Overview

The goal of this study is to test SIRPant-M, an autologous cell therapy, alone or in combination with focal external-beam radiotherapy in participants with relapsed or refractory non-Hodgkin's lymphoma (NHL). Two dose levels of SIRPant-M are being tested. The main question this study aims to answer is if SIRPant-M alone or in combination with radiotherapy is safe and well-tolerated.

Eligibility

Inclusion Criteria:

1. Adult, defined as age ≥ 18 (at screening), who are willing and able to provide informed consent
2. Must have relapsed/refractory lymphoma, received at least 2 lines of systemic therapy, be ineligible or inappropriate for other treatment regimens known to have curative potential, and must have recovered from the acute toxic effects of all prior oncologic therapy of curative intent (except alopecia)
3. Histologically or cytologically confirmed diagnosis of NHL, any one of the below:
   1. Eligible for SIRPant-M monotherapy or SIRPant-M plus focal XRT combination therapy: Diffuse large B-cell lymphoma and cutaneous T-cell lymphoma (CTCL), including mycosis fungoides (MF), Sezary Syndrome, anaplastic large cell lymphoma (ALCL), lymphomatoid papulosis; adult T-cell leukemia/lymphoma (ATLL); peripheral T cell lymphoma; and angioimmunoblastic T cell lymphoma
   2. Eligible for SIRPant-M monotherapy only: Cutaneous B-cell lymphoma, including primary cutaneous follicle center lymphoma and primary cutaneous marginal zone B-cell, leg type; follicular center lymphoma; chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL); mantle cell lymphoma (MCL); nodal marginal zone B-cell lymphoma
4. Must have at least one accessible lymph node or cutaneous or subcutaneous lesion of

   1.5 to 5 cm in one dimension as measured by computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) or ultrasound for ITI by an interventional radiologist or other appropriately qualified and trained personnel, which presents a low risk for complications as determined by the Interventional Radiologist and the Principal Investigator. The target lesion must not have been previously irradiated. Note that lesions in the vicinity of large vessels, and tumor-encased large vessels are not considered low-risk. Additional caution should be taken in patients with neck lesions and lesions connected to ulcerated skin or mucosal surface. The target lesion must not be >5 cm in any dimension.

5. Must have a life expectancy > 3 months; must also be confirmed within 7 days prior to Day 1 of SIRPant-M ITI treatment
6. Must have an Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2; must also be confirmed within 7 days prior to Day 1 of SIRPant-M ITI treatment
7. Must have hematologic values as follows: hemoglobin (Hgb) > 8 g/dL, ANC > 500 /mm3, monocyte counts ≥ 200/μL, and platelets > 50,000/µL; must also be confirmed within 7 days prior to Day 1 of SIRPant-M ITI treatment
8. Must have adequate renal and hepatic function as follows:
   1. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <3× the upper limit of normal (ULN) (unless attributed to leukemic involvement or required concomitant medication)
   2. Calculated creatinine clearance ≥60 milliliter per minute (mL/min) calculated with Cockcroft-Gault formula
   3. Bilirubin ≤1.5×ULN, unless secondary to Gilbert's Syndrome.

Must also be confirmed within 7 days prior to Day 1 of SIRPant-M ITI treatment.

          9. Cardiac function: Must be American Heart Association (AHA) class 1 without significant
             limitation of physical activity; must also be confirmed within 7 days prior to Day 1
             of SIRPant-M ITI treatment.
         10. Must not be pregnant or planning to become pregnant. A negative urine or serum
             pregnancy test result is required for persons of reproductive potential within 72
             hours prior to start of study treatment administration.
         11. All persons of reproductive potential must agree to use an effective contraceptive
             method during study participation and for a minimum of 90 days after study treatment.
               1. Biologically female: is premenarcheal, surgically sterile (post hysterectomy,
                  bilateral salpingectomy, or bilateral oophorectomy), postmenopausal (>12 months
                  of amenorrhea without alternative medical causes), or, if of reproductive
                  potential, is using a highly effective method of contraception (combined
                  estrogen/progestogen or progestogen-only hormonal contraceptives associated with
                  inhibition of ovulation, intrauterine device [IUD], intrauterine
                  hormone-releasing system [IUS], bilateral tubal occlusion/ligation, vasectomized
                  partner[s], double barrier method [male condom with either cap, diaphragm, or
                  sponge with spermicide], or true abstinence of heterosexual intercourse when this
                  is in line with the preferred and usual lifestyle of the person [periodic
                  abstinence, eg, calendar, ovulation, symptom-thermal, post-ovulation methods, and
                  withdrawal are not acceptable methods of contraception]), and agrees to continued
                  use of this method until 90 days after end of study treatment
               2. Biologically male: is vasectomized and has received medical assessment of
                  surgical success, has undergone bilateral orchidectomy, or agrees to use an
                  approved method of contraception (true abstinence of heterosexual intercourse
                  when this is in line with the preferred and usual lifestyle of the person, double
                  barrier method [male condom with either cap, diaphragm, or sponge with
                  spermicide], partner's use of a highly effective method of contraception sterile,
                  partner is postmenopausal, or partner is surgically sterile) and agrees to use
                  this method until 90 days after study treatment
         12. In the opinion of the Investigator, must be willing and able to comply with the
             protocol for the duration of the study including undergoing treatment, the required
             tumor tissue biopsy procedures, scheduled visits and examinations, and including
             follow up
        Exclusion Criteria:
          1. Must not have received prior ITI therapy
          2. Must not have received ASCT or treatment with cellular therapy including CAR-T within
             the prior 1 month; must not have received allogeneic stem cell transplantation within
             prior 6 months and must have no active graft-versus-host disease (GVHD) or be under
             active immunosuppression for GVHD.
          3. Must not have received prior systemic anti-cancer therapy within the past 14 days
             before start of study cell therapy
          4. Must not have received IL-2 therapy within the last 6 months
          5. Must not have acquired immune defects such as human immunodeficiency virus (HIV)
          6. Must not have uncontrolled hypertension (systolic >180 mmHg, diastolic >100 mmHg)
          7. Must not have diagnosis of unclassifiable B cell lymphoma
          8. Must not have bleeding diathesis or abnormal values for prothrombin time (PT) or
             activated partial thromboplastin time (aPTT), international normalized ratio (INR) >
             1.5× ULN
          9. Must not be receiving anti-platelet drugs that may present a risk for intratumor
             injections
         10. Must not have pulmonary disease which, in the opinion of the Investigator, might
             impair the patient's respiratory tolerance to moderate pulmonary fluid overload (eg,
             interstitial lung disease, severe chronic obstructive pulmonary disease)
         11. Must not have known alcohol or drug abuse
         12. Must not have received an investigational agent within the past 30 days before start
             of study cell therapy
         13. Must not require a chronic therapy with prednisone at a dose of or exceeding 10 mg/day
             or equivalent or any other form of immunosuppressive therapy
         14. Must not have active central nervous system tumors or metastases
         15. Must not be ineligible to receive 2.5 Gy ×3 focal external-beam radiation therapy as
             determined by the Radiation Oncologist and Principal Investigator (Cohort 1/Group 2,
             Cohort 2/Group 4, and Cohort -1/Group 4 only)
         16. Must not have uncontrolled active viral hepatitis-B, -C, and/or -D infection
         17. Must not have received a live vaccine within 4 weeks of the baseline/screening visit
         18. Must not have active, uncontrolled autoimmune disease and/or history of autoimmune
             diseases at high risk for relapse
         19. Must not have another malignancy or uncontrolled intercurrent illness, condition,
             serious medical or psychiatric illness, or circumstance that, in the opinion of the
             Investigator, could interfere with adherence to the study's procedures or
             requirements, or otherwise compromise the study's objectives
         20. No active systemic infection; must also be confirmed on Day 1 prior to initiation of
             ITI