Infusion of Genetically Modified T Cell for Post Transplant Patients With Relapsed Disease

This is an interventional treatment trial for Leukemia focused on measuring Leukemia, Lymphoma, Non-Hodgkin, Hodgkin Disease, Myelodysplastic Syndromes, Multiple Myeloma Read More

Inclusion Criteria for Patient:

• Patients must be prior recipients of allogeneic BMT (matched 6/6 or 5/6 according to the National Marrow Donor Program) for any hematologic malignancy. Eligible patients would include those with leukemia, non Hodgkins Lymphoma, Hodgkins Disease, myelodysplastic syndrome and multiple myeloma.
• Patients must have laboratory, histologic, or cytogenetic evidence of disease relapse after allogeneic BMT.
• Patients may not have received prior therapy with transduced or non-transduced donor lymphocytes.
• Patients ≥ 18 years of age.
• The minimum number of transduced and purified lymphocytes from the same donor of donated cells for allogeneic transplant is is 1x105 per kg for all patients.
• Expected survival of patient is at least 4 weeks.

• Required baseline organ function within 14 days prior to study entry:

  • Renal function with creatinine less than 5 mg/dl.
  • Liver function with SGOT, SGPT and alkaline phosphatase ≤ 4 times the upper limit of institutional normal.
  • Bilirubin ≤ 5.0 mg/dl.
• Patient must have signed the informed consent prior to entry and express willingness to meet all the expected requirements of the protocol for the duration of the study.
• ECOG Performance Status ≤ 2
• All patients must agree to a repeat bone marrow, liver, gastro-intestinal or skin biopsies dependent on clinical course.
• Women of child bearing potential must have a negative pregnancy test (ß-HCG ) within 7 days of study entry.

• In addition patients # 3 to 8:

  • Must have consented to participation in HRPO 09-0744, "Infusion of Genetically Modified T cells: A Pilot I Study of Tracking and Toxicity
  • Must be willing to undergo 18FHBG-PET/CT-imaging
  • Must be able to tolerate 45-60 minutes of imaging at each imaging timepoint.
  • Women of child bearing potential must have an additional negative high sensitivity pregnancy test (20mlU ß-HCG /ml urine as administered in the Center for Clinical Imaging Research, Mallinckrodt Institute of Radiology, Washington University) prior to each imaging session (i.e. at days 10-16 and days 27-33).

Inclusion Criteria for Donor:

• Must be the original donor for the allogeneic bone marrow transplant patient.
• No underlying conditions which would contra-indicate apheresis.
• Must have signed the informed consent and express willingness to meet all the expected requirements stated in the protocol for the duration of the study.
• Must be eligible according to Washington University "Guidelines for Eligibility of Normal Donors"
• Donors ≥ 18 years of age.
• Female donors of childbearing potential must have a confirmed negative pregnancy test.

Exclusion Criteria for Patient:

• Patients receiving immunosuppression (cyclosporin, FK506, prednisone, cellcept, methylprednisolone) for GvHD or other reasons at the time of lymphocyte infusion.
• Patients must not have evidence of active CMV or other active viral infection requiring antiviral therapy. A culture or PCR of blood for CMV must be negative for enrollment.
• Pregnant or lactating females.Note that a second and third high sensitivity pregnancy test (20mlU ß-HCG /ml urine as administered in the Center for Clinical Imaging Research, Mallinckrodt Institute of Radiology, Washington University) are required prior to each imaging session (i.e. at days 10-16 and days 27-33 for patients #3 to 8).
• Uncontrolled infection: Any uncontrolled viral, bacterial, or fungal infection.
• HIV infection.
• Acute medical problems such as ischemic heart or lung disease.
• Patients with any underlying conditions which would contra-indicate therapy with study treatment (or allergies to reagents used in this study).
• Patients who have received atgam, campath [alemtuzumab] or daclizumab within 4 weeks of DLI.
• Patients receiving investigational drugs or treatments within 30 days of enrollment.
• Patients with tetracycline, penicillin, or streptomycin sensitivity.
• Patients with signs of acute GVHD as defined by the International Bone Marrow Transplant Registry (IBMTR) Severity Index for Acute Graft versus Host Disease (Rowlings, et al., Brit. J. Haematol. 97:855-64 [1997]). In addition patients may be excluded at the discretion of the treating physician.

• In addition for patients # 3 to 8 who will be imaged , exclude:

  • Patients who are claustrophobic.
  • Patients who are unable to tolerate 30-45 minutes of imaging.

Exclusion Criteria for Donor:

-Pregnant female donors

Concomitant Medication and Treatment:

-The principal investigator or a designated co-investigator at the respective institution must approve use of chemotherapeutic, antiviral or immunosuppressive medications.

Medications and Treatments Not Allowed:

-No other forms of chemotherapy will be administered after cell infusion during the treatment protocol.