Low Dose IL-2, Hematopoietic Stem Cell Transplantation, IL2 for GVHD

This study has been completed.
Sponsor:
Collaborators:
The Methodist Hospital System
Texas Children's Hospital
Center for Cell and Gene Therapy, Baylor College of Medicine
Information provided by (Responsible Party):
Kathryn Leung, Baylor College of Medicine
ClinicalTrials.gov Identifier:
NCT00539695
First received: October 2, 2007
Last updated: June 3, 2014
Last verified: June 2014
  Purpose

Patients are being asked to participate in this study because treatment for their disease requires a stem cell transplant (SCT). Stem cells are the source of normal blood cells found in the bone marrow and lead to recovery of blood counts after bone marrow transplantation. With stem cell transplants, regardless of whether the donor is a full match to the patient or not, there is a risk of developing graft-versus-host disease (GVHD).

GVHD is a serious and sometimes fatal side effect of SCT. GVHD occurs when the new donor stem cells (graft) recognizes that the body tissues of the patient (host) are different from those of the donor. When this happens, cells in the graft may attack the host organs. How much this happens and how severe the GVHD is depends on many things, including how different the donors cells are, the strength of the drugs given in preparation for the transplant, the quality of transplanted cells and the age of the person receiving the transplant.

Typically, acute GVHD occurs in the first 100 days following transplant, while chronic GVHD occurs after day 100. Acute GVHD most often involves the skin, where it can cause anywhere from a mild rash to complete removal of skin; liver, where it can anywhere from a rise in liver function tests to liver failure; and the gut, where it can cause anywhere from mild diarrhea to profuse, life-threatening diarrhea. Most patients who develop GVHD experience a mild to moderate form, but some patients develop the severe, life-threatening form.

Previous studies have shown that patients who receive SCT's can have a lower number of special T cells in their blood, called regulatory T cells, than people who have not received stem cell transplants. When regulatory T cells are low, there appears to be an increased rate of severe, acute GVHD. A drug known as IL-2 (Proleukin) has been shown to increase the number of regulatory T cells in patients following stem cell transplant, and in this study investigators plan to give low dose IL-2 after transplant.

This study is called a phase II study because its major purpose is to find out whether using a low-dose of IL-2 will be effective in preventing acute GVHD. Other important purposes are to find out if this treatment helps the patient's immune system recover regulatory T cells faster after the transplant. This study will assess the safety and toxicity of low-dose IL-2 given to patients after transplantation and determine whether this drug is helpful in preventing GVHD.


Condition Intervention Phase
Acute Lymphoblastic Leukemia
ALL
Acute Myelogenous Leukemia
AML
Chronic Myelogenous Leukemia
Myelodysplastic Syndrome
Myeloproliferative Disorder
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Non-malignant Diseases Requiring Allogeneic HSCT
Biological: IL-2
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Trial Using Low Dose IL-2 to Induce Regulatory T Cells in Patients After Allogeneic Hematopoietic Stem Cell Transplantation as Graft Versus Host Disease Prophylaxis

Resource links provided by NLM:


Further study details as provided by Baylor College of Medicine:

Primary Outcome Measures:
  • Rate of Dose Limiting Toxicities [ Time Frame: 6-12 weeks ] [ Designated as safety issue: Yes ]
    Assessment of the safety and the toxicity of low-dose IL-2, administered according to the dosage described in this protocol, in this group of patients The outcome measure is the proportion of participants with dose limiting toxicities.


Secondary Outcome Measures:
  • Rate of Severe (Grade III or IV) Acute GVHD [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]
    To determine the efficacy of low-dose IL-2 in the prevention of severe (grade III or IV) acute GVHD

  • Immunomodulatory Effects of IL-2 Administered After Allogeneic Hematopoietic Stem Cell Transplantation Will be Evaluated by Descriptive Statistics. [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]

Other Outcome Measures:
  • Ancillary Studies [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]

    To conduct ancillary studies on those patients to investigate before, during and after IL-2 administration to determine:

    • The immunophenotype of PBMCs
    • The suppressive activity of CD4+ CD25+ FoxP3+ Tregs
    • Cytokines secreted by PBMCs
    • NK cell analysis


Enrollment: 25
Study Start Date: June 2007
Study Completion Date: March 2014
Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: IL2 Administration

SCHEDULE OF IL-2 ADMINISTRATION: Patients will receive a fixed dose (1x10e5 units/m2/dose) of IL-2 given as a subcutaneous injection three times weekly (separated by at least one day) for 6 weeks beginning no earlier than day +7 after HSCT but beginning no later than 30 days after HSCT.

Time will be measured as 'week beginning with first IL-2 injection.'

T cell Induction via IL-2 to reduce GVHD

Biological: IL-2

IL2 Administration:

Patients will be given a fixed dose (1x10e5 units/m2/dose) of IL-2 given as a subcutaneous injection three times weekly (separated by at least one day) for 6 weeks beginning no earlier than day +7 after HSCT but beginning no later than 30 days after HSCT. If the patient has not developed >grade I side effects to IL-2 and has not developed >grade I GVHD then the patient may continue the IL-2 for 6 additional weeks. Time will be measured as 'week beginning with first IL-2 injection.

Other Names:
  • Proleukin
  • Aldesleukin
  • Interleukin-2

Detailed Description:

Participation in this protocol will last about 1 year.

To participate in this study, the patient will need to have undergone a stem cell transplant. Before the treatment starts, investigators would like to test the patient's blood blood for the number of regulatory T cells already present before beginning IL-2.

Treatment Plan:

Before the conditioning treatment for the transplant, 30 to 40 ml (6 to 8 teaspoonfuls) of blood will be collected from the patient for regulatory T cell analysis. Approximately same amount of blood will also be collected on day 0 (the day of the transplant), and at the following times after the transplant: day 7 (the day the IL-2 will most likely start) then weekly for another eleven weeks, then monthly for 8 months.

On approximately day 7 following the transplant, if the patient is well and meets the eligibility requirements, the IL-2 injections will begin. These will be given subcutaneously (as a small injection just under the skin) three times per week for 6 weeks. The injections may also been given through a special catheter, called an Insuflon catheter, that is placed just under the skin for a week at a time. The first dose must be given in the hospital, but the remaining doses can be given at home. The patient will be taught how to give the injections to him/ herself.

If the patient's body has no serious toxicities from the IL-2 and has not developed severe GVHD, the patient can continue to get the injections the same way for an additional 6 weeks. If at any time the patient develops severe GVHD or serious toxicity related to the IL-2,the injections will be stopped. If the patient's disease returns (relapse) or he or she does not engraft (accept the donor graft), the patient will be removed from the study.

The patient's labs will be followed closely while he/she is receiving the IL-2 injections, as well as heart, kidney and lung functions; however, these are all standard tests that the patient will receive after transplant regardless of participation in this study.

  Eligibility

Ages Eligible for Study:   up to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

INCLUSION CRITERIA:

INCLUSION CRITERIA FOR INITIAL STUDY ENROLLMENT:

Patients will be eligible for initial enrollment on this study as long as they meet the following criteria:

  • Diagnosis of acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, myelodysplastic syndrome, myeloproliferative disorder, Hodgkin lymphoma, non-Hodgkin lymphoma or non-malignant disease requiring allogeneic HSCT
  • Birth to age 70 years of age
  • Study entry consent is signed and faxed to Research Coordinator

INCLUSION CRITERIA AT TIME OF IL-2 ADMINISTRATION:

  • At least day +7 post transplant
  • Less than or equal to 30 days post transplant
  • Lansky or Karnofsky score greater than or equal to 50%
  • Total bilirubin less than or equal to 1.5mg/dL
  • Alanine aminotransferase level (ALT) less than or equal to five times normal, serum direct bilirubin less than or equal to 1.5mg/dL, albumin greater than or equal to 3.0gm/dL
  • Serum creatinine less than three times normal or creatinine clearance greater than 80mg/min/1.73m2
  • Ensure that informed consent signed and faxed to Research Coordinator

EXCLUSION CRITERIA:

EXCLUSION CRITERIA AT TIME OF IL-2 ADMINISTRATION:

Patients will be ineligible to receive IL-2 injections if any of the following is true:

  • Active, acute GVHD greater than or equal to grade II
  • Serious, active bacterial, fungal or viral infection (i.e. intensive care)
  • Clinical Signs of severe pulmonary dysfunction
  • Clinical Signs of sever cardiac dysfunction
  • Receiving corticosteroids as GVHD treatment
  • Hypersensitivity or allergy to IL-2
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00539695

Locations
United States, Texas
The Methodist Hospital
Houston, Texas, United States, 77030
Texas Children's Hospital
Houston, Texas, United States, 77030
Sponsors and Collaborators
Baylor College of Medicine
The Methodist Hospital System
Texas Children's Hospital
Center for Cell and Gene Therapy, Baylor College of Medicine
Investigators
Principal Investigator: Kathryn Leung, MD Baylor College of Medicine
  More Information

No publications provided

Responsible Party: Kathryn Leung, Associate Professor of Pediatrics-Hem-Onc Cell & Gene, Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT00539695     History of Changes
Other Study ID Numbers: H-20971-IL2 for GvHD, IL-2 for GVHD
Study First Received: October 2, 2007
Results First Received: April 22, 2014
Last Updated: June 3, 2014
Health Authority: United States: Institutional Review Board
United States: Food and Drug Administration

Keywords provided by Baylor College of Medicine:
Stem Cell transplant
Graft verus host disease
IL-2
acute lymphoblastic leukemia
ALL
acute myelogenous leukemia
AML
chronic myelogenous leukemia
myelodysplastic syndrome
myeloproliferative disorder
Hodgkin lymphoma
non-Hodgkin lymphoma
non-malignant diseases requiring allogeneic HSCT

Additional relevant MeSH terms:
Hodgkin Disease
Leukemia
Leukemia, Lymphoid
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Myeloid, Acute
Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Lymphoma
Lymphoma, Non-Hodgkin
Myelodysplastic Syndromes
Preleukemia
Myeloproliferative Disorders
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Interleukin-2
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on August 20, 2014