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Donor Natural Killer Cell Infusion, Rituximab, Aldesleukin, and Chemotherapy in Treating Patients With Relapsed Non-Hodgkin Lymphoma or Chronic Lymphocytic Leukemia
This study is currently recruiting participants.
Study NCT00625729   Information provided by National Cancer Institute (NCI)
First Received: February 26, 2008   Last Updated: October 7, 2009   History of Changes

February 26, 2008
October 7, 2009
January 2008
January 2011   (final data collection date for primary outcome measure)
Safety of expanding donor-derived natural killer (NK) cells to > 100 cells/μL by day 14 after fludarabine, cyclophosphamide, and rituximab [ Designated as safety issue: Yes ]
Same as current
Complete list of historical versions of study NCT00625729 on ClinicalTrials.gov Archive Site
  • Correlation of interleukin-15 production at day 0 with NK cells expansion [ Designated as safety issue: No ]
  • Overall response (complete remission plus partial remission) rate at 3 months, as defined by International Working Group for non-Hodgkin lymphoma and NCI Working Group guidelines for chronic lymphocytic leukemia [ Designated as safety issue: No ]
  • Time to progression and overall survival [ Designated as safety issue: No ]
  • Quantitative and qualitative toxicities [ Designated as safety issue: Yes ]
  • Incidence of donor products that do not meet release criteria and the NK cell numbers infused [ Designated as safety issue: No ]
  • Correlation of clinical response rate with FcG receptor 3A genotype (CD16) on donor NK cells, donor/recipient KIR ligand matching status, and NK cells phenotype and function (ADCC) [ Designated as safety issue: No ]
  • Correlation of pharmacodynamics and pharmacogenomics with NK cell expansion and disease response [ Designated as safety issue: No ]
  • Correlation of interleukin-15 production at day 0 with NK cells expansion [ Designated as safety issue: No ]
  • Overall response (complete remission plus partial remission) rate at 3 months as defined by International Working Group for non-Hodgkin lymphoma and NCI Working Group guidelines for CLL [ Designated as safety issue: No ]
  • Time to progression and overall survival [ Designated as safety issue: No ]
  • Quantitative and qualitative toxicities [ Designated as safety issue: Yes ]
  • Incidence of donor products that do not meet release criteria and the NK cell numbers infused [ Designated as safety issue: No ]
  • Correlation of clinical response rate with FcG receptor 3A genotype (CD16) on donor NK cells, donor/recipient KIR ligand matching status, and NK cells phenotype and function (ADCC) [ Designated as safety issue: No ]
  • Correlation of pharmacodynamic and pharmacogenomic with NK cell expansion and disease response [ Designated as safety issue: No ]
 
Donor Natural Killer Cell Infusion, Rituximab, Aldesleukin, and Chemotherapy in Treating Patients With Relapsed Non-Hodgkin Lymphoma or Chronic Lymphocytic Leukemia
MT2007-12 Allogeneic Natural Killer Cells With Rituximab in Patients With CD20 Positive Relapsed Non-Hodgkin Lymphoma or Chronic Lymphocytic Leukemia. Strategies to Increase Sensitivity of CLL Tumor Cells to Natural Killer Cell-Immune-Mediated Cytolysis

RATIONALE: Aldesleukin may stimulate natural killer cells to kill cancer cells. Treating natural killer cells with aldesleukin in the laboratory may help the natural killer cells kill more cancer cells when they are put back in the body. Giving monoclonal antibodies, such as rituximab, and chemotherapy drugs, such as fludarabine and cyclophosphamide, before a donor natural killer cell infusion helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's stem cells.

PURPOSE: This phase I/II trial is studying how well giving rituximab and chemotherapy followed by a donor natural killer cell infusion that has been treated in the laboratory with aldesleukin followed by aldesleukin works in treating patients with non-Hodgkin lymphoma or chronic lymphocytic leukemia.

OBJECTIVES:

Primary

  • To determine if allogeneic natural killer (NK) cells infused following chemoimmunotherapy can be safely expanded in vivo with aldesleukin.

Secondary

  • To determine if interleukin-15 production at day 0 correlates with NK cells expansion.
  • To determine overall response rate at 3 months.
  • To determine time to progression and overall survival.
  • To characterize the quantitative and qualitative toxicities of this treatment plan.
  • To determine the incidence of donor products that do not meet release criteria and the NK cell numbers infused.
  • To correlate clinical response with donor/recipient KIR ligand matching status, FcG receptor 3A genotype, and NK cells phenotype and function
  • To determine pharmacodynamic and pharmacogenomic markers and correlate them with NK cell expansion and disease response.

OUTLINE:

  • Conditioning regimen: Patients receive rituximab IV over 6-8 hours on days -8, -1, 6, and 13; fludarabine IV on days -6 to -2; and cyclophosphamide IV on day -5.
  • Allogeneic natural killer (NK) cell administration: Patients receive aldesleukin-activated haploidentical NK cells IV over less than 1 hour on day 0. Within 4 hours after allogeneic NK cell infusion, patients receive aldesleukin subcutaneously (SC) 3 times a week for 6 doses. Patients also receive filgrastim (G-CSF) SC beginning on day 14 and continuing until ANC is > 2,500/mm³ for 2 consecutive days.

Patients who achieve a complete or partial response at 28 days are eligible for allogeneic stem cell transplantation. Patients who achieve initial response at 3 months, clinically benefit from treatment, but subsequently relapse are eligible for retreatment provided all eligibility criteria are met.

Blood samples are collected periodically for correlative laboratory studies. Patients with CLL also undergo bone marow aspiration periodically for correlative laboratory studies.

After completion of study treatment, patients are followed periodically for up to 1 year.

Phase I, Phase II
Interventional
Treatment, Open Label
  • Leukemia
  • Lymphoma
  • Biological: aldesleukin
  • Biological: lymphokine-activated killer cells
  • Biological: rituximab
  • Drug: cyclophosphamide
  • Drug: fludarabine phosphate
  • Other: laboratory biomarker analysis
  • Other: pharmacogenomic studies
  • Other: pharmacological study
 
 

*   Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
 
Recruiting
12
 
January 2011   (final data collection date for primary outcome measure)

DISEASE CHARACTERISTICS:

  • Diagnosis of CD20-positive non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukemia (CLL), meeting 1 of the following criteria:

    • Progression of NHL after at least 2 prior chemotherapy regimens*, defined by 1 of the following:

      • Failure to achieve partial remission (PR) with the last chemotherapy
      • Disease progression within 6 months after last chemotherapy
    • Progression of CLL or small lymphocytic leukemia following at least 2 prior chemotherapy regimens (containing purine analogs) in stage Rai III or IV or symptomatic disease
    • Relapsed NHL or CLL after stem cell transplantation for whom the option of donor lymphocyte infusion is not available or clinically indicated (e.g., recipients of autologous or umbilical cord transplantations) NOTE: *Must have contained rituximab (for patients with any NHL) and fludarabine (for patients with follicular NHL)
  • Measurable disease
  • No active CNS lymphoma/leukemia
  • No pleural effusion large enough to be detectable by chest x-ray
  • No HIV-associated NHL
  • No Epstein-Barr virus post-transplant lymphoproliferative disorder
  • Available related HLA-haploidentical related natural killer cell donor (by at least Class I serologic typing)

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 60-100%
  • Platelet count ≥ 80,000/mm³*
  • Hemoglobin ≥ 9 g/dL (unsupported by transfusions)*
  • ANC ≥ 1,000/mm³ (unsupported by filgrastim [G-CSF] or sargramostim [GM-CSF] for 10 days or pegfilgrastim [Neulasta] for 21 days)*
  • Glomerular filtration rate > 50 mL/min
  • ALT and AST < 3 times upper limit of normal
  • Total bilirubin < 3 mg/dL
  • DLCO > 50% corrected
  • FEV_1 > 50% corrected
  • LVEF > 40%
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Hepatitis B surface antigen negative
  • Hepatitis B core antibody negative
  • No symptoms of uncontrolled cardiac disease
  • No active serious infection (pulmonary infiltrates or lesions are allowed only after the appropriate diagnostic testing is negative for infection or appropriate therapy was initiated for probable infection)
  • No allergy to rituximab or aldesleukin
  • No active concurrent malignancy (except skin cancer) requiring systemic therapy in the past 2 years NOTE: *The hematologic requirements are waived for patients with inadequate counts due to known bone marrow involvement by lymphoma who are otherwise eligible

PRIOR CONCURRENT THERAPY:

  • At least 3 days since prior prednisone or other immunosuppressive medications
  • At least 30 days since prior experimental therapy
Both
18 Years and older
No
 
United States
 
NCT00625729
Veronika Bachanova, Masonic Cancer Center at University of Minnesota
CDR0000586667, UMN-2007LS064, MT2007-12, UMN-0707M13561
Masonic Cancer Center, University of Minnesota
National Cancer Institute (NCI)
Principal Investigator: Veronika Bachanova, MD Masonic Cancer Center, University of Minnesota
National Cancer Institute (NCI)
September 2009

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP