A trial of CAR T-cell for people with T cell lymphoma (AUTO4-TL1)

Cancer type:

Blood cancers
High grade lymphoma
Lymphoma
Non-Hodgkin lymphoma
Secondary cancers

Status:

Open

Phase:

Phase 1/2
This trial is for people with T cell lymphoma that:
  • has come back or got worse (relapsed)
  • treatment has stopped working (refractory)
It is for people who have proteins called TRBC1 on the surface of their lymphoma cells (TRBC1 positive). 
 

More about this trial

T cell lymphoma is a type of high grade non Hodgkin lymphoma (NHL) that affects immune system Open a glossary item cells called T cells. 
 
There are different types of T cell lymphomas. The most common type is peripheral T cell lymphoma. Rarer types include: 
  • anaplastic large cell lymphoma
  • angioimmunoblastic T cell lymphoma
Some T cell lymphomas have a protein called TRBC1 on their surface. 
 
Chemotherapy is a common treatment for T cell lymphoma. But sometimes, the lymphoma continues to grow or comes back after treatment has finished. You may have more chemotherapy if this happens. 
 
Researchers are looking at new ways to help people with relapsed or refractory T cell lymphoma. In this trial, they are looking at a new treatment called CAR T-cell
 
CAR T-cell treatment uses the T cells from your immune system. These cells are good at helping us fight infections, but they aren’t so good at recognising lymphoma cells. 
 
With this treatment, doctors collect your T cells and change them in the laboratory so that they recognise and attack the lymphoma cells that have the TRBC1 protein. These altered T cells are called AUTO4. 
 
This trial is in 2 parts. In part 1 doctors are looking for the best dose of AUTO4. This part is called dose escalation. In part 2, they will collect information about how well the treatment works. This is the dose expansion part. 
 
Please note – doctors are currently looking for people to join part 1. 
 
The main aims of this trial are:
  • find out the best dose of AUTO4 treatment 
  • learn more about the side effects 
  • find out how well AUTO4 treatment works for people with relapsed or refractory T cell lymphoma

Who can enter

The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you. 
 
Who can take part
You may be able to join this trial if all of the following apply:
  • you have T cell non Hodgkin lymphoma (peripheral T cell lymphoma, anaplastic large cell lymphoma or angioimmunoblastic T cell lymphoma) 
  • your T cell lymphoma has TRBC1 proteins on its surface (TRBC1 positive) 
  • your lymphoma has come back or treatment has stopped working (relapsed or refractory) 
  • you have had at least one treatment for T cell lymphoma 
  • you have at least 1 area of lymphoma that doctors can see and measure on a scan 
  • you are able to have your T cells collected
  • you have satisfactory blood tests results 
  • your kidneys, liver, heart and lungs are working well
  • you are well enough to carry out all your normal activities, apart from heavy physical work (performance status of 0 or 1)
  • you are at least 18 years old 
  • you are willing to use reliable contraception during treatment and for up to a year afterwards if there is any possibility that you or your partner could become pregnant 
Who can’t take part
You cannot join this trial if any of these apply. 
 
Cancer related
You:
  • have T cell leukaemia  
  • have lymphoma spread in your brain or the spinal cord Open a glossary item
  • have had gene therapy Open a glossary item
  • have had a stem cell transplant from a donor (allogeneic stem cell transplant Open a glossary item)  
  • have had treatment with drugs that target the programmed cell death 1 protein (PD1), the PDL1 or the CTLA-4 protein (your doctor can tell you more about this) 
  • have had chemotherapy in the past 2 weeks 
  • have had rituximab or any other similar drug in the last 3 months 
  • are having radiotherapy or a targeted cancer drug (biological therapy) 
  • have had another cancer in the last 2 years apart from non melanoma skin cancer or carcinoma in situ Open a glossary item of the breast or prostate that has been successfully treated 
Medical conditions
You cannot join this trial if any of these apply. You:
  • are having an investigational treatment 
  • have problems with your brain, spinal cord and nerves such as epilepsy 
  • have had a stroke Open a glossary item in the past 3 months 
  • have heart problems such as angina Open a glossary item that isn’t stable, an abnormal heart rhythm, high blood pressure that isn’t controlled or you have had a heart attack in the last year  
  • have had problems with blood clots in your legs in the past 3 months and you are having treatment for this 
  • have a bleed in your tummy (abdomen) 
  • have had major surgery in the last 3 months 
  • have an infection that needs treatment 
  • have taken steroids within 3 days of having CAR T-cell treatment
  • have HIV
  • have hepatitis B or hepatitis C 
  • have an autoimmune disease Open a glossary item and you need to take drugs that damp down your immune system (immunosuppressants) 
  • have any other serious medical condition or mental health problem that the trial team think could affect you taking part 
Other
You cannot join this trial if any of these apply. You:
  • have had a live vaccine Open a glossary item in the last month
  • are pregnant or breastfeeding 

Trial design

This is a phase 1/2 trial. It is in 2 parts:
  • dose escalation (part 1)
  • dose expansion (part 2)
In part 1 doctors are looking for the best dose of AUTO4. They hope that around 25 people will agree to take part. 
 
Part 2 starts when doctors find the best dose of AUTO4. They give the best dose found in part 1 to more people. Doctors hope that up to 30 people will join the second part of this trial. 
 
Please note – doctors are currently looking for people to join the 1st part of this trial. 
 
There are 4 steps in this trial:
  • biopsy 
  • collection of white blood cells (leukapheresis)
  • chemotherapy
  • having the changed white blood cells back (AUTO4 treatment) 
Biopsy 
You have a biopsy to check whether there are TRBC1 proteins on the surface of the lymphoma cells. 
 
Your doctor will tell you more about having a biopsy. How you have this depends on your individual situation. 
 
If your lymphoma does not have TRBC1 proteins on its surface (TRBC1 negative), you can’t continue taking part in the trial. Your doctor will tell you about other treatments that you may be able to have. 
 
You continue this trial if your lymphoma has TRBC1 proteins on its surface (TRBC1 positive). You have more tests such as blood tests and a CT scan to check that you meet all the other entry conditions of this trial. 
 
Collection of white blood cells (leukapheresis)
Leukapheresis is a procedure to collect white blood cells from your bloodstream. 
 
You lie on a bed or reclining chair and have a tube into a vein in your arm. The tube takes the blood and puts it through a machine that separates the T cells (white blood cells) from the blood. The rest of your blood goes back to your body.
 
Researchers in the laboratory modify and grow your T cells to recognise and attack the lymphoma cells. It usually takes between 4 to 6 weeks to do this. 
 
It isn’t always possible to collect enough T cells during leukapheresis. You may have this procedure twice if this happens.
 
Sometimes, researchers can’t grow enough T cells in the laboratory. Your doctor will talk to you about other treatment that you might be able to have if this happens. 
 
Chemotherapy 
A week before you have the AUTO4 treatment, you have chemotherapy. This helps the changed T cells to survive and grow inside the body:
 
You have 2 chemotherapy drugs:
You have both drugs as a drip into your bloodstream (intravenously). You have this once a day, for 3 days in a row, the week before your AUTO4 treatment. It takes about an hour each time you have it.
 
Having the changed white blood cells back (AUTO4 treatment) 
You have the changed T cells back as a drip into your vein. It takes about 30 minutes to have it. Some people might have this as 2 separate doses. The trial team can tell you if this applies to you. 
 
You need to stay in hospital after having the AUTO4 treatment. This is so doctors can monitor you for any side effects. They will tell you how many days you need to stay in hospital for. This is usually at least 2 weeks. 
 

Hospital visits

You see a doctor and have some tests before you take part. The tests might include:
  • physical examination
  • blood tests 
  • heart trace (ECG Open a glossary item)
  • heart scan (echocardiogram Open a glossary item] or MUGA Open a glossary item
  • CT scan or MRI scan
  • PET scan 
It takes between 4 and 6 weeks to change and grow the T cells in the laboratory. The trial team will tell you when you need to go back to hospital for your chemotherapy. 
 
You need to stay in hospital for at least 2 weeks after having the AUTO4 treatment, or until your doctors think you are well enough to go home. They will monitor you during this time for any side effects you might have. 
 
After treatment, you see the trial doctors regularly for up to 2 years. This is called follow up. Initially, you see them every week for the first month. You then see them:
  • every month for 6 months 
  • then every 3 months for a year 
  • then every 6 months for another year
During each visit you have blood tests and a physical examination. You also have a CT scan and PET scan at set times during the follow up. 

Side effects

CAR T-cell treatment is new, so there may be side effects we don’t know about yet. The trial team will monitor you during the time you have treatment and afterwards. You have a phone number to call if you are worried about anything. 
 
The possible side effects of a biopsy are:
  • bruising, bleeding and pain at the site of biopsy 
  • infection
The possible side effects of leukapheresis are:
  • feeling light headed
  • twitching muscles and cramps
  • tingling around the lips, nose or fingertips
  • bruising
The most common side effects of cyclophosphamide and fludarabine are:
A possible side effect of the AUTO4 treatment is called cytokine release syndrome (CRS). AUTO4 can cause the release of chemicals called cytokines. The side effects of the release of cytokines can be mild or severe. Side effects include:
  • high temperature
  • aching muscles 
  • flu like symptoms 
  • difficulty breathing 
  • problems with your blood clotting 
  • low blood pressure 
Other side effects of the AUTO4 treatment include:
  • confusion
  • difficulty speaking and writing 
  • fits (seizures)
  • an increased risk of infection 
  • damage to the kidneys 
  • an increased risk of developing another cancer some years after treatment has finished
We have more information about the possible risks of:

Location

London
Manchester
Newcastle upon Tyne

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Kate Cwynarski

Supported by

Autolus Limited

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

16021

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

Rate this page:

Currently rated: 5 out of 5 based on 4 votes
Thank you!
We've recently made some changes to the site, tell us what you think