nervous system (CNS) disease, a head CT and/or brain/spinal MRI as clinically appropriate will be required to follow CNS disease response per Lugano Classification response criteria. 5. Treatment failure of rituximab or interchangeable commercially available biosimilar monotherapy (C-SOT-R or C-HCT) or rituximab plus any concurrent or sequentially administered chemotherapy regimen (C-SOT-R+C) for treatment of PTLD. 6. Males and females of any age. 7. Eastern Cooperative Oncology Group performance status ≤ 3 for participants aged ≥ 16 years; Lansky score ≥ 20 for participants \< 16 years. 8. For C-HCT only: If allogeneic HCT was performed as treatment for an acute lymphoid or myeloid malignancy, the underlying primary disease for which the participant underwent transplant must be in morphologic remission. 9. Adequate organ function. 1. Absolute neutrophil count ≥ 1000/μL, (C-SOT) or ≥ 500/μL (C-HCT), with or without cytokine support. 2. Platelet count ≥ 50,000/μL, with or without transfusion or cytokine support. For C-HCT, platelet count \< 50,000/μL but ≥ 20,000/μL, with or without transfusion support, is permissible if the participant has not had grade ≥ 2 bleeding in the prior 4 weeks (where grading of the bleeding is determined per the National Cancer Institute's Common Terminology Criteria for Adverse Events \[CTCAE\], version 5.0). 3. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin each \< 5 × the upper limit of normal; however, ALT, AST, and total bilirubin each ≤ 10 × upper limit of normal is acceptable if the elevation is considered by the investigator to be due to EBV and/or PTLD involvement of the liver as long as there is no known evidence of significant liver dysfunction. 10. Participant or participant's representative is willing and able to provide written informed consent. Exclusion Criteria: 1. Currently active Burkitt, T-cell, NK/T-cell lymphoma/LPD, Hodgkin, plasmablastic, transformed lymphoma, active hemophagocytic lymphohistiocytosis, or other malignancies requiring systemic therapy. 2. Daily steroids of \> 0.5 mg/kg prednisone or glucocorticoid equivalent, ongoing methotrexate, or extracorporeal photopheresis. 3. Untreated CNS PTLD or CNS PTLD for which the participant is actively receiving CNS-directed chemotherapy (systemic or intrathecal) or radiotherapy at enrollment. NOTE: Participants with previously treated CNS PTLD may enroll if CNS-directed therapy is complete. 4. Suspected or confirmed grade ≥ 2 graft-versus-host disease (GvHD) per the Center for International Blood and Marrow Transplant Research consensus grading system at enrollment. 5. Ongoing or recent use of a checkpoint inhibitor agent (eg, ipilimumab, pembrolizumab, nivolumab) within 3 drug half-lives from the most recent dose to enrollment. 6. For C-HCT: active adenovirus viremia. 7. Need for vasopressor or ventilatory support. 8. Antithymocyte globulin or similar anti-T cell antibody therapy ≤ 4 weeks prior to enrollment. 9. Treatment with Epstein-Barr virus cytotoxic T lymphocytes or chimeric antigen receptor T cells directed against B cells within 8 weeks of enrollment (C-SOT or C-HCT), or unselected donor lymphocyte infusion within 8 weeks of enrollment (C-HCT only). 10. Female who is breastfeeding or pregnant or female of childbearing potential or male with a female partner of childbearing potential unwilling to use a highly effective method of contraception. 11. Inability to comply with study-related procedures. 12. Any medical condition or organ system dysfunction that in the investigator';s opinion, could compromise the participant's safety or ability to complete the study.

Interventions

BIOLOGICAL

tabelecleucel

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Conditions

Epstein-Barr Virus+ Associated Post-transplant Lymphoproliferative Disease (EBV+ PTLD)Solid Organ Transplant ComplicationsLymphoproliferative DisordersAllogeneic Hematopoietic Cell TransplantStem Cell Transplant Complications

Locations

City of Hope (Adults and Pediatrics)

Duarte, California 91010

United States

University of California San Diego Moores Cancer Center (Adults only)

La Jolla, California 92093

United States

Loma Linda University Medical Center (Adults only)

Loma Linda, California 92354

United States

Children's Hospital Los Angeles, Div. of Research Immunology/BMT (Adults and Pediatrics)

Los Angeles, California 90027

United States

UCLA Medical Center (Adults and Pediatrics)

Los Angeles, California 90095

United States

University of California Davis Comprehensive Cancer Center (Adults only)

Sacramento, California 95817

United States

Yale University (Adults and Pediatrics)

New Haven, Connecticut 06519

United States

MedStar Georgetown University Hospital (Adults and Pediatrics)

Washington D.C., District of Columbia 20007

United States

University of Florida (Adults and Pediatrics)

Gainesville, Florida 32610

United States

University of Miami/Jackson Memorial Hospital (Adults only)

Miami, Florida 33136

United States

Winship Cancer Institute (Adults only)

Atlanta, Georgia 30322

United States

Arthur M. Blank Hospital (Pediatrics)

Atlanta, Georgia 30329

United States

Ann & Robert H. Lurie Children's Hospital of Chicago (Adults and Pediatrics)

Chicago, Illinois 60611

United States

University of Chicago Medical Center - Duchossois Center for Advanced Medicine (Adults only)

Chicago, Illinois 60637

United States

Loyola University Medical Center (Adults and Pediatrics)

Maywood, Illinois 60153

United States

University of Maryland School of Medicine (Adults only)

Baltimore, Maryland 21201

United States

Dana Farber Cancer Institute, Brigham and Women's Hospital (Adults and Pediatrics)

Boston, Massachusetts 02215

United States

Washington University School of Medicine (Adults only)

St Louis, Missouri 63110

United States

Weill Cornell Medicine (Adults only)

New York, New York 10021

United States

Columbia University Medical Center (Adults and Pediatrics)

New York, New York 10032

United States

Memorial Sloan Kettering Cancer Center (Adults and Pediatrics)

New York, New York 10065

United States

Montefiore Medical Center (Adults only)

The Bronx, New York 10467

United States

Montefiore Medical Center (Pediatrics only)

The Bronx, New York 10467

United States

University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center (Adults and Pediatrics)

Chapel Hill, North Carolina 27599

United States

Carolinas Medical Center/Levine Children's Hospital (Adults and Pediatrics)

Charlotte, North Carolina 28204

United States

Duke Cancer Institute (Adults and Pediatrics)

Durham, North Carolina 27710

United States

Cleveland Clinic Foundation (Adults and Pediatrics)

Cleveland, Ohio 44195

United States

Nationwide Children's Hospital (Pediatrics only)

Columbus, Ohio 43205

United States

Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (Adults and Pediatrics)

Columbus, Ohio 43210

United States

Oregon Health and Science University Physicians Pavilion (Adults and Pediatrics)

Portland, Oregon 97239

United States

Hospital of the University of Pennsylvania (Adults only)

Philadelphia, Pennsylvania 19104

United States

The Children's Hospital of Philadelphia Oncology Division, Blood & Marrow Transplant Section (Pediatrics)

Philadelphia, Pennsylvania 19104

United States

University of Pittsburgh Medical Center (Adults only)

Pittsburgh, Pennsylvania 15232

United States

Medical University of South Carolina (Adults and Pediatrics)

Charleston, South Carolina 29425

United States

Saint Jude Children's Research Hospital (Pediatrics only)

Memphis, Tennessee 38105

United States

Vanderbilt University Medical Center Henry-Joyce Cancer Clinic (Adults and Pediatrics)

Nashville, Tennessee 37232

United States

Baylor Scott and White Research Institute (Adults only)

Dallas, Texas 75246

United States

University of Texas Southwestern Medical Center - Children's Medical Center (Pediatrics only)

Dallas, Texas 75390

United States

MD Anderson Cancer Center (Pediatrics and Adult)

Houston, Texas 77030

United States

Froedtert and Medical College of Wisconsin - Clinical Cancer Center (Adults only)

Milwaukee, Wisconsin 53226

United States

The Children's Hospital at Westmead (Pediatrics only)

Westmead, New South Wales 2145

Australia

Westmead Hospital (Adults only)

Westmead, New South Wales 2145

Australia

The Prince Charles Hospital (Adults only)

Chermside, Queensland 4032

Australia

Royal Adelaide Hospital (Adults only)

Adelaide, South Australia 5000

Australia

The Royal Children's Hospital Melbourne (Pediatrics only)

Melbourne, Victoria 3052

Australia

Fiona Stanley Hospital (Adults only)

Murdoch, Western Australia 6150

Australia

Medizinische Universitat Wien (Adults only)

Vienna, Austria 1090

Austria

Centre Hospitalier Universitaire de Liège Site Sart Tilman (Adults and Pediatrics)

Liège, Brussels Capital 4000

Belgium

Universitair Ziekenhuis Leuven (Adults and Pediatrics)

Leuven, Flemish Brabant 3000

Belgium

Alberta Children's Hospital (Adults and Pediatrics)

Calgary, Alberta T3B 6A8

Canada

Sick Kids (Pediatrics only)

Toronto, Ontario M5G 1X8

Canada

Princess Margaret Cancer Centre (Adults only)

Toronto, Ontario M5G 2M9

Canada

Centre Hospitalier Universitaire de Bordeaux (Adults only)

Pessac, Aquitaine 33600

France

Centre Hospitalier Régional Universitaire de Lille (Adults and Pediatrics)

Lille, Hauts-de-France 59037

France

Hôpital Necker-Enfants Malades (Pediatrics only)

Paris, Île-de-France Region 75015

France

Hôpital Saint Antoine (Adults only)

Paris, Île-de-France Region 75571

France

Hôpital Universitaire Pitié Salpêtrière (Adults only)

Paris, Île-de-France Region 75651

France

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (Adults only)

Milan, Milano 20162

Italy

Fondazione IRCCS Policlinico San Matteo (Adults and Pediatrics)

Pavia, Pavia 27100

Italy

Fondazione Policlinico Universitario Agostino Gemelli (Adults only)

Roma, Roma 00168

Italy

Ospedale Pediatrico Bambino Gesu (Pediatrics only)

Roma, Roma 165

Italy

Azienda Ospedaliera - Universitaria Città della Salute e della Scienza di Torino (Adults only)

Torino, Torino 10126

Italy

Hospital Duran i Reynals (Adults and Pediatrics)

Badalona, BARCELONA 8908

Spain

Hospital Universitari Vall d'Hebrón - Institut de Recerca (Adults and Pediatrics)

Barcelona, Barcelona 08035

Spain

Hospital Universitario Marqués de Valdecilla (Adults and Pediatrics)

Santander, Cantabria 39008

Spain

Hospital General Universitario Gregorio Marañón (Adults and Pediatrics)

Madrid, Madrid 28009

Spain

University Hospital Virgen del Rocio (Adults and Pediatrics)

Seville, Spain 41013

Spain

Hospital Universitario La Fe (Adults and Pediatrics)

Valencia, Valencia 46009

Spain

University Hospitals Birmingham NHS Foundation Trust (Adults only)

Birmingham, England B15 2GW

United Kingdom

King's College Hospital NHS Foundation Trust (Adults only)

London, England SE5 9RS

United Kingdom

Imperial College Healthcare NHS Trust (Adults only)

London, England W12 0HS

United Kingdom