Clinical Trials /

Personalized NK Cell Therapy After Chemotherapy and Cord Blood Transplant in Treating Patients With Myelodysplastic Syndrome, Leukemia, Lymphoma or Multiple Myeloma

NCT02727803

Description:

This phase II clinical trial studies how well personalized natural killer (NK) cell therapy works after chemotherapy and umbilical cord blood transplant in treating patients with myelodysplastic syndrome, leukemia, lymphoma or multiple myeloma. This clinical trial will test cord blood (CB) selection for human leukocyte antigen (HLA)-C1/x recipients based on HLA-killer-cell immunoglobulin-like receptor (KIR) typing, and adoptive therapy with CB-derived NK cells for HLA-C2/C2 patients. Natural killer cells may kill tumor cells that remain in the body after chemotherapy treatment and lessen the risk of graft versus host disease after cord blood transplant.

Related Conditions:
  • Acute Biphenotypic Leukemia
  • Acute Lymphoblastic Leukemia
  • Acute Myeloid Leukemia
  • Acute Myeloid Leukemia Arising from Previous Myelodysplastic Syndrome
  • Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
  • Chronic Myeloid Leukemia
  • Chronic Myelomonocytic Leukemia
  • Double-Hit Lymphoma
  • Hodgkin Lymphoma
  • Multiple Myeloma
  • Myelodysplastic Syndromes
  • Myelodysplastic/Myeloproliferative Neoplasm
  • Non-Hodgkin Lymphoma
  • Refractory Anemia with Excess Blasts
  • Therapy-Related Acute Myeloid Leukemia
  • Therapy-Related Myelodysplastic Syndrome
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Personalized NK Cell Therapy After Chemotherapy and Cord Blood Transplant in Treating Patients With Myelodysplastic Syndrome, Leukemia, Lymphoma or Multiple Myeloma
  • Official Title: Personalized NK Cell Therapy in Cord Blood Transplantation

Clinical Trial IDs

  • ORG STUDY ID: 2015-0313
  • SECONDARY ID: NCI-2016-00584
  • SECONDARY ID: 2015-0313
  • SECONDARY ID: P30CA016672
  • SECONDARY ID: R01CA211044
  • NCT ID: NCT02727803

Conditions

  • Accelerated Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Acute Biphenotypic Leukemia
  • Acute Lymphoblastic Leukemia
  • Acute Lymphoblastic Leukemia in Remission
  • Acute Myeloid Leukemia With Myelodysplasia-Related Changes
  • Acute Myeloid Leukemia With Variant MLL Translocations
  • B Acute Lymphoblastic Leukemia With t(9;22)(q34.1;q11.2); BCR-ABL1
  • Chemotherapy-Related Leukemia
  • Chronic Myelomonocytic Leukemia
  • Chronic Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements
  • ISS Stage II Plasma Cell Myeloma
  • ISS Stage III Plasma Cell Myeloma
  • Myelodysplastic Syndrome
  • Myelodysplastic Syndrome With Excess Blasts
  • Myelodysplastic Syndrome With Gene Mutation
  • Myelodysplastic/Myeloproliferative Neoplasm
  • Previously Treated Myelodysplastic Syndrome
  • Recurrent Acute Myeloid Leukemia
  • Recurrent Adult Acute Myeloid Leukemia
  • Recurrent Hodgkin Lymphoma
  • Recurrent Non-Hodgkin Lymphoma
  • Refractory Acute Lymphoblastic Leukemia
  • Refractory Adult Acute Lymphoblastic Leukemia
  • Secondary Acute Myeloid Leukemia
  • Therapy-Related Myelodysplastic Syndrome

Interventions

DrugSynonymsArms
Allogeneic Natural Killer Cell Line NK-92haNK, NK-92, NK-92 CellsMyeloablative regimen 1
Anti-Thymocyte GlobulinAntithymocyte Globulin, Antithymocyte Serum, ATG, ATSMyeloablative regimen 1
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-19508Myeloablative regimen 1
ClofarabineClofarex, ClolarMyeloablative regimen 1
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, Cyclophosphamidum, Cyclophosphan, Cyclophosphane, Cyclophosphanum, Cyclostin, Cyclostine, Cytophosphan, Cytophosphane, Cytoxan, Fosfaseron, Genoxal, Genuxal, Ledoxina, Mitoxan, Neosar, Revimmune, Syklofosfamid, WR- 138719Non-myeloablative regimen 2
Fludarabine Phosphate2-F-ara-AMP, 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-, Beneflur, Fludara, SH T 586Myeloablative regimen 1
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-19813Reduced intensity regimen 3
RituximabABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, rituximab biosimilar TQB2303, rituximab-abbs, RTXM83, TruximaNon-myeloablative regimen 2

Purpose

This phase II clinical trial studies how well personalized natural killer (NK) cell therapy works after chemotherapy and umbilical cord blood transplant in treating patients with myelodysplastic syndrome, leukemia, lymphoma or multiple myeloma. This clinical trial will test cord blood (CB) selection for human leukocyte antigen (HLA)-C1/x recipients based on HLA-killer-cell immunoglobulin-like receptor (KIR) typing, and adoptive therapy with CB-derived NK cells for HLA-C2/C2 patients. Natural killer cells may kill tumor cells that remain in the body after chemotherapy treatment and lessen the risk of graft versus host disease after cord blood transplant.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Progression-free survival (PFS) time.

      SECONDARY OBJECTIVES:

      I. Overall survival (OS) time. II. Transplant related mortality (TRM). III. Graft versus host
      disease (GVHD). IV. Infection

      OUTLINE: Patients are assigned to 1 of 3 preparative regimens.

      MYELOABLATIVE REGIMEN 1: Patients receive anti-thymocyte globulin intravenously (IV) over 4
      hours on days -9 and -8, fludarabine phosphate IV over 1 hour, clofarabine IV over 1 hour,
      and busulfan IV over 3 hours on days -7 to -4. Patients undergo total body irradiation (TBI)
      on day -3.

      NON-MYELOABLATIVE REGIMEN 2: Patients with cluster of differentiation (CD)20 positive
      malignancies receive rituximab IV over 6 hours on day -9. Patients receive anti-thymocyte
      globulin IV over 4 hours on days -8 and -7, fludarabine phosphate IV over 1 hour on days -6
      to -3, and cyclophosphamide IV over 3 hours on day -6 and undergo TBI on day -1 at the
      discretion of the investigator(s).

      REDUCED INTENSITY REGIMEN 3: Patients receive anti-thymocyte globulin IV over 4 hours on days
      -7 and -6, fludarabine phosphate IV over 1 hour on days -5 to -2, and melphalan IV over 30
      minutes on day -2.

      UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo umbilical cord blood transplantation on day
      0.

      NK CELLS INFUSION: Patients receive NK cells IV over 30 minutes between days 30-180.

      After completion of study treatment, patients are followed up at 1, 7, 14, 28, 45, 60, and
      100 days, and at 6, 9, and 12 months, and then yearly for up to 4 years.
    

Trial Arms

NameTypeDescriptionInterventions
Myeloablative regimen 1ExperimentalPatients receive anti-thymocyte globulin IV over 4 hours on days -9 and -8, fludarabine phosphate IV over 1 hour, clofarabine IV over 1 hour, and busulfan IV over 3 hours on days -7 to -4. Patients undergo TBI on day -3. UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo umbilical cord blood transplantation on day 0. NK CELLS INFUSION: Patients receive NK cells IV over 30 minutes between days 30-180.
  • Allogeneic Natural Killer Cell Line NK-92
  • Anti-Thymocyte Globulin
  • Busulfan
  • Clofarabine
  • Fludarabine Phosphate
Non-myeloablative regimen 2ExperimentalPatients with CD20 positive malignancies receive rituximab IV over 6 hours on day -9. Patients receive anti-thymocyte globulin IV over 4 hours on days -8 and -7, fludarabine phosphate IV over 1 hour on days -6 to -3, and cyclophosphamide IV over 3 hours on day -6 and undergo TBI on day -1 at the discretion of the investigator(s). UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo umbilical cord blood transplantation on day 0. NK CELLS INFUSION: Patients receive NK cells IV over 30 minutes between days 30-180.
  • Allogeneic Natural Killer Cell Line NK-92
  • Anti-Thymocyte Globulin
  • Cyclophosphamide
  • Fludarabine Phosphate
  • Rituximab
Reduced intensity regimen 3ExperimentalPatients receive anti-thymocyte globulin IV over 4 hours on days -7 and -6, fludarabine phosphate IV over 1 hour on days -5 to -2, and melphalan IV over 30 minutes on day -2. UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo umbilical cord blood transplantation on day 0. NK CELLS INFUSION: Patients receive NK cells IV over 30 minutes between days 30-180.
  • Allogeneic Natural Killer Cell Line NK-92
  • Anti-Thymocyte Globulin
  • Fludarabine Phosphate
  • Melphalan

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must have one of the following hematologic malignancies: acute myelogenous
             leukemia (AML), induction failure, high-risk for relapse first remission (with
             intermediate-risk or high-risk cytogenetics including complex karyotype, abnormal
             [abn][3q], -5/5q-, -7/7q-, abn[12p], abn[17p], myeloid/lymphoid or mixed-lineage
             leukemia [MLL] gene re-arrangement and t [6;9]47, fms related tyrosine kinase 3 [flt3]
             mutation positive and/or evidence of minimal residual disease by flow cytometry),
             secondary leukemia from prior chemotherapy and/or arising from myelodysplastic
             syndromes (MDS), any disease beyond first remission

          -  Myelodysplastic syndrome (MDS): Primary or therapy related, including patients that
             will be considered for transplant; these include any of the following categories: 1)
             revised International Prognostic Scoring System (IPSS) intermediate and high risk
             groups, 2) malondialdehyde (MDA) with transfusion dependency, 3) failure to respond or
             progression of disease on hypomethylating agents, 4) refractory anemia with excess of
             blasts, 5) transformation to acute leukemia, 6) chronic myelomonocytic leukemia, 7)
             atypical MDS/myeloproliferative syndromes, 8) complex karyotype, abn(3g), -5/5g-,
             -7/7g-, abn(12p), abn(17p)

          -  Acute lymphoblastic leukemia (ALL): Induction failure, primary refractory to treatment
             (do not achieve complete remission after first course of therapy) or are beyond first
             remission including second or greater remission or active disease; patients in first
             remission are eligible if they are considered high risk, defined as any of the
             following detected at any time: with translocations 9;22 or 4;11, hypodiploidy,
             complex karyotype, secondary leukemia developing after cytotoxic drug exposure, and/or
             evidence of minimal residual disease or acute biphenotypic leukemia, or double hit
             non-Hodgkin's lymphoma

          -  Non-Hodgkin's lymphoma (NHL) in second or third complete remission, or relapse
             (including relapse post autologous hematopoietic stem cell transplant); relapsed
             double hit lymphomas; patients with options for treatment that are known to be
             curative are not eligible

          -  Small lymphocytic lymphoma (SLL), or chronic lymphocytic leukemia (CLL) with
             progressive disease following a minimum of two lines of standard therapy

          -  Chronic myeloid leukemia (CML) second chronic phase or accelerated phase

          -  Hodgkin's disease (HD): Induction failures, after first complete remission, or relapse
             (including relapse post autologous hematopoietic stem cell transplant), or those with
             active disease

          -  Multiple myeloma: stage II or III, symptomatic, secretory multiple myeloma requiring
             treatment

          -  A person (such as a haploidentical family member) or unit of cord blood must be
             identified as a source of back-up cells source in case of engraftment failure

          -  Patient age criteria: age >= 15 and =< 45 years (myeloablative regimen 1; age >= 15
             and =< 80 years (nonmyeloablative regimen 2) at the discretion of the investigator(s);
             age >= 15 and =< 80 years old that in the opinion of the investigator(s) would
             preclude myeloablative therapy may receive reduced intensity regimen 3

          -  Performance score of at least 60% by Karnofsky

          -  Left ventricular ejection fraction of at least 40% (myeloablative regimen 1, reduced
             intensity regimen 3)

          -  Left ventricular ejection fraction of at least 30% (nonmyeloablative regimen 2)

          -  Pulmonary function test (PFT) demonstrating an adjusted diffusion capacity of least
             50% predicted value for hemoglobin concentration (myeloablative regimen 1, reduced
             intensity regimen 3)

          -  Serum creatinine within normal range, or if serum creatinine outside normal range,
             then renal function (measured or estimated creatinine clearance or glomerular
             filtration rate [GFR]) > 40mL/min/1.73 m^2

          -  Serum glutamate pyruvate transaminase (SGPT)/bilirubin < to 2.0 x normal
             (myeloablative regimen 1), reduced intensity regimen 3; SGPT/bilirubin < to 4.0 x
             normal (nonmyeloablative regimen 2)

          -  Negative beta human chorionic gonadotropin (HCG) test in a woman with child bearing
             potential defined as not post-menopausal for 12 months

          -  Patients with options for treatment that are known to be curative are not eligible

          -  Patients enrolled in this study may be enrolled on other supportive care
             investigational new drug (IND) studies at the discretion of the principal investigator
             (PI)

        Exclusion Criteria:

          -  Human immunodeficiency virus (HIV) positive; HIV results will be determined by nucleic
             acid testing

          -  Uncontrolled serious medical condition such as persistent septicemia despite adequate
             antibiotic therapy, decompensated congestive heart failure despite cardiac medications
             or pulmonary insufficiency requiring intubation (excluding primary disease for which
             cord blood [CB] transplantation is proposed), or psychiatric condition that would
             limit informed consent

          -  Active central nervous system (CNS) disease in patient with history of CNS malignancy

          -  Availability of appropriate, willing, human leukocyte antigen (HLA)-matched related
             stem cell donor
      
Maximum Eligible Age:80 Years
Minimum Eligible Age:15 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression free survival (PFS) time in C2C2 patients
Time Frame:From the date of engraftment to disease progression or death, assessed up to 4 years
Safety Issue:
Description:Distributions of time-to-event variables will be estimated using the method of Kaplan and Meier, and Bayesian regression models will be used to assess the relationship of each outcome with patient covariates, including disease stage, KIR haplotype, age, diagnosis, human leukocyte antigen (HLA) match, cytomegalovirus (CMV) status, and gender. Categorical outcomes will be evaluated by tabulation and Bayesian regression modeling.

Secondary Outcome Measures

Measure:Overall survival time
Time Frame:Up to 4 years
Safety Issue:
Description:Distributions of time-to-event variables will be estimated using the method of Kaplan and Meier, and Bayesian regression models will be used to assess the relationship of each outcome with patient covariates, including disease stage, KIR haplotype, age, diagnosis, HLA match, CMV status, and gender. Categorical outcomes will be evaluated by tabulation and Bayesian regression modeling.
Measure:Incidence of transplant related mortality
Time Frame:Up to 4 years
Safety Issue:
Description:Bayesian regression models will be used to assess the relationship of each outcome with patient covariates, including disease stage, KIR haplotype, age, diagnosis, HLA match, CMV status, and gender. Categorical outcomes will be evaluated by tabulation and Bayesian regression modeling.
Measure:Incidence of graft-versus host disease
Time Frame:Up to 4 years
Safety Issue:
Description:Bayesian regression models will be used to assess the relationship of each outcome with patient covariates, including disease stage, KIR haplotype, age, diagnosis, HLA match, CMV status, and gender. Categorical outcomes will be evaluated by tabulation and Bayesian regression modeling.
Measure:Incidence of infection
Time Frame:Up to 4 years
Safety Issue:
Description:Bayesian regression models will be used to assess the relationship of each outcome with patient covariates, including disease stage, KIR haplotype, age, diagnosis, HLA match, CMV status, and gender. Categorical outcomes will be evaluated by tabulation and Bayesian regression modeling.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

August 7, 2020