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Ex Vivo TCR αβ T Cell Depletion for Graft-Versus-Host Disease Prophylaxis in Mismatched Donor Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies

Primary Purpose

Hematologic Malignancy

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ClinicMACs
Sponsored by
Dana-Farber Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hematologic Malignancy focused on measuring Graft vs. Host Disease, Hematologic Malignancy

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnoses and stage at time of transplant admission:

    • Acute leukemia (AML or ALL or MPAL) in first or subsequent remission
    • Myelodysplastic syndromes (MDS) with <10% marrow blasts
    • Myeloproliferative neoplasm (MPN) with <10% marrow blasts
    • CMML with less than 10% marrow blast
    • CML accelerated phase or second or subsequent chronic phase
    • Non-Hodgkin's lymphoma in PR or CR2 or beyond
    • Hodgkin lymphoma in PR or CR2 or beyond
  • Age 18-65 years
  • Patient has a related or unrelated donor who is 8 or 9 out of 10 match at HLA A, B, C, DRB1 and DQB1, based on allele level typing.
  • Patient ECOG performance status 0-2 (Karnofsky ≥60%, see Appendix A)
  • Patient deemed to be appropriate candidate for myeloablative conditioning transplantation.
  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Patient with active HIV infection
  • Chronic active hepatitis B infection (HepB surface Ag+ or detectable Hep B viral load)
  • Prior allogeneic hematopoietic stem cell transplantation
  • Impaired cardiac function- ejection fraction < 40%
  • Impaired pulmonary function- pretransplant FEV1, DLCO < 50%
  • Impaired renal function, based on

    --Serum creatinine > 2.0 mg/dl

  • Impaired liver function unrelated to primary disease, based on

    --ALT or AST > 3x ULN, or Total Bilirubin > 2.0mg/dl (with exception for known or suspected Gilbert's disease)

  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Women who are pregnant or breast feeding. Women of child bearing potential must have a negative serum pregnancy test at study entry.
  • Participants who are receiving any other investigational agents are eligible but such agent must be discontinued before admission for HSCT, and if resumption of investigation agent is planned after HSCT, this must be approved by the study PI.
  • Participants with known active CNS disease. CNS disease that has been treated is eligible

Sites / Locations

  • Dana Farber Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

TCR α/β Reagent System

Arm Description

The stem cell apheresis product will be depleted of TCRαβ T cells by negative selection using the automated CliniMACS® Plus device. CD34+ stem cell counts will be obtained before and after processing with the Miltenyi ClinicMACs device

Outcomes

Primary Outcome Measures

Number of Participants With Severe Acute GVHD-free Survival
Number of participants with severe acute GVHD-free survival will be assessed at 100 days post-SCT

Secondary Outcome Measures

Number of Participants With Grades II-IV Acute GVHD
Grades II-IV acute GVHD will be assessed at 2 years post-SCT. Grade I GVHD is characterized as mild disease, grade II as moderate, grade III as severe, and grade IV as life-threatening. Higher grades of acute GVHD are associated with worse outcomes. Acute GVHD will be staged by assessment of clinical manifestations in the skin, gastrointestinal tract, and liver.
Number of Participants With Chronic GVHD
Number of participants with chronic GVHD will be assessed at 2 years post-SCT.
Number of Participants With GVHD and Relapse Free Survival (GRFS)
GRFS will be defined as alive without having experienced grade III-IV acute GVHD, moderate/severe chronic GVHD, or relapse of underlying malignancy.
Number of Participants With Immunosuppression-free Survival
Number of participants with immunosuppression-free survival will be assessed at 2 years post-SCT.
Number of Participants With Hematologic Recovery
Hematologic recovery will be assessed in participants at 2 years post-SCT.
Number of Participants With Immune Reconstitution
Immune reconstitution will be assessed in participants at 2 years post-SCT.
Number of Participants With Disease Relapse
Disease relapse will be assessed in participants at 2 years post-SCT.
Number of Participants With Transplant-related Mortality
Participant transplant-related mortality will be assessed at 2 years post-SCT.
Number of Participants With Organ Toxicity
Participant organ toxicity will be assessed at 2 years post-SCT.
Rates of Infections
Participant rate of infections will be assessed at 2 years post-SCT.
Number of Participants With Relapse-free and Overall Survival
Number of participants with relapse-free and overall survival will be assessed at 2 years post-SCT.

Full Information

First Posted
October 22, 2018
Last Updated
April 15, 2022
Sponsor
Dana-Farber Cancer Institute
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1. Study Identification

Unique Protocol Identification Number
NCT03717480
Brief Title
Ex Vivo TCR αβ T Cell Depletion for Graft-Versus-Host Disease Prophylaxis in Mismatched Donor Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies
Official Title
A Phase 2 Study of Ex Vivo TCR αβ T Cell Depletion for Graft-Versus-Host Disease (GVHD) Prophylaxis in Mismatched Donor Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Terminated
Why Stopped
The study was prematurely closed to enrollment due to feasibility issues, as the site has promising upcoming competing trials, and the study was already not enrolling at a rate sufficient to meet the accrual goal.
Study Start Date
January 21, 2020 (Actual)
Primary Completion Date
April 26, 2021 (Actual)
Study Completion Date
April 26, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dana-Farber Cancer Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research study is studying the removal of a subset of white blood cells (called alpha/beta T cells) from the donor product using a cell separation device before the product is transplanted into the participant. The device used to remove the α/βT cells in this study is: -CliniMACS® TCR α/β Reagent System
Detailed Description
Patients who receive an allogeneic (using another person as the donor) stem cell transplant (SCT) are at risk for developing graft-versus-host disease (GVHD). The word "graft" refers to the donor blood cells that you will receive during the transplant. The word "host" refers to the person receiving the cells. GVHD is a complication of transplantation where the donor graft attacks and damages some of the participant's tissues. GVHD may occur when the T cells (a type of white blood cell that helps protect the body from infection) from the donor react against normal tissues or organs in the body. There are two basic types of GVHD: Acute GVHD often occurs early (generally first 3-6 months after SCT) may affect skin, gastrointestinal tract (stomach and intestines) and liver. Chronic GVHD often occurs later (Usually after 3-6 months after SCT) and may affect many organs and significantly diminish quality of life. To confirm the diagnosis of acute or chronic GVHD, the participant may be asked to have a biopsy (a small sample of the participant's tissue to look at under the microscope) of the skin, gut, or, rarely, the liver. In this research study, the investigator are investigating a pre-transplant intervention aimed to prevent GVHD by processing the donor product with the Miltenyi CliniMACS TCR α/β Reagent System. The Reagent System will remove certain cells (called T-Cell Receptor (TCR) α/β positive T-cells) that are thought to cause GVHD from donor product before it is given to the participant. By selectively removing this specific type of T cells from the donor product, the investigators hope to reduce the risk for GVHD without reducing the efficacy of the transplant. This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. "Investigational" means that the intervention is being studied. The FDA (the U.S. Food and Drug Administration) has not approved CliniMACS α/β T cell depletion system for use in the US, but this system is approved by the European Medicines Agency (EMA) and used in Europe

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hematologic Malignancy
Keywords
Graft vs. Host Disease, Hematologic Malignancy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
TCR α/β Reagent System
Arm Type
Experimental
Arm Description
The stem cell apheresis product will be depleted of TCRαβ T cells by negative selection using the automated CliniMACS® Plus device. CD34+ stem cell counts will be obtained before and after processing with the Miltenyi ClinicMACs device
Intervention Type
Device
Intervention Name(s)
ClinicMACs
Intervention Description
The Reagent System will remove certain cells (called T-Cell Receptor (TCR) α/β positive T-cells) that are thought to cause GVHD from donor product before it is given to participants
Primary Outcome Measure Information:
Title
Number of Participants With Severe Acute GVHD-free Survival
Description
Number of participants with severe acute GVHD-free survival will be assessed at 100 days post-SCT
Time Frame
100 Days
Secondary Outcome Measure Information:
Title
Number of Participants With Grades II-IV Acute GVHD
Description
Grades II-IV acute GVHD will be assessed at 2 years post-SCT. Grade I GVHD is characterized as mild disease, grade II as moderate, grade III as severe, and grade IV as life-threatening. Higher grades of acute GVHD are associated with worse outcomes. Acute GVHD will be staged by assessment of clinical manifestations in the skin, gastrointestinal tract, and liver.
Time Frame
2 years
Title
Number of Participants With Chronic GVHD
Description
Number of participants with chronic GVHD will be assessed at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With GVHD and Relapse Free Survival (GRFS)
Description
GRFS will be defined as alive without having experienced grade III-IV acute GVHD, moderate/severe chronic GVHD, or relapse of underlying malignancy.
Time Frame
2 years
Title
Number of Participants With Immunosuppression-free Survival
Description
Number of participants with immunosuppression-free survival will be assessed at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Hematologic Recovery
Description
Hematologic recovery will be assessed in participants at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Immune Reconstitution
Description
Immune reconstitution will be assessed in participants at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Disease Relapse
Description
Disease relapse will be assessed in participants at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Transplant-related Mortality
Description
Participant transplant-related mortality will be assessed at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Organ Toxicity
Description
Participant organ toxicity will be assessed at 2 years post-SCT.
Time Frame
2 years
Title
Rates of Infections
Description
Participant rate of infections will be assessed at 2 years post-SCT.
Time Frame
2 years
Title
Number of Participants With Relapse-free and Overall Survival
Description
Number of participants with relapse-free and overall survival will be assessed at 2 years post-SCT.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnoses and stage at time of transplant admission: Acute leukemia (AML or ALL or MPAL) in first or subsequent remission Myelodysplastic syndromes (MDS) with <10% marrow blasts Myeloproliferative neoplasm (MPN) with <10% marrow blasts CMML with less than 10% marrow blast CML accelerated phase or second or subsequent chronic phase Non-Hodgkin's lymphoma in PR or CR2 or beyond Hodgkin lymphoma in PR or CR2 or beyond Age 18-65 years Patient has a related or unrelated donor who is 8 or 9 out of 10 match at HLA A, B, C, DRB1 and DQB1, based on allele level typing. Patient ECOG performance status 0-2 (Karnofsky ≥60%, see Appendix A) Patient deemed to be appropriate candidate for myeloablative conditioning transplantation. Ability to understand and the willingness to sign a written informed consent document Exclusion Criteria: Patient with active HIV infection Chronic active hepatitis B infection (HepB surface Ag+ or detectable Hep B viral load) Prior allogeneic hematopoietic stem cell transplantation Impaired cardiac function- ejection fraction < 40% Impaired pulmonary function- pretransplant FEV1, DLCO < 50% Impaired renal function, based on --Serum creatinine > 2.0 mg/dl Impaired liver function unrelated to primary disease, based on --ALT or AST > 3x ULN, or Total Bilirubin > 2.0mg/dl (with exception for known or suspected Gilbert's disease) Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Women who are pregnant or breast feeding. Women of child bearing potential must have a negative serum pregnancy test at study entry. Participants who are receiving any other investigational agents are eligible but such agent must be discontinued before admission for HSCT, and if resumption of investigation agent is planned after HSCT, this must be approved by the study PI. Participants with known active CNS disease. CNS disease that has been treated is eligible
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Vincent T Ho, MD
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Ex Vivo TCR αβ T Cell Depletion for Graft-Versus-Host Disease Prophylaxis in Mismatched Donor Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies

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