- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT00052520
Biological Therapy in Treating Patients With Advanced Myelodysplastic Syndrome, Acute or Chronic Myeloid Leukemia, or Acute Lymphoblastic Leukemia Who Are Undergoing Stem Cell Transplantation
Phase I/II Study of Adoptive Immunotherapy With CD8+ WT1-Specific CTL Clones for Patients With Advanced MDS, CML, AML or ALL After Allogeneic Hematopoietic Stem Cell Transplant
Studieoversigt
Status
Betingelser
- Polycytæmi Vera
- Essentiel trombocytæmi
- Kronisk myelomonocytisk leukæmi
- Tilbagevendende akut myeloid leukæmi hos voksne
- Akut myeloid leukæmi hos voksne med 11q23 (MLL) abnormiteter
- Voksen akut myeloid leukæmi med Inv(16)(p13;q22)
- Voksen akut myeloid leukæmi med t(16;16)(p13;q22)
- Voksen akut myeloid leukæmi med t(8;21)(q22;q22)
- Sekundær akut myeloid leukæmi
- Kronisk myelogen leukæmi i barndommen
- Myelodysplastiske syndromer i barndommen
- Tidligere behandlede myelodysplastiske syndromer
- Tilbagevendende akut lymfatisk leukæmi hos voksne
- Tilbagevendende akut lymfatisk leukæmi i barndommen
- Tilbagevendende akut myeloid leukæmi i barndommen
- Recidiverende kronisk myelogen leukæmi
- Voksen akut myeloid leukæmi med t(15;17)(q22;q12)
- B-celle akut lymfoblastisk leukæmi hos voksne
- B-celle akut lymfatisk leukæmi i barndommen
- T-celle akut lymfatisk leukæmi i barndommen
- Ildfast anæmi med overskydende eksplosioner
- Ildfast anæmi med overskydende eksplosioner i transformation
- T-celle voksen akut lymfatisk leukæmi
Intervention / Behandling
- Andet: laboratoriebiomarkøranalyse
- Andet: flowcytometri
- Genetisk: polymerase kædereaktion
- Andet: immunologisk teknik
- Biologisk: aldesleukin
- Procedure: perifer blodstamcelletransplantation
- Genetisk: cytogenetisk analyse
- Genetisk: genekspressionsanalyse
- Biologisk: terapeutiske allogene lymfocytter
- Procedure: allogen knoglemarvstransplantation
- Andet: farvningsmetode
Detaljeret beskrivelse
PRIMARY OBJECTIVES:
I. To determine the safety and potential toxicities associated with infusing donor CD8+ cytotoxic T lymphocyte (CTL) clones specific for Wilms' tumor (WT1) in patients who have relapsed or at a high risk of relapse post transplant for myelodysplastic syndromes (MDS), chronic myelogenous leukemia (CML), acute myeloid leukemia (AML), or acute lymphoblastic leukemia (ALL).
SECONDARY OBJECTIVES:
I. To determine the in vivo persistence of transferred T cells and assess migration to the bone marrow, a predominant site of leukemic relapse.
II. To determine if adoptively transferred WT1-specific T cells mediate antileukemic activity.
OUTLINE: Donors undergo leukapheresis for stem cell harvest to generate CD8-positive WT1 gene-specific CTL clones at the time of allogeneic stem cell transplantation.
After post-transplantation hematopoietic recovery, patients receive treatment for either highest-risk disease (prophylactically) or relapsed disease.
Highest-risk disease group: Patients receive CD8-positive WT1 gene-specific CTL clones intravenously (IV) over 1-2 hours on days 0, 14, and 28. Beginning 2-4 hours after CTL infusion, patients receive interleukin-2 subcutaneously (SC) twice daily on days 28-42 in the absence of unacceptable toxicity.
Relapsed-disease group: Some patients with evidence of leukemic relapse may receive standard salvage chemotherapy prior to donor CTL infusions and then receive CD8-positive WT1 gene-specific CTL clones and interleukin-2 as in the highest-risk group.
Patients in both groups who have progressive disease after complete or partial response to therapy may be eligible for retreatment with CD8-positive WT1 gene-specific CTL clones.
After completion of study treatment, patients are followed every 3 months for 2 years.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiesteder
-
-
Washington
-
Seattle, Washington, Forenede Stater, 98109
- Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
Eligibility for Enrollment:
a.
- i) Pre-transplant: Patients undergoing allogeneic hematopoietic stem cell transplantation for refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-t), CML beyond chronic phase, AML beyond first remission, Philadelphia chromosome (BCR-ABL)-positive ALL at any stage, any ALL beyond first remission, primary refractory AML or ALL, therapy-related AML at any stage, or acute leukemia at any stage arising in a patient with an antecedent diagnosis of a myelodysplastic or myeloproliferative syndrome (including chronic myelomonocytic leukemia, CML, polycythemia vera, essential thrombocytosis, and agnogenic myeloid metaplasia with myelofibrosis);
- ii) Post-transplant: Patients who have relapsed after transplant (morphologic, flow cytometric, cytogenetic and molecular relapse) can be offered enrollment on the protocol and may undergo therapy if it is considered possible to control their disease while waiting for the generation of study therapy
- b. Patients and donors must both express an human leukocyte antigen (HLA)-allele for which it is possible to generate WT1-specific clones for
- c. Patients must be able to provide blood and bone marrow samples required for this protocol
Eligibility for Prophylactic Treatment with CD8+ CTL After Transplant (Highest Risk Subgroup): At time of planned treatment, CD8+ CTL specific for WT1 must have been generated and have completed Quality Control (QC) testing
- a. Patients must have had > 5% morphologic blasts detectable in bone marrow or peripheral blood just prior to or at the time of transplant
- b. Patients must have evidence of post transplant recovery of normal hematopoiesis (absolute neutrophil count [ANC] > 500/mm^3) for at least 7 days prior to the initiation of CTL infusions
- c. Patients on immunosuppressive therapy for graft-versus-host disease (GVHD) are eligible for treatment if not receiving corticosteroids or if the dose of corticosteroids can be tapered to =< the equivalent of 0.5 mg/kg/day of prednisone; the patient's symptoms have to remain stable and unlikely to increase to stage III or IV acute GVHD or chronic GVHD is unlikely to progress following the change in immunosuppressive therapy, after an appropriate monitoring period, as deemed by the patients treating physician and the principal investigator
Eligibility for Treatment with CD8+ CTL at the Time of Relapse after Transplant (All Others): At time of planned treatment, CD8+ CTL specific for WT1 must have been generated and have completed Quality Control (QC) testing
a. Patients must have evidence of recurrent disease post transplant; this includes patients with the following:
- i) Morphologic relapse defined as one or more of the following: Abnormal peripheral blasts in absence of growth factor therapy; abnormal bone marrow blasts > 5% of nucleated cells; extramedullary chloroma or granulocytic sarcoma
- ii) Flow cytometric relapse defined as: the appearance in the peripheral blood or bone marrow of cells with an abnormal; immunophenotype detected by flow cytometry that is consistent with leukemia recurrence
- iii) Cytogenetic relapse defined as: the appearance in one or more metaphases from bone marrow or peripheral blood cells of either a non-constitutional cytogenetic abnormality identified in at least one cytogenetic study performed prior to transplant or a new abnormality known to be associated with leukemia; (for CML) an increase in the number of Ph+ metaphases from bone marrow or peripheral blood between two consecutive samples after engraftment, or; an increase in the percentage of BCR/ABL+ cells by fluorescence in situ hybridization (FISH) between two consecutive samples after engraftment
- iv) Molecular relapse defined as: one or more positive polymerase chain reaction (PCR) assays for the presence of clonotypic immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangement in patients transplanted for B-or T-cell acute lymphoblastic leukemia, respectively; one or more positive post transplant reverse transcription (RT)-PCR assays for the presence of BCR-ABL messenger ribonucleic acid (mRNA) fusion transcripts in patients transplanted for Philadelphia chromosome (BCRABL)-positive acute lymphoblastic leukemia; (for CML) a PCR assay of bone marrow (BM) or peripheral blood mononuclear cell (PBMC) positive for the presence of the BCR/ABL mRNA fusion transcript that quantitatively increases by greater than one order of magnitude on a subsequent sample
- b. Patients on immunosuppressive therapy for GVHD at the time of relapse are eligible for treatment if not receiving corticosteroids or if the dose of corticosteroids can be tapered to < the equivalent of 0.5 mg/kg/day of prednisone; the patient's symptoms have to remain stable and unlikely to increase to stage III or IV acute GVHD or chronic GVHD is unlikely to progress following the change in immunosuppressive therapy, after an appropriate monitoring period, as deemed by the patients treating physician and the principal investigator
- DONOR: Both the patient and donor must have an HLA-allele which it is possible to generate WT1-specific clones for
- DONOR: If a separate leukapheresis via peripheral intravenous access can be arranged, the stem cell donor will undergo leukapheresis to provide the required PBMC no sooner than 2 weeks before or after the stem cell mobilization and harvest
- DONOR: If a separate leukapheresis is not possible, a portion of the PBMC from the donor's peripheral blood stem cell harvest may potentially be used to generate WT1-specific CTL clones; the feasibility of this option will depend upon the minimal cell dose required for transplantation and the presence of an excess harvest yield and the possibility of generating CTL from this product
- DONOR: Some donors will be asked to provide both a separate leukapheresis and a portion of the peripheral blood mononuclear cells (PBMC) from the donor's peripheral blood stem cell harvest
- DONOR: Leukapheresis donors must be age 18 or older
Exclusion Criteria:
- Patients for whom CD8+ CTL clones specific for WT1 have not been generated in time for planned infusion (these patients can potentially be treated later if CTL become available); Also we will exclude patients whose malignant cells do not over express WT-1, based on direct analysis of a bone marrow sample with > 50% blasts or of leukemia cells isolated for expression analysis; in either case patients will be informed about the availability of other treatment protocols for which they might be eligible
- Patients with Karnofsky performance status or Lansky play score =< 30%
- Patients with current stage III or IV GVHD unresponsive to therapy or requiring therapy with anti-CD3 mAb, prednisone > 0.5 mg/kg/day (or corticosteroid equivalent), or other treatments resulting in the ablation or inactivation of T cells (such as other anti-T cell monoclonal antibodies); although the concurrent use of cyclosporine, FK506, or MMF is not strictly an exclusion criteria, attempts should be made to discontinue it if possible
- Patients requiring concurrent therapy with hydroxyurea or other agents that may interfere with the function or survival of infused CTL clones
- Patients with a preexisting nonhematopoietic organ toxicity that is deemed by the principal investigator to place the patient at unacceptable risk for treatment on the protocol
- Patients with graft rejection or failure
DONOR: Medical conditions precluding either leukapheresis or blood donation may include but are not limited to:
- Inadequate age or weight (leukapheresis donors must be age 18 or older, other criteria per physician discretion)
- Active infection, with or without antibiotic treatment
- Recent hepatitis exposure, hepatitis A or B antigenemia, or hepatitis C antibody positivity
- Pregnancy or nursing; HIV or human T-lymphotropic virus (HTLV) infection
- Severe cardiovascular disease (e.g., uncontrolled hypertension, recent myocardial infarction [MI], or unstable angina)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
---|---|
Eksperimentel: Behandling
Se detaljeret beskrivelse
|
Korrelative undersøgelser
Korrelative undersøgelser
Korrelative undersøgelser
Andre navne:
Korrelative undersøgelser
Andre navne:
Givet SC
Andre navne:
Gennemgå transplantation
Andre navne:
Korrelative undersøgelser
Korrelative undersøgelser
Givet IV
Andre navne:
Gennemgå transplantation
Andre navne:
Korrelative undersøgelser
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Toxicity rate associated with infusing donor CD8+ CTL clones specific for WT1 in patients at high risk for post transplant relapse of CML, AML, or ALL
Tidsramme: Up to 4 weeks after the final dose of CTL
|
Assessed by Common Terminology Criteria (CTC) version 3.0.
|
Up to 4 weeks after the final dose of CTL
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Relapse of disease
Tidsramme: Up to 2 years
|
Patients achieving complete remission with chemotherapy and T cell infusions will be followed to determine the duration of response.
The proportion of responders will be estimated with associated confidence intervals.
Duration of remission will be summarized using time-to-event methods, which will allow estimates to be made while some patients remain in remission.
|
Up to 2 years
|
Samarbejdspartnere og efterforskere
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Merav Bar, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Datoer for undersøgelser
Studer store datoer
Studiestart
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Patologiske processer
- Sygdomme i immunsystemet
- Neoplasmer efter histologisk type
- Neoplasmer
- Lymfoproliferative lidelser
- Lymfesygdomme
- Immunproliferative lidelser
- Neoplasmer efter sted
- Sygdomsegenskaber
- Sygdom
- Knoglemarvssygdomme
- Hæmatologiske sygdomme
- Hæmoragiske lidelser
- Myeloproliferative lidelser
- Blodkoagulationsforstyrrelser
- Blodpladeforstyrrelser
- Forstadier til kræft
- Myelodysplastisk-myeloproliferative sygdomme
- Knoglemarvsneoplasmer
- Hæmatologiske neoplasmer
- Syndrom
- Myelodysplastiske syndromer
- Leukæmi
- Leukæmi, myeloid
- Leukæmi, Myeloid, Akut
- Tilbagevenden
- Præleukæmi
- Leukæmi, myelomonocytisk, kronisk
- Leukæmi, myelomonocytisk, juvenil
- Trombocytose
- Trombocytæmi, essentiel
- Precursorcelle lymfoblastisk leukæmi-lymfom
- Leukæmi, lymfoid
- Anæmi
- Leukæmi, myelogen, kronisk, BCR-ABL positiv
- Polycytæmi Vera
- Polycytæmi
- Anæmi, ildfast, med overskud af eksplosioner
- Anæmi, ildfast
- Lægemidlers fysiologiske virkninger
- Anti-infektionsmidler
- Agenter fra det perifere nervesystem
- Antivirale midler
- Anti-HIV-midler
- Anti-retrovirale midler
- Analgetika
- Sensoriske systemagenter
- Analgetika, ikke-narkotisk
- Antineoplastiske midler
- Aldesleukin
- Interleukin-2
Andre undersøgelses-id-numre
- 1655.00
- P01CA018029 (U.S. NIH-bevilling/kontrakt)
- NCI-2009-01471 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .
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