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Activated White Blood Cells With ASCT for Newly Diagnosed Multiple Myeloma

Primary Purpose

Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
MILs
Melphalan
PCV13
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma and Plasma Cell Neoplasm focused on measuring stage II multiple myeloma, stage III multiple myeloma

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Diagnosis of multiple myeloma

    • Newly diagnosed disease
    • Durie-Salmon stage II or III disease
  • Measurable disease, defined by any of the following:

    • Measurable serum and/or urine M-protein levels documented and available prior to induction therapy
    • Positive serum free light chain assay
  • Must have completed a minimum of 3 courses of myeloma specific therapy
  • Candidate for autologous stem cell transplantation
  • Patients who have achieved a complete remission at the time of bone marrow harvest for marrow infiltrating lymphocytes (MILs) expansion are not eligible
  • No evidence of spinal cord compression
  • Diagnosis of the following cancers are not allowed:

    • POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes)
    • Non-secretory myeloma (no measurable protein on serum free light chain assay)
    • Plasma cell leukemia
  • No amyloidosis

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy ≥ 6 months
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and up to day 180
  • Corrected serum calcium < 11 mg/dL and no evidence of symptomatic hypercalcemia
  • Total bilirubin ≤ 2.0 times upper limit of normal (ULN)
  • ALT ≤ 2.0 times ULN
  • Serum creatinine < 2.0 mg/dL
  • No history of other malignancy within the past 5 years, except adequately treated basal cell or squamous cell skin cancer
  • No history of autoimmune disease (e.g., rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus) requiring systemic treatment

    • Hypothyroidism without evidence of Graves' disease or Hashimoto thyroiditis is allowed
  • No infection requiring treatment with antibiotics, antifungal, or antiviral agents within the past 7 days
  • No HIV infection
  • No major organ system dysfunction including, but not limited to, the following:

    • New York Heart Association class III or IV congestive heart failure
    • Pulmonary disease requiring the use of inhaled steroids or bronchodilators
    • Renal, hepatic, gastrointestinal, neurologic, or psychiatric dysfunction that would impair ability to participate in the study

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior hematopoietic stem cell transplantation
  • At least 3 weeks since prior corticosteroids (i.e., glucocorticoids)
  • At least 3 weeks since prior myeloma-specific therapy
  • At least 4 weeks since participation in any clinical trial that involved an investigational drug or device
  • No concurrent therapy with any of the following:

    • Corticosteroids (e.g., hydrocortisone, prednisone, prednisolone, dexamethasone [Decadron])

      • Inhaled steroids used for treatment of allergic rhinitis or pulmonary disease allowed
    • Thalidomide
    • Interferon
    • Growth factors, interleukins, or other cytokines (except filgrastim [G-CSF] as outlined in the protocol, or erythropoietin)
    • Cytotoxic chemotherapy agents (except cyclophosphamide for stem cell mobilization and high-dose melphalan)
    • Immunosuppressive drugs
    • Experimental therapies
    • Radiotherapy

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ASCT+MILs

Arm Description

Autologous stem cell transplant with a conditioning regimen of melphalan 100 mg/m^2 on each of Days -2 and -1. Infusion of activated marrow infiltrating lymphocytes (MILs) on Day 3. PCV13 vaccine will be given before and/or after Day 0 depending on when participants are enrolled.

Outcomes

Primary Outcome Measures

Hematopoietic Engraftment
Days to absolute neutrophil count > 500 cells per microliter.
Disease Response
Percentage of participants with partial or complete response by Bladé criteria. Partial response is defined as a >= 50% decrease in serum paraprotein or 90% decrease in urinary light chains (for participants without measurable serum paraprotein). Complete response is defined as negative serum and urine immunofixation and a bone marrow aspirate with < 5% plasma cells.
Feasibility of MILs Generation as Assessed by Percentage of Participants With Successful MIL Generation
Success rate of expanding MILs in vitro and obtaining a protocol-specified product.

Secondary Outcome Measures

T-cell Reconstitution as Determined by Absolute Lymphocyte Count (ALC)
ALC counts trending over time.
Survival
Survival in months for participants who are alive (Overall Survival) and alive without disease progression (Progression-free survival). Disease progression is defined as a change from negative to positive on immunofixation or electrophoresis for participants previously in complete remission or a 25% increase in serum electrophoresis for participants not previously in complete remission. Partial response is defined as a >= 50% decrease in serum paraprotein or 90% decrease in urinary light chains (for participants without measurable serum paraprotein). Complete response is defined as negative serum and urine immunofixation and a bone marrow aspirate with < 5% plasma cells.
Pneumococcal-specific Vaccine Responses
CRM-197 Prevnar-specific vaccine responses that measure the T-cell response of the vaccine quantified as %CD3+/CFSE-low/IFN-gamma+.
Anti-tumor Immune Responses
Myeloma lysate response that measures the T-cell response quantified as %CD3+/CFSE-low/IFN-gamma+.

Full Information

First Posted
November 30, 2007
Last Updated
May 24, 2023
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00566098
Brief Title
Activated White Blood Cells With ASCT for Newly Diagnosed Multiple Myeloma
Official Title
Adoptive Immunotherapy Utilizing Activated Marrow Infiltrating Lymphocytes in the Autologous Transplant Setting in Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
November 2007 (Actual)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
October 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Activating white blood cells in the laboratory may help them kill more cancer cells when they are put back in the body. This may be an effective treatment for patients undergoing a stem cell transplant for multiple myeloma. PURPOSE: This phase I/II trial is studying the side effects of activated white blood cells and to see how well they work in treating patients who are undergoing a stem cell transplant for newly diagnosed stage II or stage III multiple myeloma.
Detailed Description
OBJECTIVES: Primary Evaluate the safety and response rate of activated marrow infiltrating lymphocytes (aMILs) in patients undergoing autologous peripheral blood stem cell transplantation for newly diagnosed, stage II-III multiple myeloma. Determine the overall in vitro fold-expansion and assess pre- and post-expansion for myeloma T-cell specificity in assessing the feasibility of generating aMILs from myeloma patients. Assess the toxicity of aMILs. Evaluate the effect of aMILs on hematopoietic engraftment, including neutrophil engraftment, platelet engraftment, and primary graft failure (if failure occurs). Evaluate response rates utilizing the Blade criteria, including the complete response (CR) rate, near complete response (nCR) rate, very good partial response (VGPR) rate, partial response (PR) rate, minimal response (MR) rate, and overall response rate (CR, VGPR, PR, MR). Secondary Evaluate T-cell reconstitution, including absolute lymphocyte counts, CD3+, CD4+, and CD8+ T-cell counts. Evaluate progression-free survival and overall survival. Evaluate anti-tumor immune response. Determine pneumococcal-specific vaccine responses. Determine delayed-type hypersensitivity (DTH) responses. OUTLINE: Patients undergo collection of marrow infiltrating lymphocytes (MILs)* either at diagnosis prior to the initiation of induction therapy or upon completion of induction therapy. The MILs bone marrow product undergo ex vivo activation and expansion of T cells for 7-8 days to produce activated marrow infiltrating lymphocytes (aMILs). Patients then undergo stem cell mobilization and leukapheresis to collect the peripheral blood stem cells 12 days after mobilization. Patients receive melphalan IV over 20-30 minutes on days -2 and -1 and undergo a peripheral blood stem cell transplantation on day 0 as planned. Patients receive aMILs infusion on day 3. Patients receive pneumococcal polyvalent vaccine on day 21. NOTE: *Patients who have completed induction therapy receive pneumococcal polyvalent vaccine approximately 2 weeks prior to MILs collection; patients undergoing MILs collection prior to starting induction therapy do not receive a pre-transplantation vaccine. Blood and bone marrow samples are collected periodically for laboratory correlative studies. After completion of study treatment, patients are followed periodically for up to 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma and Plasma Cell Neoplasm
Keywords
stage II multiple myeloma, stage III multiple myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
26 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ASCT+MILs
Arm Type
Experimental
Arm Description
Autologous stem cell transplant with a conditioning regimen of melphalan 100 mg/m^2 on each of Days -2 and -1. Infusion of activated marrow infiltrating lymphocytes (MILs) on Day 3. PCV13 vaccine will be given before and/or after Day 0 depending on when participants are enrolled.
Intervention Type
Biological
Intervention Name(s)
MILs
Other Intervention Name(s)
Marrow infiltrating lymphocytes, Activated marrow infiltrating lymphocytes, aMILs
Intervention Type
Drug
Intervention Name(s)
Melphalan
Other Intervention Name(s)
Alkeran
Intervention Type
Biological
Intervention Name(s)
PCV13
Other Intervention Name(s)
Prevnar
Primary Outcome Measure Information:
Title
Hematopoietic Engraftment
Description
Days to absolute neutrophil count > 500 cells per microliter.
Time Frame
Up to 1 year
Title
Disease Response
Description
Percentage of participants with partial or complete response by Bladé criteria. Partial response is defined as a >= 50% decrease in serum paraprotein or 90% decrease in urinary light chains (for participants without measurable serum paraprotein). Complete response is defined as negative serum and urine immunofixation and a bone marrow aspirate with < 5% plasma cells.
Time Frame
Up to 2 years
Title
Feasibility of MILs Generation as Assessed by Percentage of Participants With Successful MIL Generation
Description
Success rate of expanding MILs in vitro and obtaining a protocol-specified product.
Time Frame
Up to 1 year
Secondary Outcome Measure Information:
Title
T-cell Reconstitution as Determined by Absolute Lymphocyte Count (ALC)
Description
ALC counts trending over time.
Time Frame
Days 14, 28, 60, 180, and 360
Title
Survival
Description
Survival in months for participants who are alive (Overall Survival) and alive without disease progression (Progression-free survival). Disease progression is defined as a change from negative to positive on immunofixation or electrophoresis for participants previously in complete remission or a 25% increase in serum electrophoresis for participants not previously in complete remission. Partial response is defined as a >= 50% decrease in serum paraprotein or 90% decrease in urinary light chains (for participants without measurable serum paraprotein). Complete response is defined as negative serum and urine immunofixation and a bone marrow aspirate with < 5% plasma cells.
Time Frame
Up to 129 months
Title
Pneumococcal-specific Vaccine Responses
Description
CRM-197 Prevnar-specific vaccine responses that measure the T-cell response of the vaccine quantified as %CD3+/CFSE-low/IFN-gamma+.
Time Frame
At time of bone marrow harvest, Day 60 post-transplant, Day 180 post-transplant, and Day 360 post-transplant
Title
Anti-tumor Immune Responses
Description
Myeloma lysate response that measures the T-cell response quantified as %CD3+/CFSE-low/IFN-gamma+.
Time Frame
At time of bone marrow harvest, Day 60 post-transplant, Day 180 post-transplant, and Day 360 post-transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma Newly diagnosed disease Durie-Salmon stage II or III disease Measurable disease, defined by any of the following: Measurable serum and/or urine M-protein levels documented and available prior to induction therapy Positive serum free light chain assay Must have completed a minimum of 3 courses of myeloma specific therapy Candidate for autologous stem cell transplantation Patients who have achieved a complete remission at the time of bone marrow harvest for marrow infiltrating lymphocytes (MILs) expansion are not eligible No evidence of spinal cord compression Diagnosis of the following cancers are not allowed: POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes) Non-secretory myeloma (no measurable protein on serum free light chain assay) Plasma cell leukemia No amyloidosis PATIENT CHARACTERISTICS: ECOG performance status 0-2 Life expectancy ≥ 6 months Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and up to day 180 Corrected serum calcium < 11 mg/dL and no evidence of symptomatic hypercalcemia Total bilirubin ≤ 2.0 times upper limit of normal (ULN) ALT ≤ 2.0 times ULN Serum creatinine < 2.0 mg/dL No history of other malignancy within the past 5 years, except adequately treated basal cell or squamous cell skin cancer No history of autoimmune disease (e.g., rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus) requiring systemic treatment Hypothyroidism without evidence of Graves' disease or Hashimoto thyroiditis is allowed No infection requiring treatment with antibiotics, antifungal, or antiviral agents within the past 7 days No HIV infection No major organ system dysfunction including, but not limited to, the following: New York Heart Association class III or IV congestive heart failure Pulmonary disease requiring the use of inhaled steroids or bronchodilators Renal, hepatic, gastrointestinal, neurologic, or psychiatric dysfunction that would impair ability to participate in the study PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior hematopoietic stem cell transplantation At least 3 weeks since prior corticosteroids (i.e., glucocorticoids) At least 3 weeks since prior myeloma-specific therapy At least 4 weeks since participation in any clinical trial that involved an investigational drug or device No concurrent therapy with any of the following: Corticosteroids (e.g., hydrocortisone, prednisone, prednisolone, dexamethasone [Decadron]) Inhaled steroids used for treatment of allergic rhinitis or pulmonary disease allowed Thalidomide Interferon Growth factors, interleukins, or other cytokines (except filgrastim [G-CSF] as outlined in the protocol, or erythropoietin) Cytotoxic chemotherapy agents (except cyclophosphamide for stem cell mobilization and high-dose melphalan) Immunosuppressive drugs Experimental therapies Radiotherapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ivan Borrello, MD
Organizational Affiliation
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Official's Role
Study Chair
Facility Information:
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231-2410
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25995224
Citation
Noonan KA, Huff CA, Davis J, Lemas MV, Fiorino S, Bitzan J, Ferguson A, Emerling A, Luznik L, Matsui W, Powell J, Fuchs E, Rosner GL, Epstein C, Rudraraju L, Ambinder RF, Jones RJ, Pardoll D, Borrello I. Adoptive transfer of activated marrow-infiltrating lymphocytes induces measurable antitumor immunity in the bone marrow in multiple myeloma. Sci Transl Med. 2015 May 20;7(288):288ra78. doi: 10.1126/scitranslmed.aaa7014.
Results Reference
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Activated White Blood Cells With ASCT for Newly Diagnosed Multiple Myeloma

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