Alpha/Beta CD19+ Depleted Haploidentical Transplantation + Zometa for Pediatric Hematologic Malignancies and Solid Tumors
Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Hodgkin Lymphoma
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring alpha beta depleted, alphabeta, TCR alpha beta depleted, alpha beta, haploidentical, Zoledronate, Zoledronic acid, Pediatric cancers, alfa beta, αβ T cell depleted HSCT, alpha beta T cell and B cell depleted HSCT, haploidentical HSCT
Eligibility Criteria
Inclusion Criteria:
- Availability of an eligible haploidentical donor
- Hematologic malignancy or solid tumor
- Patients with more than one malignancy (hematologic or solid tumor) are eligible
Patients with hematologic malignancy must have no HLA identical sibling or suitable unrelated donor OR time needed to find an acceptable unrelated donor match would likely result in disease progression such that the patient may become ineligible for any type of potentially curative transplant
- Relapsed or primary therapy-refractory AML with bone marrow blast < 20%
- High-risk refractory or relapsed ALL in patients for whom transplantation is deemed indicated (relapse occurring < 30 months from diagnosis, patients relapsing after previous allogeneic transplant, relapse after 2nd remission, primary induction failure or hypodiploidy)
- Relapsed Hodgkin lymphoma unable to achieve 2nd remission or Very Good Partial Response (VGPR) and therefore ineligible to receive autologous hematopoietic stem cell transplant (auto-HSCT)
- Hodgkin lymphoma relapsing after auto-HSCT
- Primary refractory or relapsed non-Hodgkin lymphoma unable to achieve 2nd remission or VGPR and therefore ineligible to receive auto-HSCT
- Non-Hodgkin lymphoma relapsing after auto-HSCT
- Myelodysplastic Syndrome/Myeloproliferative Syndrome
Solid Tumor
- Patients with solid tumor must have failed or have been ineligible to receive auto-HSCT or if auto-HSCT would not offer > 20% chance of cure
Neuroblastoma
- high risk with relapsed or refractory disease
Soft tissue sarcomas (Rhabdomyosarcoma, Ewing sarcoma, Primitive Neuroectodermal Tumor or other high-risk extracranial solid tumors)
- Relapsed or primary refractory metastatic
- 1st complete remission, but very high-risk features (i.e., < 20% survival with conventional therapy)
Osteosarcoma
- Failure to achieve Complete Response (CR) following initial therapy
- Relapsed with pulmonary or bone metastases and did not achieve a CR with surgery and/or chemotherapy
- Karnofsky (patients > 16 years) or Lansky (patients 16 years or older) performance score of ≥ 60
- Life expectancy of ≥ 3 months
- Patient must have fully recovered from acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study
- Study enrollment no earlier than 3 months after preceding HSCT
- Glomerular Filtration Rate (GFR) ≥ 60 ml/min/1.73m2
- Total bilirubin < 3 mg/dL
- ALT (alanine aminotransferase, SCPT) ≤ 5 x Upper LImit of Normal (ULN) for age
- Ejection fraction of > 40% by Multigated Acquisition Scan (MUGA) or echocardiogram
- No evidence of dyspnea at rest
- No supplemental oxygen requirement
- If measured, carbon monoxide diffusion capacity (DLCO) >50%
- No severe peripheral neuropathy, signs of leukoencephalopathy or active Central Nervous System (CNS) infection
- Patients with seizure disorders may be enrolled if seizures are well controlled on anticonvulsant therapy
- If of reproductive potential, negative pregnancy test and willing to use effective birth control method
- Informed consent from patient or legal guardian (if patient is minor)
Inclusion Criteria for Donors:
- Donor must be 18 years of age minimum, 65 years of age maximum
- Donor must be in good general health as determined by evaluating medical provider
Must meet donor criteria for human cells, tissues, and cellular and tissue-based products per Code of Federal Regulations 21 CFR 1271, subpart C. Specifically:
Donor screening in accordance with 1271.75 indicates that the donor:
- Is free from risk factors for, and clinical evidence of, infection due to relevant communicable disease agents and diseases; and
- Is free from communicable disease risks associated with xenotransplantation; and
- The results of donor testing for relevant communicable disease agents in accordance with 1271.80 and 1271.85 are negative or nonreactive, except as provided in 1271.80(d)(1).
- Haploidentical by HLA-typing
- Preference will be given to donors who demonstrate KIR incompatibility with recipient HLA class I ligands defined as the donor expressing a KIR gene for which the corresponding HLA class I ligand is not expressed by the recipient.
Negative testing for relevant communicable diseases:
- Hepatitis B surface antigen (HBsAg)
- Hepatitis B core antibody (Anti-HBc)
- Hepatitis C antibody (Anti-HCV)
- HIV 1 & 2 antibody (Anti-HIV-1, 2 plus O)
- HTLV I/II antibody (Anti-HTLV I/II)
- RPR (Syphilis TP)
- CMV (Capture CMV)
- MPX for: HepB (HBV-PCR), HepC (HCV-PCR), HIV (HIV-PCR)
- NAT for West Nile Virus (WNV-PCR)
- T. Cruzi - EIA (Chagas)
Exclusion Criteria:
- Pregnant or breast-feeding
- HIV infection
- Heart failure or uncontrolled cardiac rhythm disturbance
- Uncontrolled, Serious Active Infection
- Prior organ allograft
- Significant serious intercurrent illness unrelated to cancer or its treatment not covered by other exclusion criteria expected to significantly increase the risk of HSCT
- Any mental or physical condition, in the opinion of the PI (or PI designee), which could interfere with the ability of the subject (or the only parent or legal guardian available to care for the subject) to understand or adhere to the requirements of the study
- Enrollment in any other clinical study from screening up to Day 100 (unless PI judges such enrollment would not interfere with endpoints of this study)
Exclusion Criteria for Donors:
- Lactating females
- Pregnant females
Sites / Locations
- University of Wisconsin Carbone Cancer CenterRecruiting
Arms of the Study
Arm 1
Experimental
TCRαβ+/CD19+ depleted Haploidentical HSCT+ Zoledronate
Patients with high-risk leukemia (who are at least one year of age and who have not received TBI as conditioning for a previous HSCT) will receive myeloablative conditioning with ATG, Fludarabine, Thiotepa, and TBI. All other subjects will undergo a reduced-intensity conditioning regimen consisting of ATG, Fludarabine, Thiotepa, and Melphalan prior to transplant with a KIR/KIR ligand mismatched haploidentical donor peripheral blood stem cell graft depleted of TCR-αβ+ and CD19+ cells. Patients will receive 5 doses of zoledronate (at 28 day intervals) starting 28 days after stem cell transplant.