- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03537599
Daratumumab and Donor Lymphocyte Infusion in Treating Participants With Relapsed Acute Myeloid Leukemia After Stem Cell Transplant
Phase I/II Clinical Trial of Daratumumab and Donor Lymphocyte Infusion in Patients With Relapsed Acute Myeloid Leukemia Post-Allogeneic Hematopoietic Stem Cell Transplant
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate safety and tolerability of daratumumab and escalating doses of donor lymphocyte infusions (DLI) in post-hematopoietic cell transplantation (HCT) patients with relapsed acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) transformed to AML (phase I).
II. To evaluate overall response rate to daratumumab and DLI in patients with post-HCT relapsed AML and MDS (phase II).
SECONDARY OBJECTIVES:
I. To assess overall response rates in minimal residual disease (MRD) positive patients and in patients with overt morphological relapse.
II. To assess MRD conversion rates from MRD positive to MRD negative. III. To determine the post-relapse 6-month overall response (OS) rates of patients with relapsed AML and MDS following allogeneic hematopoietic stem cell transplantation (allo-HSCT) who are treated with daratumumab.
IV. To determine the rates of graft-versus-host disease (GVHD) (both grades II-IV and III-IV) and autoimmune side effects of daratumumab.
V. To determine the post-relapse 6-month progression-free survival (PFS) rates of patients with relapsed AML and MDS following allo-HSCT who are treated with daratumumab.
EXPLORATORY OBJECTIVES:
I. To compare CD38 expression levels in myeloid blasts and interferon gamma (IFN-y) levels in plasma at the time of relapse before starting daratumumab and at progression or relapse after daratumumab.
II. To compare peripheral blood T cell number and subsets (CD3, CD4, CD8, (CD38 expression on regulatory T cells [T-regs], CD4 and CD8), T regs, B-regulatory cells, natural killer (NK) cell numbers and bone marrow T cell subsets at the time of relapse before starting daratumumab, at the time of partial/complete response to daratumumab, and at the time of progression or relapse after daratumumab.
III. To evaluate whether daratumumab has (i) direct anti-leukemia effects (ii) antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP) and (III) immune modulation of autologous immune system (NK cells, T cells, T-regs, B-regulatory cells [B-regs], and myeloid-derived suppressor cells [MDSCS]) in AML.
IV. To evaluate the effect of daratumumab on exosome content and clearance along with other soluble factors in AML.
V. To evaluate serum interferon (IFN) levels pre-daratumumab, during and post-daratumumab.
VI. To evaluate whether fratricide occurs in patients treated with daratumumab.
OUTLINE: This is a phase I, dose escalation study of donor lymphocyte infusions followed by a phase II study.
Participants receive daratumumab intravenously once a week for 8 weeks and donor lymphocyte infusion in weeks 3 or 4 in the absence of disease progression or unacceptable toxicity. Participants found to be in complete response (CR) at the end of 8 weeks may receive daratumumab IV once every 2 weeks for 8 weeks, and then once monthly for 6 months in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up for 1 year.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
-
-
Ohio
-
Columbus, Ohio, United States, 43210
- Ohio State University Comprehensive Cancer Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- AML relapse following Allo-HSCT (Morphological relapse, or MRD positive verified by flow cytometry, cytogenetics, and molecular mutations)
- Relapsed/Refractory AML must not be candidates for available therapies known to be effective for treatment of their AML.
- MDS transformed to AML following Allo-HCT
- Patients who received a 10/10 HLA-matched allogeneic HCT either from sibling donors or unrelated donors or atleast a 5/10 haploidentical transplant.
Engraftment must have occurred as defined by platelet (PLT) count > 20,000/µL and ANC
- 0.5
- Eastern Cooperative Oncology Group (ECOG) performance status < 3
- Creatinine clearance > 40 ml/min (calculated or measured)
- Aspartate aminotransferase (AST) < 3 x upper limit of normal (ULN), alanine aminotransferase (ALT) < 3 x ULN
- Total bilirubin < 1.5 x ULN
- Off calcineurin inhibitors for at least 2 weeks
- Prednisone dose ≤ 20 mg/day
- Patients with proliferative disease can be cytoreduced with cytotoxic chemotherapy at Investigator discretion, but there should be at least a 14 day window between start of cytoreductive therapy and start of daratumumab
- Blast count ˂20K/day (hydrea use is allowed)
Exclusion Criteria:
- No demonstrable evidence of donor chimerism (˂ 55% donor CD3 or CD33 chimerism)
- Patients with a molecular mutation without chromosomal abnormalities or declining chimerisms (MRD status must be verified by surface marker and mutational analyses)
- Active graft-versus-host disease (GvHD) grades II-IV; prior acute GVHD could have occurred but resolved at time of initiation of daratumumab
- Extensive chronic GvHD requiring ongoing immunosuppression with calcineurin inhibitors
- Patients with FLT3+ AML or blast crisis CML who have not yet received post-transplant TKI therapy
- Active central nervous system (CNS) disease testicular disease
EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR.; seropositive for hepatitis C (except in the setting of a sustained virologic response [SVR], defined as aviremia at least 12 weeks after completion of antiviral therapy).
- Patients must not have moderate or severe persistent asthma within the past 2 years and must not have currently uncontrolled asthma of any classification.
- History of grade IV anaphylactic reaction to monoclonal antibody therapy
- Active autoimmune disease prior to transplant
- Concurrent use of any other investigational drugs
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (DLI, daratumumab)
Participants receive daratumumab intravenously once a week for 8 weeks and donor lymphocyte infusion in weeks 3 or 4 in the absence of disease progression or unacceptable toxicity.
|
Correlative studies
Given IV
Other Names:
Given via infusion
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Safety and feasibility defined as the establishment of the appropriate dose level of donor lymphocyte infusion when given with a fixed dose of daratumumab
Time Frame: Up to 6 months
|
Up to 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rates of complete remission
Time Frame: Up to 6 months
|
Kaplan-Meier estimates of survival and relapse will be made.
Response will be measured using standard criteria.
For pre/post-treatment comparisons in the correlative part of the study, a paired t-test will be applied.
Two-tailed p values <0.05 will be considered statistically significant in all analyses.
|
Up to 6 months
|
Post-relapse progression-free survival
Time Frame: At 6 months
|
Kaplan-Meier estimates of survival and relapse will be made.
Response will be measured using standard criteria.
For pre/post-treatment comparisons in the correlative part of the study, a paired t-test will be applied.
Two-tailed p values <0.05 will be considered statistically significant in all analyses.
|
At 6 months
|
Post-relapse overall survival
Time Frame: Up to 6 months
|
Kaplan-Meier estimates of survival and relapse will be made.
Response will be measured using standard criteria.
For pre/post-treatment comparisons in the correlative part of the study, a paired t-test will be applied.
Two-tailed p values <0.05 will be considered statistically significant in all analyses.
|
Up to 6 months
|
Minimal residual disease (MRD) conversion rates
Time Frame: Up to 6 months
|
Up to 6 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Expression of CD38 on bone marrow
Time Frame: Up to 6 months
|
CD38 expression on bone marrow is checked prior to transplant.
Most patients are in remission prior to transplant.
Patients who were initially treated at Ohio State University (OSU) will have banked leukemia samples at the time of diagnosis.
Expression of CD38 on samples at diagnosis and prior to transplant by immunohistochemical staining will be performed.
|
Up to 6 months
|
Expression of CD38 in lymphocytes in bone marrow
Time Frame: Baseline to 6 months
|
Percentage of lymphocytes in bone marrow pre- and post-treatment with daratumumab will be studied.
In addition to percentage, expression of CD38 on lymphocytes will be evaluated by immunohistochemistry (IHC).
|
Baseline to 6 months
|
Phenotypic studies to evaluate T cell exhaustion/function
Time Frame: Baseline to 6 months
|
This will be performed on bone marrow samples pre-and post-treatment with Daratumumab at the specified time points.
|
Baseline to 6 months
|
Phenotypic studies to evaluate activation status of natural killer (NK) cells
Time Frame: Up to 6 months
|
This will be performed on bone marrow samples pre-and post-treatment with daratumumab.
|
Up to 6 months
|
T-cell, NK cell, B-cell, and myeloid-derived suppressor cells (MDSC) infiltration in bone marrow
Time Frame: Baseline to 6 months
|
This will be evaluated on bone marrow samples pre-and post-treatment with daratumumab.
|
Baseline to 6 months
|
Exosomes from bone marrow
Time Frame: Up to 6 months
|
This will be examined for both number and also content (protein, messenger ribonucleic acid [mRNA], and micro RNAs [mIRs]).
|
Up to 6 months
|
Serial assessment of microenvironment
Time Frame: Up to 6 months
|
Will be assessed with with stromal cell cultures.
|
Up to 6 months
|
Chimerism analysis
Time Frame: Up to 6 months
|
Using single-nucleotide polymorphisms, relative contributions from donor vs. recipient in sorted CD3+ and CD33+ cells will be measured and expressed as a percentage.
|
Up to 6 months
|
Immune reconstitution
Time Frame: Up to 6 months
|
Dr.Gerard Lozanski has developed a panel called the Immunome to study reconstitution of T cells, NK cells and B cells post-transplant.
Specific information regarding stages of activation of T cells is also available from this panel.
|
Up to 6 months
|
Immune response post daratumumab
Time Frame: Up to 6 months
|
Up to 6 months
|
|
Phenotypic studies to evaluate T cell exhaustion
Time Frame: Baseline to 6 months
|
This will be performed on bone marrow samples pre-and post-treatment with daratumumab.
|
Baseline to 6 months
|
Phenotypic studies to evaluate activation status of NK cells
Time Frame: Baseline to 6 months
|
This will be performed on bone marrow samples pre-and post-treatment with daratumumab.
|
Baseline to 6 months
|
Measurements of cytokines including but not limited to interferon gamma (IFN-y)
Time Frame: Up to 6 months
|
This will be measured at relapse, pre and post daratumumab treatment.
Exosomes from bone marrow will be examined at these serial times for both number and also content (protein, messenger ribonucleic acid [mRNA], and micro RNA [mIRs]).
|
Up to 6 months
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- OSU-17102
- NCI-2018-00616 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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