Description:
This is a Phase I open-label dose escalation study of a single infusion of FATE-NK100 and a
short course of subcutaneous interleukin-2 (IL-2) administered after lymphodepleting
chemotherapy (CY/FLU) in subjects with refractory or relapsed acute myelogenous leukemia
(AML). FATE-NK100 is a natural killer (NK) cell product that is enriched for NK cells with an
"adaptive", or human cytomegalovirus (CMV)-induced, phenotype. The NK cell product is
comprised of peripheral blood (PB) leukocytes sourced from a related donor
(HLA-haploidentical or better but not fully HLA-matched) that is seropositive for
cytomegalovirus (CMV+), and enriched for adaptive NK cells by depletion of CD3+
(T-lymphocytes) and CD19+ (B-lymphocytes) cells followed by ex-vivo culture expansion.
Title
- Brief Title: Open Label NK Cell Infusion (FATE-NK100) With Subq IL-2 in Adults With AML
- Official Title: Open Label Dose Escalation Trial of an Adaptive Natural Killer (NK) Cell Infusion (FATE-NK100) With Subcutaneous IL-2 in Adults With Refractory or Relapsed Acute Myelogenous Leukemia (AML)
Clinical Trial IDs
- ORG STUDY ID:
2016LS153
- NCT ID:
NCT03081780
Conditions
- Refractory Acute Myelogenous Leukemia
- Relapsed Acute Myelogenous Leukemia
Interventions
Drug | Synonyms | Arms |
---|
FATE-NK100 | | FATE NK-100 |
Purpose
This is a Phase I open-label dose escalation study of a single infusion of FATE-NK100 and a
short course of subcutaneous interleukin-2 (IL-2) administered after lymphodepleting
chemotherapy (CY/FLU) in subjects with refractory or relapsed acute myelogenous leukemia
(AML). FATE-NK100 is a natural killer (NK) cell product that is enriched for NK cells with an
"adaptive", or human cytomegalovirus (CMV)-induced, phenotype. The NK cell product is
comprised of peripheral blood (PB) leukocytes sourced from a related donor
(HLA-haploidentical or better but not fully HLA-matched) that is seropositive for
cytomegalovirus (CMV+), and enriched for adaptive NK cells by depletion of CD3+
(T-lymphocytes) and CD19+ (B-lymphocytes) cells followed by ex-vivo culture expansion.
Trial Arms
Name | Type | Description | Interventions |
---|
FATE NK-100 | Experimental | | |
Eligibility Criteria
Inclusion Criteria:
- ≥18 but ≤ 70 years of age
- Diagnosis of acute myeloid leukemia (AML) and meets one of the following disease
criteria:
* Primary induction failure:
** De Novo AML: no CR after 2, 3 or 4 induction attempts with high dose chemotherapy
- Secondary AML (from MDS or treatment related): no CR after 1, 2 or 3 cycles of
high dose chemotherapy
- Relapsed:
- Not in CR after 1 or 2 cycles of standard re-induction therapy
- Relapse diagnosed at the time of the 6 months post-HCT standard of care follow-up
or later (i.e. based on bone marrow biopsy performed Day +170 or later) and
without evidence of graft versus host disease (GVHD)
- For patients > 60 years of age, the minimum of 1 cycle of standard
chemotherapy is not required.
- Available HLA-matched or better but not fully HLA-matched (2/4 or 3/4 antigens)
related donor (aged 18 to 75 years) with donor/recipient match based on a minimum of
intermediate resolution DNA based Class I typing of the A and B locus who is CMV
seropositive.
- Karnofsky Performance Status ≥ 60%
- Adequate organ function within 14 days of study registration (28 days for pulmonary
and cardiac) defined as:
- Creatinine: Estimated glomerular filtration rate (eGFR) ≥ 50 mL/min/1.73m^2 per
current institutional calculation formula
- Hepatic: AST and ALT ≤ 3 x upper limit of institutional normal
- Pulmonary Function: oxygen saturation ≥ 90% on room air; PFT's required only if
symptomatic or prior known impairment - must have pulmonary function >50%
corrected DLCO and FEV1
- Cardiac Function: LVEF ≥ 40% by echocardiography or MUGA
- No symptomatic active conduction system abnormalities
- Able to be off prednisone or other immunosuppressive medications for at least 3 days
prior to FATE-NK100 cell infusion (excluding preparative regimen premedications)
- Sexually active females of child bearing potential and males with partners of child
bearing potential must agree to use effective contraception during therapy and for 4
months after completion of therapy
- Voluntary written consent prior to the performance of any research related procedures
Arm Specific Inclusion Criteria
High-Risk aGVHD (ARM 1):
- Pediatric or adult (ages 0-76 years) HCT recipients with high-risk acute GVHD, as
determined either by the refined MN acute GVHD risk score [28]:
http://z.umn.edu/MNAcuteGVHDRiskScore OR high risk on the basis of blood biomarkers (Ann
Arbor Score 3) [31]. Patients in this arm must start treatment within the first 7 days
after onset of high-risk aGVHD.
or
Steroid- Dependent aGVHD (ARM 2A):
- Pediatric or adult (ages 0-76 years) HCT recipient with grade II-IV steroid-dependent
acute GVHD, defined as any one of the following: Flare of acute GVHD of at least grade
II/IV severity within 8 weeks of tapering down or (off of) immunosuppression for acute
GVHD, with the flare occurring on ≤0.5 mg/kg prednisone. This can include late-onset aGVHD
and overlap syndrome.
or
Steroid-Refractory aGVHD (ARM 2B):
- Pediatric or adult (ages 0-76 years) HCT recipient with grade II-IV steroid refractory
acute GVHD, defined as any one of the following:
- No response of acute GVHD after at least 4 days of systemic corticosteroids of at
least 2 mg/kg prednisone or equivalent
- Progression of acute GVHD within 3 days of systemic corticosteroids of at least 2
mg/kg prednisone or equivalent
- Failure to improve to at least grade II acute GVHD after 14 days of systemic
corticosteroids, with initial doses of at least 2 mg/kg prednisone or equivalent
- Flare of acute GVHD of at least grade II/IV severity while on steroids at a dose
>0.5/mg/kg/day. This can include late-onset aGVHD and overlap syndrome.
Exclusion Criteria:
- Myocardial Infraction (MI) within the previous 6 months
- Acute leukemias of ambiguous lineage
- Pregnant or breastfeeding - The agents used in this study include those that fall
under Pregnancy Category D - have known teratogenic potential. Women of child bearing
potential must have a negative pregnancy test at screening
- History of or known active CNS involvement with AML
- Active autoimmune disease requiring systemic immunosuppressive therapy
- History of severe asthma and currently on chronic systemic medications (mild asthma
requiring inhaled steroids only is eligible)
- New or progressive pulmonary infiltrates on screening chest X-ray or chest CT scan
unless cleared for study by Pulmonary. Infiltrates attributed to infection must be
stable/improving (with associated clinical improvement) after 1 week of appropriate
therapy (4 weeks for presumed or documented fungal infections).
- Uncontrolled bacterial, fungal or viral infections including HIV-1/2 or active
hepatitis C/B - chronic asymptomatic viral hepatitis is allowed
- Received any investigational agent within the 14 days before the start of study
treatment (1st dose of fludarabine)
Maximum Eligible Age: | 70 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum tolerated dose (MTD) |
Time Frame: | 3 months |
Safety Issue: | |
Description: | Maximum FATE-NK100 dose which could be given to 3 participants such that not more than 1 participant experienced a DLT. |
Secondary Outcome Measures
Measure: | Clinical activity by CR/CRp leukemia clearance |
Time Frame: | Day +42 |
Safety Issue: | |
Description: | Incidence of CRp defined as leukemia clearance (≤5%marrow blasts and no circulating peripheral blasts) |
Measure: | Clinical activity by CR/CRp neutrophil recovery |
Time Frame: | Day +42 |
Safety Issue: | |
Description: | Incidence of CRp defined as neutrophil recovery (ANC >500 cells/microliter) but with incomplete platelet recovery |
Measure: | In vivo expansion of NK cells |
Time Frame: | Day +14 |
Safety Issue: | |
Description: | Incidence of in vivo expansion (≥ 100 donor derived NK cells per uL blood) of NK cells |
Measure: | Treatment Related Mortality (TRM) |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Incidence of treatment related mortality (TRM) |
Measure: | Minimal residual disease (MRD) by bone marrow morphology |
Time Frame: | up to Day 28 |
Safety Issue: | |
Description: | Incidence of minimal residual disease (MRD) clearance by bone marrow morphology after NK Cell infusion |
Measure: | Minimal residual disease (MRD) by flow cytometry |
Time Frame: | up to Day 28 |
Safety Issue: | |
Description: | Incidence of minimal residual disease (MRD) clearance by flow cytometry after NK Cell infusion |
Measure: | Leukemia free survival (LFS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Incidence of Leukemia free survival (LFS) |
Measure: | Overall survival (OS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Incidence of overall survival (OS) |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Masonic Cancer Center, University of Minnesota |
Trial Keywords
Last Updated
March 12, 2021