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.
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
Drug | Synonyms | Arms |
---|
iTreg | | Cohort 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
Name | Type | Description | Interventions |
---|
Cohort 1 | Experimental | Administered 3 x 10^6 iTregs/kg infusion | |
Cohort 2 | Experimental | Administered 3 x 10^7 iTregs/kg infusion | |
Cohort 3 | Experimental | Administered 3 x 10^8 iTregs/kg infusion | |
Cohort 4 | Experimental | Administered 10 x 10^8 iTregs/kg infusion | |
Cohort 5 Extension | Experimental | Administered 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. | |
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