Feasibility and Safety of Collecting and Combining Autologous Hematopoietic Stem Cells with Chimeric Antigen Receptor (CAR) T-Cell Therapy in Subjects with Relapsed/Refractory Hematological Malignancies

The study is designed to examine the feasibility and safety of collecting autologous hematopoietic stem cells (HSCs) to be combined with CAR T-cell therapy for patients with relapsed/refractory (r/r) hematological disease. The study will evaluate feasibility of collecting the target dose of HSCs from at least 50% of enrolled patients. The study will assess safety based on incidence and severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in the first 60 days post CAR T dosing, and also through the collection of adverse events (AEs) and serious adverse events (SAEs) as well as the durability of response after treatment with HSCs with CAR T. The study follows an open-label, single-center and single non-randomized cohort design. 20 subjects with r/r hematological malignancies will be enrolled and treated to evaluate the feasibility and preliminary safety of collecting autologous HSCs and combining them with CAR T-cell therapy.


Eligibility Criteria:
Inclusion Criteria:

* Age 18 - 85 years.
* Histologically proven hematological malignancy according to the World Health Organization 2016 classification criteria for which a commercially available, FDA-approved CAR T product exists.
* Relapsed or refractory disease, defined by the following:

  * Disease progression after last regimen, or
  * Refractory disease: failure to achieve a partial response (PR) or complete remission (CR) to the last regimen
* At least 2 weeks or 5 half-lives, whichever is shorter, must have elapsed since any prior systemic therapy for the malignancy at the time the subject is planned for leukapheresis.
* Toxicities due to prior therapy must be stable or recovered to ≤ Grade 1 with the exception of alopecia.
* Subjects with an active uncontrolled infection should not start CAR T treatment until the infection has resolved.
* Eastern cooperative oncology group (ECOG) performance status 0 - 2.
* Adequate hematologic, hepatic, and cardiac function
* Serum pregnancy test for women of childbearing potential (WOCBP) at Screening.
* Willing to comply to research specimen collection as specified in the protocol.
* Written informed consent obtained from subject and ability for subject to comply with the requirements of the study.

Exclusion Criteria:

* Autologous hematopoietic cell transplant intent or execution within 8 weeks of planned CAR T infusion.
* History of allogeneic cell transplantation within 8 weeks of planned CAR T infusion.
* Presence or suspicion of fungal, bacterial, viral, or other infection that is uncontrolled or requiring IV antimicrobials for management at time of screening.
* History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, or other clinically significant cardiac disease within 6 months of enrollment.
* History of a seizure disorder, cerebrovascular ischemia/hemorrhage, dementia, or any autoimmune disease with CNS involvement.
* Doses of corticosteroids of greater than or equal to 5 mg/day of prednisone or equivalent doses of other corticosteroids and other immunosuppressive drugs are not allowed prior to enrollment. A washout period of 10 days prior to leukapheresis and 10 days prior to anti-CD19 CAR T cell administration is required.
* Any medical condition likely to interfere with assessment of feasibility or safety of study treatment.
* Live vaccine ≤ 6 weeks prior to planned start of conditioning regimen.
* History of severe immediate hypersensitivity reaction to any of the agents used in this study.
* Current pregnancy or breastfeeding because of the potentially dangerous effects of the preparative chemotherapy on the fetus or infant.
* Subjects of both sexes who are not willing to practice birth control from the time of consent through 6 months after the completion of conditioning chemotherapy. Females who have undergone surgical sterilization or who have been postmenopausal for at least 1 year are not considered to be of childbearing potential.
* In the investigator's judgment, the subject is unlikely to complete all protocol-required study visits or procedures, including follow-up visits, or comply with the study requirements for participation.
* Patients with obvious myeloid clonal hematopoiesis on the screening bone marrow biopsy will be excluded based on the risk of developing myeloid neoplasms with aHSC infusion.