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Study of a Humanized Antibody Initiated 2 Months After an HLA Matched Allogenic Stem Cell Transplantation (PIRAT)

Primary Purpose

Hematologic Malignancies

Status
Unknown status
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
Monalizumab
Sponsored by
Institut Paoli-Calmettes
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hematologic Malignancies

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients presenting a hematological malignancy (acute myeloid leukemia, acute lymphoblastic leukemia, High risk R-IPSS myelodysplastic syndromes, multiple myeloma, chronic lymphoid leukemia, chronic myeloid leukemia, myeloproliferative neoplasm, Hodgkin lymphoma or Non-Hodgkin lymphoma) treated by allogeneic HSCT according to the following parameters :

    • Donor : HLA matched related or unrelated (10/10) donor
    • Graft : peripheral blood stem cells
    • Conditioning : All types of conditioning reduced toxicity conditioning regimens ATG as in-vivo T-cell depletion
    • GVHD prophylaxis by cyclosporine, still ongoing at full dose at the time of the inclusion
  2. Patient being in one of the following post-graft situation at the time of inclusion:

    • Acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) patients: in morphological complete remission (CR) with less than 5% bone marrow blast count.
    • High risk R-IPSS myelodysplastic syndromes patients: with at least marrow CR with less than 5% marrow blast count.
    • Multiple myeloma patients: in at least very good partial response.
    • Chronic Lymphoid Leukemia patients: in CR.
    • Chronic Myeloid Leukemia patients: in hematological CR.
    • Myeloproliferative neoplasm patients: no criteria for disease in acceleration phase.
    • Hodgkin lymphoma or Non-Hodgkin lymphoma patients: in CR.
  3. Age ≥ 18 and ≤ 70 years
  4. ECOG = 0-1 or Karnofsky index ≥ 70%
  5. Clinical laboratory values at screening

    • Calculated creatinine clearance (according to MDRD) > 50 ml/min/1.73 m2
    • Independence of red blood cell transfusion
    • Platelet count > 75 x 109/l
    • ANC > 1 x 109/l
    • Bilirubin < 1.5 ULN
    • ALT and AST < 3 ULN
  6. Patients (male or female) who accept and are able to use contraceptive methods recognized as highly effective throughout the study and up to 5 months after the drug administration
  7. Signed informed consent of the current clinical study, prior to any protocol-specific procedure
  8. Patient affiliated to the national "Social Security" regimen or beneficiary of this regimen

Non inclusion Criteria:

  1. Previous history of grade ≥ II acute GVHD (Glucksberg classification)
  2. Current active disease or positive serology for HIV before grafting, and/or HCV with detectable viremia and/ or HBV with positive Hbs Antigen.
  3. Abnormal cardiac status with any of the following :

    • Ejection fraction (measured by ultrasound or radionuclide imaging) < 50%
    • Unstable angina
    • Myocardial infarction within the last 6 months
    • Presence or persistence of documented congestive heart failure (New York Heart Association functional classification III-IV)
    • Arrhythmia requiring treatment and which is not stabilized by the treatment.
    • QTc ≥ 450 ms (M) or 470 ms (F) (Bazett formula)
  4. Previous other allogeneic hematopoietic transplantation or solid organ transplantation
  5. Any other serious concurrent uncontrolled medical disorder within 4 weeks prior to IPH2201 administration
  6. Use of systemic corticosteroids ongoing or within the last 1 week prior IPH2201 admin-istration
  7. Use of any investigational agent within 3 months prior to first dosing (except procedure of conditioning regimen including registered drugs combinations, i.e. Busulfan and Fludarabine or Busulfan and Endoxan)
  8. History of another malignancy (except, basal cell carcinoma of the skin, or in situ cervix carcinoma, or any other malignancy in complete remission for more than 3 years since the completion of the treatment). However in the case of leukemia or MDS a previous malignancy accountable for the present disease will not be an exclusion criteria if in complete remission for more than 2 years
  9. Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
  10. Pregnant or lactating women

Sites / Locations

  • Institut Paoli CalmettesRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Monalizumab

Arm Description

Monalizumab treatment will be initiated 75 to 100 days after hematopoietic stem cells transplantation. Patients will receive a single dose of monalizumab by intravenous route over 1 hour.

Outcomes

Primary Outcome Measures

Occurence ratio of dose-limiting toxicity (DLT)
The occurrence of any of these 3 events will lead to the reporting of a Dose Limiting Toxicity: Any Grade ≥ 3 toxicity according to CTCAE attributable to IPH2201 administration, occurring within 4 weeks of IPH2201 administration and considered as relevant by the investigator Any grade ≥ II acute GVHD requiring a treatment by systemic corticosteroids and occurring within 4 weeks of IPH2201 administration. Any grade ≥ moderate chronic GVHD occurring within 4 weeks of IPH2201 administration.

Secondary Outcome Measures

Incidence of acute GVHD of each grade or chronic GVHD of each degree of severity
Safety will be assessed using Glucksberg's classification for acute Graft versus host disease (GVHD) and NIH classification for chronic GVHD.
Probabilities of non-relapse mortality (NRM)
Cumulative incidence of relapse (CIR)
Efficacy endpoint
Probability of Disease Free Survival (DFS)
Efficacy endpoint
Probability of Overall survival (OS)
Efficacy endpoint

Full Information

First Posted
September 27, 2016
Last Updated
September 18, 2018
Sponsor
Institut Paoli-Calmettes
Collaborators
Innate Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT02921685
Brief Title
Study of a Humanized Antibody Initiated 2 Months After an HLA Matched Allogenic Stem Cell Transplantation
Acronym
PIRAT
Official Title
A Phase 1 Study of MONALIZUMAB (IPH2201), a Humanized Anti CD94/NKG2A Monoclonal Antibody (Mab) Initiated 2 Months After an HLA Matched Allogenic Stem Cell Transplantation (SCT) Prepared With a Reduced Intensity Conditioning
Study Type
Interventional

2. Study Status

Record Verification Date
September 2018
Overall Recruitment Status
Unknown status
Study Start Date
November 28, 2016 (Actual)
Primary Completion Date
May 28, 2019 (Anticipated)
Study Completion Date
April 28, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Institut Paoli-Calmettes
Collaborators
Innate Pharma

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will determine the Maximal Tolerated Dose if any and the recommended dose for phase 2 of monalizumab, a monoclonal antibody directed against the CD94/NKG2A receptor, after allogenic stem cell transplantation. All patients will receive one single intravenous administration of one of the four doses of monalizumab.
Detailed Description
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a curative option for most of hematological malignancies, though the graft-versus-tumor (GVT) effect mediated by immune cells from the donor. However, the use of Allo-HSCT is limited by its toxicity, notably the graft-versus-host disease (GVHD) that is a major cause of non-relapse mortality (NRM). Conditioning regimens dramatically improved during the last fifteen years, with a decrease of both GVHD and NRM rates. Now, disease recurrence after Allo-HSCT is the first cause of treatment failure and remains a concern for approximately 30% of the patients. Based on a safety immunologic platform (ATG based reduced toxicity conditioning regimens), it is needed to develop post Allo-HSCT strategies to decrease the incidence of relapse. In this context, the modulation of immune cell activity could play a role to prevent relapse. NK cells have a unique capacity to exert potent GVT effects without inducing GVHD. Moreover, NK cells recovery occurs early after Allo-HSCT and NK cells function are not severely impaired by the use of ciclosporin A, that is given for few months after Allo-HSCT as GVHD prophylaxis. Thus, NK cell modulation appears as a viable option for early immune intervention after Allo-HSCT. Monalizumab (IPH2201), a monoclonal antibody has a non-depleting and purely blocking activity directed with high affinity and specificity against the CD94/NKG2A receptor expressed by subsets of NK cells, activated αβ CD8+ T cells, γδ-T cells and NK T cells. By suppressing the inhibitory signal transduced by NKG2A, IPH2201 enhances the anti-tumor functions, including cytolytic activity of these immune effector cells.The aim of the study is to determine the safety of IPH2201 after allogenic stem cell transplantation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hematologic Malignancies

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Monalizumab
Arm Type
Experimental
Arm Description
Monalizumab treatment will be initiated 75 to 100 days after hematopoietic stem cells transplantation. Patients will receive a single dose of monalizumab by intravenous route over 1 hour.
Intervention Type
Drug
Intervention Name(s)
Monalizumab
Other Intervention Name(s)
anti CD94/NKG2A, IPH2201
Intervention Description
Four dose levels will be tested.
Primary Outcome Measure Information:
Title
Occurence ratio of dose-limiting toxicity (DLT)
Description
The occurrence of any of these 3 events will lead to the reporting of a Dose Limiting Toxicity: Any Grade ≥ 3 toxicity according to CTCAE attributable to IPH2201 administration, occurring within 4 weeks of IPH2201 administration and considered as relevant by the investigator Any grade ≥ II acute GVHD requiring a treatment by systemic corticosteroids and occurring within 4 weeks of IPH2201 administration. Any grade ≥ moderate chronic GVHD occurring within 4 weeks of IPH2201 administration.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Incidence of acute GVHD of each grade or chronic GVHD of each degree of severity
Description
Safety will be assessed using Glucksberg's classification for acute Graft versus host disease (GVHD) and NIH classification for chronic GVHD.
Time Frame
from D0 to Week 26 after administration of IPH2201 and at 1 year after transplantation
Title
Probabilities of non-relapse mortality (NRM)
Time Frame
1 year after the administration of IPH2201
Title
Cumulative incidence of relapse (CIR)
Description
Efficacy endpoint
Time Frame
1 year after administration of IPH2201.
Title
Probability of Disease Free Survival (DFS)
Description
Efficacy endpoint
Time Frame
1 year after the administration of IPH2201
Title
Probability of Overall survival (OS)
Description
Efficacy endpoint
Time Frame
1 year after the administration of IPH2201

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients presenting a hematological malignancy (acute myeloid leukemia, acute lymphoblastic leukemia, High risk R-IPSS myelodysplastic syndromes, multiple myeloma, chronic lymphoid leukemia, chronic myeloid leukemia, myeloproliferative neoplasm, Hodgkin lymphoma or Non-Hodgkin lymphoma) treated by allogeneic HSCT according to the following parameters : Donor : HLA matched related or unrelated (10/10) donor Graft : peripheral blood stem cells Conditioning : All types of conditioning reduced toxicity conditioning regimens ATG as in-vivo T-cell depletion GVHD prophylaxis by cyclosporine, still ongoing at full dose at the time of the inclusion Patient being in one of the following post-graft situation at the time of inclusion: Acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) patients: in morphological complete remission (CR) with less than 5% bone marrow blast count. High risk R-IPSS myelodysplastic syndromes patients: with at least marrow CR with less than 5% marrow blast count. Multiple myeloma patients: in at least very good partial response. Chronic Lymphoid Leukemia patients: in CR. Chronic Myeloid Leukemia patients: in hematological CR. Myeloproliferative neoplasm patients: no criteria for disease in acceleration phase. Hodgkin lymphoma or Non-Hodgkin lymphoma patients: in CR. Age ≥ 18 and ≤ 70 years ECOG = 0-1 or Karnofsky index ≥ 70% Clinical laboratory values at screening Calculated creatinine clearance (according to MDRD) > 50 ml/min/1.73 m2 Independence of red blood cell transfusion Platelet count > 75 x 109/l ANC > 1 x 109/l Bilirubin < 1.5 ULN ALT and AST < 3 ULN Patients (male or female) who accept and are able to use contraceptive methods recognized as highly effective throughout the study and up to 5 months after the drug administration Signed informed consent of the current clinical study, prior to any protocol-specific procedure Patient affiliated to the national "Social Security" regimen or beneficiary of this regimen Non inclusion Criteria: Previous history of grade ≥ II acute GVHD (Glucksberg classification) Current active disease or positive serology for HIV before grafting, and/or HCV with detectable viremia and/ or HBV with positive Hbs Antigen. Abnormal cardiac status with any of the following : Ejection fraction (measured by ultrasound or radionuclide imaging) < 50% Unstable angina Myocardial infarction within the last 6 months Presence or persistence of documented congestive heart failure (New York Heart Association functional classification III-IV) Arrhythmia requiring treatment and which is not stabilized by the treatment. QTc ≥ 450 ms (M) or 470 ms (F) (Bazett formula) Previous other allogeneic hematopoietic transplantation or solid organ transplantation Any other serious concurrent uncontrolled medical disorder within 4 weeks prior to IPH2201 administration Use of systemic corticosteroids ongoing or within the last 1 week prior IPH2201 admin-istration Use of any investigational agent within 3 months prior to first dosing (except procedure of conditioning regimen including registered drugs combinations, i.e. Busulfan and Fludarabine or Busulfan and Endoxan) History of another malignancy (except, basal cell carcinoma of the skin, or in situ cervix carcinoma, or any other malignancy in complete remission for more than 3 years since the completion of the treatment). However in the case of leukemia or MDS a previous malignancy accountable for the present disease will not be an exclusion criteria if in complete remission for more than 2 years Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule. Pregnant or lactating women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Dominique GENRE, MD
Phone
33 4 91 22 37 78
Email
genred@ipc.unicancer.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Margot BERLINE, MSc, MBA
Phone
33 4 91 22 37 78
Email
boqueti@ipc.unicancer.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Didier BLAISE, MD, PhD
Organizational Affiliation
Institut Paoli-Calmettes
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institut Paoli Calmettes
City
Marseille
State/Province
Bouches Du Rhônes
ZIP/Postal Code
13009
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dominique GENRE, MD
Phone
33 4 91 22 37 78
Email
genred@ipc.unicancer.fr
First Name & Middle Initial & Last Name & Degree
Isabelle BOQUET, PhD
Phone
33 4 91 22 37 78
Email
boqueti@ipc.unicancer.fr
First Name & Middle Initial & Last Name & Degree
Raynier DEVILLIER, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
26721894
Citation
Ruggeri L, Urbani E, Andre P, Mancusi A, Tosti A, Topini F, Blery M, Animobono L, Romagne F, Wagtmann N, Velardi A. Effects of anti-NKG2A antibody administration on leukemia and normal hematopoietic cells. Haematologica. 2016 May;101(5):626-33. doi: 10.3324/haematol.2015.135301. Epub 2015 Dec 31.
Results Reference
background
PubMed Identifier
20139023
Citation
Godal R, Bachanova V, Gleason M, McCullar V, Yun GH, Cooley S, Verneris MR, McGlave PB, Miller JS. Natural killer cell killing of acute myelogenous leukemia and acute lymphoblastic leukemia blasts by killer cell immunoglobulin-like receptor-negative natural killer cells after NKG2A and LIR-1 blockade. Biol Blood Marrow Transplant. 2010 May;16(5):612-21. doi: 10.1016/j.bbmt.2010.01.019. Epub 2010 Feb 6.
Results Reference
background
PubMed Identifier
20044012
Citation
Rathmann S, Glatzel S, Schonberg K, Uhrberg M, Follo M, Schulz-Huotari C, Kaymer M, Veelken H, Finke J, Fisch P. Expansion of NKG2A-LIR1- natural killer cells in HLA-matched, killer cell immunoglobulin-like receptors/HLA-ligand mismatched patients following hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2010 Apr;16(4):469-81. doi: 10.1016/j.bbmt.2009.12.008. Epub 2010 Jan 4.
Results Reference
background
PubMed Identifier
25579888
Citation
Pical-Izard C, Crocchiolo R, Granjeaud S, Kochbati E, Just-Landi S, Chabannon C, Frassati C, Picard C, Blaise D, Olive D, Fauriat C. Reconstitution of natural killer cells in HLA-matched HSCT after reduced-intensity conditioning: impact on clinical outcome. Biol Blood Marrow Transplant. 2015 Mar;21(3):429-39. doi: 10.1016/j.bbmt.2014.11.681. Epub 2015 Jan 9.
Results Reference
background
Links:
URL
http://www.institutpaolicalmettes.fr
Description
Official web site of the sponsor

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Study of a Humanized Antibody Initiated 2 Months After an HLA Matched Allogenic Stem Cell Transplantation

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