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Active Immunization of Sibling Bone Marrow Transplant Donors Against Purified Myeloma Protein of the Recipient Undergoing Allogeneic Bone Marrow Transplantation

Primary Purpose

Graft vs Host Disease, Multiple Myeloma

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Myeloma Immunoglobulin Idiotype Vaccine-KLH
GM-CSF
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Graft vs Host Disease focused on measuring Multiple Myeloma, Vaccine, Idiotype-Specific Immunity, Immune Transfer, Myeloma Immunoglobulin

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: Patient Selection: Patients with IgG or IgA multiple myeloma who attain at least a PR before transplantation are eligible for thsi protocol. Patients may only have received 3-4 courses of VAD, high dose cyclophosphamide and one autologous transplant before entering the study. All previous therapy must be completed at least 2 weeks prior to study entry. Patients should have recovered from all hematologic and non-hematologic toxicity of previous therapy. Steroid must be discontinued at least two weeks prior to vaccination. Only patients less than 60 years are eligible for this protocol. Patients must meet the following criteria: A. Karnofsky performance status greater than or equal to 70 percent. B. Life expectancy greater than 8 weeks and absence of co-existing medical problems which would significantly increase the risk of the transplant procedure in the judgment of the bone marrow transplant attending physicians (e.g., the MUGA left ventricular ejection fraction has to be greater than 50% and DLCO greater thant 50% of the expected value when corrected for Hb). Creatinine less than 2x normal and not rising for at least 2-4 weeks before transplantation. If creatinine is elevated, then creatinine clearance must be greater than 40 ml/min. Direct bilirubin less than 2 mg/dl, SGOT less than 4x top normal, and none of these parameters increasing, for at least 2-4 weeks before transplantation. Patients must be HIV-negative, HBsAg-, and Hepatitis C antibody Negative. Not pregnant or lactating. Patients of childbearing potential must use an effective method of contraception. M-protein concentration in the harvested plasma must be greater than 90 percent of the total Ig of the corresponding isotype. Patients must be greater than or equal to 18 years old. Donor criteria: Any consenting healthy individual who fulfills the donor criteria will be considered for the marrow donation. HLA-identical sibling donors. HLA, A and B and DR phenotypically identical family donors. HIV, hepatitis B or C seropositive. Complete blood count, platelets, and PT, PTT within normal limits.

Sites / Locations

  • National Cancer Institute (NCI)

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 3, 1999
Last Updated
September 21, 2007
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00001561
Brief Title
Active Immunization of Sibling Bone Marrow Transplant Donors Against Purified Myeloma Protein of the Recipient Undergoing Allogeneic Bone Marrow Transplantation
Official Title
Active Immunization of Sibling Bone Marrow Transplant Donors Against Purified Myeloma Protein of the Recipient Undergoing Allogeneic Bone Marrow Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
September 2005
Overall Recruitment Status
Completed
Study Start Date
November 1996 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
September 2005 (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
Both patients and marrow donors are treated on Regimen A; patients then proceed to Regimen B. The following acronyms are used: ABM Allogeneic Bone Marrow BU Busulfan, NSC-750 CF Leucovorin calcium, NSC-3590 CTX Cyclophosphamide, NSC-26271 G-CSF Granulocyte Colony-Stimulating Factor (source not specified) GM-CSF Granulocyte-Macrophage Colony-Stimulating Factor (Hoechst/Immunex), NSC-613795 GVHD Graft-vs.-Host Disease Mesna Mercaptoethane sulfonate, NSC-113891 MTX Methotrexate, NSC-740 PP Unconjugated Myeloma Immunoglobulin plasma paraprotein, NSC-684150 PP-KLH Myeloma immunoglobulin plasma paraprotein vaccine, NSC-678327, with keyhole limpet hemocyanin TBI Total-Body Irradiation TSPA Thiotepa, NSC-6396 Regimen A (Donor and Patient): Vaccine Therapy with Immunoadjuvant. PP-KLH (individual myeloma immunoglobulin plasma paraprotein vaccine prepared from recipient's plasma paraprotein and conjugated with KLH); and PP; with GM-CSF. Regimen B (Patient): Myeloablative Radiotherapy and 2-Drug Combination Chemotherapy or 2-Drug Combination Myeloablative Chemotherapy followed by Hematopoietic Rescue with Growth Factor Support and GVHD Prophylaxis followed by Vaccine Therapy with Immunoadjuvant. TBI; and CTX/TSPA; or BU/CTX; followed by ABM; with G-CSF; and CYSP; MTX/CF; followed by PP-KLH; with GM-CSF.
Detailed Description
Multiple Myeloma remains a largely incurable disease with current therapy. Allogeneic bone marrow transplantation provides an opportunity to add the potential antitumor effect of marrow grafts to those of high dose chemotherapy. One potential strategy for enhancing a graft vs. tumor effect without aggravating graft vs. host disease would be to selectively target an immune response against a defined tumor-specific antigen. The idiotype of the rearranged immunoglobulin gene product of a myeloma can serve as a unique tumor-specific antigen for vaccine development. We are testing the hypothesis that tumor antigen-specific immunity can be adoptively transferred to BMT recipients by active immunization of marrow transplant donors with purified myeloma idiotype protein, conjugated to a carrier protein (KLH) and administered with GM-CSF as an immunological adjuvant. Patients under age 60 with an HLA-matched sibling donor, with minimal prior treatment, defined by less than six months prior chemotherapy, and who are in a minimal residual disease state prior to allogeneic BMT, as defined by the achievement of at least a PR, are eligible. HLA matched sibling donors receive a series of three vaccinations during an eight week period prior to bone marrow harvest. Recipients concurrently receive vaccinations pre-BMT, as well as three booster vaccinations at weeks 12, 16, and 24 post-BMT. Id-KLH (0.5 mg) is administered s.c. GM-CSF (250 micrograms/m(2)) is administered s.c. locally with the vaccine on the day of vaccination and for the three consecutive days following vaccination. The objective of this protocol is to induce cellular and humoral immunity in marrow transplant donors and recipients against the unique idiotype expressed by the recipient's myeloma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Graft vs Host Disease, Multiple Myeloma
Keywords
Multiple Myeloma, Vaccine, Idiotype-Specific Immunity, Immune Transfer, Myeloma Immunoglobulin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Enrollment
30 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Myeloma Immunoglobulin Idiotype Vaccine-KLH
Intervention Type
Drug
Intervention Name(s)
GM-CSF

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Patient Selection: Patients with IgG or IgA multiple myeloma who attain at least a PR before transplantation are eligible for thsi protocol. Patients may only have received 3-4 courses of VAD, high dose cyclophosphamide and one autologous transplant before entering the study. All previous therapy must be completed at least 2 weeks prior to study entry. Patients should have recovered from all hematologic and non-hematologic toxicity of previous therapy. Steroid must be discontinued at least two weeks prior to vaccination. Only patients less than 60 years are eligible for this protocol. Patients must meet the following criteria: A. Karnofsky performance status greater than or equal to 70 percent. B. Life expectancy greater than 8 weeks and absence of co-existing medical problems which would significantly increase the risk of the transplant procedure in the judgment of the bone marrow transplant attending physicians (e.g., the MUGA left ventricular ejection fraction has to be greater than 50% and DLCO greater thant 50% of the expected value when corrected for Hb). Creatinine less than 2x normal and not rising for at least 2-4 weeks before transplantation. If creatinine is elevated, then creatinine clearance must be greater than 40 ml/min. Direct bilirubin less than 2 mg/dl, SGOT less than 4x top normal, and none of these parameters increasing, for at least 2-4 weeks before transplantation. Patients must be HIV-negative, HBsAg-, and Hepatitis C antibody Negative. Not pregnant or lactating. Patients of childbearing potential must use an effective method of contraception. M-protein concentration in the harvested plasma must be greater than 90 percent of the total Ig of the corresponding isotype. Patients must be greater than or equal to 18 years old. Donor criteria: Any consenting healthy individual who fulfills the donor criteria will be considered for the marrow donation. HLA-identical sibling donors. HLA, A and B and DR phenotypically identical family donors. HIV, hepatitis B or C seropositive. Complete blood count, platelets, and PT, PTT within normal limits.
Facility Information:
Facility Name
National Cancer Institute (NCI)
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
4108872
Citation
Sirisinha S, Eisen HN. Autoimmune-like antibodies to the ligand-binding sites of myeloma proteins. Proc Natl Acad Sci U S A. 1971 Dec;68(12):3130-5. doi: 10.1073/pnas.68.12.3130.
Results Reference
background
Links:
URL
http://clinicalstudies.info.nih.gov/detail/B_1997-C-0030.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Active Immunization of Sibling Bone Marrow Transplant Donors Against Purified Myeloma Protein of the Recipient Undergoing Allogeneic Bone Marrow Transplantation

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