Profylakse af Cytomegalovirus-infektion med adoptiv celle-inmunterapi (INMUNOCELL)
Anti-CMV pilot klinisk forsøg: profylakse af cytomegalovirus infektion i haploidentisk transplatation af hæmatopoietiske stamceller med adoptiv celle immunterapi
Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality for recipients of allogeneic hematopoietic stem cell transplantation(HSCT). Recently, strategies based on immunotherapy adoptive cells (IAC) with anti-CMV Cytolitic T Lymphocytes (CMV-CTLs) has been incorporated to prevent or treat CMV after HSCT. The aim to study donor derived CMV-CTLs after haploidentical HSCT (HAPLO) as prophylaxis for CMV infection in transplant patients. CMV-CTLs will be administer at day 21 (+-7 days) post-HAPLO. CMV DNA levels with quantitative PCR will be weekly monitored.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
In HAPLO, CMV infection and disease are more frequent than in other type of HSCT, this is related to delayed immune reconstitution after transplant increasing post-transplant infectious complications. Approximately 60% of patients reactivated CMV infection after HAPLO and 15%, developed CMV disease afecting organs and causing the death of the patient in 8% of CMV disease cases.
If patient and donor are eligible, it will take 1x10^9 cells from donor leukapheresis. Donor cells will be selected and procesed by CliniMACs PRODIGY and after 12h it will obtain 7mL of CMV-CTLs. It will use 6mL of CMV-CTLs to infused a dose of 1x10^5 cells/kg in our patient. The donor derived CMV-CTL cells will be transfused into the patients' intravenous line. The patients will receive the dose of CMV-CTL cells when they are sero-positive for CMV-DNA 21 (+- 7 days) days after transplant.
The CMV-DNA levels will be monitored weekly for at least 100 days after the transplant. If after the initial dose of CMV-CTL cells the patient develops a viral infection, then the patient will receive treatment with anti-CMV comercial drugs.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Miriam Sanchez-Escamilla, MD
- Telefonnummer: +34646393234
- E-mail: msanchez@idival.org
Undersøgelse Kontakt Backup
- Navn: Lucía Lavín Alconero, Phd
- E-mail: eclinicos5@idival.org
Studiesteder
-
-
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Santander, Spanien
- Rekruttering
- Hospital Marques de Valdecilla
-
Kontakt:
- enrique ocio
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Adult patients who received an alogeneic stem cell transplantation from haploidentical donors (HAPLO).
-
Any source of stem cells (peripheral blood or bone marrow).
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CMV-seropositive donors.
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Negative pregnancy test in women.
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Signed writen informed consent.
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DONORS:
- HLA haploidentical and CMV-seropositve donors.
- Donor must be checked and suitable.
- Signed writen informed consent.
- Donor without active infection evidence at leukapheresis.
Exclusion Criteria:
- Patients without haploidentical CMV-seropositive donors.
- Patients who are not suitable for follow up visits.
CMV-CTLs Infusion Criteria:
- Hematopoiesis recovery at least partial (neutrophil counts >0.5x10^9/L in at least 3 consecutive samples post-transplant).
CMV-CTLs NON-Infusion Criteria:
- Patients receiving corticosteroid (dose of 0.5mg/kg/day of prednisone or equivalent) at infusion.
- ECOG > or = 3.
- Organic toxicities grade > or = 3.
- Patients who received ATG, donor lymphocytes or alemtuzuamb, 28 days pre-infusion.
- Patients with uncontroled infection defined by fevers and/or inestability and/or infection not resolved.
- Persistent fevers 3 days before infusion.
- Acute Graft Versus Host Disease (GVHD) grade II-IV.
- Relapse or progression after transplant and before infusion day.
- CMV reactivation/infection after transplant and before infusion day.
Patients who don´t fill infusion criteria, after day 28 post-HAPLO, will be considered screening failures and will be out of the study.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Forebyggelse
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: CMV CTLs
1x10^5 CMV-CTLs/kg |
The donor derived cytomegalovirus specific T lymphocytes (CMV-CTL) will be transfused to the patients. The patients will receive CMV-CTL cells when their donors are sero-positive for CMV-DNA 21 days after transplant. The CMV-DNA levels will be monitored weekly for at least 100 days after the HAPLO. If after the initial dose of CMV-CTL cells the patient develops a viral infection, then they may be eligible to receive a CMV specific antiviral drug. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
100-days incidence of CMV infection
Tidsramme: From date of CMV-CTLs infusion to 100 days after transplant
|
Viral load >200 copies in 1 sample |
From date of CMV-CTLs infusion to 100 days after transplant
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
1-year incidence of CMV specific antiviral drug use
Tidsramme: From date of CMV-CTLs infusion to 1 year after transplant
|
If viral load >200 copies in 2 samples or >1000 in 1 sample, treatment with valganciclovir will be started. Time from CMV-CTLs infusion until valganciclovir start and days of valganciclovir. |
From date of CMV-CTLs infusion to 1 year after transplant
|
|
1-year incidence of CMV disease
Tidsramme: From date of CMV-CTLs infusion to 1 year after transplant
|
CMV disease P.Lungman criteria. CMV as primary cause of death. |
From date of CMV-CTLs infusion to 1 year after transplant
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
1-year incidence of CMV-CTLs adverse events
Tidsramme: From date of CMV-CTLs infusion to 1 year after transplant
|
Infusion reactions, causes of death, secondary graft failures and graft versus host disease (GVHD). |
From date of CMV-CTLs infusion to 1 year after transplant
|
|
CMV-CTLs persistence
Tidsramme: From date of CMV-CTLs infusion to 2 months after infusion
|
Expansion of CMV-CTLs detected by flow cytometry. |
From date of CMV-CTLs infusion to 2 months after infusion
|
|
Immune reconstitution post-HAPLO
Tidsramme: From date of transplant to day 180 post-transplant
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CD3, CD4, CD8, B and NK lymphocyte counts in patient peripheral blood post-transplant (day 30, 60, 90 and 180) detected by flow cytometry. |
From date of transplant to day 180 post-transplant
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studieleder: Galo Peralta Fernandez, MD, Instituto de Investigación Marqués de Valdecilla
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- INMUNOCELL
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