Full Text View
Tabular View
No Study Results Posted
Related Studies
Most Closely HLA Matched Allogeneic Virus Specific Cytotoxic T-Lymphocytes (CTL) to Treat Persistent Reactivation Or Infection With Adenovirus, CMV and EBV After Hemopoietic Stem Cell Transplantation (HSCT) (CHALLAH)
This study is currently recruiting participants.
Verified by Baylor College of Medicine, April 2009
First Received: June 20, 2008   Last Updated: April 9, 2009   History of Changes
Sponsor: Baylor College of Medicine
Collaborators: National Heart, Lung, and Blood Institute (NHLBI)
Texas Children's Hospital
The Methodist Hospital System
Information provided by: Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT00711035
  Purpose

This trial is designed to evaluate the feasibility, safety and efficacy of most closely HLA-matched multivirus specific CTL lines (CHM-CTLs) in HSCT patients with EBV, CMV or adenovirus infections that are persistent despite standard therapy.


Condition Intervention Phase
Allogeneic Transplant
Cytomegalovirus
Adenovirus Infection
EBV Infection
Biological: Most Closely Matched CTLs with Adenovirus
Phase I

Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Active Control, Single Group Assignment, Safety/Efficacy Study
Official Title: Most Closely HLA Matched Allogeneic Virus Specific Cytotoxic T-Lymphocytes (CTL) to Treat Persistent Reactivation Or Infection With Adenovirus, CMV and EBV After Hemopoietic Stem Cell Transplantation (HSCT)

Resource links provided by NLM:


Further study details as provided by Baylor College of Medicine:

Primary Outcome Measures:
  • The primary purpose of the study is to assess the safety of administering CHM-CTLs in transplant patients with EBV, CMV, or adenovirus infection. We have elected to use a dose of 2 x 107 CHM-CTLs/m2. [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 45
Study Start Date: November 2008
Estimated Study Completion Date: July 2012
Estimated Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Treatment: Experimental
If a patient has a partial response they are eligible to receive up to 4 additional doses at biweekly intervals. These doses would come from the original infused line if sufficient vials were available but may come from another line if there are insufficient cells in the original line.
Biological: Most Closely Matched CTLs with Adenovirus

Follow-up Assessments: The timing of follow-up visits is based on the date of CTL infusion. If a patient has multiple CTL doses the schedule resets again at the beginning so follow up relates to the last CTL dose.

Follow up will occur at 7 days, 14 days, 21 days, 28 days, 42 days, 90 days, 180 days, and 365 days post enrollment.


  Show Detailed Description

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Prior allogeneic hematopoietic stem cell transplant using either bone marrow, peripheral blood stem cells or cord blood. Recipients of non-myeloablative transplants are also eligible.
  2. CMV, adenovirus or EBV infection persistent despite standard therapy

    1. CMV infection defined as: i.Patients with CMV disease: defined as the demonstration of CMV by biopsy specimen from visceral sites (by culture or histology) or the detection of CMV by culture or direct fluorescent antibody stain in bronchoalveolar lavage fluid in the presence of new or changing pulmonary infiltrates OR ii. Failure of antiviral therapy: defined as the continued presence of pp65 antigenemia (>1+ cell/100,000 cells) or DNAemia (as defined by reference lab performing PCR assay but usually >400 copies/ml) after at least 7 days of antiviral therapy OR iii. Relapse after antiviral therapy defined as recurrence of either pp65 antigenemia or DNAemia after at least 2 weeks of antiviral therapy
    2. EBV infection is defined as: i. Biopsy proven lymphoma with EBV genomes detected in tumor cells by immunocytochemistry or in situ PCR ii. Or clinical or imaging findings consistent with EBV lymphoma and elevated EBV viral load in peripheral blood.
    3. Adenovirus infection is defined as the presence of adenoviral positivity as detected by PCR, DAA or culture from ONE site such as stool or blood or urine or nasopharynx. Adenovirus disease will be defined as the presence of adenoviral positivity as detected by culture from more than two sites such as stool or blood or urine or nasopharynx
    4. Standard therapy is defined as: i.For CMV infection, 7 days therapy with Ganciclovir, Foscarnet or Cidofovir for patients with disease (see 2.a.i) or recurrence after 14 days therapy (see 2.a.iii) ii. For EBV infection, rituximab given at 375mg/m2 in patients with a CD20+ve tumor iii. For adenovirus infection, 7 days therapy with Cidofovir (if renal function permits this agent to be given)
    5. The virus infection would be defined as progressive if: i. There was a rise or a fall of less than 50% in viral load in peripheral blood or any site of disease as measured by PCR for adenovirus, CMV or EBV (or in antigenemia levels for CMV or any other quantitative assay) ii. There was an increase or less than 50% response at sites of disease for EBV lymphoma
  3. Clinical status at enrollment to allow tapering of steroids to less than 0.5 mg/kg/day prednisone.
  4. Absolute neutrophil count (ANC) greater than 500/µL.
  5. Written informed consent from patient, parent or guardian.
  6. Education materials have been provided to, and reviewed with, patients under the age of 18.

Donors will be eligible if they meet eligibility criteria for blood donors on history and exam by a transplant donor physician and have negative infectious diseases testing for HIV-1 antibody, HIV-2 antibody, HIV NAT, HTLV-1/2 antibodies, HBs antigen, HBc antibody, HCV NAT, RPR, West Nile virus NAT, and Chagas testing

Exclusion Criteria:

  1. Patients receiving ATG, or Campath or other immunosuppressive monoclonal antibodies within 28 days of screening for enrollment.
  2. Patients with other uncontrolled infections. For bacterial infections, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to enrollment. For fungal infections patients must be receiving definitive systemic anti-fungal therapy and have no signs of progressing infection for 1 week prior to enrollment.

    Progressing infection is defined as hemodynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.

  3. Patients who have received DLI within 28 days.
  4. Patients with active acute GVHD grades II-IV.

Donors will be ineligible if they do not meet eligibility criteria for blood donors on the donor questionaire or have positive infectious diseases testing on any of the tests outlined in the inclusion criteria

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00711035

Contacts
Contact: Helen Heslop, MD 832-824-4662 hheslop@bcm.tmc.edu
Contact: Malcolm Brenner, MB, PhD 832-824-4671 mkbrenne@txccc.org

Locations
United States, California
Children's Hospital of Los Angeles Recruiting
Los Angeles, California, United States, 90027
Contact: Neena Kapoor, MD     323-669-2546     nkapoor@chla.usc.edu    
Principal Investigator: Neena Kapoor, MD            
United States, Massachusetts
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02115
Contact: Bimalangshu Dey, MD     617-724-1124     BDEY@partners.org    
Principal Investigator: Bimalangshu Dey, MD            
United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States, 27710
Contact: Paul Szabolcs, MD     919-668-1122     szabo001@mc.duke.edu    
Principal Investigator: Paul Szabolcs, MD            
United States, Texas
Texas Children's Hospital Recruiting
Houston, Texas, United States, 77030
Principal Investigator: Helen Heslop, MD            
The Methodist Hospital Recruiting
Houston, Texas, United States, 77073
Sponsors and Collaborators
Baylor College of Medicine
Texas Children's Hospital
The Methodist Hospital System
Investigators
Principal Investigator: Helen Heslop, MD Baylor College of Medicine
  More Information

No publications provided

Responsible Party: BCM/CAGT ( Helen Heslop, MD )
Study ID Numbers: 22994, CHALLAH
Study First Received: June 20, 2008
Last Updated: April 9, 2009
ClinicalTrials.gov Identifier: NCT00711035     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by Baylor College of Medicine:
CMV
Adenovirus
EBV
non-myeloablative transplants
Prior allogeneic hematopoietic stem cell transplant

Additional relevant MeSH terms:
Virus Diseases
Communicable Diseases
Neoplasms
Adenoviridae Infections
Tumor Virus Infections
Cytomegalovirus Infections
DNA Virus Infections
Epstein-Barr Virus Infections
Infection
Neoplasms, Experimental
Herpesviridae Infections

ClinicalTrials.gov processed this record on November 20, 2009