TK008: Efficacy Study on the Strategy of Herpes Simplex Virus Thymidine Kinase (HSV-Tk) Donor Lymphocytes to Treat Patients With High Risk Acute Leukemia

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2014 by MolMed S.p.A.
Sponsor:
Information provided by (Responsible Party):
MolMed S.p.A.
ClinicalTrials.gov Identifier:
NCT00914628
First received: June 3, 2009
Last updated: May 29, 2014
Last verified: May 2014
  Purpose

The main objective of this randomized trial is To compare disease-free survival (DFS) in high risk leukemia patients who underwent haploidentical HCT followed by an add back strategy of HSV-Tk donor lymphocytes or standard haploidentical HCT


Condition Intervention Phase
High Risk Acute Leukemia
Genetic: HSV-Tk
Other: T cell repletion strategies
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: TK008 Randomized Phase III Trial of Haploidentical HCT With or Without an Add Back Strategy of HSV-Tk Donor Lymphocytes in Patients With High Risk Acute Leukemia

Resource links provided by NLM:


Further study details as provided by MolMed S.p.A.:

Primary Outcome Measures:
  • Disease-free survival (DFS) [ Time Frame: From the randomization date to relapse date or death ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Overall Survival (OS) [ Time Frame: From randomization to death ] [ Designated as safety issue: No ]
  • Immuno reconstitution (IR) [ Time Frame: Weekly after HCT ] [ Designated as safety issue: Yes ]
    Defined as the time to reach a level of circulating CD3+ ≥ 100/µl for two consecutive observations

  • Engraftment rate [ Time Frame: Weekly up to IR after HCT or up to 6 months after HCT if no IR ] [ Designated as safety issue: Yes ]
    Defined as the persistent blood cells count as a predefined level

  • Cumulative incidence of grade 2, 3, or 4 acute GVHD (aGvHD) [ Time Frame: From the date of HCT until the date to the first occurence of relapse ] [ Designated as safety issue: Yes ]
    Diagnosed and graded according to standard criteria and computed in patients who will survive during the first 100 days after the transplantation.

  • Cumulative incidence of extensive chronic GvHD (cGvHD) [ Time Frame: For at least 100 days after transplantation ] [ Designated as safety issue: Yes ]
    Diagnosed and graded according to standard NIH consensus criteria and computed in patients who will survive for at least 100 days after transplantation.

  • Cumulative incidence of relapse (CIR) [ Time Frame: From the date of HCT until the date to the first occurence of relapse or death ] [ Designated as safety issue: Yes ]
    Defined on the basis of morphologic evidence of leukaemia in bone marrow or other sites.

  • Disease-Free Survival (DFS) [ Time Frame: From the date of randomization until the date of relapse or death ] [ Designated as safety issue: No ]
  • Incidence and duration of infectious episodes and infectious disease mortality [ Time Frame: From randomization to the end of study ] [ Designated as safety issue: Yes ]
  • Evaluate the acute and long-term toxicity related to the HSV-Tk infusions [ Time Frame: From HSV-Tk infusions to death ] [ Designated as safety issue: Yes ]
  • Quality of life (QoL) and Medical Care Utilization (MCU) in both arms [ Time Frame: From randomization to end of study ] [ Designated as safety issue: No ]
    Medical resource use data collected will be used in health economic analyses where it may be combined with other data from other sources such as cost data or other clinical parameters.

  • Non-relapse mortality (NRM) [ Time Frame: From the date of HCT until to death ] [ Designated as safety issue: Yes ]
    Defined for all patients as any death without previous occurrence of a documented relapse


Estimated Enrollment: 170
Study Start Date: February 2010
Estimated Study Completion Date: June 2016
Estimated Primary Completion Date: June 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: A Genetic: HSV-Tk
Infusion of genetically modified lymphocytes 1x10^7 c/kg: first at +21-+49 days after HSCT; in absence of immune reconstitution and GvHD further infusions up to 4 will be administered on monthly basis.
Active Comparator: B Other: T cell repletion strategies
Haploidentical HCT with the infusion of CD34+ cells plus a fixed dose of T cells (1 x 10^4/Kg)

Detailed Description:

Delayed immune-reconstitution remains one of the main limitation of haploidentical stem cell transplantation. The risk of severe infections remains high for several months and CD4+ reconstitution could take more than 10 months. The low number of lymphocytes infused with the graft, the degree of HLA (Human Leukocyte Antigen) disparity, and a reduced thymic function in adults and differences in host/donor antigen presenting cells are contributing causes.

The infusions of HSV-TK engineered lymphocytes may represent a significant therapeutic improvement in haploidentical HCT (hematopoietic cell transplantation), because it remarkably may enhance both GvL (Graft versus Leukemia) activity, thus reducing the occurrence of disease relapse, and post-transplant immune reconstitution in the absence of chronic immune suppression, thus decreasing the rate of both post-transplant opportunistic infections and transplant-related mortality. Furthermore, the efficient control of GvHD achieved via the suicide mechanism allows also the multiple infusion of HSV-TK-treated donor lymphocytes, when needed, that might further improve post-transplant host immune reconstitution, and survival in patients receiving haplo-HCT. Finally, this therapeutic approach can become a valuable option for all candidates, including patients with advanced disease and older age.

The proposed clinical trial represents an innovative therapeutic treatment for patients affected by high risk acute leukemia, who have undergone haploidentical stem cell transplantation.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ≥ 18 years with HCT comorbidity index < 3
  • Any of the following conditions:

    • AML and ALL in 1st complete remission (CR) at high risk of relapse based on negative prognostic factors (for the definition of high-risk of relapse see Appendix H).
    • AML and ALL in 2nd or subsequent CR
    • secondary AML in CR
  • Absence of timely and suitable fully HLA matched or one HLA locus mismatched family or unrelated donor and, at Investigator's discretion, absence of other possible therapeutic alternatives
  • Stable clinical conditions and life expectancy > 3 months
  • PS ECOG < or = 2
  • Patients, or legal guardians, and donors must sign an informed consent indicating that they are aware this is a research study and have been told of its possible benefits and toxic side effects
  • Serum creatinine < 1.5 x ULN
  • Bilirubin < 1.5 x ULN; transaminases < 3 x ULN
  • Left ventricular ejection fraction > 45%
  • QTc interval < 450 ms
  • DLCO > 50%

Exclusion Criteria:

  • Patients with life-threatening condition or complication other than their basic condition
  • Contraindication to haploidentical HCT as defined by the Investigator
  • Patients with active CNS disease
  • Pregnant or lactation.

Exclusion criteria for HSV-Tk infusion:

  • Infections requiring administration of ganciclovir, valganciclovir or acyclovir at the time of infusion: HSV-Tk cells can be administered after a 24-hour discontinuation interval of antiviral therapy
  • GvHD requiring systemic immunosuppressive therapy
  • Ongoing systemic immunosuppressive therapy after haploidentical HCT
  • Administration of G-CSF after haploidentical HCT
  • CD3+ cells ≥ 100/µl at day of planned experimental infusion after haploidentical HCT
  • Any grade 3-4 adverse event related to HSV-Tk infusion or a grade 2 adverse event that does not resolve to no more than grade 1 before the next infusion

For criteria 2, 3 and 4: HSV-Tk cells can be administered after an adequate patient wash-out period

  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: NCT00914628

Contacts
Contact: Fabio Ciceri, MD 0

Locations
United States, Illinois
Northwestern University Feinberg School of Medicine Recruiting
Chicago, Illinois, United States, IL 60611
Contact: Jayesh Mehta, MD         
Principal Investigator: Jayesh Mehta, MD         
United States, Missouri
Washington University Medical School Recruiting
St. Louis, Missouri, United States, 63110
Contact: John F. Di Persio, MD         
Principal Investigator: John F. Di Persio, MD         
United States, New Jersey
John Theurer Cancer Center at Hackensack University Medical Center Recruiting
Hackensack, New Jersey, United States, 07601
Contact: Michele Donato, MD         
Principal Investigator: Michele Donato, MD         
Belgium
AZ St Jan AV Recruiting
Brugge, Belgium, 8000
Contact: Dominik Selleslag, MD         
Principal Investigator: Dominik Selleslag, MD         
University Hospitals Leuven Recruiting
Leuven, Belgium, 3000
Contact: Johan Maertens, MD         
Principal Investigator: Johan Maertens, MD         
France
Hôpital Jean Minjoz Recruiting
Besançon, France, 25030
Contact: Eric Deconinck, MD         
Principal Investigator: Eric Deconinck, MD         
Germany
Charitè; Campus Benjamin Franklin Recruiting
Berlin, Germany, 13353
Contact: Lutz Uharek, MD         
Principal Investigator: Lutz Uharek, MD         
Medizinische Hochschule Hannover Recruiting
Hannover, Germany, 30625
Contact: Arnold Ganser, MD         
Contact: Eva Mischak-Weissinger, MD         
Principal Investigator: Arnold Ganser, MD         
Sub-Investigator: Eva Mischak-Weissinger, MD         
University of Leipzig Recruiting
Leipzig, Germany, 04103
Contact: Dietger Niederwieser, MD         
Principal Investigator: Dietger Niederwieser, MD         
Universitat Tubingen Recruiting
Tubingen, Germany, 72076
Contact: Wolfgang Bethge, MD         
Principal Investigator: Wolfgang Bethge, MD         
Medizinische Klinik und Poliklinik Recruiting
Ulm, Germany, 89081
Contact: Donald Bunjes, MD         
Principal Investigator: Donald Bunjes, MD         
Greece
George Papanicolaou Hospital Recruiting
Thessaloniki, Greece, 57010
Contact: Evangelia Yannaki, MD         
Principal Investigator: Evangelia Yannaki, MD         
Israel
Chaim Sheba Medical Center Recruiting
Tel Hashomer, Israel, 52621
Contact: Arnon Nagler, MD         
Principal Investigator: Arnon Nagler, MD         
Italy
Fondazione San Raffaele Recruiting
Milan, Italy
Contact: Fabio Ciceri, MD    0      
Principal Investigator: Fabio Ciceri, MD         
Azienda Ospedaliero-Universitaria Policlinico di Modena Recruiting
Modena, Italy, 41124
Contact: Mario Luppi, MD         
Contact: Franco Narni, MD         
Principal Investigator: Mario Luppi, MD         
Sub-Investigator: Franco Narni, MD         
Spain
Hospital de Navarra Recruiting
Pamplona, Spain, 31008
Contact: Eduardo Olavarria, MD         
Principal Investigator: Eduardo Olavarria, MD         
Sponsors and Collaborators
MolMed S.p.A.
Investigators
Principal Investigator: Fabio Ciceri, MD Fondazione San Raffaele
  More Information

No publications provided

Responsible Party: MolMed S.p.A.
ClinicalTrials.gov Identifier: NCT00914628     History of Changes
Other Study ID Numbers: TK008, 2009-012973-37
Study First Received: June 3, 2009
Last Updated: May 29, 2014
Health Authority: Italy: The Italian Medicines Agency
United States: Food and Drug Administration
Spain: Agencia Española de Medicamentos y Productos Sanitarios
Greece: Ministry of Health and Social Solidarity
Germany: Paul-Ehrlich-Institut
Belgium: Federal Agency for Medicines and Health Products, FAMHP
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
Israel: Ministry of Health

Keywords provided by MolMed S.p.A.:
high risk acute leukemia
HSV-TK
Haploidentical HCT
GvHD
GvL
Immunoreconstitution

Additional relevant MeSH terms:
Leukemia
Acute Disease
Neoplasms by Histologic Type
Neoplasms
Disease Attributes
Pathologic Processes

ClinicalTrials.gov processed this record on October 19, 2014