Clinical Trials /

Safety and Effectiveness of EBV-specific Cytotoxic T Cells for the Treatment for EBV Lymphomas or Other EBV-associated Malignancies

NCT03988582

Description:

The purpose of this study is to test whether treatment with EBV-specific cytotoxic T cells (EBV-CTLs) is effective, and to test any good and bad effects of treatment with EBV-CTLs. EBV-CTLs are a special immune cells that may attack abnormal cells. EBV-CTLs are made by taking cells from a healthy person, growing them in a laboratory for several weeks to educate them to recognize and destroy EBV infected cells, and then storing them in a freezer until they are required for treatment.

Related Conditions:
  • Cancer
  • Gastric Carcinoma
  • Leiomyosarcoma
  • Lymphoma
  • Nasopharyngeal Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Safety and Effectiveness of EBV-specific Cytotoxic T Cells for the Treatment for EBV Lymphomas or Other EBV-associated Malignancies
  • Official Title: A Phase II Trial of EBV-Specific Cytotoxic T Cells for the Treatment of EBV Lymphomas or Other EBV-associated Malignancies

Clinical Trial IDs

  • ORG STUDY ID: 18-315
  • NCT ID: NCT03988582

Conditions

  • EBV Lymphomas
  • EBV-associated Malignancies

Interventions

DrugSynonymsArms
EBV-specific T-cellsHCT (hematopoietic cell transplant) recipients

Purpose

The purpose of this study is to test whether treatment with EBV-specific cytotoxic T cells (EBV-CTLs) is effective, and to test any good and bad effects of treatment with EBV-CTLs. EBV-CTLs are a special immune cells that may attack abnormal cells. EBV-CTLs are made by taking cells from a healthy person, growing them in a laboratory for several weeks to educate them to recognize and destroy EBV infected cells, and then storing them in a freezer until they are required for treatment.

Trial Arms

NameTypeDescriptionInterventions
HCT (hematopoietic cell transplant) recipientsExperimentalEBV-CTLs will be administered in cycles lasting 5 weeks (35 days). During each cycle, patients will receive intravenous (IV) EBV-CTLs at a dose of 1×106 CD3+ cells/kg on Days 1, 8, and 15, followed by a 2-week observation period. Each dose, or the cumulative three doses can be within 20% of the targeted dose.Treatment will continue until maximal response, unacceptable toxicity, or failure of EBV-CTLs (progression of disease after three cycles of cells or 6 months of therapy without response).
  • EBV-specific T-cells
SOT (solid organ transplant) recipientsExperimentalEBV-CTLs will be administered in cycles lasting 5 weeks (35 days). During each cycle, patients will receive intravenous (IV) EBV-CTLs at a dose of 1×106 CD3+ cells/kg on Days 1, 8, and 15, followed by a 2-week observation period. Each dose, or the cumulative three doses can be within 20% of the targeted dose.Treatment will continue until maximal response, unacceptable toxicity, or failure of EBV-CTLs (progression of disease after three cycles of cells or 6 months of therapy without response).
  • EBV-specific T-cells
Other immune competent or immune compromised patientsExperimentalEBV-CTLs will be administered in cycles lasting 5 weeks (35 days). During each cycle, patients will receive intravenous (IV) EBV-CTLs at a dose of 1×106 CD3+ cells/kg on Days 1, 8, and 15, followed by a 2-week observation period. Each dose, or the cumulative three doses can be within 20% of the targeted dose.Treatment will continue until maximal response, unacceptable toxicity, or failure of EBV-CTLs (progression of disease after three cycles of cells or 6 months of therapy without response).
  • EBV-specific T-cells

Eligibility Criteria

        Inclusion Criteria:

          -  A patient will be considered eligible to receive EBV-CTL treatment if the following
             inclusion criteria are met. Patients should receive established effective therapy if
             it exists and they can tolerate it prior to enrolling on protocol to receive
             experimental therapy. Patients will be considered eligible regardless of initial
             response to rituximab (alloHCT recipients) rituximab and/or multi-agent chemotherapy
             (SOT and other immune compromised recipients) and appropriate first line chemotherapy
             (non immune compromised recipients).

          -  Three cohorts of patients will be eligible for enrollment:

             °Cohort 1

          -  Patients after allogeneic HCT who have:

               1. EBV+ malignancies

               2. EBV viremia (as evidenced by two serial plasma EBV DNA assays) without EBV+
                  malignancy

        Included in cohort 1 will be patients with underlying immunodeficiency syndromes with:

        3. EBV+ malignancies 4. EBV viremia without current but with a history of prior EBV+
        malignancy

          -  Cohort 2

               -  Patients after allogeneic SOT who have:

                    1. EBV+ malignancies

                    2. EBV viremia (as evidenced by two serial plasma EBV DNA assays) without
                       current but with a history of prior EBV+ malignancy.

               -  Patients in Cohort 1 (D) and 2 (B) treated for EBV viremia without evidence of
                  EBV+ malignancy will need to have a history of a prior EBV malignancy with:

               -  Continued viremia at the completion of planned therapy

               -  Recurrence of viremia within 2 months from completion of planned therapy

               -  High grade viremia (>20,000 copies) after treatment for EBV malignancy

               -  Evidence of EBV positivity for patients in cohort 1 and 2 is determined as
                  follows:

               -  A biopsy showing EBV+ malignancy or

               -  A combination of EBV viremia AND radiographic appearance consistent with an EBV+
                  malignancy

          -  Cohort 3

        A. EBV-associated lymphomas and lymphoproliferative disorders not associated with
        immunodeficiency (biopsy required) (e.g. EBV+ Hodgkin lymphoma, etc).

        - Based on prior studies, patients with NK/T lymphoma will only be eligible for protocol if
        EBV-CTL therapy is being administered from their HCT donor either prior to or after HCT.

        B. Other EBV-associated malignancies (biopsy required) including nasopharyngeal carcinoma,
        EBV+ gastric cancer, EBV+ leiomyosarcoma.

          -  Patients in cohort 3 will be assessed for whether alternative standard therapy is
             available prior to being consented to the trial.

          -  Patients in cohort 3 will need a biopsy showing EBV+ disease.

          -  Patients in cohort 3 will not be treated for viremia alone.

        All Patients:

          1. Availability of EBV-CTLs generated specifically for the patient and demonstrated to be
             restricted by a shared HLA-allele.

          2. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3 for patients aged >
             16 years; Lansky score ≥ 20 for patients ≤ 16 years

          3. For patients with PTLD in the alloHCT setting, the underlying disease for which
             alloHCT transplant was performed is either an EBV+ malignancy or in morphologic
             remission

          4. Adequate organ function per the following (unless deemed to be caused by the
             underlying EBV-driven process which EBV-CTLs are intended to treat, or its prior
             therapy):

             A. Absolute neutrophil count ≥ 500/μL, with or without cytokine support B. Platelet
             count ≥ 20,000/μL, with or without transfusion support C. Alanine aminotransferase
             (ALT) and aspartate aminotransferase (AST) < 3× the upper limit of normal (ULN) and
             total bilirubin < 2.5×ULN; D. Creatinine < 3×ULN

          5. Patient or patient's representative is willing and able to provide written informed
             consent

        Exclusion Criteria:

          1. Any concomitant investigational therapy that would impair the ability to assess
             efficacy or toxicity of the EBV-CTL treatment. Simultaneous initiation of rituximab
             therapy in a patient who has received no prior rituximab.

          2. Uncontrolled graft versus host disease or organ rejection or ongoing need for
             methotrexate, extracorporeal photopheresis, or corticosteroids at a dose greater than
             0.5mg/kg/day prednisone or equivalent.

          3. Need for vasopressor or ventilatory support, unless deemed to be caused by the
             EBV-driven process which EBV-CTLs are intended to treat

          4. Pregnancy

          5. Female of childbearing potential or male with a female partner of childbearing
             potential unwilling to use a highly effective method of contraception

          6. Inability to comply with study procedures

          7. Patients who have received allogenic cells from a donor other than their HCT or SOT
             donor within 30 days.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:N/A
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:best overall response rate
Time Frame:6 months
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Memorial Sloan Kettering Cancer Center

Trial Keywords

  • cytotoxic T cells
  • HLA-haplotype
  • 18-315

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