Clinical Trials /

Natural Killer Cells Before and After Donor Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia, Myelodysplastic Syndrome, or Chronic Myelogenous Leukemia

NCT01904136

Description:

This phase I/II studies the side effects and best dose of natural killer cells before and after donor stem cell transplant and to see how well they work in treating patients with acute myeloid leukemia, myelodysplastic syndrome, or chronic myelogenous leukemia. Giving chemotherapy with or without total body irradiation before a donor peripheral blood stem cell or bone marrow 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
  • Myelodysplastic Syndromes
Recruiting Status:

Active, not recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Natural Killer Cells Before and After Donor Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia, Myelodysplastic Syndrome, or Chronic Myelogenous Leukemia
  • Official Title: A Phase I/II Clinical Trial of NK Cells Administration to Prevent Disease Relapse for Patient With High-Risk Myeloid Malignancies Undergoing Haploidentical Stem-Cell Transplantation

Clinical Trial IDs

  • ORG STUDY ID: 2012-0708
  • SECONDARY ID: NCI-2013-02183
  • SECONDARY ID: P01 - 5P01
  • SECONDARY ID: RP110553 05-07-04832
  • SECONDARY ID: 05-07-04832
  • SECONDARY ID: 2012-0708
  • SECONDARY ID: P01CA049639
  • NCT ID: NCT01904136

Conditions

  • Accelerated Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome
  • Acute Myeloid Leukemia With Gene Mutations
  • Blast Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • de Novo Myelodysplastic Syndrome
  • Myelodysplastic Syndrome
  • Recurrent Acute Myeloid Leukemia
  • Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Therapy-Related Acute Myeloid Leukemia

Interventions

DrugSynonymsArms
Cyclophosphamide(-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Carloxan, Ciclofosfamida, Ciclofosfamide, Cicloxal, Clafen, Claphene, CP monohydrate, CTX, CYCLO-cell, Cycloblastin, Cycloblastine, Cyclophospham, Cyclophosphamid monohydrate, Cyclophosphamide Monohydrate, Cyclophosphamidum, Cyclophosphan, Cyclophosphane, Cyclophosphanum, Cyclostin, Cyclostine, Cytophosphan, Cytophosphane, Cytoxan, Fosfaseron, Genoxal, Genuxal, Ledoxina, Mitoxan, Neosar, Revimmune, Syklofosfamid, WR- 138719Treatment (NK cells, allogeneic stem cell transplant)
FludarabineFluradosaTreatment (NK cells, allogeneic stem cell transplant)
MelphalanAlanine Nitrogen Mustard, CB-3025, L-PAM, L-Phenylalanine Mustard, L-Sarcolysin, L-Sarcolysin Phenylalanine mustard, L-Sarcolysine, Melphalanum, Phenylalanine Mustard, Phenylalanine Nitrogen Mustard, Sarcoclorin, Sarkolysin, WR-19813Treatment (NK cells, allogeneic stem cell transplant)
Mycophenolate MofetilCellCept, MMFTreatment (NK cells, allogeneic stem cell transplant)
Natural Killer Cell TherapyTreatment (NK cells, allogeneic stem cell transplant)
TacrolimusFK 506, Fujimycin, Hecoria, Prograf, ProtopicTreatment (NK cells, allogeneic stem cell transplant)

Purpose

This phase I/II studies the side effects and best dose of natural killer cells before and after donor stem cell transplant and to see how well they work in treating patients with acute myeloid leukemia, myelodysplastic syndrome, or chronic myelogenous leukemia. Giving chemotherapy with or without total body irradiation before a donor peripheral blood stem cell or bone marrow 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 OBJECTIVE:

      I. To evaluate safety, tolerability and identify the maximum tolerated dose (MTD) of expanded
      natural killer (NK) cells to be used in patients with myeloid malignancies undergoing a
      haploidentical stem-cell transplant.

      SECONDARY OBJECTIVES:

      I. To determine survival of NK cells in vivo post-transplant. II. To determine the function
      of NK cells post-transplant and compare with a retrospective control treated with no NK
      cells.

      III. To estimate the proportion of patients with engraftment/graft failure. IV. To estimate
      the non-relapse mortality (NRM) at day 100 post-transplant. V. To estimate the cumulative
      incidence of grade III-IV aGVHD (acute graft-versus-host disease) at day 100.

      VI. To assess the rate of chronic graft-versus-host disease (GVHD) within the first year post
      transplantation.

      VII. To assess immune reconstitution post-transplant. VIII. To assess disease response,
      disease-free survival (DFS) and overall survival (OS) after transplantation.

      IX. To perform a retrospective comparison of patients treated on the study with NK cells will
      be performed with a Center for International Blood and Marrow Transplant Research (CIBMTR)
      control of similar patients who did not receive NK cells.

      OUTLINE: This is a phase I, dose-escalation study of NK cells followed by a phase II study.
      Patients are assigned to 1 of 2 conditioning regimens.

      MYELOABLATIVE CONDITIONING REGIMEN: Patients receive high-dose melphalan intravenously (IV)
      over 30 minutes on day -7, fludarabine IV over 1 hour on days -7 to -4, undergo total-body
      irradiation (TBI) on day -3, and NK cells IV over 30 minutes on day -2 or -1.

      NON-MYELOABLATIVE CONDITIONING REGIMEN: Patients receive melphalan IV over 30 minutes on day
      -7, fludarabine IV over 1 hour on days -7 to -4, undergo TBI on day -3, and receive NK cells
      IV over 30 minutes on day -2 or -1.

      TRANSPLANT: Patients undergo allogeneic peripheral blood stem cell (PBSC) or bone marrow
      transplant on day 0.

      POST-TRANSPLANT CYCLOPHOSPHAMIDE AND GVHD PROPHYLAXIS: Patients receive cyclophosphamide IV
      over 3 hours on days 3 and 4, tacrolimus IV beginning on day 5 for 2 weeks and then orally
      (PO) for approximately 4 months, and mycophenolate mofetil PO thrice daily (TID) beginning on
      day 5 for approximately 6-7 months.

      NK CELLS: Patients receive NK cells IV over 30 minutes on days 7 and 28-90.

      After completion of study treatment, patients are followed up for 2 years.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (NK cells, allogeneic stem cell transplant)ExperimentalMYELOABLATIVE CONDITIONING REGIMEN: Patients receive high-dose melphalan IV over 30 minutes on day -7, fludarabine IV over 1 hour on days -7 to -4, undergo TBI on day -3, and NK cells IV over 30 minutes on day -2 or -1. NON-MYELOABLATIVE CONDITIONING REGIMEN: Patients receive melphalan IV over 30 minutes on day -7, fludarabine IV over 1 hour on days -7 to -4, undergo TBI on day -3, and receive NK cells IV over 30 minutes on day -2 or -1. TRANSPLANT: Patients undergo allogeneic PBSC or bone marrow transplant on day 0. POST-TRANSPLANT CYCLOPHOSPHAMIDE AND GVHD PROPHYLAXIS: Patients receive cyclophosphamide IV over 3 hours on days 3 and 4, tacrolimus IV beginning on day 5 for 2 weeks and then PO for approximately 4 months, and mycophenolate mofetil PO TID beginning on day 5 for approximately 6-7 months. NK CELLS: Patients receive NK cells IV over 30 minutes on days 7 and 28-90.
  • Cyclophosphamide
  • Fludarabine
  • Melphalan
  • Mycophenolate Mofetil
  • Natural Killer Cell Therapy
  • Tacrolimus

Eligibility Criteria

        Inclusion Criteria:

          -  Eligibility for pediatric patients will be determined in conjunction with an MD
             Anderson Cancer Center (MDACC) pediatrician; patients age 2-17 years old may be
             enrolled after at least 4 adults (ages 18-65 years old) have been treated without
             toxicity

          -  Patient with no matched related donor who has a related haploidentical donor
             identified (=< 7/8 allele match at the A, B, C, DR loci) who is willing to undergo a
             bone marrow harvest and an NK cell collection approximately 2 weeks of the recipient's
             admission for transplant; the donor must be 16 years of age or older and weigh at
             least 110 pounds

          -  Patients with one of the following diseases: acute myeloid leukemia (AML): a. first
             complete remission with high-risk features defined as: (i) greater than 1 cycle of
             induction therapy required to achieve remission; (ii) preceding myelodysplastic
             syndrome (MDS); (iii) presence of FLT3 mutations or internal tandem duplication or
             other mutations associated with poor-risk AML (e.g. DNMT3A, TET2); (iv)
             French-American-British Classification (FAB) M6 or M7 classification; (v) adverse
             cytogenetics: -5, deletion (del) 5q, -7, del7q, abnormalities involving 3q, 9q, 11q,
             20q, 21q, 17, +8 or complex karyotype (> 3 abnormalities); (vi) treatment-related AML,
             or b. second or greater remission; patients beyond second remission have to be in
             complete remission (CR) at transplant to be eligible, or c. primary induction failure
             with partial response to therapy who achieve adequate cytoreduction

          -  Patients with myelodysplastic syndromes (MDS): a. de novo MDS with intermediate or
             high-risk International Prognostic Scoring System (IPSS) scores; patients with
             intermediate-1 features should have failed to respond to hypomethylating agent
             therapy, or b. patients with treatment-related MDS

          -  Chronic myeloid leukemia (CML): a. failed to achieve cytogenetic remission or have
             cytogenetic relapse after treatment with at least 2 tyrosine kinase inhibitors, or b.
             accelerated phase or blast phase at any time

          -  Performance score of at least 70% by Karnofsky or 0 to 1 by Eastern Cooperative
             Oncology Group (ECOG) (age >= 12 years), or Lansky Play-performance scale of at least
             70% or greater (age < 12 years)

          -  Serum creatinine clearance equal or more than 50 ml/min (calculated with
             Cockcroft-Gault formula)

          -  Bilirubin equal or less than 1.5 mg/dl except for Gilbert's disease

          -  Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) equal or less than
             200 IU/ml for adults

          -  Conjugated (direct) bilirubin less than 2 x upper limit of normal

          -  Left ventricular ejection fraction equal or greater than 40%

          -  Diffusing capacity of the lung for carbon monoxide (DLCO) equal or greater than 50%
             predicted corrected for hemoglobin; for children =< 7 years of age who are unable to
             perform pulmonary function tests (PFT), oxygen saturation >= 92% on room air by pulse
             oximetry

          -  Patient or patient's legal representative, parent(s) or guardian should provide
             written informed consent; assent of a minor if participant's age is at least seven and
             less than eighteen years

        Exclusion Criteria:

          -  Human immunodeficiency virus (HIV) positive; active hepatitis B or C

          -  Uncontrolled infections; principal investigator (PI) is the final arbiter of this
             criterion

          -  Liver cirrhosis

          -  Central nervous system (CNS) involvement within 3 months

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

          -  Inability to comply with medical therapy or follow-up
      
Maximum Eligible Age:65 Years
Minimum Eligible Age:2 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated doses (MTD) of natural killer (NK) cells
Time Frame:Up to day 70 post-transplant
Safety Issue:
Description:Will be defined by incidence of dose limiting toxicity including death, grade 3-4 toxicities, graft failure, or grade 3-4 graft versus host disease (GVHD). Dose-finding will be carried out using the time-to-event continual reassessment method of Cheung and Chappell. All adverse events will be tabulated by dose, and the fitted dose-toxicity curve will be summarized.

Secondary Outcome Measures

Measure:100-day treatment related mortality
Time Frame:Up to 100 days post-transplant
Safety Issue:
Description:Will be defined as death due to any cause without disease recurrence within 100 days post stem cell transplant (SCT). The method of Thall and Sung will be used, based on an historical rate of 35%.
Measure:Overall survival
Time Frame:Up to 2 years
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method, and distributions will be compared using log-rank tests.
Measure:Relapse-free survival
Time Frame:Up to 2 years
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method, and distributions will be compared using log-rank tests.
Measure:Time to engraftment
Time Frame:Up to 2 years
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method, and distributions will be compared using log-rank tests.
Measure:Time to graft failure
Time Frame:Up to 2 years
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method, and distributions will be compared using log-rank tests.

Details

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

Last Updated

February 10, 2021