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Efficacy of Dendritic Cell Therapy for Myeloid Leukemia and Myeloma

Primary Purpose

Acute Myeloid Leukemia, Chronic Myeloid Leukemia, Multiple Myeloma

Status
Unknown status
Phase
Phase 2
Locations
Belgium
Study Type
Interventional
Intervention
dendritic cell vaccination (active specific immunotherapy)
Sponsored by
University Hospital, Antwerp
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring AML (acute myeloid leukemia), CML (chronic myeloid leukemia), MM (multiple myeloma)

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Acute Myeloid Leukemia (AML): all FAB subtypes except M3. Extent of disease:

    • clinical remission after at least one course of polychemotherapy
    • high risk of relapse due to age (> 60 years) or poor risk cytogenetic/molecular markers or hyperleukocytosis at presentation or previous relapse
  • Chronic myeloid leukemia (CML): patients in chronic phase under therapy with tyrosinase kinase inhibitors who have sub-optimal response or failure and who are not eligible for hematopoietic stem cell transplantation.
  • Multiple Myeloma (MM): symptomatic with active disease, independent of earlier and/or concomitant treatment:

    • Presence of serum/urine M protein (> 3 g/dl)
    • Bone marrow plasmacytosis (>10-30%)
    • Anemia, renal failure, hypercalcemia, and/or lytic bone lesions
  • Overexpression of WT1 RNA in peripheral blood and or bone marrow as assessed by quantitative RT-PCR at the time of presentation.For CML: residual molecular disease as demonstrated by BCR-ABL RT-PCR
  • Prior treatments: Patients must have received at least one prior antileukemic chemotherapeutic regimen and must be more than 1 month past the last treatment.
  • Age: ≥ 18 years
  • Performance status: WHO PS grade 0-1 (Appendix B)
  • Objectively assessable parameters of life expectancy: more than 3 months
  • Prior and concomitant associated diseases allowed with the exception of underlying autoimmune disease and positive serology for HIV/HBV/HCV
  • No concomitant use of immunosuppressive drugs
  • adequate renal and liver function, i.e. creatinin and bilirubin = 1.2 times the upper limit of normal
  • absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
  • Women of child-bearing potential should use adequate contraception prior to study entry and for the duration of study participation

Exclusion Criteria:

  • Subjects with concurrent additional malignancy (with exception of non-melanoma skin cancers and carcinoma in situ of the cervix)
  • Subjects who are pregnant
  • Subjects who have sensitivity to drugs that provide local anesthesia
  • Subjects needing corticosteroids 1 mg/kg during vaccination; corticosteroids are allowed as part of their treatment when taken ≥ 30 days before the start of vaccination.

Sites / Locations

  • University Hospital Antwerp

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

standard therapy + vaccination

standard therapy

Arm Description

Outcomes

Primary Outcome Measures

Immunogenicity of WT1 mRNA-transfected DC vaccination
Induction/maintenance of molecular remission as evidenced by molecular MRD monitoring of WT1 (AML, CML and MM) and BCR/ABL RNA (CML) copies in peripheral blood

Secondary Outcome Measures

Time to relapse (TTR)
progression-free survival
overall survival (OS)

Full Information

First Posted
August 24, 2009
Last Updated
July 11, 2013
Sponsor
University Hospital, Antwerp
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1. Study Identification

Unique Protocol Identification Number
NCT00965224
Brief Title
Efficacy of Dendritic Cell Therapy for Myeloid Leukemia and Myeloma
Official Title
Therapeutic Efficacy of Wilms Tumor Gene (WT1) mRNA-electroporated Autologous Dendritic Cell Vaccination in Patients With Myeloid Malignancies and Multiple Myeloma: A Phase II Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2013
Overall Recruitment Status
Unknown status
Study Start Date
January 2010 (undefined)
Primary Completion Date
December 2014 (Anticipated)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
University Hospital, Antwerp

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Dendritic cell therapy is a promising strategy for adjuvant cancer therapy in the setting of minimal residual disease (MRD) to fight off cancer relapse and/or progression. The investigators already performed a phase I safety study in leukemia patients that were in complete remission demonstrating the absence of side effects and feasibility of the therapy. Here, the investigators want to extend on this strategy by studying the clinical efficacy of autologous DC vaccination in patients with acute and chronic myeloid leukemia and myeloma patients. Effects of DC therapy on the immune reactivity towards leukemia cells as well as clinical parameters such molecular MRD monitoring, time to relapse (TTR), progression-free survival (PFS) and overall survival(OS) will be studied in vaccinated and non-vaccinated (control) patients. Patients will be vaccinated using their own dendritic cells electroporated with mRNA coding for the full-length Wilms' tumor antigen WT1.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Chronic Myeloid Leukemia, Multiple Myeloma
Keywords
AML (acute myeloid leukemia), CML (chronic myeloid leukemia), MM (multiple myeloma)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
standard therapy + vaccination
Arm Type
Experimental
Arm Title
standard therapy
Arm Type
No Intervention
Intervention Type
Biological
Intervention Name(s)
dendritic cell vaccination (active specific immunotherapy)
Primary Outcome Measure Information:
Title
Immunogenicity of WT1 mRNA-transfected DC vaccination
Title
Induction/maintenance of molecular remission as evidenced by molecular MRD monitoring of WT1 (AML, CML and MM) and BCR/ABL RNA (CML) copies in peripheral blood
Secondary Outcome Measure Information:
Title
Time to relapse (TTR)
Title
progression-free survival
Title
overall survival (OS)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Acute Myeloid Leukemia (AML): all FAB subtypes except M3. Extent of disease: clinical remission after at least one course of polychemotherapy high risk of relapse due to age (> 60 years) or poor risk cytogenetic/molecular markers or hyperleukocytosis at presentation or previous relapse Chronic myeloid leukemia (CML): patients in chronic phase under therapy with tyrosinase kinase inhibitors who have sub-optimal response or failure and who are not eligible for hematopoietic stem cell transplantation. Multiple Myeloma (MM): symptomatic with active disease, independent of earlier and/or concomitant treatment: Presence of serum/urine M protein (> 3 g/dl) Bone marrow plasmacytosis (>10-30%) Anemia, renal failure, hypercalcemia, and/or lytic bone lesions Overexpression of WT1 RNA in peripheral blood and or bone marrow as assessed by quantitative RT-PCR at the time of presentation.For CML: residual molecular disease as demonstrated by BCR-ABL RT-PCR Prior treatments: Patients must have received at least one prior antileukemic chemotherapeutic regimen and must be more than 1 month past the last treatment. Age: ≥ 18 years Performance status: WHO PS grade 0-1 (Appendix B) Objectively assessable parameters of life expectancy: more than 3 months Prior and concomitant associated diseases allowed with the exception of underlying autoimmune disease and positive serology for HIV/HBV/HCV No concomitant use of immunosuppressive drugs adequate renal and liver function, i.e. creatinin and bilirubin = 1.2 times the upper limit of normal absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial Women of child-bearing potential should use adequate contraception prior to study entry and for the duration of study participation Exclusion Criteria: Subjects with concurrent additional malignancy (with exception of non-melanoma skin cancers and carcinoma in situ of the cervix) Subjects who are pregnant Subjects who have sensitivity to drugs that provide local anesthesia Subjects needing corticosteroids 1 mg/kg during vaccination; corticosteroids are allowed as part of their treatment when taken ≥ 30 days before the start of vaccination.
Facility Information:
Facility Name
University Hospital Antwerp
City
Edegem
State/Province
Antwerp
ZIP/Postal Code
2650
Country
Belgium

12. IPD Sharing Statement

Citations:
PubMed Identifier
19530029
Citation
Van Driessche A, Van de Velde AL, Nijs G, Braeckman T, Stein B, De Vries JM, Berneman ZN, Van Tendeloo VF. Clinical-grade manufacturing of autologous mature mRNA-electroporated dendritic cells and safety testing in acute myeloid leukemia patients in a phase I dose-escalation clinical trial. Cytotherapy. 2009;11(5):653-68. doi: 10.1080/14653240902960411.
Results Reference
background
PubMed Identifier
19289488
Citation
Smits EL, Berneman ZN, Van Tendeloo VF. Immunotherapy of acute myeloid leukemia: current approaches. Oncologist. 2009 Mar;14(3):240-52. doi: 10.1634/theoncologist.2008-0165. Epub 2009 Mar 16.
Results Reference
background
PubMed Identifier
16121214
Citation
Van Driessche A, Gao L, Stauss HJ, Ponsaerts P, Van Bockstaele DR, Berneman ZN, Van Tendeloo VF. Antigen-specific cellular immunotherapy of leukemia. Leukemia. 2005 Nov;19(11):1863-71. doi: 10.1038/sj.leu.2403930.
Results Reference
background
PubMed Identifier
19656053
Citation
Smits EL, Anguille S, Cools N, Berneman ZN, Van Tendeloo VF. Dendritic cell-based cancer gene therapy. Hum Gene Ther. 2009 Oct;20(10):1106-18. doi: 10.1089/hum.2009.145.
Results Reference
background
PubMed Identifier
28830889
Citation
Anguille S, Van de Velde AL, Smits EL, Van Tendeloo VF, Juliusson G, Cools N, Nijs G, Stein B, Lion E, Van Driessche A, Vandenbosch I, Verlinden A, Gadisseur AP, Schroyens WA, Muylle L, Vermeulen K, Maes MB, Deiteren K, Malfait R, Gostick E, Lammens M, Couttenye MM, Jorens P, Goossens H, Price DA, Ladell K, Oka Y, Fujiki F, Oji Y, Sugiyama H, Berneman ZN. Dendritic cell vaccination as postremission treatment to prevent or delay relapse in acute myeloid leukemia. Blood. 2017 Oct 12;130(15):1713-1721. doi: 10.1182/blood-2017-04-780155. Epub 2017 Aug 22.
Results Reference
derived

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Efficacy of Dendritic Cell Therapy for Myeloid Leukemia and Myeloma

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