Description:
This study seeks to examine treatment therapy that will reduced regimen-related toxicity and
relapse while promoting rapid immune reconstitution with limited serious
graft-versus-host-disease (GVHD) and also improve disease-free survival and quality of life.
The investigators propose to evaluate the safety and efficacy of selective naive T-cell
depleted (by TCRɑβ and CD45RA depletion, respectively) haploidentical hematopoietic cell
transplant (HCT) following reduced intensity conditioning regimen that avoids radiation in
patients with hematologic malignancies that have relapsed or are refractory following prior
allogeneic transplantation.
PRIMARY OBJECTIVE:
- To estimate engraftment by day +30 post-transplant in patients who receive
TCRɑβ-depleted and CD45RA-depleted haploidentical donor progenitor cell transplantation
following reduced intensity conditioning regimen without radiation.
SECONDARY OBJECTIVES:
- Assess the safety and feasibility of the addition of Blinatumomab in the early
post-engraftment period in patients with CD19+ malignancy.
- Estimate the incidence of malignant relapse, event-free survival, and overall survival
at one-year post-transplantation.
- Estimate incidence and severity of acute and chronic (GVHD).
- Estimate the rate of transplant related mortality (TRM) in the first 100 days after
transplantation.
Title
- Brief Title: Provision of TCRγδ T Cells and Memory T Cells Plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory Despite Prior Transplantation
- Official Title: Provision of TCRγδ T Cells and Memory T Cells Plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory Despite Prior Transplantation
Clinical Trial IDs
- ORG STUDY ID:
REF2HCT
- SECONDARY ID:
NCI-2016-00812
- NCT ID:
NCT02790515
Conditions
- Acute Lymphoblastic Leukemia (ALL)
- Acute Myeloid Leukemia (AML)
- Myeloid Sarcoma
- Chronic Myeloid Leukemia (CML)
- Juvenile Myelomonocytic Leukemia (JMML)
- Myelodysplastic Syndrome (MDS)
- Non-Hodgkin Lymphoma (NHL)
Interventions
Drug | Synonyms | Arms |
---|
Anti-thymocyte globulin (rabbit) | Thymoglobulin®, rabbit ATG | Treatment |
Blinatumomab | Blincyto | Treatment |
Cyclophosphamide | Cytoxan | Treatment |
Fludarabine | Fludara | Treatment |
G-CSF | Filgrastim, Neupogen® | Treatment |
Melphalan | L-phenylalanine mustard, Phenylalanine mustard, L-PAM, L-sarcolysin, Alkeran | Treatment |
Mesna | Mesnex | Treatment |
Rituximab | Rituxan™ | Treatment |
Tacrolimus | FK506, Prograf®, Protopic® | Treatment |
Thiotepa | Thioplex® by Immunex, TESPA, TSPA | Treatment |
HPC,A Infusion | Transplant | Treatment |
Sirolimus | Rapamycin, Rapamune® | Treatment |
Purpose
This study seeks to examine treatment therapy that will reduced regimen-related toxicity and
relapse while promoting rapid immune reconstitution with limited serious
graft-versus-host-disease (GVHD) and also improve disease-free survival and quality of life.
The investigators propose to evaluate the safety and efficacy of selective naive T-cell
depleted (by TCRɑβ and CD45RA depletion, respectively) haploidentical hematopoietic cell
transplant (HCT) following reduced intensity conditioning regimen that avoids radiation in
patients with hematologic malignancies that have relapsed or are refractory following prior
allogeneic transplantation.
PRIMARY OBJECTIVE:
- To estimate engraftment by day +30 post-transplant in patients who receive
TCRɑβ-depleted and CD45RA-depleted haploidentical donor progenitor cell transplantation
following reduced intensity conditioning regimen without radiation.
SECONDARY OBJECTIVES:
- Assess the safety and feasibility of the addition of Blinatumomab in the early
post-engraftment period in patients with CD19+ malignancy.
- Estimate the incidence of malignant relapse, event-free survival, and overall survival
at one-year post-transplantation.
- Estimate incidence and severity of acute and chronic (GVHD).
- Estimate the rate of transplant related mortality (TRM) in the first 100 days after
transplantation.
Detailed Description
Blood progenitor cells will be obtained from a partially matched adult family member (donor).
After processing and filtration using the CliniMACS device, cells will be infused into
participants meeting eligibility criteria.
Prior to transplant, participants will receive a conditioning treatment of rabbit ATG,
cyclophosphamide, fludarabine, thiotepa, melphalan, and rituximab. Mesna will be given to
help prevent side effects of cyclophosphamide. Tacrolimus will be given to help reduce the
risk of GVHD. G-CSF will be given after transplant to help the donor progenitor cells make
white blood cells faster so that the immune system is better able to fight infection.
Blood progenitor cells will be given in two infusions on Day 0 and Day +1. Progenitor cells
then move through the blood stream to the bone marrow space where they should begin to grow.
Participant blood will be monitored for 100 days to assure that the progenitor cells begin to
grow. If the growth is low, additional progenitor cells may be given.
Blood tests will be monitored for up to one year to observe how well the donor cells grow and
their effect on the infection-fighting system.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment | Experimental | Participants receive a conditioning regimen of antithymocyte globulin (rabbit), cyclophosphamide, mesna, fludarabine, thiotepa, tacrolimus (first 5 participants enrolled), sirolimus (used beginning with 6th enrolled participant), melphalan, rituximab. This is followed by HPC,A infusion (transplant), then by G-CSF and blinatumomab.
Cells for infusion are prepared using the CliniMACS System. | - Anti-thymocyte globulin (rabbit)
- Blinatumomab
- Cyclophosphamide
- Fludarabine
- G-CSF
- Melphalan
- Mesna
- Rituximab
- Tacrolimus
- Thiotepa
- HPC,A Infusion
- Sirolimus
|
Eligibility Criteria
Inclusion Criteria for Transplant Recipient:
- Age less than or equal to 21 years.
- Any of the following hematologic malignancies that has relapsed or remains refractory
after prior allogeneic HCT (this includes any stage of disease - such as refractory
due to induction failure, refractory in relapse, or in any CR - as long as the
hematologic malignancy remained persistent or returned after a previous allogeneic
HCT):
- ALL, AML, Myeloid Sarcoma, CML, Juvenile myelomonocytic leukemia (JMML),
myelodysplastic syndrome (MDS), non-Hodgkin lymphoma (NHL)
- Has a suitable single haplotype matched (≥ 3 of 6) family member donor.
- Does not have any other active malignancy other than the one for which this transplant
is indicated.
- If prior CNS leukemia, it must be treated and in CNS CR
- Does not have current uncontrolled bacterial, fungal, or viral infection.
- There is no minimum time from the previous transplant, but patients must meet the
following criteria:
- Left ventricular ejection fraction > 40%, or shortening fraction ≥ 25%.
- Creatinine clearance (CrCl) or glomerular filtration rate (GFR) ≥ 50
ml/min/1.73m2.
- Forced vital capacity (FVC) ≥ 40% of predicted value; or pulse oximetry ≥ 92% on
room air if patient is unable to perform pulmonary function testing.
- Karnofsky or Lansky (age-dependent) performance score ≥ 50 (See Appendix A).
- Bilirubin ≤ 3 times the upper limit of normal for age.
- Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 5 times the
upper limit of normal for age.
- Not pregnant. If female with child bearing potential, must be confirmed by
negative serum or urine pregnancy test within 14 days prior to enrollment.
- Not breast feeding
Inclusion Criteria for Haploidentical Donor:
- At least single haplotype matched (≥ 3 of 6) family member
- At least 18 years of age.
- HIV negative.
- Not pregnant as confirmed by negative serum or urine pregnancy test within 14 days
prior to enrollment (if female).
- Not breast feeding.
- Regarding donation eligibility, is identified as either:
- Completed the process of donor eligibility determination as outlined in 21 CFR
1271 and agency guidance; OR
- Does not meet 21 CFR 1271 eligibility requirements, but has a declaration of
urgent medical need completed by the principal investigator or physician
sub-investigator per 21 CFR 1271.
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | The number of patients engrafted by day +30 post-transplant |
Time Frame: | 30 days post-transplant |
Safety Issue: | |
Description: | ANC engraftment is defined as the first of 3 consecutive tests performed on different days of an ANC ≥ 500/mm^3 with evidence of donor cell engraftment. |
Secondary Outcome Measures
Measure: | The number of patients experiencing Blinatumomab permanent discontinuation due to toxicity |
Time Frame: | 3 months post-transplant |
Safety Issue: | |
Description: | If the drug is held for more than 2 weeks due to toxicity, it will be permanently discontinued. |
Measure: | The estimate of cumulative incidence of relapse |
Time Frame: | One year post-transplant |
Safety Issue: | |
Description: | The estimate of cumulative incidence of relapse will be estimated using Kalbfleisch-Prentice method. Death is the competing risk event. The Kaplan-Meier estimates of overall survival (OS) and event-free survival (EFS) along with their standard errors will be calculated.
OS is defined as time from transplantation to death or last follow-up, whichever comes first. EFS is defined as time from transplantation to events including relapse, graft failure, death due to any cause and last follow-up whichever comes first. The participants surviving at the time of analysis without events will be censored. |
Measure: | The cumulative incidence of acute and chronic Graft-Versus-Host Disease (GVHD) |
Time Frame: | One year post transplant |
Safety Issue: | |
Description: | The cumulative incidence of acute and chronic GVHD will be estimated using Kalbfleisch-Prentice method. Death is the competing risk event. GVHD will be reported separately for participants receiving tacrolimus and those receiving sirolimus.
The severity of acute GVHD and chronic GVHD will be described. |
Measure: | The cumulative incidence of transplant related mortality |
Time Frame: | 100 days post transplant |
Safety Issue: | |
Description: | The cumulative incidence of transplant related mortality will be estimated using Kalbfleisch-Prentice method. Deaths before day 100 because of other reasons are the competing risk events. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | St. Jude Children's Research Hospital |
Last Updated
January 27, 2021