Clinical Trials /

Efficacy Study of Dendritic Cell Vaccination in Patients With Acute Myeloid Leukemia in Remission

NCT01686334

Description:

The primary aim of this innovative immunotherapeutic study is to determine whether the antileukemic effects seen in our previous phase I/II study can be confirmed in a large cohort of patients and whether dendritic cell vaccination can significantly prevent relapse and increase survival of acute myeloid leukemia (AML) patients by eradicating minimal residual disease.

Related Conditions:
  • Acute Myeloid Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Efficacy Study of Dendritic Cell Vaccination in Patients With Acute Myeloid Leukemia in Remission
  • Official Title: Wilms' Tumor (WT1) Antigen-targeted Dendritic Cell Vaccination to Prevent Relapse in Adult Patients With Acute Myeloid Leukemia: a Multicenter Randomized Phase II Trial

Clinical Trial IDs

  • ORG STUDY ID: CCRG12-001
  • NCT ID: NCT01686334

Conditions

  • Acute Myeloid Leukemia

Interventions

DrugSynonymsArms
DC vaccineDC vaccine

Purpose

The primary aim of this innovative immunotherapeutic study is to determine whether the antileukemic effects seen in our previous phase I/II study can be confirmed in a large cohort of patients and whether dendritic cell vaccination can significantly prevent relapse and increase survival of acute myeloid leukemia (AML) patients by eradicating minimal residual disease.

Detailed Description

      Together with the Transplant Committee of the Belgian Hematological Society (BHS), we will
      perform a multicenter randomized open-label phase II clinical study in 130 patients with
      acute myeloid leukemia (AML). Adult patients (> 18 years) with AML who have entered
      morphological CR or CRi after (1) intensive chemotherapy (i.e (i) at least one cycle of
      induction and one cycle of consolidation chemotherapy or (ii) one to two cycles of CPX-351
      induction treatment and up to two cycles of CPX-351 consolidation treatment) or (2)
      low-intensity chemotherapy (i.e (iii) at least two cycles to maximum six cycles of
      hypomethylating agents whether or not combined with venetoclax or (iv) at least two cycles to
      maximum six cycles of low-dose cytarabine combined with venetoclax); and fulfilling all other
      eligibility criteria will be randomized to be vaccinated with dendritic cells or to receive
      regular follow-up care. After randomization, patients receiving low-intensity chemotherapy
      are allowed to continue this treatment in combination with DC vaccination or the follow-up
      care. The primary aim of this innovative immunotherapeutic study is to determine whether the
      antileukemic effects seen in our previous phase I/II study can be confirmed in a large cohort
      of patients and whether dendritic cell vaccination can significantly prevent relapse and
      increase survival of AML patients by eradicating minimal residual disease. Patients will be
      recruited at 8 different centers in Belgium. Recruitment will start in the second half of
      2013 and will last for 10 years or until 130 efficacy-evaluable AML patients are included. In
      the interventional group, 65 patients will be treated during two years with autologous
      dendritic cells loaded by messenger RNA electroporation with the Wilms' tumor antigen (WT1).
      The dendritic cell therapy product will be generated and generally administered in the
      coordinating center, which is the Antwerp University Hospital, more specifically the Center
      for Cell Therapy and Regenerative Medicine (CCRG) and the Division of Hematology, both headed
      by Prof. Zwi Berneman. After inclusion of 130 efficacy-evaluable patients, relapse rate,
      relapse-free survival and overall survival analysis will be performed. Tumor marker levels
      and immune activation will also be monitored to compare the 2 groups at a molecular and
      immunological level. General and disease-specific quality of life will be evaluated using
      quality of life questionnaires at regular time points.
    

Trial Arms

NameTypeDescriptionInterventions
DC vaccineExperimentalVaccination with autologous WT1 mRNA-electroporated DCs plus follow-up care. Patients receiving low-intensity chemotherapy are allowed to continue this treatment in combination with DC vaccination.
  • DC vaccine
Control armNo InterventionFollow-up care. Patients receiving low-intensity chemotherapy are allowed to continue this treatment during the follow-up care

    Eligibility Criteria

            Inclusion Criteria:
    
              -  Diagnosis of acute myeloid leukemia (AML) according to the 2008 criteria of the World
                 Health Organization (WHO).
    
                   -  all French-American-British (FAB) subtypes, except:
    
                      - M3 (acute promyelocytic leukemia)
    
                   -  all cases of de novo AML or secondary AML with ≥ 20 % blasts in peripheral blood
                      and/or bone marrow, except:
    
                        -  AML secondary to myeloproliferative neoplasms (MPN)
    
                        -  AML secondary to exposure of leukemogenic agents (t-AML) unless treated with
                           CPX-351 chemotherapy or hypomethylating agents combined with venetoclax.
    
              -  Completion of one of the following treatment options:
    
                   -  I) Intensive chemotherapy:
    
                        -  (1) at least one cycle of induction chemotherapy and one cycle of
                           consolidation chemotherapy (low-dose cytarabine as consolidation therapy is
                           allowed) OR
    
                        -  (2) one to two cycles of CPX-351 induction treatment and up to two cycles of
                           CPX-351 consolidation treatment OR
    
                   -  II) Low-intensity chemotherapy:
    
                        -  (3) at least two cycles to maximum six cycles of hypomethylating agents
                           whether or not combined with venetoclax OR
    
                        -  (4) at least two cycles to maximum six cycles of low-dose cytarabine
                           combined with venetoclax;
    
                   -  resulting in:
    
                        -  morphological complete remission (CR), i.e. bone marrow blast count <5% with
                           neutrophil count >1000 cells/µL and platelet count >100,000 cells/µL OR
    
                        -  morphological complete remission with incomplete blood recovery (CRi), i.e.
                           bone marrow blast count <5% with neutrophil count <1000 cells/µL or platelet
                           count <100,000 cells/µL.
    
            For the purpose of this study protocol, platelet count must be >50,000 cells/µL.
    
              -  Interval between the completion of the last intensive chemotherapy administration (in
                 case of low-intensity chemotherapy: last cycle (min. 2 to max. 6 cycles) before
                 achieving CR or CRi) and the start of vaccination (or the start of follow-up in case
                 of the control arm): 6 weeks (minimum) and 16 weeks (maximum) (in case of
                 low-intensity chemotherapy: maximum 10 weeks).
    
              -  Adult (≥ 18 years) at very high risk of relapse according to:
    
                   -  Age ≥ 60 years, and/or
    
                   -  Adverse biological features (e.g. adverse cytogenetics, adverse morphological
                      features, adverse molecular features, hyperleukocytosis (> 100000 cells/µL)), and
    
                   -  Ineligible for or unwilling to receive hematopoietic stem cell transplantation.
    
              -  WHO performance status: grade 0, 1 or 2 at the time of enrollment. For definition of
                 performance status, see: http://www.ecog.org/general/perf_stat.html
    
              -  Absence of any psychological, familial, sociological, geographical or physical
                 condition potentially hampering compliance with the study protocol and follow-up
                 schedule; those conditions should be discussed with the patient before study entry.
    
            Exclusion Criteria:
    
              -  Participation in any other interventional clinical trial during the study period.
    
              -  History or concomitant presence of any other malignancy, except for:
    
                   -  non-melanoma skin cancer
    
                   -  carcinoma in situ of the cervix
    
                   -  any other effectively treated malignancy that has been in remission for >5 years
                      or that is highly likely to be cured at the time of enrollment.
    
              -  Concomitant presence of any immunosuppressive disease (e.g. HIV) or any active
                 autoimmune condition, except for vitiligo.
    
              -  Concomitant use of systemic corticosteroids in immunosuppressive doses (>1 mg/kg/day
                 of prednisone, or equivalent dose for other corticosteroid preparations) or any other
                 immunosuppressive agent. A minimum of 4 weeks must have elapsed between the last dose
                 of immunosuppressive therapy and the first vaccination. Topical corticosteroids are
                 permitted, except if applied at the sites of DC injection.
    
              -  Pregnant or breast-feeding
          
    Maximum Eligible Age:N/A
    Minimum Eligible Age:18 Years
    Eligible Gender:All
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:Overall survival
    Time Frame:At study completion, an average of 5 year
    Safety Issue:
    Description:The primary objective of this randomized phase II clinical study is to determine the effect of WT1-targeted dendritic cell vaccination on overall survival in adult AML patients at very high risk of relapse and in complete remission.

    Secondary Outcome Measures

    Measure:Relapse rate
    Time Frame:At study completion, an average of 5 year
    Safety Issue:
    Description:to determine the effect of WT1-targeted dendritic cell vaccination on relapse rate in adult AML patients at very high risk of relapse and in complete remission.
    Measure:relapse-free survival
    Time Frame:At study completion, an average of 5 year
    Safety Issue:
    Description:to determine the effect of WT1-targeted dendritic cell vaccination on relapse-free survival in adult AML patients at very high risk of relapse and in complete remission.
    Measure:Change in WT1 mRNA levels in peripheral blood
    Time Frame:Through study completion, at every vaccination during 2 years
    Safety Issue:
    Description:Efficacy assessment will also be performed on a molecular level. To this end, peripheral blood samples will be obtained from participants in both study groups (vaccine group and control group) and analyzed by qRT-PCR for WT1 expression, which is a promising molecular biomarker in AML.
    Measure:Immune activation
    Time Frame:After the 4th DC vaccine
    Safety Issue:
    Description:This study aims to examine the presence of leukemia-specific immune responses in AML patients in remission and to investigate whether they can be induced or increased in these patients by WT1 mRNA-electroporated DC vaccination.
    Measure:General and disease-specific quality of life
    Time Frame:At study completion, an average of 5 year
    Safety Issue:
    Description:Patients will be asked to fill out general and disease-specific quality of life questionnaires to assess changes in general and disease-specific quality of life during the study at regular time points

    Details

    Phase:Phase 2
    Primary Purpose:Interventional
    Overall Status:Recruiting
    Lead Sponsor:Zwi Berneman

    Trial Keywords

    • in complete remission
    • Adult (>18 years) at very high risk of relapse

    Last Updated

    January 19, 2021