Immunotherapy for Acute Myeloid Leukemia (AML), Acute Lymphoblastic Leukemia (ALL), Blast Phase Chronic Myelogenous Leukemia (BP CML), and Myelodysplastic Syndrome (MDS) Relapse After Allogeneic Transplantation

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Martha Arellano, Emory University
ClinicalTrials.gov Identifier:
NCT00548847
First received: October 22, 2007
Last updated: November 22, 2013
Last verified: November 2013
  Purpose

The relapse of acute leukemia, MDS and blast phase CML after allogeneic transplantation affects approximately 1/3 to 1/2 of all transplant recipients and is the main cause of treatment failure. There is currently no effective standard treatment for this condition.

This study will test the activity and feasibility of using a regimen to boost the immune system in order to treat AML, ALL, blast phase CML, and MDS relapse after allogeneic transplantation.


Condition Intervention Phase
Leukemia
Drug: GM-CSF, Interferon-α-2b
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Pilot Phase II Study of Immunotherapy for the Treatment of AML, ALL, BP CML, and MDS Relapsed After Allogeneic Transplantation

Resource links provided by NLM:


Further study details as provided by Emory University:

Primary Outcome Measures:
  • To assess the efficacy of GM-CSF and pegylated interferon-alpha 2b when administered to patients with AML, ALL, blast phase CML, and MDS relapse after allogeneic transplantation, defined as progression-free survival of > 33% at 3 months [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To evaluate overall survival at 6 months; evaluate overall responses; perform lab experiments to test hypothesis that exposure to interferon-alpha and GM-CSF up-regulates co-stimulatory molecule expression on relapsed acute leukemia cells [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 15
Study Start Date: January 2007
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: May 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Drug: GM-CSF, Interferon-α-2b
Dosing schedule: GM-CSF, 250 mcg/m2 Mon-Wed-Fri; Pegylated Interferon-α-2b 1.5 mcg/kg Monday weekly. Response assessed between 2 and 4 weeks. Duration on study is 3 months.
Other Names:
  • GM-CSF
  • Interferon-α-2b

Detailed Description:

This is a pilot phase I1 open label study testing the activity and feasibility of utilizing a regimen to boost the immune system in order to treat AML, ALL, blast phase CML, and MDS relapse after allogeneic transplantation. The regimen is a step-wise use of withdrawal of immunosuppression, cytoreduction if needed, administration of GM-CSF and pegylated IFN α-2b to patients who relapsed after an allogeneic transplant and will assess efficacy.

Relapse is the major problem following allogeneic hematopoietic progenitor cell transplants. There is currently no standard way to treat leukemia that relapsed after transplant, and patients have a poor prognosis.

A retrospective analysis of patients treated at Emory showed that administration of GM-CSF and interferon-alpha-2b was well-tolerated and affected long-term remissions in a small number of relapsed patients (after allogeneic transplant). Pre-clinical and clinical data from ours and other centers showed that relapsed leukemic blasts have down-regulation of co-stimulatory molecules and a tendency to evade the immune system. Cytokines can up-regulate co-stimulatory molecules on leukemic blasts and have been shown to increase the cytotoxicity of T-cells. This effect may be beneficial as a graft vs. leukemia effect for patients with relapse after allogeneic transplant.

  Eligibility

Ages Eligible for Study:   1 Year and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age > 1 year.
  2. Patients who have received an allogeneic transplant to treat AML, ALL, MDS, or CML and have relapse or progression of their AML, ALL, MDS, or CML are eligible to participate in the study. Relapse is defined as: reappearance of leukemic blasts as determined by morphologic analysis of the blood or marrow, reappearance of a phenotypic population of leukemia blasts by flow cytometric analysis of the blood or marrow, reappearance of a chromosome abnormality which is associated with the original leukemia as determined by chromosomal or FISH testing (ex: a translocation between chromosomes 9 and 22 for CML), reappearance of the molecular marker which is associated with the original leukemia as determined by PCR (ex: BCR-ABL for CML or ALL).

    *Patients who received allogeneic transplantation to treat AML, ALL, MDS, or CML with detectable disease, and did not achieve remission of their leukemia after transplant are eligible.

  3. ECOG performance status < 2 for adults, and Lansky status 60% for children.
  4. Liver functions tests (AST/ALT/bilirubin) < 5x the upper limit of normal.
  5. Creatinine < 3x the upper limit of normal.
  6. Lack of active grade 2-4 acute GVHD 3 weeks after discontinuation of immunosuppression.
  7. Patients with limited stage and extensive stage chronic GVHD of mild severity (lichenoid changes), or requiring < prednisone 10 mg/m2 daily will be included.
  8. Recipients of grafts procured from related and unrelated donors with any level of HLA-matching.

Exclusion Criteria:

  1. Pregnant patients are excluded due to unknown risk to the unborn fetus with cytokines.
  2. Allergy to components of interferon-alpha-2b or GM-CSF.
  3. Current uncontrolled infection.
  4. Current grade 2-4 acute GVHD or chronic extensive GVHD of moderate to severe nature, requiring treatment with more than 10 mg/m2 of prednisone daily.
  5. Uncompensated heart failure, NYHA class III-IV:

    • Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities;
    • Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion;
    • Class III: patients with marked limitation of activity; they are comfortable only at rest;
    • Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.
  6. Breast feeding, due to unknown risk to the infant.
  7. Inability to give informed consent.
  8. Children under 1 year of age.
  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: NCT00548847

Locations
United States, Georgia
Emory University Winship Cancer Institute
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Investigators
Principal Investigator: Martha Arellano, MD Emory University Winship Cancer Institute
  More Information

No publications provided

Responsible Party: Martha Arellano, Principal Investigator, Emory University
ClinicalTrials.gov Identifier: NCT00548847     History of Changes
Other Study ID Numbers: IRB00002219, 2219
Study First Received: October 22, 2007
Last Updated: November 22, 2013
Health Authority: United States: Institutional Review Board
United States: Food and Drug Administration

Keywords provided by Emory University:
Leukemia

Additional relevant MeSH terms:
Blast Crisis
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Myelodysplastic Syndromes
Preleukemia
Neoplasms by Histologic Type
Neoplasms
Cell Transformation, Neoplastic
Carcinogenesis
Neoplastic Processes
Myeloproliferative Disorders
Bone Marrow Diseases
Hematologic Diseases
Pathologic Processes
Leukemia, Lymphoid
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Precancerous Conditions
Interferons
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Antiviral Agents
Anti-Infective Agents

ClinicalTrials.gov processed this record on August 21, 2014