Clinical Trials /

Inducible Regulatory T Cells (iTregs) in Non-Myeloablative Sibling Donor Peripheral Blood Stem Cell Transplantation

NCT01634217

Description:

This is a phase I single center dose escalation study with an extension at the best available dose to determine the tolerability of inducible regulatory T cells (iTregs) when given to adult patients undergoing non-myeloablative HLA-identical sibling donor peripheral blood stem cell (PBSC) transplantation for the treatment of a high risk malignancy. Up to 5 dose cohorts will be tested. Once the tolerable dose is determined for iTregs, enrollment will continue with an additional 10 patients using sirolimus/Mycophenolate mofetil (MMF) graft-versus-host disease (GVHD) prophylaxis to gain further safety information and to provide pilot data in this treatment setting.

Related Conditions:
  • Acute Lymphoblastic Leukemia
Recruiting Status:

Completed

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Inducible Regulatory T Cells (iTregs) in Non-Myeloablative Sibling Donor Peripheral Blood Stem Cell Transplantation
  • Official Title: Dose Escalation Study With Extension of Inducible Regulatory T Cells (iTregs) in Adult Patients Undergoing Non-Myeloablative HLA Identical Sibling Donor Peripheral Blood Stem Cell Transplantation

Clinical Trial IDs

  • ORG STUDY ID: 2012LS019
  • SECONDARY ID: MT2012-06R
  • NCT ID: NCT01634217

Conditions

  • Acute Myelogenous Leukemia
  • Acute Lymphocytic Leukemia
  • Chronic Myelogenous Leukemia
  • Non-Hodgkin Lymphoma
  • Hodgkin Lymphoma
  • Chronic Lymphocytic Leukemia
  • Multiple Myeloma
  • Myelodysplastic Syndrome

Interventions

DrugSynonymsArms
iTregCohort 1

Purpose

This is a phase I single center dose escalation study with an extension at the best available dose to determine the tolerability of inducible regulatory T cells (iTregs) when given to adult patients undergoing non-myeloablative HLA-identical sibling donor peripheral blood stem cell (PBSC) transplantation for the treatment of a high risk malignancy. Up to 5 dose cohorts will be tested. Once the tolerable dose is determined for iTregs, enrollment will continue with an additional 10 patients using sirolimus/Mycophenolate mofetil (MMF) graft-versus-host disease (GVHD) prophylaxis to gain further safety information and to provide pilot data in this treatment setting.

Detailed Description

      Co-enrollment in University Of Minnesota protocol MT2001-10 is required and transplantation
      will be according to that protocol with iTregs administered the morning of day 0 followed no
      sooner than 4 hours later by the PBSC transplantation.
    

Trial Arms

NameTypeDescriptionInterventions
Cohort 1ExperimentalAdministered 3 x 10^6 iTregs/kg infusion
  • iTreg
Cohort 2ExperimentalAdministered 3 x 10^7 iTregs/kg infusion
  • iTreg
Cohort 3ExperimentalAdministered 3 x 10^8 iTregs/kg infusion
  • iTreg
Cohort 4ExperimentalAdministered 10 x 10^8 iTregs/kg infusion
  • iTreg
Cohort 5 ExtensionExperimentalAdministered 10 x 10^8 iTregs/kg or best available dose using sirolimus/MMF as graft-versus-host disease (GVHD) prophylaxis. Immunosuppression will consist of a combination of sirolimus and mycophenolate mofetil (MMF). Sirolimus will be administered starting at day -3 with 8mg-12mg oral loading dose followed by single dose 4 mg/day. MMF will be administered starting on day -3 at a dose of 3 gram/day divided in 2 or 3 doses. Intravenous (IV) route between days -3 and +5, then may change to PO between days +6 and +30. Stop MMF at day +30 or 7 days after engraftment, whichever day is later, if no acute GVHD.
  • iTreg

Eligibility Criteria

        Inclusion Criteria:

          -  18 - 75 years of age with an HLA-identical sibling donor

          -  One of the following disease categories:

               -  Acute myelogenous leukemia - high risk CR1 (as evidenced by preceding MDS,
                  intermediate to high risk cytogenetics, ≥ 2 cycles to obtain CR, erythroblastic
                  or megakaryocytic leukemia; CR2+. All patients must be in CR as defined by
                  hematological recovery (ANC > 0.5x 109/L), AND <5% blasts by light microscopy
                  within the bone marrow with a cellularity of ≥15%.

               -  Acute lymphocytic leukemia - high risk CR1 [t(9;22), t (1:19), t(4;11) or other
                  MLL rearrangements] or >1cycle to obtain CR; CR2+. All patients must be in CR as
                  defined by hematological recovery (ANC > 0.5x 109/L), AND <5% blasts by light
                  microscopy within the bone marrow with a cellularity of ≥15%.

               -  Chronic myelogenous leukemia all types except blast crisis (note treated blast
                  crisis in chronic phase is eligible)

               -  Non-Hodgkin lymphoma or Hodgkin lymphoma demonstrating chemosensitive disease

               -  Myelodysplastic syndrome with severe pancytopenia, leading to either transfusion
                  dependency or increased risk for infections

          -  Performance status: Karnofsky ≥ 60%

          -  Adequate organ function within 28 days of study enrollment defined as:

               -  Liver: SGOT and SGPT < 5.0 x ULN; total bilirubin < 3 x ULN

               -  Renal: serum creatinine < 2.0 mg/dl or glomerular filtration rate (GFR) > 40
                  mL/min/1.73m2. Patients with a creatinine > 1.2 mg/dl or a history of renal
                  dysfunction must have glomerular filtration rate (GFR) > 40 mL/min/1.73m2

               -  Albumin: > 2.5 g/dL

               -  Cardiac: No decompensated CHF or uncontrolled arrhythmia; ejection fraction > 35%
                  within 6 weeks prior to study enrollment

               -  Pulmonary: No O2 requirements; DLCO > 30% predicted within 6 weeks prior to study
                  enrollment

          -  If recent mold infection (e.g. aspergillus) must have minimum of 30 days of therapy
             and responsive disease and be cleared by Infectious Disease

          -  Sexually active females of child bearing potential and males must agree to use
             effective contraception for the duration of the transplant period

          -  Voluntary written consent

        Exclusion Criteria:

          -  Pregnancy or breast feeding - women of childbearing potential must have a negative
             pregnancy test within 28 days of study enrollment.

          -  Prior myeloablative transplant within previous 3 months of study enrollment.

          -  Evidence of HIV infection or known HIV positive serology.

          -  Active serious infection.
      
Maximum Eligible Age:75 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of grade 3-5 infusional toxicity
Time Frame:Within 48 Hours After iTregs Administration
Safety Issue:
Description:Targeted adverse events and unexpected events not explained by the PBSCT or disease will be collected [(1-4 hours after the iTreg infusion and before the PBSCT at day 0) and 24 hours and 48 hours after the iTreg infusion (+/- 2 hours)]

Secondary Outcome Measures

Measure:Cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD)
Time Frame:Day 100
Safety Issue:
Description:Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow transplant in which the newly transplanted material attacks the transplant recipient's body. Abstracted from the routine clinical data collected for the primary transplant protocol (MT2001-10).
Measure:Incidence of chronic graft-versus-host disease (GVHD)
Time Frame:12 Months
Safety Issue:
Description:Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow transplant in which the newly transplanted material attacks the transplant recipient's body. Abstracted from the routine clinical data collected for the primary transplant protocol (MT2001-10).
Measure:Relapse of Disease
Time Frame:12 Months
Safety Issue:
Description:The return of signs and symptoms of a disease after a remission.
Measure:Survival
Time Frame:1 Year
Safety Issue:
Description:Number (count) of patients alive at 1 year after treatment.
Measure:Survival
Time Frame:Day 100
Safety Issue:
Description:Number (count) of patients alive at Day 100.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Masonic Cancer Center, University of Minnesota

Last Updated

January 18, 2019