Clinical Trials /

Donor Natural Killer Cells and Donor Stem Cell Transplant in Treating Patients With High Risk Myeloid Malignancies

NCT01823198

Description:

This phase I/II trial studies the side effects and best dose of donor natural killer cells when given together with donor stem cell transplant and to see how well they work in treating patients with myeloid malignancies that are likely to come back or spread. Giving chemotherapy, such as busulfan and fludarabine phosphate, before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells and natural killer cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.

Related Conditions:
  • Acute Myeloid Leukemia
  • Chronic Myeloid Leukemia
  • Chronic Myelomonocytic Leukemia
  • Myelodysplastic Syndromes
Recruiting Status:

Active, not recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Donor Natural Killer Cells and Donor Stem Cell Transplant in Treating Patients With High Risk Myeloid Malignancies
  • Official Title: NK Cells With HLA Compatible Hematopoietic Transplantation for High Risk Myeloid Malignancies

Clinical Trial IDs

  • ORG STUDY ID: 2012-0819
  • SECONDARY ID: NCI-2013-00993
  • SECONDARY ID: RP110553-P3
  • SECONDARY ID: 2012-0819
  • NCT ID: NCT01823198

Conditions

  • Accelerated Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Acute Erythroid Leukemia
  • Acute Megakaryoblastic Leukemia
  • Acute Myeloid Leukemia
  • Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome
  • Acute Myeloid Leukemia in Remission
  • Blast Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Blasts Under 20 Percent of Bone Marrow Nucleated Cells
  • Blasts Under 20 Percent of Peripheral Blood White Cells
  • Chronic Myelomonocytic Leukemia
  • High Risk Myelodysplastic Syndrome
  • Myelodysplastic Syndrome
  • Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Therapy-Related Acute Myeloid Leukemia
  • Therapy-Related Myelodysplastic Syndrome

Interventions

DrugSynonymsArms
Aldesleukin125-L-Serine-2-133-interleukin 2, Proleukin, r-serHuIL-2, Recombinant Human IL-2, Recombinant Human Interleukin-2Treatment (NK cells, PBSC transplant)
Allogeneic CD56-positive CD3-negative Natural Killer CellsTreatment (NK cells, PBSC transplant)
Busulfan1, 4-Bis[methanesulfonoxy]butane, BUS, Bussulfam, Busulfanum, Busulfex, Busulphan, CB 2041, CB-2041, Glyzophrol, GT 41, GT-41, Joacamine, Methanesulfonic Acid Tetramethylene Ester, Methanesulfonic acid, tetramethylene ester, Mielucin, Misulban, Misulfan, Mitosan, Myeleukon, Myeloleukon, Myelosan, Mylecytan, Myleran, Sulfabutin, Tetramethylene Bis(methanesulfonate), Tetramethylene bis[methanesulfonate], WR-19508Treatment (NK cells, PBSC transplant)
Fludarabine Phosphate2-F-ara-AMP, 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-, Beneflur, Fludara, SH T 586Treatment (NK cells, PBSC transplant)

Purpose

This phase I/II trial studies the side effects and best dose of donor natural killer cells when given together with donor stem cell transplant and to see how well they work in treating patients with myeloid malignancies that are likely to come back or spread. Giving chemotherapy, such as busulfan and fludarabine phosphate, before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells and natural killer cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Assess the safety of infusing ex vivo expanded natural killer (NK) cells in patients
      receiving busulfan-fludarabine phosphate (fludarabine) with an allogeneic human leukocyte
      antigen (HLA) matched hematopoietic transplantation for myeloid malignancies. Two sources of
      NK cells could be studied, depending on what donor source is available: cells from the HLA
      matched related donor or cells from an unrelated cord blood unit.

      II. For each source of NK cells: the maximum tolerated cell dose; the phenotype and function
      of the ex vivo expanded NK cells and their survival in vivo; the rate of engraftment,
      graft-vs.-host disease (GVHD), immune reconstitution, relapse rates and survival for patients
      receiving this regimen will be determined.

      OUTLINE: This is a phase I, dose-escalation study of NK cells followed by a phase II study.

      Patients receive fludarabine phosphate intravenously (IV) over 1 hour and busulfan IV over 3
      hours on days -13 to -10. Patients then receive allogeneic CD56-positive CD3-negative natural
      killer cells IV over 1 hour on day -8. Patients also receive aldesleukin subcutaneously (SC)
      once daily (QD) on days -8 to -4. Patients then undergo allogeneic peripheral blood stem cell
      (PBSC) transplant on day 0.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (NK cells, PBSC transplant)ExperimentalPatients receive fludarabine phosphate IV over 1 hour and busulfan IV over 3 hours on days -13 to -10. Patients then receive allogeneic CD56-positive CD3-negative natural killer cells IV over 1 hour on day -8. Patients also receive aldesleukin SC QD on days -8 to -4. Patients then undergo allogeneic PBSC transplant on day 0.
  • Aldesleukin
  • Allogeneic CD56-positive CD3-negative Natural Killer Cells
  • Busulfan
  • Fludarabine Phosphate

Eligibility Criteria

        Inclusion Criteria:

          -  Acute myeloid leukemia who fail to achieve complete remission with one course of
             induction chemotherapy or after relapse; patients must have less than 20% bone marrow
             or peripheral blood blasts

          -  Acute myeloid leukemia in first remission with any of the following high risk features
             defined as:

               -  Adverse cytogenetics: -5, deletion (del) 5q, -7, del7q, abnormalities involving
                  3q, 9q, 11q, 20q, 21q, 17, +8 or complex karyotype (> 3 abnormalities)

               -  Preceding myelodysplastic or myeloproliferative syndrome

               -  Presence of high risk molecular abnormalities including FLT3 mutations, DNMT3A,
                  TET2; ras; kit

               -  French-American-British (FAB) monosomy (M)6 or M7 classification

               -  Treatment related acute myeloid leukemia (AML)

               -  Residual cytogenetic or molecular abnormalities

          -  Myelodysplastic syndromes with intermediate, high or very high risk Revised
             International Prognostic Scoring System (R-IPSS) score, chronic myelomonocytic
             leukemia (CMML) or therapy related myelodysplastic syndromes (MDS)

          -  Chronic myeloid leukemia (CML) which:

               -  Failed to achieve a cytogenetic remission to tyrosine kinase inhibitor treatment
                  or has a cytogenetic relapse

               -  Has ever been in accelerated phase or blast crisis

          -  Patient must have an identified HLA (A,B,C,DR) compatible related or unrelated donor
             who is age 16 years of age or older and weighs at least 110 pounds for the stem cell
             donation

          -  Zubrod performance status 0 to 2 or Karnofsky of at least 60

          -  Left ventricular ejection fraction >= 45%; no uncontrolled arrhythmias or uncontrolled
             symptomatic cardiac disease

          -  Forced expiratory volume in one second (FEV1) >= 50% of expected, corrected for
             hemoglobin

          -  Forced vital capacity (FVC) >= 50% of expected, corrected for hemoglobin

          -  Diffusing capacity of the lung for carbon monoxide (DLCO) >= 50% of expected,
             corrected for hemoglobin

          -  Bilirubin =< 1.5 mg/dl (unless Gilbert's syndrome)

          -  Serum glutamate pyruvate transaminase (SGPT) =< 200 IU/ml unless related to patient
             malignancy

          -  Hepatitis B surface antigen negative and hepatitis C antibody negative

          -  No evidence of chronic active hepatitis or cirrhosis

          -  Patients with a history of hepatitis C, but have a negative viral load, are eligible

          -  The protocol chairman will determine the eligibility of patients related to hepatic
             abnormalities

          -  Serum creatinine < 1.5 mg%

          -  Patient or patient's legal representative, parent(s) or guardian able to sign informed
             consent; patients aged 7 to < 18 to provide assent

          -  Pediatric patients (age 7-18 years) will be entered only after 3 adult patients have
             been entered without dose limiting toxicity

        Exclusion Criteria:

          -  Uncontrolled infection, not responding to appropriate antimicrobial agents after seven
             days of therapy; the protocol principal investigator (PI) is the final arbiter of
             eligibility

          -  Pleural/pericardial effusion or ascites > 1 L

          -  Patients who are known to be human immunodeficiency virus (HIV)-seropositive

          -  Pregnancy: positive pregnancy test in a woman with child bearing potential defined as
             not post-menopausal for 12 months or no previous surgical sterilization

          -  Women of child bearing potential not willing to use an effective contraceptive measure
             while on study

          -  Patients who are known to have allergy to mouse proteins
      
Maximum Eligible Age:65 Years
Minimum Eligible Age:7 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Optimal natural killer cell dose based on incidence of dose-limiting toxicity
Time Frame:Up to 42 days
Safety Issue:
Description:The Bayesian model averaging (BMA)-continual reassessment method (CRM) will be applied. The data will be analyzed by fitting the CRM model to the final data and summarizing the posterior distributions of the probability of overall toxicity and of each adverse event in the definition of toxicity at the maximum tolerated dose and at the other doses, by tabulating the counts and rates of all secondary events both overall and cross-tabulated with dose, and fitting appropriate logistic or ordinal outcome regression models to assess possible patterns of change with dose.

Secondary Outcome Measures

Measure:Overall survival time
Time Frame:Up to 5 years
Safety Issue:
Description:Will assess overall survival time.
Measure:Disease-free survival time
Time Frame:Up to 5 years
Safety Issue:
Description:Will assess disease-free survival time.
Measure:Incidence of graft versus host disease
Time Frame:Up to 5 years
Safety Issue:
Description:Will assess incidence of graft versus host disease.
Measure:Incidence of grade 3 toxicities
Time Frame:Up to 5 years
Safety Issue:
Description:It will be determined if any grade 3 toxicities occur in increased frequency compared to historical experience with this regime without natural killer cells.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

December 4, 2020