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Planned Donor Lymphocyte Infusion (DLI) After Allogeneic Stem Cell Transplantation (SCT)

This study has been terminated.
(Objectives not met.)
Sponsor:
Information provided by (Responsible Party):
M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier:
NCT01518153
First received: January 23, 2012
Last updated: August 21, 2014
Last verified: August 2014
  Purpose

The goal of this clinical research study is to learn what dose of a kind of immune cell called T-lymphocytes (T-cells) given as a donor infusion about 8-9 weeks after a stem cell transplant has the best results. The safety of this treatment will also be studied. This will be tested in patients with leukemia, MDS, lymphoma, Hodgkin disease, and multiple myeloma. These results are measured as helping to control the disease without severe graft-versus-host disease (GvHD). GvHD is when transplanted donor tissue attacks the tissues of the recipient's body.

Fludarabine, melphalan, and alemtuzumab are commonly given before stem cell transplants:

  • Fludarabine is designed to interfere with the DNA (genetic material) of cancer cells, which may cause the cancer cells to die.
  • Melphalan is designed to bind to the DNA of cells, which may cause cancer cells to die.
  • Alemtuzumab is designed to weaken the immune system and reduce the risk of rejection of the transplant and graft-vs-host disease (GvHD).

The donor infusion of T-cells is designed to help restore the immune system after the transplant, cause an immune reaction against the cancer, and reduce the risk of the cancer coming back.


Condition Intervention Phase
Leukemia
Lymphoma
Myeloma
Myeloproliferative Diseases
Drug: Fludarabine
Drug: Melphalan
Drug: Alemtuzumab
Procedure: Stem Cell Infusion
Drug: Tacrolimus
Drug: Methotrexate
Drug: G-CSF
Procedure: Low Dose Donor T-Cells
Procedure: High Dose Donor T-Cells
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase 2 Study of Planned Donor Lymphocyte Infusion After Reduced Intensity Allogeneic Stem Cell Transplantation

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Success Rate [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
    Success rate defined as alive, engrafted without grade 3 or 4 GvHD or relapse at day 100 post allotx.


Secondary Outcome Measures:
  • Disease Free Survival (DFS) [ Time Frame: 3 , 6, and 12 months ] [ Designated as safety issue: Yes ]
    Disease free survival (DFS) defined as interval between day of transplant and day of death or disease progression.


Enrollment: 16
Study Start Date: February 2012
Primary Completion Date: August 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Low Dose Donor T-Cells
Fludarabine 40 mg/m2 by vein on Day -6 to -3. Melphalan 140 mg/m2 by vein on Day -2. Alemtuzumab 50 mg by vein on Day -1. Reduced intensity stem cell transplant on Day 0. Planned Donor Lymphocyte Infusion CD3+ cells: 3 * 106 CD3+ cells/kg between Day +56 and +64. Tacrolimus 0.015 mg/kg by vein as a 24 hour continuous infusion daily adjusted to achieve a therapeutic level of 5-15 ng/ml (target is 10 ng/ml). Tacrolimus is changed to oral dosing when tolerated. Tapering should start on approximately Day +24 with intention to be completely off drug by approximately Day +35. Methotrexate 5 mg/m2 dosed based on actual body surface area and administered intravenously on days +1, +3, +6. G-CSF 5 mcg/kg/day subcutaneously beginning on Day +7, and continuing until absolute neutrophil count (ANC) is > 500 * 10/L for 3 consecutive days.
Drug: Fludarabine
40 mg/m2 by vein on Day -6 to -3.
Other Names:
  • Fludarabine Phosphate
  • Fludara
Drug: Melphalan
140 mg/m2 by vein on Day -2.
Other Name: Alkeran
Drug: Alemtuzumab
50 mg by vein on Day -1.
Other Names:
  • CAMPATH-1H
  • Campath
Procedure: Stem Cell Infusion
Reduced intensity stem cell transplant on Day 0.
Drug: Tacrolimus
0.015 mg/kg by vein as a 24 hour continuous infusion daily adjusted to achieve a therapeutic level of 5-15 ng/ml (target is 10 ng/ml). Tacrolimus is changed to oral dosing when tolerated. Tapering should start on approximately Day +24 with intention to be completely off drug by approximately Day +35.
Other Name: Prograf
Drug: Methotrexate
5 mg/m2 dosed based on actual body surface area and administered intravenously on days +1, +3, +6.
Drug: G-CSF
5 mcg/kg/day subcutaneously beginning on Day +7, and continuing until absolute neutrophil count (ANC) is > 500 * 10/L for 3 consecutive days.
Other Names:
  • Filgrastim
  • NeupogenTM
Procedure: Low Dose Donor T-Cells
Planned Donor Lymphocyte Infusion CD3+ cells: 3 * 106 CD3+ cells/kg between Day +56 and +64.
Experimental: High Dose Donor T-Cells
Fludarabine 40 mg/m2 by vein on Day -6 to -3. Melphalan 140 mg/m2 by vein on Day -2. Alemtuzumab 50 mg by vein on Day -1. Reduced intensity stem cell transplant on Day 0. High Dose Donor T-Cells Planned Donor Lymphocyte Infusion CD3+ cells: 1 * 107 CD3+ cells/kg between Day +56 and +64. Tacrolimus 0.015 mg/kg by vein as a 24 hour continuous infusion daily adjusted to achieve a therapeutic level of 5-15 ng/ml (target is 10 ng/ml). Tacrolimus is changed to oral dosing when tolerated. Tapering should start on approximately Day +24 with intention to be completely off drug by approximately Day +35. Methotrexate 5 mg/m2 dosed based on actual body surface area and administered intravenously on days +1, +3, +6. G-CSF 5 mcg/kg/day subcutaneously beginning on Day +7, and continuing until absolute neutrophil count (ANC) is > 500 * 10/L for 3 consecutive days.
Drug: Fludarabine
40 mg/m2 by vein on Day -6 to -3.
Other Names:
  • Fludarabine Phosphate
  • Fludara
Drug: Melphalan
140 mg/m2 by vein on Day -2.
Other Name: Alkeran
Drug: Alemtuzumab
50 mg by vein on Day -1.
Other Names:
  • CAMPATH-1H
  • Campath
Procedure: Stem Cell Infusion
Reduced intensity stem cell transplant on Day 0.
Drug: Tacrolimus
0.015 mg/kg by vein as a 24 hour continuous infusion daily adjusted to achieve a therapeutic level of 5-15 ng/ml (target is 10 ng/ml). Tacrolimus is changed to oral dosing when tolerated. Tapering should start on approximately Day +24 with intention to be completely off drug by approximately Day +35.
Other Name: Prograf
Drug: Methotrexate
5 mg/m2 dosed based on actual body surface area and administered intravenously on days +1, +3, +6.
Drug: G-CSF
5 mcg/kg/day subcutaneously beginning on Day +7, and continuing until absolute neutrophil count (ANC) is > 500 * 10/L for 3 consecutive days.
Other Names:
  • Filgrastim
  • NeupogenTM
Procedure: High Dose Donor T-Cells
Planned Donor Lymphocyte Infusion CD3+ cells: 1 * 107 CD3+ cells/kg between Day +56 and +64.

  Hide Detailed Description

Detailed Description:

Study Groups:

If you agree to take part in this study, you will be randomly assigned (as in the flip of a coin) to 1 of 2 study groups involving the dose of T-cells in the donor lymphocyte infusion.

  • Group 1 will receive a low dose of donor T-cells.
  • Group 2 will receive a higher dose of donor T-cells than Group 1.

Both you and your study doctor will know which group you are in. Both groups will have a stem cell transplant. The stem cells will be given by vein. The cells will travel to your bone marrow where they are designed to make healthy, new blood cells after several weeks.

Study Drug Administration:

Patients receive fludarabine, melphalan and alemtuzumab to kill malignant cells and suppress immunity to prevent rejection of the stem cell transplant. The day you receive the stem cells is called Day 0. The days before you receive your stem cells are called minus days. The days after you receive the stem cells are called plus days.

On Day -7, you will be admitted to the hospital and given fluids by vein to hydrate you.

On Days -6 through -3, you will receive fludarabine by vein over 1 hour each day.

On Day -2, you will receive melphalan by vein over 30 minutes.

On Day -1, you will receive alemtuzumab by vein over 2 hours.

On Day 0, you will receive the stem cell transplant as a cell infusion by vein.

After the transplant, you will receive tacrolimus and methotrexate. At first, you will receive tacrolimus as a continuous (nonstop) infusion until you are able to take it by mouth. You will then take tacrolimus by mouth 2 times a day for about 5 weeks and then your doctor will tell you how to taper it off (gradually stop taking it). On Days 1, 3, and 6 after the transplant, you will receive methotrexate by vein over 30 minutes.

You will receive filgrastim as an injection under the skin 1 time a day, starting 1 week after the transplant, until your blood cell levels return to normal. Filgrastim is designed to help with the growth of white blood cells.

Between Day +56 and +64, if you are in stable medical condition and have not developed GvHD, you will receive a donor lymphocyte infusion containing T-cells by vein over 10-30 minutes. You will receive Benadryl (diphenhydramine) by vein over 15 minutes before the infusion to lower the risk of an allergic reaction.

Study Visits:

Before the T-cell infusion:

  • You will have a physical exam, including measurement of your vital signs (blood pressure, heart rate, temperature, and breathing rate).
  • You will be asked about how you are feeling and about any side effects you may be having.
  • Blood (about 2 teaspoons) will be drawn to see how well the transplant has "taken".
  • You will have a bone marrow aspiration and biopsy to check the status of the disease, if your doctor thinks it is needed. To collect a bone marrow aspiration/biopsy, an area of the hip or other site is numbed with anesthetic, and a small amount of bone marrow and bone is withdrawn through a large needle.

After the T-cell infusion, you will have a physical exam every week for at least 6 weeks.

About 3, 6, and 12 months after the transplant:

  • You will have a physical exam, including measurement of your vital signs.
  • You will be asked about how you are feeling and about any side effects you may be having.
  • Blood (about 4 tablespoons) will be drawn for routine tests and to check the level of the infused T-cells, for immune function tests, and to check the status of the disease.
  • You will have a bone marrow aspiration, blood tests and CT scans as medically necessary to check the status of the disease, if your doctor thinks it is needed.

During the study, you will have blood draws (about 2 teaspoons) and urine will be collected for routine tests, to check your blood counts, kidney and liver function, and/or to check for infections as often as the doctor thinks is needed during this time.

Length of Treatment:

You will be off study after your 12-month follow-up visit. You will be taken off study early if you have graft failure (the donor cells did not "take") or if the cancer comes back and needs another treatment.

This is an investigational study. Melphalan, fludarabine, and alemtuzumab are FDA approved and commercially available for the treatment of blood cancers. Donor T-cell infusions are commonly used to treat blood cancers that come back after a stem cell transplant. The investigational part of this study is to find the best dose of T-cells that are given with the goal of helping to prevent the cancer from coming back.

Up to 56 patients will take part in this study. All will be enrolled at MD Anderson.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age >/= 18 years and </= 65 years with one of the following: a. Acute leukemia past first remission, in first or subsequent relapse, in second or greater remission. Patients in first remission should have intermediate or high cytogenetic risk factors or flt3 mutation. Patients with primary induction failure or relapse are eligible if they have <10% bone marrow blasts, and no circulating blasts. b. Myelodysplastic syndrome with intermediate or high risk IPSS score, or treatment related MDS. c. CML resistant to tyrosine kinase inhibitor treatment in a first or subsequent chronic phase, or in accelerated phase. d. CLL, Lymphoma or Hodgkin's disease which has failed to achieve remission or recurred following initial chemotherapy. Patients must have at least a PR to salvage therapy, or low bulk untreated relapse (<2 cm largest mass). e. Multiple myeloma which has relapsed or progressed and has achieved a partial response to salvage chemotherapy.
  2. Patients must have one of the following donor types identified and willing to donate: a. Related donor, HLA-matched for HLA-A, -B, C and DR matched or, b. Matched Unrelated Donor (MUD), HLA-matched for HLA A, B, C and DRB1 using allele level typing.
  3. Performance score of at least 80% by Karnofsky or performance score 0 to 2 (ECOG).
  4. Estimated creatinine clearance >40 ml/min (based on serum creatinine)
  5. Bilirubin <1.5 mg/dl except for Gilbert's disease.
  6. ALT < 300 IU/ml d.
  7. Left ventricular ejection fraction equal or greater than 40%.
  8. Pulmonary function test (PFT) demonstrating a diffusion capacity (corrected for hemoglobin) of least 50% predicted.
  9. Patient or patient's legal representative able to sign informed consent.

Exclusion Criteria:

  1. Patients who have had prior autologous transplants or prior allogeneic transplants are not eligible.
  2. Uncontrolled active infection.
  3. Positive Beta HCG test in a woman with child bearing potential, defined as not post-menopausal for 12 months or no previous surgical sterilization.
  4. Women of child bearing potential not willing to use an effective contraceptive measure while on study.
  5. Subject has known sensitivity to any of the products that will be administered during the study.
  6. Patients who are HIV seropositive.
  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: NCT01518153

Locations
United States, Texas
University of Texas MD Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Principal Investigator: Richard E. Champlin, MD,BS M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT01518153     History of Changes
Other Study ID Numbers: 2011-1104, NCI-2012-00131
Study First Received: January 23, 2012
Last Updated: August 21, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by M.D. Anderson Cancer Center:
Blood and Marrow Transplantation
Lymphoma
Myeloma
Myeloproliferative Diseases
Leukemia
Myelodysplastic syndrome
MDS
Hodgkin disease
Multiple myeloma
Fludarabine
Fludarabine Phosphate
Fludara
Melphalan
Alkeran
Tacrolimus
Prograf
Methotrexate
G-CSF
Filgrastim
NeupogenTM
Donor Lymphocyte Infusion
DLI
Allogeneic Stem Cell Transplantation
Graft-vs-host disease
GvHD
T-lymphocytes
T-cells
Alemtuzumab
CAMPATH-1H
Campath

Additional relevant MeSH terms:
Leukemia
Lymphoma
Myeloproliferative Disorders
Bone Marrow Diseases
Hematologic Diseases
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Alemtuzumab
Fludarabine
Fludarabine phosphate
Melphalan
Methotrexate
Tacrolimus
Vidarabine
Abortifacient Agents
Abortifacient Agents, Nonsteroidal
Alkylating Agents
Anti-Infective Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Antiviral Agents
Dermatologic Agents
Enzyme Inhibitors

ClinicalTrials.gov processed this record on November 23, 2014