Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
- Diagnosis of:
1. CLL with an indication for treatment based on the Investigator's opinion and
measurable disease, or
2. SLL (lymphadenopathy and/or splenomegaly and < 5×10^9 CD19+ CD5+ clonal B
lymphocytes/L [< 5000/µL] in the peripheral blood at diagnosis with measurable
disease that is biopsy-proven SLL)
- Subjects (other than those in the ibrutinib + JCAR017 combination therapy cohort) must
have received and failed Bruton tyrosine kinase inhibitor (BTKi) treatment or have
been deemed ineligible for BTKi therapy.
- Subjects (other than those in the ibrutinib + JCAR017 combination therapy cohort) must
have received previous treatment as follows:
1. Subjects with CLL or SLL and high-risk features must have failed at least 2 lines
of prior therapy.
2. Subjects with CLL or SLL and standard-risk features must have failed at least 3
lines of prior therapy.
- Subjects in the ibrutinib + JCAR017 combination therapy cohort must either:
1. be receiving ibrutinib and progressing at the time of study enrollment
2. be receiving ibrutinib for at least 6 months with a response less than complete
response/remission (CR) and have high-risk features as defined in inclusion
criterion 5a
3. have BTK or PLCgamma2 mutations per local laboratory assessment, with or without
progression on ibrutinib
4. have previously received ibrutinib and have no contraindications to restarting
ibrutinib
- Eastern Cooperative Oncology Group performance status of ≤ 1
- Assessed by the Investigator to have adequate bone marrow function to receive
lymphodepleting chemotherapy
- Adequate organ function, defined as:
1. Serum creatinine ≤ 1.5 × age-adjusted upper limit of normal (ULN) OR calculated
creatinine clearance > 30 mL/min
2. Alanine aminotransferase ≤ 5 × ULN and total bilirubin < 2.0 mg/dL (or < 3.0
mg/dL for subjects with Gilbert's syndrome or leukemic infiltration of the liver)
3. Adequate pulmonary function, defined as ≤ Common Terminology Criteria for Adverse
Events (CTCAE) Grade 1 dyspnea and saturated oxygen (SaO2) ≥ 92% on room air
4. Adequate cardiac function, defined as left ventricular ejection fraction ≥ 40% as
assessed by echocardiogram or multiple uptake gated acquisition scan performed
within 30 days prior to determination of eligibility
- Subject either currently has central vascular access or is a candidate to receive
central vascular access or peripheral vascular access for leukapheresis procedure.
- If prior CD19-targeted therapy has been administered, subject must have CD19-positive
disease confirmed by immunohistochemistry or flow cytometry since completing the prior
CD19-targeted therapy.
- Subjects in ibrutinib + JCAR017 combination cohort must have progressed on a BTKi and
have received prior therapy with venetoclax
- Subjects in venetoclax + JCAR017 combination cohort must:
1. have failed at least 1 prior line of therapy, including failed BTKi therapy or
have been deemed ineligible to receive BTKi
2. be venetoclax naive (required for dose expansion) or
3. if prior venetoclax (only for dose escalation)
4. have no contraindictions to re-initiation of venetoclax based on prior
intolerance and have had at least 6 months elapsed since the last dose of
venetoclax, if either, best response was stable disease, or subject experienced
disease progression on venetoclax, or within 6 months of venetoclax
discontinuation
- subjects in the venetoclax + JCAR017 combination must have hemoglobin >=9 g/dL,
absolute neutrophil count >=500mm3 and platelets>= 75,000/mm3, unless cytopenias are
judged by investigator to be due to CLL infiltration of the bone marrow
- must have diagnosis of CLL or SLL with an indication for treatment based on the
investigator's opinion and measurable disease (any of the following measurable lymph
nodes ≥1.5 cm in the greatest transverse diameter and/or hepatomegaly or splenomegaly)
and demonstration of CLL cells in the peripheral blood by flow cytometry
Exclusion Criteria:
- Subjects with known active central nervous system (CNS) involvement by malignancy.
Those with prior CNS disease that has been effectively treated will be eligible if
treatment was completed at least 3 months prior to enrollment with no evidence of
symptomatic disease and stable abnormalities on repeat imaging.
- History of another primary malignancy that has not been in remission for at least 2
years. (The following are exempt from the 2-year limit: nonmelanoma skin cancer,
completely resected stage 1 solid tumor with low risk for recurrence, curatively
treated localized prostate cancer, cervical carcinoma in situ on biopsy or a squamous
intraepithelial lesion on Pap smear, and in situ breast cancer that has been
completely resected.)
- Subjects with Richter's transformation
- Prior treatment with any gene therapy product
- Active hepatitis B, active hepatitis C, or active human immunodeficiency virus (HIV)
infection
- Systemic fungal, bacterial, viral, or other infection that is not controlled
- Presence of acute or extensive chronic graft versus host disease (GVHD)
- History of any one of the following cardiovascular conditions within the past 6
months: Class III or IV heart failure as defined by the New York Heart Association
(NYHA), cardiac angioplasty or stenting, myocardial infarction, unstable angina, or
other clinically significant cardiac disease
- History or presence of clinically relevant CNS pathology such as epilepsy, generalized
seizure disorder, aphasia, stroke with current neurologic sequelae, severe brain
injuries, dementia, Parkinson's disease, cerebellar disease,cerebral edema, or
psychosis
- Pregnant or nursing (lactating) women
- Use of any of the following medications or treatments within the noted time prior to
leukapheresis:
1. Alemtuzumab within 6 months prior to leukapheresis
2. Allogeneic hematopoietic stem cell transplant within 100 days prior to
leukapheresis
3. Cladribine within 3 months prior to leukapheresis
4. Donor lymphocyte infusions (DLI) within 2 months prior to leukapheresis
5. Radiation including large bone marrow fields such as sternum or pelvis within 6
weeks prior to leukapheresis
6. Fludarabine within 4 weeks prior to leukapheresis
7. GVHD therapies such as calcineurin inhibitors, methotrexate or other
chemotherapeutics, mycophenolate mofetil, rapamycin, or immunosuppressive
antibodies (such as anti-tumor necrosis factor-α [TNFα], anti-interleukin-6
[IL-6], or anti-interleukin-6 receptor [IL 6R]) within 4 weeks prior to
leukapheresis
8. Cyclophosphamide, ifosfamide, bendamustine, chlorambucil, or melphalan within 2
weeks prior to leukapheresis
9. Therapeutic doses of corticosteroids (defined as > 20 mg/day prednisone or
equivalent) within 7 days prior to leukapheresis
10. Anti-CD20 monoclonal antibodies within 7 days prior to leukapheresis
11. Venetoclax within 4 days prior to leukapheresis
12. Idelalisib or duvelisib within 2 days prior to leukapheresis
13. Lenalidomide within 1 day prior to leukapheresis
14. Experimental agents, including off-label use of approved drugs (with the
exception of acalabrutinib which may be continued up to the day before
leukapheresis), within 4 weeks prior to leukapheresis unless progression is
documented on the experimental therapy and at least 3 half-lives have elapsed
prior to leukapheresis
- Uncontrolled medical, psychological, familial, sociological, or geographical
conditions that do not permit compliance with the protocol, as judged by the
Investigator; or subject unwillingness or inability to follow the procedures required
in the protocol
- Progressive vascular tumor invasion, thrombosis, or embolism
- Deep vein thrombosis or embolism not managed on a stable regimen of anticoagulation
- Use of any of the following medications or treatments within the noted time prior to
leukapheresis lenalidomide or acalabrutinib within 1 day prior to leukapheresis
experimental agents, including off-label use of approved drugs, within 4 weeks prior
to leukapheresis.
- Venous thrombosis or embolism requiring treatment but not managed on a stable regimen
of anticoagulation
- For subjects in the venetoclax + JCAR017 combination cohorts only, concomitant
treatment with CYP3A moderate/strong inducers or moderate/strong inhibitors which
cannot be discontinued