Description:
Donor Lymphocyte Infusion (DLI) following salvage chemotherapy is the one of the most widely
used treatment approaches in patients who relapse after allogeneic hematopoietic cell
transplant (allo-HCT). However, the complete remission (CR) rates and long term survival
remain very poor in these patients and, therefore, there is an unmet need to develop more
effective treatment approaches in patients who relapse after allo-HCT.
Based on the initial promising results with our ongoing cytokine-induced memory-like (CIML)
natural killer (NK) cell trial, the investigators hypothesize that combining the CIML NK
cells with DLI approach will significantly enhance the graft versus leukemia and therefore
potentially provide potentially curative therapy for these patients with otherwise extremely
poor prognosis. Combining CIML NK cells with the DLI platform will also potentially allow
these adoptively transferred cells to persist for longer duration as they should not be
rejected by donor T cells as the CIML NK cells are derived from the same donor. The use of
CIML NK cells is unlikely to lead to excessive graft versus host disease (GVHD) as previous
studies have not been associated with excessive GVHD rates.
Title
- Brief Title: Cytokine Induced Memory-like NK Cell Adoptive Therapy for Relapsed AML After Allogeneic Hematopoietic Cell Transplant
- Official Title: Cytokine Induced Memory-like NK Cell Adoptive Therapy for Relapsed AML After Allogeneic Hematopoietic Cell Transplant in Children and Adults
Clinical Trial IDs
- ORG STUDY ID:
201709041
- NCT ID:
NCT03068819
Conditions
- Acute Myeloid Leukemia in Children
Interventions
Drug | Synonyms | Arms |
---|
CIML NK Cell Infusion | | CIML NK cell after T cell DLT (Phase 2 Adult Cohort) |
Purpose
Donor Lymphocyte Infusion (DLI) following salvage chemotherapy is the one of the most widely
used treatment approaches in patients who relapse after allogeneic hematopoietic cell
transplant (allo-HCT). However, the complete remission (CR) rates and long term survival
remain very poor in these patients and, therefore, there is an unmet need to develop more
effective treatment approaches in patients who relapse after allo-HCT.
Based on the initial promising results with our ongoing cytokine-induced memory-like (CIML)
natural killer (NK) cell trial, the investigators hypothesize that combining the CIML NK
cells with DLI approach will significantly enhance the graft versus leukemia and therefore
potentially provide potentially curative therapy for these patients with otherwise extremely
poor prognosis. Combining CIML NK cells with the DLI platform will also potentially allow
these adoptively transferred cells to persist for longer duration as they should not be
rejected by donor T cells as the CIML NK cells are derived from the same donor. The use of
CIML NK cells is unlikely to lead to excessive graft versus host disease (GVHD) as previous
studies have not been associated with excessive GVHD rates.
Trial Arms
Name | Type | Description | Interventions |
---|
CIML NK cell after T cell DLT (Pilot Pediatric/Young Adult Cohort) | Experimental | The recipient will receive standard of care salvage chemotherapy consisting of fludarabine, cytarabine, and G-CSF (FLAG) (or decitabine as an acceptable alternative) to be started 2 to 4 weeks prior to the CIML NK cell infusion, with Day -1 the day of T cell DLI, and Day 0 denoting the CIML NK cell infusion day. The donor will undergo non-mobilized large volume (20L) leukapheresis on Day -2 or -1, anticipating processing for T cell DLI and NK cell isolation on Day -1.
A second cycle of therapy may be administered if the patient shows evidence of AML > 30 days after the administration of the first course of protocol therapy, and if they continue to meet the inclusion/exclusion criteria. Salvage chemotherapy may be omitted before a second infusion of DLI and CIML NK cells. In the setting of GVHD following the first cycle of therapy, the T cell DLI may be omitted, and ML NK cells administered. | |
CIML NK cell after T cell DLT (Phase 2 Adult Cohort) | Experimental | The recipient will receive standard of care salvage chemotherapy consisting of fludarabine, cytarabine, and G-CSF (FLAG) (or decitabine as an acceptable alternative) to be started 2 to 4 weeks prior to the CIML NK cell infusion, with Day -1 the day of T cell DLI, and Day 0 denoting the CIML NK cell infusion day. The donor will undergo non-mobilized large volume (20L) leukapheresis on Day -2 or -1, anticipating processing for T cell DLI and NK cell isolation on Day -1.
A second cycle of therapy may be administered if the patient shows evidence of AML > 30 days after the administration of the first course of protocol therapy, and if they continue to meet the inclusion/exclusion criteria. Salvage chemotherapy may be omitted before a second infusion of DLI and CIML NK cells. In the setting of GVHD following the first cycle of therapy, the T cell DLI may be omitted, and ML NK cells administered. | |
Eligibility Criteria
Recipient Inclusion Criteria:
- Relapsed AML after HLA-matched related or unrelated allogeneic hematopoietic cell
transplant (per IWG definition of relapse)
- For pilot pediatric/young adult patient cohort ≥1 and <18 years of age
- For phase 2 adult patient cohort ≥18 years of age
- Available original donor (same donor as used for the initial stem cell transplant)
that is willing and eligible for non-mobilized collection
- Patients with known central nervous system (CNS) involvement with AML are eligible
provided that they have been treated and cerebrospinal fluid (CSF) is clear for at
least 2 weeks prior to enrollment into the study. CNS therapy (chemotherapy or
radiation) should continue as medically indicated during the study treatment.
- Karnofsky performance status > 60 %
- Adequate organ function as defined below:
- Total bilirubin < 2 mg/dL
- AST(SGOT)/ALT(SGPT) < 3.0 x IULN
- Creatinine within normal institutional limits OR creatinine clearance > 60
mL/min/1.73 m2 by Cockcroft-Gault Formula
- Oxygen saturation ≥90% on room air
- Not currently requiring systemic corticosteroid therapy (10 mg or less of prednisone
or equivalent doses of other systemic steroids are allowed) or any other immune
suppressive medications
- Women of childbearing potential must have a negative pregnancy test within 28 days
prior to study registration. Female and male patients (along with their female
partners) must agree to use two forms of acceptable contraception, including one
barrier method, during participation in the study including throughout the initial
evaluation period (100 days after CIML NK cell infusion).
- Ability to understand and willingness to sign an IRB approved written informed consent
document (or that of legally authorized representative, if applicable).
Recipient Exclusion Criteria:
- Acute or chronic GvHD with ongoing active systemic treatment.
- Circulating blast count >30,000/uL by morphology or flow cytometry (cyto-reductive
therapies including leukapheresis or hydroxyurea are allowed).
- Uncontrolled bacterial or viral infections, or known HIV, Hepatitis B, or Hepatitis C
infection.
- Uncontrolled angina, severe uncontrolled ventricular arrhythmias, or EKG suggestive of
acute ischemia or active conduction system abnormalities.
- New or progressive pulmonary infiltrates concerning for new or uncontrolled infectious
process.
- Known hypersensitivity to one or more of the study agents
- Received any investigational drugs within the 14 days prior to CIML NK cell infusion
date
- Pregnant and/or breastfeeding
Donor Inclusion Criteria:
- At least 18 years of age
- Same donor as used for the allo-HCT
- In general good health, and medically able to tolerate leukapheresis
- Ability to understand and willingness to sign an IRB approved written informed consent
document
Donor Exclusion Criteria:
- Active hepatitis, positive for HTLV, or HIV on donor viral screen
- Pregnant
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 1 Year |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Feasibility of regimen defined as the number of participants who are successfully infused with T cell DLT and CIML NK cells (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | Completion of all patients through Day 0 (estimated to be 54 months) |
Safety Issue: | |
Description: | -Will be considered successful if doses above the minimum can be delivered in at least 9 of 12 patients. Target and minimum doses are: T cell DLI (5x106/kg with a minimum dose of 1x106/kg) and CIML NK cells (dose capped at 10x106/kg with a minimum dose of 0.5x106/kg). |
Secondary Outcome Measures
Measure: | Complete remission rate (CR/CRi) (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | Day 30 |
Safety Issue: | |
Description: | Complete remission (CR):Morphologically leukemia free state (i.e. bone marrow with <5% blasts by morphologic criteria and no blasts with Auer rods, no evidence of extramedullary leukemia) and absolute neutrophil count ≥1000 /μL and platelets ≥100,000 /μL. Patient must be independent of transfusions
Complete remission with incomplete blood count recover (CRi): All of the above criteria for CR must be met, except that absolute neutrophils <1000 /μL or platelets <100,000 /μL in the blood. |
Measure: | Rate of leukemia-free survival (LFS) (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | 100 days post CIML NK cell infusion |
Safety Issue: | |
Description: | -LFS is defined as the time from achievement of CR/CRi to the time of relapse, death in remission, or last follow-up. |
Measure: | Overall survival (OS) (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | 100 days post CIML NK cell infusion |
Safety Issue: | |
Description: | -OS is defined as the time from the date of Day 0 until death from any cause. |
Measure: | Rate of leukemia-free survival (LFS) (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | 1 year post CIML NK cell infusion |
Safety Issue: | |
Description: | -LFS is defined as the time from achievement of CR/CRi to the time of relapse, death in remission, or last follow-up. |
Measure: | Overall survival (OS) (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | 1 year post CIML NK cell infusion |
Safety Issue: | |
Description: | -OS is defined as the time from the date of Day 0 until death from any cause. |
Measure: | Incidence and severity of acute GVHD rates (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | Day 14 through 6 months |
Safety Issue: | |
Description: | -Incidence and severity of acute GVHD will be assessed based on the Minnesota grading scale. Attempts should be made to confirm the diagnosis pathologically by biopsy of target organ(s). |
Measure: | Incidence and severity of acute GVHD rates (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | Day 14 through 6 months |
Safety Issue: | |
Description: | -Incidence and severity of acute GVHD will be assessed based on the CIBMTR grading scale. Attempts should be made to confirm the diagnosis pathologically by biopsy of target organ(s). |
Measure: | Incidence and severity of chronic GVHD rates (Pilot Pediatric/Young Adult Cohort) |
Time Frame: | Day 100 through 12 months |
Safety Issue: | |
Description: | -Incidence and severity of chronic GVHD will be assessed based on the NIH consensus criteria and global severity scoring system. Attempts should be made to confirm the diagnosis pathologically by biopsy of target organ(s). |
Measure: | Complete remission rate (CR/CRi) (Phase 2 Adult Cohort) |
Time Frame: | Day 30 |
Safety Issue: | |
Description: | Complete remission (CR):Morphologically leukemia free state (i.e. bone marrow with <5% blasts by morphologic criteria and no blasts with Auer rods, no evidence of extramedullary leukemia) and absolute neutrophil count ≥1000 /μL and platelets ≥100,000 /μL. Patient must be independent of transfusions
Complete remission with incomplete blood count recover (CRi): All of the above criteria for CR must be met, except that absolute neutrophils <1000 /μL or platelets <100,000 /μL in the blood. |
Measure: | Rate of leukemia-free survival (LFS) (Phase 2 Adult Cohort) |
Time Frame: | 100 days post CIML NK cell infusion |
Safety Issue: | |
Description: | -LFS is defined as the time from achievement of CR/CRi to the time of relapse, death in remission, or last follow-up. |
Measure: | Overall survival (OS) (Phase 2 Adult Cohort) |
Time Frame: | 100 days post CIML NK cell infusion |
Safety Issue: | |
Description: | -OS is defined as the time from the date of Day 0 until death from any cause. |
Measure: | Rate of leukemia-free survival (LFS) (Phase 2 Adult Cohort) |
Time Frame: | 1 year post CIML NK cell infusion |
Safety Issue: | |
Description: | -LFS is defined as the time from achievement of CR/CRi to the time of relapse, death in remission, or last follow-up. |
Measure: | Overall survival (OS) (Phase 2 Adult Cohort) |
Time Frame: | 1 year post CIML NK cell infusion |
Safety Issue: | |
Description: | -OS is defined as the time from the date of Day 0 until death from any cause. |
Measure: | Incidence and severity of acute GVHD rates (Phase 2 Adult Cohort) |
Time Frame: | Day 14 through 6 months |
Safety Issue: | |
Description: | -Incidence and severity of acute GVHD will be assessed based on the CIBMTR grading scale. Attempts should be made to confirm the diagnosis pathologically by biopsy of target organ(s). |
Measure: | Incidence and severity of chronic GVHD rates (Phase 2 Adult Cohort) |
Time Frame: | Day 100 through 12 months |
Safety Issue: | |
Description: | -Incidence and severity of chronic GVHD will be assessed based on the NIH consensus criteria and global severity scoring system. Attempts should be made to confirm the diagnosis pathologically by biopsy of target organ(s). |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Washington University School of Medicine |
Last Updated
April 8, 2021