Primary Outcome Measures:
- To determine the safety of two IV injections of auto EBV specific CTLs in patients with relapsed Hodgkin disease or Non-Hodgkin Lymphoma. These CTLs may be marked with the neomycin resistance gene introduced by a retroviral vector. [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
- To determine the feasibility of generating EBV specific cytotoxic T cell lines from patients with active EBV positive Lymphoma including Hodgkin Disease (HD) or Non-Hodgkin Lymphoma (NHL). [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- To determine the survival, immunological efficacy and anti-tumor effects of EBV specific cytotoxic T-lymphocyte lines. [ Time Frame: 6 weeks, 3 months, 6 months, 9 months and 1 year ] [ Designated as safety issue: No ]
- To obtain preliminary information on the safety and response to an extended dosage regimen. [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
We will take 60-70 ml (12 teaspoonfuls) of blood from the patient to make a B cell line called a lymphoblastoid cell line or LCL by infecting the blood with a laboratory strain of EBV called B95. We will then use this EBV infected cell line (which have been treated with radiation so that they cannot grow) as stimulator cells and mix it with more blood. This stimulation will train the T cells to kill EBV infected cells and result in the growth of an EBV specific T cell line. We will then test the T cells to make sure that they kill the EBV infected cells and not normal cells and freeze them.
Patients will be entered into one of three different dosing schedules being evaluated. Three to six patients will be evaluated on each dosing schedule. Escalation will continue until irreversible or life threatening side effects considered to be related to the T cells are seen.
For patients who agree to gene marking (this is optional), we will mark these cells with a special bacterial marker gene. We will use a mouse virus (retrovirus) that has been changed to stop it from causing infection. The marker, a gene called Neo, is put inside this special virus.
The cells will be injected into the patients' vein over 10 minutes, after pretreatment with Tylenol and Benadryl. Tylenol and Benadryl are given to prevent a possible allergic reaction to the T cell administration. A total of two doses will be given two weeks apart. All of the treatments will be given at Texas Children's Hospital or The Methodist Hospital.
Patients will be followed in the clinic after the injections. At each visit about 10ml (2 teaspoonfuls) of blood will be taken every other week for 6 weeks after the injection and then every 3 months for 1 year to monitor the patients' blood chemistry and hematology.
For patients who agreed to gene marking, an extra 8 teaspoons (40 mls) of blood will be taken before each infusion, 24 hours after each infusion, 3-4 days after each infusion and at 1, 2, 4, and 6 weeks post infusion and then at 3, 6, 9 and 12 months post infusion) then once every 6 months for the first 5 years and then yearly thereafter for the next 10 years. We will use this blood to test for the frequency and activity of EBV specific T cells. That is, to learn more about the way the T cells are working and how long they last in the body.
We will also use this blood to see if there are any long term side effects of gene transfer. Patients who received cells that have a marker gene will need to be followed (seen in clinic or contacted by a research nurse) at least every six months for the next five years and then yearly thereafter for the next ten years so we can see if there are any long term side effects of the gene transfer.