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Treatment of BK Virus Infection With CTL Cells in Immunocompromised Transplant Patients (BK-CTLs)

Primary Purpose

BK Polyomavirus

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
BK-virus specific CTLs
Sponsored by
Children's Hospital of Philadelphia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for BK Polyomavirus

Eligibility Criteria

5 Weeks - 25 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patient Eligibility

  • Patients with symptoms of cystitis and elevated BK virus DNA by screening PCR as above (section 4) post allogeneic HSCT, post chemotherapy

    1. Symptoms of cystitis may include: hematuria (microscopic or gross), pain with urination, frequency, bladder spasms.
    2. Patient may be otherwise treated for cystitis as per local institutional standards. Such treatments may include hydration, antiviral medications, or surgical intervention as deemed appropriate by treating physician.
  • Consent: Written informed consent given (by patient or legal representative) prior to any study-related procedures.
  • Performance Status > 30% (Lansky < 16 yrs and Karnofsky > 16 yrs)
  • Age: 0.1 to 25 years
  • Females of childbearing potential with a negative urine pregnancy test.

Donor Eligibility

  • Related donor available with a T-cell response to the BK-virus MACS® PepTivator® antigen(s).

    1. Original allogeneic donor if available, IgG positive for BKV or confirmatory testing to respond to BKV MACS Peptivator®.
    2. Third Party Allogeneic Donor: If original donor is not available or does not have a T-cell response: third party allogeneic donor (family donor > 1 HLA A, B, DR match to recipient) with a T-cell response to the BK MACS® PepTivator.

      AND

  • Allogeneic donor disease screening is complete similar to hematopoietic stem cell donors (Appendix 1).

AND

• Obtained informed consents by donor or donor legally authorized representative prior to donor collection.

Exclusion Criteria:

Patient exclusion criteria:

A patient meeting any of the following criteria is not eligible for the present study:

  • Patient with acute GVHD > grade 2 or extensive chronic GVHD at the time of BK Virus CTL infusion
  • Patient receiving steroids (>0.5 mg/kg prednisone equivalent) at the time of BK Virus CTL infusion or within 3 days of planned infusion.
  • Thymoglobulin (ATG), campath or T cell immunosuppressive monoclonal antibodies within 30 days
  • Patient with poor performance status determined by Karnofsky (patients >16 years) or Lansky (patients ≤16 years) score ≤30%
  • Concomitant enrollment in another experimental clinical trial investigating the treatment of refractory BK virus infection.
  • Any medical condition which could compromise participation in the study according to the investigator's assessment
  • Known HIV infection
  • Female patient of childbearing age who is pregnant or breast-feeding or not willing to use an effective method of birth control during study treatment.
  • Known hypersensitivity to iron dextran
  • Patients unwilling or unable to comply with the protocol or unable to give informed consent.
  • Known human anti-mouse antibodies

Sites / Locations

  • Children's Hospital of PhiladelphiaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

BK cystitis and/or nephropathy

Arm Description

All patients with symptoms that are consistent with BK cystitis and/or nephropathy (frequency, dysuria, hematuria, elevated creatinine) will have serum quantitative DNA PCR for BK virus level measured in log copies per mL (results also expressed in copies per milliliter), performed in the Children's Hospital of Philadelphia Infectious Disease Diagnostics Laboratory

Outcomes

Primary Outcome Measures

Number of participants with Grade III-IV acute GVHD
Number of participants with Grade III-IV acute GVHD as assessed by CTCAE v4.0
Number of patients with undetectable BK viral load
Number of patients with undetectable BK viral load as measured by qPCR

Secondary Outcome Measures

Full Information

First Posted
January 23, 2020
Last Updated
February 20, 2023
Sponsor
Children's Hospital of Philadelphia
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1. Study Identification

Unique Protocol Identification Number
NCT04293042
Brief Title
Treatment of BK Virus Infection With CTL Cells in Immunocompromised Transplant Patients
Acronym
BK-CTLs
Official Title
A Pilot Study in the Treatment of BK Virus Infection With Cytotoxic T Cells in Immunocompromised Transplant Patients
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 7, 2019 (Actual)
Primary Completion Date
December 30, 2023 (Anticipated)
Study Completion Date
December 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Children's Hospital of Philadelphia

4. Oversight

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

5. Study Description

Brief Summary
This is a pilot study using cytotoxic T lymphocytes (CTLs) manufactured with the Miltenyi CliniMACS Prodigy Gamma-capture system will be effective in decreasing specific viral load in patients with BK virus viremia and BK virus-associated symptoms post-allogeneic hematopoietic stem cell transplantation (HSCT), renal transplantation, and chemotherapy.
Detailed Description
This open-label, single-arm clinical trial will assess the safety and efficacy of BK virus-specific CTLs isolated from whole blood or leukapheresis products. The BK virus -specific CTLs will be generated automatically by the CliniMACS® Prodigy using the CliniMACS Cytokine Capture System (IFNgamma) after incubation with MACS GMP PepTivator® Peptide Pools of BKV VP1 and BKV LT.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
BK Polyomavirus

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This open-label, single-arm clinical trial
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
BK cystitis and/or nephropathy
Arm Type
Experimental
Arm Description
All patients with symptoms that are consistent with BK cystitis and/or nephropathy (frequency, dysuria, hematuria, elevated creatinine) will have serum quantitative DNA PCR for BK virus level measured in log copies per mL (results also expressed in copies per milliliter), performed in the Children's Hospital of Philadelphia Infectious Disease Diagnostics Laboratory
Intervention Type
Biological
Intervention Name(s)
BK-virus specific CTLs
Intervention Description
HLA Matched Related Donors: BK-virus specific CTLs (2.5 x 104 CD3/kg) infused intravenously on day 0 and may be additionally reinfused at a minimum of every two weeks (depending on safety and efficacy) for a maximum of five total infusions (maximum 12.5 x 104 CD3/kg). HLA Mismatched Related Donors: BK-virus specific CTLs (0.5x104 CD3/kg) infused intravenously on day 0 and may additionally be reinfused at a minimum of every two weeks (depending on safety and efficacy) for a maximum of five total infusions (maximum 2.5 x 104 CD3/kg).
Primary Outcome Measure Information:
Title
Number of participants with Grade III-IV acute GVHD
Description
Number of participants with Grade III-IV acute GVHD as assessed by CTCAE v4.0
Time Frame
Up to 8 weeks after last BK-CTL infusion
Title
Number of patients with undetectable BK viral load
Description
Number of patients with undetectable BK viral load as measured by qPCR
Time Frame
12 weeks after first BK-CTL infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Weeks
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient Eligibility Patients with symptoms of cystitis and elevated BK virus DNA by screening PCR as above (section 4) post allogeneic HSCT, post chemotherapy Symptoms of cystitis may include: hematuria (microscopic or gross), pain with urination, frequency, bladder spasms. Patient may be otherwise treated for cystitis as per local institutional standards. Such treatments may include hydration, antiviral medications, or surgical intervention as deemed appropriate by treating physician. Consent: Written informed consent given (by patient or legal representative) prior to any study-related procedures. Performance Status > 30% (Lansky < 16 yrs and Karnofsky > 16 yrs) Age: 0.1 to 25 years Females of childbearing potential with a negative urine pregnancy test. Donor Eligibility Related donor available with a T-cell response to the BK-virus MACS® PepTivator® antigen(s). Original allogeneic donor if available, IgG positive for BKV or confirmatory testing to respond to BKV MACS Peptivator®. Third Party Allogeneic Donor: If original donor is not available or does not have a T-cell response: third party allogeneic donor (family donor > 1 HLA A, B, DR match to recipient) with a T-cell response to the BK MACS® PepTivator. AND Allogeneic donor disease screening is complete similar to hematopoietic stem cell donors (Appendix 1). AND • Obtained informed consents by donor or donor legally authorized representative prior to donor collection. Exclusion Criteria: Patient exclusion criteria: A patient meeting any of the following criteria is not eligible for the present study: Patient with acute GVHD > grade 2 or extensive chronic GVHD at the time of BK Virus CTL infusion Patient receiving steroids (>0.5 mg/kg prednisone equivalent) at the time of BK Virus CTL infusion or within 3 days of planned infusion. Thymoglobulin (ATG), campath or T cell immunosuppressive monoclonal antibodies within 30 days Patient with poor performance status determined by Karnofsky (patients >16 years) or Lansky (patients ≤16 years) score ≤30% Concomitant enrollment in another experimental clinical trial investigating the treatment of refractory BK virus infection. Any medical condition which could compromise participation in the study according to the investigator's assessment Known HIV infection Female patient of childbearing age who is pregnant or breast-feeding or not willing to use an effective method of birth control during study treatment. Known hypersensitivity to iron dextran Patients unwilling or unable to comply with the protocol or unable to give informed consent. Known human anti-mouse antibodies
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Barb McGlynn, RN, BSN
Phone
215-590-1303
Email
MCGLYNN@chop.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Nancy J Bunin, MD
Phone
215-590-2255
Email
buninn@chop.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nancy J Bunin, MD
Organizational Affiliation
Children's Hospital of Philadelphia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Barb McGlynn, RN, BSN
Phone
215-590-1303
Email
MCGLYNN@chop.edu
First Name & Middle Initial & Last Name & Degree
Nancy J Bunin, MD
Phone
215-590-2255
Email
BUNINN@chop.edu
First Name & Middle Initial & Last Name & Degree
Nancy J Bunin, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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Treatment of BK Virus Infection With CTL Cells in Immunocompromised Transplant Patients

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