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Ultra-Low Dose Interleukin-2 for Refractory Chronic Graft Versus Host Disease

22. juni 2020 oppdatert av: John Koreth, MD, Dana-Farber Cancer Institute

A Phase I Study of Ultra-Low Dose Subcutaneous Interleukin-2 (IL-2) for Treatment of Refractory Chronic Graft Versus Host Disease

The purpose of this research study is to determine the safety of IL-2 and the highest dose of this drug that can be given safely to people with chronic graft versus host disease (GVHD). Chronic GVHD is a medical condition that may occur after patients receive a bone marrow, stem cell or cord blood transplant. The donor's immune system may recognize their body (the host) as foreign and attempt to "reject" it. Traditional standard therapy to treat chronic GVHD is prednisone (steroids). Treatment options are limited, and it is thought that IL-2 may help to control chronic GVHD.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

  • IL-2 will be given daily through an injection under the skin for a period of 8 weeks. To determine the highest safest dose of IL-2, the dose participants receive will increase as lower doses are determined to be safe. There will be three dose levels.
  • Participants will be seen periodically while they are receiving IL-2. Physical exams and blood tests will be performed weekly for the first two weeks and then every other week until week 8.

Studietype

Intervensjonell

Registrering (Faktiske)

29

Fase

  • Fase 1

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Forente stater
    • Massachusetts
      • Boston, Massachusetts, Forente stater, 02115
        • Dana-Farber Cancer Institute

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • Recipients of allogeneic stem cell transplantation with myeloablative or non-myeloablative conditioning regimens
  • Patients must be at least 180 days from the allogeneic stem cell transplantation procedure
  • Steroid refractory cGVHD, defined as having persistent symptoms and signs of GVHD despite the use of prednisone for at least 4 weeks in the preceding 12 months without complete resolution of signs and symptoms.
  • Stable dose of corticosteroids for 4 weeks prior to enrollment
  • No addition or subtraction of other immunosuppressive medications for 4 weeks prior to enrollment.
  • Adequate bone marrow, renal and hepatic function as outlined in the protocol
  • 18 years of age or older
  • ECOG Performance Status of 0-2

Exclusion Criteria:

  • Ongoing prednisone requirement > 1mg/kg/day (or equivalent)
  • Exposure to any new immunosuppressive medication in the 4 weeks prior to enrollment
  • Concurrent ECP therapy within 4 weeks prior to enrollment
  • Post-transplant exposure to any novel immunosuppressive medication within 100 days prior to enrollment
  • Donor lymphocyte infusion within 100 days prior to IL-2 therapy
  • Active malignant disease relapse
  • Active, uncontrolled infection
  • Positive serologic test for Hepatitis B or a positive serologic or nucleic acid test for Hepatitis C
  • HIV seropositivity
  • Life expectancy < 3 months
  • Pregnancy or lactation
  • Inability to comply with IL-2 treatment regimen
  • Uncontrolled cardiac angina or symptomatic congestive heart failure
  • Organ transplant (allograft) recipient

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Intervensjonsmodell: Enkeltgruppeoppdrag
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: Interleukin-2

Interleukin-2 (IL-2) will be given daily through an injection under the skin for a period of 8 weeks. To determine the highest safest dose of IL-2, the dose participants receive will increase as lower doses are determined to be safe. There will be three dose levels:

Dose Level -A 0.3 x 106 (IU/m2/d) Dose Level -B 1 x 106 (IU/m2/d) Dose Level-C 3 x 106 (IU/m2/d)
Legemiddel: Interleukin-2
Dose will vary depending upon when participant enters the trial: Given as a daily injection under the skin for 8 weeks.
Andre navn:
  • IL-2

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
The Maximum Tolerated Dose and Toxicity Profile of an 8 Week Course of IL-2 in Patients With cGVHD and an Inadequate Response to Steroids.
Tidsramme: Participants were assessed for toxicities at mandatory study follow-up visits during the 8 week course of study therapy and four weeks post therapy

Three dose levels were evaluated to determine the maximally tolerated dose (MTD):

Dose level A: 0.3 x 10^6 IU/m^2/day Dose level B: 1.0 x 10^6 IU/m^2/day Dose level C: 3.0 x 10^6 IU/m^2/day Once the MTD (dose level B) was established, an additional 10 participants were enrolled at this dose.
Participants were assessed for toxicities at mandatory study follow-up visits during the 8 week course of study therapy and four weeks post therapy

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
The Number of Participants Who Tolerated at Least 6 Weeks of Subcutaneous Low Dose IL-2.
Tidsramme: Participants were assessed for toxicities at mandatory study follow-up visits during the 8 week course of study therapy and four weeks post therapy. cGVHD was assessed at Weeks 8 and 12

Feasibility: the number of participants who tolerated at least 6 weeks of therapy, and were thus evaluable for response. Efficacy: chronic GVHD response per NIH consensus criteria in evaluable patients.

A complete response was defined as resolution of all reversible chronic GVHD-associated manifestations, a partial response as an improvement of 50% or more on the organ-specific chronic GVHD scale without progression at other organs or sites, progressive disease as an increase of 25% or more on the organ specific chronic GVHD scale, and stable disease as an improvement of less than 50% or increase of less than 25%. Please refer to the Supplementary Appendix in our published report (Koreth et al, NEJM 2011) for further details.
Participants were assessed for toxicities at mandatory study follow-up visits during the 8 week course of study therapy and four weeks post therapy. cGVHD was assessed at Weeks 8 and 12
CD3+T, CD4+T (Including Regulatory CD4+T Cells (Treg) and Conventional CD4+T Cells (Tcon)), CD8+T, NK, NKT and B Cell Counts.
Tidsramme: Immunological samples taken at study appointments during the 12 week protocol schedule

Changes in the above immune cell populations (CD3+T, CD4+T (including CD4+Treg and CD4+Tcon), CD8+T, NK, NKT and B cell counts were measured at study appointments during the 8-week IL-2 treatment and four weeks post study therapy.

All study participants (n=28) with a sample available were reported in the data table.

Immune outcome data cannot be meaningfully rendered in the template provided, owing to complexity. The tables below only represent a general overview of the data. Please refer to figure 2 in our published report (Koreth et al, NEJM 2011).
Immunological samples taken at study appointments during the 12 week protocol schedule
Treg Cell:Tcon Cell Ratio
Tidsramme: Immunological samples taken at study appointments during the 12 week protocol schedule

Changes in the ratio of the CD4+ regulatory T cell (Treg) and CD4+ conventional T cell (Tcon) counts were measured at study appointments during the 8-week IL-2 treatment and four weeks post study therapy.

All study participants (n=28) with a sample available were reported in the data table.

Immune outcome data cannot be meaningfully rendered in the template provided, owing to complexity. The tables below only represent a general overview of the data. Please refer to figure 2 in our published report (Koreth et al, NEJM 2011).
Immunological samples taken at study appointments during the 12 week protocol schedule

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Dana-Farber Cancer Institute

Samarbeidspartnere

Novartis
Brigham and Women's Hospital

Etterforskere

  • Hovedetterforsker: John Koreth, MBBS, D.Phil, Dana-Farber Cancer Institute

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. august 2007

Primær fullføring (Faktiske)

1. juni 2011

Studiet fullført (Faktiske)

27. mai 2020

Datoer for studieregistrering

Først innsendt

11. september 2007

Først innsendt som oppfylte QC-kriteriene

11. september 2007

Først lagt ut (Anslag)

14. september 2007

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

1. juli 2020

Siste oppdatering sendt inn som oppfylte QC-kriteriene

22. juni 2020

Sist bekreftet

1. juni 2020

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 07-083

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