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Maintenance Therapy With Ceplene® (Histamine) and IL-2 on Immune Response and MRD in Acute Myeloid Leukemia

Primary Purpose

Acute Myeloid Leukemia

Status
Completed
Phase
Phase 4
Locations
Sweden
Study Type
Interventional
Intervention
histamine dihydrochloride and IL-2
Sponsored by
Cytovia, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring AML, Leukemia, Acute Myeloid Leukemia, Minimal Residual Disease, Ceplene, Histamine, interleukin 2

Eligibility Criteria

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

Inclusion Criteria:

  • AML patients in CR1 whose AML subtype has been well-characterized using conventional karyotyping and molecular genetic techniques (eg, RQ-PCR) at diagnosis. Patients may be considered eligible if they have not had this assessment performed at diagnosis provided that stored samples of diagnostic genetic material (DNA/RNA) from blood and BM are available that can be assayed for the presence of markers such as WT1 and/or AML-specific genetic markers.
  • Bone marrow examination confirming CR (defined as less than 5% blasts in a normocellular bone marrow).
  • Eighteen years of age or older.
  • Patients have received any form of induction and consolidation therapy as per standard practice at the institution, including autologous stem cell transplantation (ASCT).
  • Within 8 weeks following the date of the last dose of consolidation or conditioning chemotherapy for AML, or following ASCT.
  • Patients not undergoing consolidation therapy must have been in CR1 for at least one month prior to enrollment.
  • Platelet count recovered after chemotherapy to ≥75 x 109/L, and Partial Thromboplastin Time (PTT) within normal limits.
  • WBC ≥1.5 x 109/L and LFTs (to include SGPT [ALAT] or SGOT [AST] and bilirubin) should not exceed twice the upper limit of normal.
  • Serum creatinine less than or equal to 1.5 times the upper normal limit.
  • Able to function without significant decrease in daily activities (WHO Performance Status 0 - 1 or Karnofsky ≥70).
  • Life expectancy of more than three months and able to undergo routine outpatient evaluations for efficacy, safety, and/or compliance.
  • Women of childbearing potential must be practicing barrier or oral contraception, for the duration of the treatment, or documented as surgically sterile or one year post-menopausal.
  • If female, be non-nursing, non-pregnant and have a negative pregnancy test within two weeks of starting study drug.
  • The patient must be informed of the investigational nature of the study and written informed consent obtained.

Exclusion Criteria:

  • Patients who have undergone or are planned for allogeneic stem cell transplantation.
  • Patients with M3 as an AML subtype.
  • Class III or IV cardiac disease, hypotension or severe hypertension, vasomotor instability, serious or uncontrolled cardiac dysrhythmias (including ventricular arrhythmias) at any time, acute myocardial infarction within the past 12 months, active uncontrolled angina pectoris or symptomatic arteriosclerotic blood vessel disease.
  • Other active malignancies except in situ carcinoma of the cervix, localized squamous or basal cell carcinoma of the skin.
  • Serious concurrent or recent non-malignant medical conditions which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study.
  • History of seizures, central nervous system disorders, stroke within the last 12 months, or psychiatric disability thought to be clinically significant in the opinion of the Investigator and adversely affecting compliance to protocol.
  • Patients unable to undergo repeat treatments, clinical evaluations and other diagnostic procedures required by the protocol.
  • Active autoimmune disease (including but not limited to systemic lupus, inflammatory bowel disease, and psoriasis).
  • Patients with active peptic or esophageal ulcer disease or with past peptic ulcer or esophageal disease with a history or bleeding.
  • Patients requiring active treatment for hypotension.
  • Medical, sociologic, or psychological impediment to probable compliance with the protocol.
  • Patients continuing systemic treatment with clonidine, steroids, and/or H2 receptor blocking agents.
  • Patients with a history of histamine hypersensitivity, severe allergies to food or contrast media requiring treatment within the last five years.
  • Patients unable to provide written consent.

Sites / Locations

  • Sahlgrenska Academy, University of Gothenburg

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

histamine dihydrochloride and IL-2

Arm Description

histamine and IL-2 subcutaneous injections

Outcomes

Primary Outcome Measures

Minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2
A second primary objective of this study is to evaluate MRD in patients who are receiving remission maintenance therapy with Ceplene/IL-2. MRD will be evaluated using RQ-PCR for molecular detection of genetic markers of AML. Patients' MRD status will be quantified at the time of enrollment (baseline) and within ten days after completion of Cycles 3, 5, 6, 7, 9 and 10 of Ceplene/IL-2 therapy, corresponding to approximately every 3 months during this immunotherapy.
Pharmacodynamic effects of Ceplene plus low dose IL-2 (Ceplene/IL-2) by monitoring T and NK cell phenotypes and their functionality after the first and third cycles of treatment
The quantitative and qualitative pharmacodynamic effects of Ceplene/IL-2 on the immune responses of T and NK cells will be assessed as follows: Changes in T and NK cell phenotypes (CD56, CD3, CD4, CD8) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3. Changes in immune response markers (CD3, NKp46 [and other NCRs], CD25, CD69, and IFN-γ) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3

Secondary Outcome Measures

Duration of LFS
Duration of LFS: LFS will be defined as the time from achieving CR after successful induction therapy until relapse of AML (defined as 5% or more blast cells in the bone marrow).

Full Information

First Posted
May 2, 2011
Last Updated
November 27, 2017
Sponsor
Cytovia, Inc.
Collaborators
EpiCept Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT01347996
Brief Title
Maintenance Therapy With Ceplene® (Histamine) and IL-2 on Immune Response and MRD in Acute Myeloid Leukemia
Official Title
Open-Label, Multicenter, Effects of Remission Maintenance Therapy With Ceplene® , Given in Conjunction With Low-Dose Interleukin-2, on Immune Response and Minimal Residual Disease in Adult Patients With AML in First Complete Remission
Study Type
Interventional

2. Study Status

Record Verification Date
November 2017
Overall Recruitment Status
Completed
Study Start Date
July 2009 (undefined)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cytovia, Inc.
Collaborators
EpiCept Corporation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Ceplene/IL-2 remission maintenance therapy has been shown to significantly prolong Leukemia Free Survival in patients with Acute Myeloid Leukemia (AML) in first complete remission. This is an international, multicenter, open-label study to evaluate the effects of remission maintenance therapy with Ceplene/IL-2 in adult patients with AML in CR1 on specific immune system cells (T and NK cells) and prospectively defined markers of immune response that are known to reflect T and NK cell ability to combat AML.
Detailed Description
Outcome Measures: Primary: To assess the quantitative and qualitative pharmacodynamic effects of Ceplene plus low-dose IL-2 (Ceplene/IL-2) by monitoring T and natural killer (NK) cell phenotypes and their functionality after the first and third treatment cycles in adult patients with acute myeloid leukemia (AML) in first complete remission (CR1). To evaluate minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2. Secondary: To document, in adult AML patients in CR1 treated with Ceplene/IL-2: Leukemia-free survival (LFS) after a follow-up period of up to two years. The safety of Ceplene/IL-2 therapy. The potential relationship of Ceplene/IL-2 effects on T and NK cell phenotypes and their functionality to MRD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
AML, Leukemia, Acute Myeloid Leukemia, Minimal Residual Disease, Ceplene, Histamine, interleukin 2

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
84 (Actual)

8. Arms, Groups, and Interventions

Arm Title
histamine dihydrochloride and IL-2
Arm Type
Experimental
Arm Description
histamine and IL-2 subcutaneous injections
Intervention Type
Drug
Intervention Name(s)
histamine dihydrochloride and IL-2
Other Intervention Name(s)
Ceplene, Proleukin, IL-2, interleukin-2, histamine
Intervention Description
Ceplene 0.5 mg subcutaneously twice daily and IL-2 1 µg/kg [16,400 IU/kg] body weight twice daily for 10, 21 day cycles
Primary Outcome Measure Information:
Title
Minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2
Description
A second primary objective of this study is to evaluate MRD in patients who are receiving remission maintenance therapy with Ceplene/IL-2. MRD will be evaluated using RQ-PCR for molecular detection of genetic markers of AML. Patients' MRD status will be quantified at the time of enrollment (baseline) and within ten days after completion of Cycles 3, 5, 6, 7, 9 and 10 of Ceplene/IL-2 therapy, corresponding to approximately every 3 months during this immunotherapy.
Time Frame
Comparison at baseline and various time points up to 2 years
Title
Pharmacodynamic effects of Ceplene plus low dose IL-2 (Ceplene/IL-2) by monitoring T and NK cell phenotypes and their functionality after the first and third cycles of treatment
Description
The quantitative and qualitative pharmacodynamic effects of Ceplene/IL-2 on the immune responses of T and NK cells will be assessed as follows: Changes in T and NK cell phenotypes (CD56, CD3, CD4, CD8) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3. Changes in immune response markers (CD3, NKp46 [and other NCRs], CD25, CD69, and IFN-γ) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3
Time Frame
Baseline vs Cycle 1 and 3
Secondary Outcome Measure Information:
Title
Duration of LFS
Description
Duration of LFS: LFS will be defined as the time from achieving CR after successful induction therapy until relapse of AML (defined as 5% or more blast cells in the bone marrow).
Time Frame
up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: AML patients in CR1 whose AML subtype has been well-characterized using conventional karyotyping and molecular genetic techniques (eg, RQ-PCR) at diagnosis. Patients may be considered eligible if they have not had this assessment performed at diagnosis provided that stored samples of diagnostic genetic material (DNA/RNA) from blood and BM are available that can be assayed for the presence of markers such as WT1 and/or AML-specific genetic markers. Bone marrow examination confirming CR (defined as less than 5% blasts in a normocellular bone marrow). Eighteen years of age or older. Patients have received any form of induction and consolidation therapy as per standard practice at the institution, including autologous stem cell transplantation (ASCT). Within 8 weeks following the date of the last dose of consolidation or conditioning chemotherapy for AML, or following ASCT. Patients not undergoing consolidation therapy must have been in CR1 for at least one month prior to enrollment. Platelet count recovered after chemotherapy to ≥75 x 109/L, and Partial Thromboplastin Time (PTT) within normal limits. WBC ≥1.5 x 109/L and LFTs (to include SGPT [ALAT] or SGOT [AST] and bilirubin) should not exceed twice the upper limit of normal. Serum creatinine less than or equal to 1.5 times the upper normal limit. Able to function without significant decrease in daily activities (WHO Performance Status 0 - 1 or Karnofsky ≥70). Life expectancy of more than three months and able to undergo routine outpatient evaluations for efficacy, safety, and/or compliance. Women of childbearing potential must be practicing barrier or oral contraception, for the duration of the treatment, or documented as surgically sterile or one year post-menopausal. If female, be non-nursing, non-pregnant and have a negative pregnancy test within two weeks of starting study drug. The patient must be informed of the investigational nature of the study and written informed consent obtained. Exclusion Criteria: Patients who have undergone or are planned for allogeneic stem cell transplantation. Patients with M3 as an AML subtype. Class III or IV cardiac disease, hypotension or severe hypertension, vasomotor instability, serious or uncontrolled cardiac dysrhythmias (including ventricular arrhythmias) at any time, acute myocardial infarction within the past 12 months, active uncontrolled angina pectoris or symptomatic arteriosclerotic blood vessel disease. Other active malignancies except in situ carcinoma of the cervix, localized squamous or basal cell carcinoma of the skin. Serious concurrent or recent non-malignant medical conditions which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study. History of seizures, central nervous system disorders, stroke within the last 12 months, or psychiatric disability thought to be clinically significant in the opinion of the Investigator and adversely affecting compliance to protocol. Patients unable to undergo repeat treatments, clinical evaluations and other diagnostic procedures required by the protocol. Active autoimmune disease (including but not limited to systemic lupus, inflammatory bowel disease, and psoriasis). Patients with active peptic or esophageal ulcer disease or with past peptic ulcer or esophageal disease with a history or bleeding. Patients requiring active treatment for hypotension. Medical, sociologic, or psychological impediment to probable compliance with the protocol. Patients continuing systemic treatment with clonidine, steroids, and/or H2 receptor blocking agents. Patients with a history of histamine hypersensitivity, severe allergies to food or contrast media requiring treatment within the last five years. Patients unable to provide written consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robin FOA, MD, PhD
Organizational Affiliation
Università degli Studi di Roma "La Sapienza" Dipartimento di Biotecnologie Cellulari ed Ematolgia
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Mats L Brune, MD, PhD
Organizational Affiliation
Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sahlgrenska Academy, University of Gothenburg
City
Gothenburg
Country
Sweden

12. IPD Sharing Statement

Citations:
PubMed Identifier
34956230
Citation
Hussein BA, Hallner A, Wennstrom L, Brune M, Martner A, Hellstrand K, Bernson E, Thoren FB. Impact of NK Cell Activating Receptor Gene Variants on Receptor Expression and Outcome of Immunotherapy in Acute Myeloid Leukemia. Front Immunol. 2021 Dec 9;12:796072. doi: 10.3389/fimmu.2021.796072. eCollection 2021. Erratum In: Front Immunol. 2022 Jan 13;12:843461.
Results Reference
derived
PubMed Identifier
34367728
Citation
Grauers Wiktorin H, Aydin E, Christenson K, Issdisai N, Thoren FB, Hellstrand K, Martner A. Impact of IL-1beta and the IL-1R antagonist on relapse risk and survival in AML patients undergoing immunotherapy for remission maintenance. Oncoimmunology. 2021 Jul 25;10(1):1944538. doi: 10.1080/2162402X.2021.1944538. eCollection 2021.
Results Reference
derived
PubMed Identifier
30315349
Citation
Grauers Wiktorin H, Nilsson MS, Kiffin R, Sander FE, Lenox B, Rydstrom A, Hellstrand K, Martner A. Histamine targets myeloid-derived suppressor cells and improves the anti-tumor efficacy of PD-1/PD-L1 checkpoint blockade. Cancer Immunol Immunother. 2019 Feb;68(2):163-174. doi: 10.1007/s00262-018-2253-6. Epub 2018 Oct 12.
Results Reference
derived
PubMed Identifier
28721449
Citation
Sander FE, Nilsson M, Rydstrom A, Aurelius J, Riise RE, Movitz C, Bernson E, Kiffin R, Stahlberg A, Brune M, Foa R, Hellstrand K, Thoren FB, Martner A. Role of regulatory T cells in acute myeloid leukemia patients undergoing relapse-preventive immunotherapy. Cancer Immunol Immunother. 2017 Nov;66(11):1473-1484. doi: 10.1007/s00262-017-2040-9. Epub 2017 Jul 18.
Results Reference
derived
PubMed Identifier
28529313
Citation
Bernson E, Hallner A, Sander FE, Wilsson O, Werlenius O, Rydstrom A, Kiffin R, Brune M, Foa R, Aurelius J, Martner A, Hellstrand K, Thoren FB. Impact of killer-immunoglobulin-like receptor and human leukocyte antigen genotypes on the efficacy of immunotherapy in acute myeloid leukemia. Leukemia. 2017 Dec;31(12):2552-2559. doi: 10.1038/leu.2017.151. Epub 2017 May 22.
Results Reference
derived
PubMed Identifier
28235771
Citation
Rydstrom A, Hallner A, Aurelius J, Sander FE, Bernson E, Kiffin R, Thoren FB, Hellstrand K, Martner A. Dynamics of myeloid cell populations during relapse-preventive immunotherapy in acute myeloid leukemia. J Leukoc Biol. 2017 Aug;102(2):467-474. doi: 10.1189/jlb.5VMA1116-455R. Epub 2017 Feb 24.
Results Reference
derived
PubMed Identifier
26863635
Citation
Sander FE, Rydstrom A, Bernson E, Kiffin R, Riise R, Aurelius J, Anderson H, Brune M, Foa R, Hellstrand K, Thoren FB, Martner A. Dynamics of cytotoxic T cell subsets during immunotherapy predicts outcome in acute myeloid leukemia. Oncotarget. 2016 Feb 16;7(7):7586-96. doi: 10.18632/oncotarget.7210.
Results Reference
derived

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Maintenance Therapy With Ceplene® (Histamine) and IL-2 on Immune Response and MRD in Acute Myeloid Leukemia

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