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Selective T-Cell Depletion to Reduce GVHD (Patients) Receiving Stem Cell Tx to Treat Leukemia, Lymphoma or MDS

Primary Purpose

Graft vs Host Disease, Myelodysplastic Syndromes, Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
RFT5-SMPT-dgA
Isolex system
Sponsored by
National Heart, Lung, and Blood Institute (NHLBI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Graft vs Host Disease focused on measuring Peripheral Blood Stem Cell, Melphalan, Fludarabine, Donor Apheresis, Non-Myeloablative, MDS, Chronic Myeloid Leukemia, CML, Chronic Lymphocytic Leukemia, CLL, Lymphoma, Non-Hodgkin's Lymphoma, Hodgkin's Disease, Mantle Cell Lymphoma, Acute Myelogenous Leukemia (AML), Chronic Myeloid Leukemia (CML), Chronic Lymphocytic Leukemia (CLL), Myelodysplasia (MDS), Acute Lymphoblastic Leukemia (ALL), Bone Marrow Transplant

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

- INCLUSION CRITERIA: PATIENT Ages 50-75 years Relapsed CML in chronic or accelerated phase after therapy with STI-571 (Gleevec) Acute lymphoblastic leukemia (ALL), all patients in complete or partial remission. Exceptions: T cell ALL Acute myelogenous leukemia (AML): AML in first complete or partial remission including AML secondary to chemotherapy or prior hematological disease such as myelodysplastic syndrome, and myeloproliferative disorder. Myelodysplastic syndromes: (1) refractory anemia with excess of blasts (RAEB), (2) refractory anemia with excess blasts in transformation (RAEBT), (3) MDS with poor risk cytogenetics defined by a complex karyotype (greater than or equal to three anomalies) or chromosome 7 abnormalities, (4) secondary MDS after prior cytotoxic or radiation therapy, or (5) chronic myelomonocytic leukemia (CMML) Chronic lymphocytic leukemia (CLL) and prolymphocytic leukemia, refractory to nucleoside analog therapy, with either progressive bulky disease or anemia (less than 10 g/dl) or thrombocytopenia (less than 100,000/microliter) not due to recent chemotherapy Mantle cell lymphoma Relapsed intermediate- or high-grade non-Hodgkin's lymphoma: (1) post autologous marrow or PBSC transplant, or (2) chemorefractory relapse. Exceptions: T cell NHL Relapse Hodgkin's disease: (1) post autologous marrow or PBSC transplant, or (2) chemorefractory relapse Low-grade follicular or small lymphocytic lymphoma: (1) relapsed following conventional chemotherapy, (2) relapsed following autologous marrow or PBSC transplant, or (3) chemoresistant disease Life expectancy greater than 3 months Ability to comprehend the investigational nature of the study and provide informed consent Availability of an HLA-identical family donor, 18 to 75 years old INCLUSION CRITERIA: DONOR HLA identical family donor, 18 to 75 years old Fit to receive G-CSF and give peripheral blood stem cells (normal blood count, normotensive, no history of stroke, no history of severe heart disease) Ability to comprehend the investigational nature of the study and provide informed consent EXCLUSION CRITERIA: RECIPIENT Pregnant or lactating Eastern Cooperative Oncology Group (ECOG) performance status of 3 or more Major anticipated illness or organ failure incompatible with survival from PBSC transplant Diffusion Capacity fir carbon monoxide (DLCO) less than 60% predicted Left ventricular ejection fraction less than 40%, or any angina. Absolute lymphocyte count less than 300/mm(3) Serum creatinine greater than 2.5 mg/dl Serum bilirubin greater than 4 mg/dl, transaminases greater than 5x upper limit of normal HIV positive Other malignant diseases liable to relapse or progress within 2 years EXCLUSION CRITERIA: DONOR Pregnant or lactating HIV positive. Donors who are positive for Hepatitis B Virus, Hepatitis C Virus or human t-cell lymphoma virus (HTLV) will be used at the discretion of the investigator and with appropriate consent of the recipient Donor unfit to receive G-CSF and undergo apheresis (uncontrolled hypertension, history of heart failure or unstable angina, platelet count less than 90,000/cu mm)

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

RFT5-SMPT-dgA Isolex system

Arm Description

RFT5-SMPT-dgA, a specific anti-interleukin-2 receptor immunotoxin used in allogeneic stem cell transplantation (SCT) in older patients with hematologic malignancies using a graft manipulation process

Outcomes

Primary Outcome Measures

Treatment-related Mortality
Nonrelapse mortality in the first 100 days of transplant expressed as a percentage of the total subjects. This is different from outcome measure 3 (Cumulative Nonrelapse Mortality), which is cumulative non relapse mortality till December 2011.

Secondary Outcome Measures

Overall Survival
Percent overall survival (actuarial) at analysis in Dec 2011.
Cumulative Non Relapse Mortality
Percent non relapse mortality (actuarial) at analysis in Dec 2011

Full Information

First Posted
October 11, 2001
Last Updated
September 21, 2016
Sponsor
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT00025662
Brief Title
Selective T-Cell Depletion to Reduce GVHD (Patients) Receiving Stem Cell Tx to Treat Leukemia, Lymphoma or MDS
Official Title
Ex Vivo Selective Depletion of Alloreactive Donor T-Lymphocytes Using "RFT5-SMPT-dgA": Reducing GVHD Risk Associated With Matched, Nonmyeloablative, Stem Cell Transplant for Hematologic Malignancies in Older Adults
Study Type
Interventional

2. Study Status

Record Verification Date
September 2016
Overall Recruitment Status
Completed
Study Start Date
May 2001 (undefined)
Primary Completion Date
February 2008 (Actual)
Study Completion Date
February 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will evaluate the safety and effectiveness of stem cell transplantation in which the donors T lymphocytes have undergone "selective depletion." Certain patients with cancers of the blood undergo transplantation of donated stem cells to generate new and normally functioning bone marrow. In addition to producing the new bone marrow, the donor's T-lymphocytes also fight any tumor cells that might have remained in the body. This attack on tumor cells is called a "graft-versus-leukemia" (GVL) effect. However, another type of T-lymphocyte from the donor may cause what is called "graft-versus-host-disease" (GVHD), in which the donor cells recognize the patient's cells as foreign and mount an immune response to reject them. Selective depletion is a technique that was developed to remove the T-lymphocytes that cause harmful GVHD, while keeping those that produce the desirable GVL effect.
Detailed Description
Despite improved prophylaxis and treatment, graft-versus-host disease (GVHD) remains a major complication after allogeneic stem cell transplantation. Although the most effective way to prevent GVHD is T cell depletion, this process results in poor immune function leading to increased rates of relapse, graft rejection, and post-transplant infections. Ideally, a method of removing GVHD- producing effector cells while retaining a broad T cell repertoire, including preservation of 3rd party, antiviral and anti-tumor responses would be desirable. Preclinical studies from our lab have demonstrated that alloreactive T cells can be selectively removed from the donor lymphocyte pool in vitro with the use of a specific immunotoxin directed against the interleukin-2 receptor. To test this clinically, we will perform nonmyeloablative allogeneic stem cell transplants in older patients with hematologic malignancies. Although these patients can be cured with this approach, they have significant morbidity and mortality from GVHD. At our institution, nonmyeloablative transplantation is associated with an incidence of grade II-IV acute GVHD of approximately 50%. Although well tolerated in younger patients, patients over the age of 50 years have a transplant-related mortality (TRM) of approximately 35%, which is mostly related to GVHD. Through selective depletion of alloreactive donor lymphocytes, we hope to reduce GVHD mortality, while preserving the transplant efficacy. Patients receive a reduced intensity preparative regimen, followed by a mobilized peripheral blood stem cell allograft from an HLA-identical sibling donor, containing "selectively-depleted" donor lymphocytes. To obtain such a graft, colony stimulating factor (G-CSF)-mobilized peripheral blood from the donor undergoes a positive cluster of differentiation (CD34) selection followed by a negative T cell selection using the "Nexell" Isolex 300i system. This stem cell-rich, T cell-depleted product will contain a CD34+ cell dose of at least 5x10(6)/kg. The unabsorbed fraction, remaining after the positive CD34 selection, is then co-cultured for 72 hours with irradiated lymphocytes from the patient. The immunotoxin, RFT5-SMPT-dgA, is added during the last 24 hours of culture to remove alloreacting cells. The washed T cell product (CD3+ cell dose of 1-4 x 10(8)/kg) is cryopreserved. Following the preparative regimen, the patient receives successive infusions of the stem cell product and selected lymphocytes. All patients receive standard post transplant immunosuppression with cyclosporine for a minimum of 30 days, followed by dose reduction depending on the degree of donor lymphocyte chimerism. The primary end point of this study is the incidence and severity of acute GVHD. We will also examine the incidence of chronic GVHD, engraftment, degree of donor-host chimerism, transplant related morbidity and mortality, as well as disease-free and overall survival. Stopping rules will minimize the risk of untoward or unexpected side effects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Graft vs Host Disease, Myelodysplastic Syndromes, Leukemia, Leukemia, Myeloid, Leukemia, Myelomonocytic, Chronic, Leukemia, Lymphocytic, Lymphoma, Lymphoma, Mantle-cell, Lymphoma, Non-Hodgkin, Hodgkin Disease
Keywords
Peripheral Blood Stem Cell, Melphalan, Fludarabine, Donor Apheresis, Non-Myeloablative, MDS, Chronic Myeloid Leukemia, CML, Chronic Lymphocytic Leukemia, CLL, Lymphoma, Non-Hodgkin's Lymphoma, Hodgkin's Disease, Mantle Cell Lymphoma, Acute Myelogenous Leukemia (AML), Chronic Myeloid Leukemia (CML), Chronic Lymphocytic Leukemia (CLL), Myelodysplasia (MDS), Acute Lymphoblastic Leukemia (ALL), Bone Marrow Transplant

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
RFT5-SMPT-dgA Isolex system
Arm Type
Experimental
Arm Description
RFT5-SMPT-dgA, a specific anti-interleukin-2 receptor immunotoxin used in allogeneic stem cell transplantation (SCT) in older patients with hematologic malignancies using a graft manipulation process
Intervention Type
Drug
Intervention Name(s)
RFT5-SMPT-dgA
Other Intervention Name(s)
anti-interleukin-2 receptor immunotoxin
Intervention Description
A specific anti-interleukin-2 receptor immunotoxin
Intervention Type
Drug
Intervention Name(s)
Isolex system
Other Intervention Name(s)
Nexell Isolex system
Intervention Description
CD34 selection/ T cell depletion used this system
Primary Outcome Measure Information:
Title
Treatment-related Mortality
Description
Nonrelapse mortality in the first 100 days of transplant expressed as a percentage of the total subjects. This is different from outcome measure 3 (Cumulative Nonrelapse Mortality), which is cumulative non relapse mortality till December 2011.
Time Frame
100 days after stem cell infusion
Secondary Outcome Measure Information:
Title
Overall Survival
Description
Percent overall survival (actuarial) at analysis in Dec 2011.
Time Frame
Dec 2011.
Title
Cumulative Non Relapse Mortality
Description
Percent non relapse mortality (actuarial) at analysis in Dec 2011
Time Frame
Dec 2011.
Other Pre-specified Outcome Measures:
Title
Acute GVHD (Any Grade) Using the CIBMTR Grading System.
Description
Proportion of patients with acute GVHD, grade 1 to 4
Time Frame
100 days from transplant
Title
Acute GVHD (Grade 3 or 4) Using the CIBMTR Grading System.
Time Frame
100 days from transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
- INCLUSION CRITERIA: PATIENT Ages 50-75 years Relapsed CML in chronic or accelerated phase after therapy with STI-571 (Gleevec) Acute lymphoblastic leukemia (ALL), all patients in complete or partial remission. Exceptions: T cell ALL Acute myelogenous leukemia (AML): AML in first complete or partial remission including AML secondary to chemotherapy or prior hematological disease such as myelodysplastic syndrome, and myeloproliferative disorder. Myelodysplastic syndromes: (1) refractory anemia with excess of blasts (RAEB), (2) refractory anemia with excess blasts in transformation (RAEBT), (3) MDS with poor risk cytogenetics defined by a complex karyotype (greater than or equal to three anomalies) or chromosome 7 abnormalities, (4) secondary MDS after prior cytotoxic or radiation therapy, or (5) chronic myelomonocytic leukemia (CMML) Chronic lymphocytic leukemia (CLL) and prolymphocytic leukemia, refractory to nucleoside analog therapy, with either progressive bulky disease or anemia (less than 10 g/dl) or thrombocytopenia (less than 100,000/microliter) not due to recent chemotherapy Mantle cell lymphoma Relapsed intermediate- or high-grade non-Hodgkin's lymphoma: (1) post autologous marrow or PBSC transplant, or (2) chemorefractory relapse. Exceptions: T cell NHL Relapse Hodgkin's disease: (1) post autologous marrow or PBSC transplant, or (2) chemorefractory relapse Low-grade follicular or small lymphocytic lymphoma: (1) relapsed following conventional chemotherapy, (2) relapsed following autologous marrow or PBSC transplant, or (3) chemoresistant disease Life expectancy greater than 3 months Ability to comprehend the investigational nature of the study and provide informed consent Availability of an HLA-identical family donor, 18 to 75 years old INCLUSION CRITERIA: DONOR HLA identical family donor, 18 to 75 years old Fit to receive G-CSF and give peripheral blood stem cells (normal blood count, normotensive, no history of stroke, no history of severe heart disease) Ability to comprehend the investigational nature of the study and provide informed consent EXCLUSION CRITERIA: RECIPIENT Pregnant or lactating Eastern Cooperative Oncology Group (ECOG) performance status of 3 or more Major anticipated illness or organ failure incompatible with survival from PBSC transplant Diffusion Capacity fir carbon monoxide (DLCO) less than 60% predicted Left ventricular ejection fraction less than 40%, or any angina. Absolute lymphocyte count less than 300/mm(3) Serum creatinine greater than 2.5 mg/dl Serum bilirubin greater than 4 mg/dl, transaminases greater than 5x upper limit of normal HIV positive Other malignant diseases liable to relapse or progress within 2 years EXCLUSION CRITERIA: DONOR Pregnant or lactating HIV positive. Donors who are positive for Hepatitis B Virus, Hepatitis C Virus or human t-cell lymphoma virus (HTLV) will be used at the discretion of the investigator and with appropriate consent of the recipient Donor unfit to receive G-CSF and undergo apheresis (uncontrolled hypertension, history of heart failure or unstable angina, platelet count less than 90,000/cu mm)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
A. J Barrett, MD
Organizational Affiliation
NHLBI, NIH
Official's Role
Study Chair
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
15764025
Citation
Barrett J, Solomon S. The transition from bench to bedside: lessons learned in the creation of a new T-cell product for the clinic. Cytotherapy. 2004;6(6):593-5. doi: 10.1080/14653240410011936.
Results Reference
background
PubMed Identifier
12473206
Citation
Solomon SR, Tran T, Carter CS, Donnelly S, Hensel N, Schindler J, Bahceci E, Ghetie V, Michalek J, Mavroudis D, Read EJ, Vitetta ES, Barrett AJ. Optimized clinical-scale culture conditions for ex vivo selective depletion of host-reactive donor lymphocytes: a strategy for GvHD prophylaxis in allogeneic PBSC transplantation. Cytotherapy. 2002;4(5):395-406. doi: 10.1080/146532402320775982.
Results Reference
background
PubMed Identifier
16040390
Citation
Mielke S, Solomon SR, Barrett AJ. Selective depletion strategies in allogeneic stem cell transplantation. Cytotherapy. 2005;7(2):109-15. doi: 10.1080/14653240510018172.
Results Reference
background
PubMed Identifier
15817673
Citation
Solomon SR, Mielke S, Savani BN, Montero A, Wisch L, Childs R, Hensel N, Schindler J, Ghetie V, Leitman SF, Mai T, Carter CS, Kurlander R, Read EJ, Vitetta ES, Barrett AJ. Selective depletion of alloreactive donor lymphocytes: a novel method to reduce the severity of graft-versus-host disease in older patients undergoing matched sibling donor stem cell transplantation. Blood. 2005 Aug 1;106(3):1123-9. doi: 10.1182/blood-2005-01-0393. Epub 2005 Apr 7.
Results Reference
result
Links:
URL
http://clinicalstudies.info.nih.gov/detail/B_2001-H-0162.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Selective T-Cell Depletion to Reduce GVHD (Patients) Receiving Stem Cell Tx to Treat Leukemia, Lymphoma or MDS

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