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Cellular Adoptive Immunotherapy in Treating Patients With Relapsed or Refractory Follicular Non-Hodgkin's Lymphoma

Primary Purpose

Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
aldesleukin
rituximab
therapeutic autologous lymphocytes
fludarabine phosphate
Sponsored by
City of Hope Medical Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoma focused on measuring recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma

Eligibility Criteria

16 Years - 70 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed follicular non-Hodgkin's lymphoma (NHL) High-risk disease, as defined by any of the following: Relapsed within 6 months after the last treatment Failed to achieve a complete response during the last treatment Relapsed after prior autologous hematopoietic stem cell transplantation (HSCT) No current transformation of lymphoma (e.g., elements of intermediate- or high-grade lymphoma by biopsy) No active CNS disease by lumbar puncture or radiology scan NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology. PATIENT CHARACTERISTICS: Age 16 to 70 Performance status Karnofsky 50-100% Life expectancy More than 16 weeks Hematopoietic Absolute neutrophil count > 500/mm^3 Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN)* (unless due to Gilbert's disease) ALT ≤ 2.5 times ULN* NOTE: *Unless due to NHL Renal Creatinine ≤ 1.5 times ULN* OR Creatinine clearance ≥ 80 mL/min* NOTE: *Unless due to NHL Immunologic HIV negative Epstein-Barr virus positive No history of allergy or intolerance to ganciclovir Other Negative pregnancy test No history of another malignancy except basal cell skin cancer or carcinoma in situ No other uncontrolled or severe illness that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy No prior allogeneic HSCT No other immunotherapy during and for approximately 65 days after the last T-cell infusion, unless approved by the Principal Investigator (PI) Chemotherapy No other chemotherapy during and for approximately 65 days after the last T-cell infusion, unless approved by the PI Patients may receive chemotherapy after leukapheresis while waiting for CD19-specific T cells to be manufactured Endocrine therapy No systemic corticosteroids during and for approximately 65 days after the last T-cell infusion, unless approved by the PI Radiotherapy Not specified Surgery Not specified Other No concurrent participation in another investigational study No immunosuppression agents or other investigational agents during and for approximately 65 days after the last T-cell infusion, unless approved by the PI

Sites / Locations

  • City of Hope Comprehensive Cancer Center

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
September 15, 2005
Last Updated
December 23, 2009
Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00182650
Brief Title
Cellular Adoptive Immunotherapy in Treating Patients With Relapsed or Refractory Follicular Non-Hodgkin's Lymphoma
Official Title
Pilot/Feasibility Study To Evaluate The Safety Of Cellular Immunotherapy For CD19+ Follicular Lymphoma Using Autologous Cytolytic T Cells Genetically-Modified To Be CD19-Specific And Co-Express HyTK
Study Type
Interventional

2. Study Status

Record Verification Date
December 2009
Overall Recruitment Status
Completed
Study Start Date
June 2004 (undefined)
Primary Completion Date
March 2008 (Actual)
Study Completion Date
March 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Cellular adoptive immunotherapy uses a person's white blood cells that are treated in the laboratory to stimulate the immune system in different ways and stop cancer cells from growing. Rituximab and fludarabine may also prevent the body from making an immune response against the laboratory-treated white blood cells that are put back into the body. Interleukin-2 may help the laboratory-treated white blood cells stay in the body longer. Giving cellular adoptive immunotherapy together with rituximab, fludarabine, and interleukin-2 may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects of cellular adoptive immunotherapy in treating patients with relapsed or refractory follicular non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Primary Determine the safety and feasibility of cellular adoptive immunotherapy using autologous cytotoxic T lymphocytes genetically modified to express a CD19-specific chimeric immunoreceptor gene and HyTK selection/suicide gene in patients with relapsed or refractory follicular non-Hodgkin's lymphoma. Secondary Determine the in vivo persistence of adoptively transferred cytolytic T cells in patients treated with lymphodepleting therapy comprising rituximab and fludarabine. Assess the development of host immune responses against the CD19-specific chimeric immunoreceptor gene and/or HyTK selection/suicide gene. Determine the safety of low-dose interleukin-2 in supporting in vivo persistence of adoptively transferred cytotoxic T cells. Determine the anti-tumor activity of this regimen in these patients. OUTLINE: This is a nonrandomized, open-label, pilot study. Leukapheresis: Patients undergo leukapheresis for collection of peripheral blood mononuclear cells (PBMCs). CD3-positive cytotoxic T lymphocytes (CTLs) are isolated and genetically modified to express a CD19-specific chimeric immunoreceptor and the HyTK fusion protein, and are then expanded in vitro. Lymphodepleting therapy: Patients receive rituximab and fludarabine prior to T-cell infusions. Cellular adoptive immunotherapy and interleukin-2 (IL-2): Patients receive a total of 5 infusions of genetically modified autologous T cells. Patients may receive low-dose IL-2 subcutaneously after infusions 3, 4, and 5. Additional IL-2 therapy: After the completion of the last T-cell infusion, patients with evidence of adoptively transferred T cells may receive additional IL-2. After completion of study treatment, patients are followed periodically for approximately 65 days and then annually for at least 15 years. PROJECTED ACCRUAL: At least 5 patients will be accrued for this study within 3 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma
Keywords
recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
5 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
aldesleukin
Intervention Type
Biological
Intervention Name(s)
rituximab
Intervention Type
Biological
Intervention Name(s)
therapeutic autologous lymphocytes
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed follicular non-Hodgkin's lymphoma (NHL) High-risk disease, as defined by any of the following: Relapsed within 6 months after the last treatment Failed to achieve a complete response during the last treatment Relapsed after prior autologous hematopoietic stem cell transplantation (HSCT) No current transformation of lymphoma (e.g., elements of intermediate- or high-grade lymphoma by biopsy) No active CNS disease by lumbar puncture or radiology scan NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology. PATIENT CHARACTERISTICS: Age 16 to 70 Performance status Karnofsky 50-100% Life expectancy More than 16 weeks Hematopoietic Absolute neutrophil count > 500/mm^3 Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN)* (unless due to Gilbert's disease) ALT ≤ 2.5 times ULN* NOTE: *Unless due to NHL Renal Creatinine ≤ 1.5 times ULN* OR Creatinine clearance ≥ 80 mL/min* NOTE: *Unless due to NHL Immunologic HIV negative Epstein-Barr virus positive No history of allergy or intolerance to ganciclovir Other Negative pregnancy test No history of another malignancy except basal cell skin cancer or carcinoma in situ No other uncontrolled or severe illness that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy No prior allogeneic HSCT No other immunotherapy during and for approximately 65 days after the last T-cell infusion, unless approved by the Principal Investigator (PI) Chemotherapy No other chemotherapy during and for approximately 65 days after the last T-cell infusion, unless approved by the PI Patients may receive chemotherapy after leukapheresis while waiting for CD19-specific T cells to be manufactured Endocrine therapy No systemic corticosteroids during and for approximately 65 days after the last T-cell infusion, unless approved by the PI Radiotherapy Not specified Surgery Not specified Other No concurrent participation in another investigational study No immunosuppression agents or other investigational agents during and for approximately 65 days after the last T-cell infusion, unless approved by the PI
Facility Information:
Facility Name
City of Hope Comprehensive Cancer Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010-3000
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Cellular Adoptive Immunotherapy in Treating Patients With Relapsed or Refractory Follicular Non-Hodgkin's Lymphoma

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