Haploidentical Natural Killer (NK) Cells With Epratuzumab for Relapsed Acute Lymphoblastic Leukemia (ALL)
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Purpose
The goal of this clinical research study is to learn if transferring the donor's NK cells, in combination with an antibody called epratuzumab and low-dose interleukin (IL-2), into your body can be done safely. Researchers want to find out if the infused NK cells will survive after the infusion and if the NK cell infusion helps to destroy cancer cells in the recipient's body and possibly to help control the disease.
Primary Objectives:
· Evaluate the feasibility of collecting an adequate number of natural killer (NK) cells from a donor and evaluate the safety of a haploidentical donor-derived NK cell infusion, Epratuzumab, and low-dose interleukin-2 (IL-2).
Secondary Objectives:
- Quantification and persistence of the infused donor NK cell in vivo;
- Quantification and persistence of cytokine levels;
- Assessment of NK cell immunophenotype and function;
- Correlate above with anti-tumor effect.
| Condition | Intervention | Phase |
|---|---|---|
|
Leukemia Pediatric Cancer |
Drug: Epratuzumab Drug: Fludarabine Drug: Cyclophosphamide Drug: Mesna Procedure: Infusion of NK cells Drug: Interleukin-2 |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Adoptive Transfer of Haploidentical NK Cells in Combination With Epratuzumab for the Treatment of Relapsed Acute Lymphoblastic Leukemia |
- Time to Progression (TTP) [ Time Frame: 1 Year ] [ Designated as safety issue: Yes ]TTP calculated as average time, in months, from baseline to participants disease progression or death, monitored for a minimum of 1 year
- Overall Survival (OS) [ Time Frame: Minimum of 1 year, or unitl disease progression or death ] [ Designated as safety issue: No ]Number of surviving participants without disease progression or death for any reason at one year post treatment.
| Enrollment: | 3 |
| Study Start Date: | July 2009 |
| Study Completion Date: | May 2012 |
| Primary Completion Date: | May 2012 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Haploidentical NK cells + Epratuzumab
Haploidentical donor-derived NK cell infusion, Epratuzumab 360 mg/m^2 once a day by vein (IV) on Day -4, Day -1 and Days 3, 6, 10, 13 and 17, and low-dose interleukin-2 (IL-2) Subcutaneous injections three times a week for 9 doses on Days 0 to 21; Fludarabine 25 mg/m^2 once a day IV on Day -6 through Day -2 over 30 minutes; Cyclophosphamide 60 mg/kg once a day IV on Days -5 and -4 over 2 hours.
|
Drug: Epratuzumab
360 mg/m^2 once a day by vein on Day -4, Day -1 and Days 3, 6, 10, 13 and 17.
Drug: Fludarabine
25 mg/m^2 once a day by vein on Day -6 through Day -2 over 30 minutes.
Other Names:
Drug: Cyclophosphamide
60 mg/kg once a day by vein on Days -5 and -4 over 2 hours.
Other Names:
Drug: Mesna
12 mg/kg by vein 5 times per day on Days -5 and -4 over 15 minutes.
Other Name: Mesnex
Procedure: Infusion of NK cells
Transplant of Haploidentical NK cells by vein on Day 0.
Other Names:
Drug: Interleukin-2
Subcutaneous injections three times a week for 9 doses on Days 0 to 21.
Other Names:
|
Show Detailed Description
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Recipient Inclusion criteria (within 28 days of this protocol's lymphodepleting conditioning regimen and after donor and recipient consent-signing)
- Diagnosis of CD22+ acute lymphoblastic leukemia that is a. refractory to therapy or b. in second or greater relapse without other standard therapeutic options
- Patient may have been the recipient of an allogeneic hematopoietic stem cell transplant; however; there must be no evidence of Graft-versus-host disease (GVHD)
- Off prednisone or other immunosuppressive medications for at least 3 days prior to both the lymphodepleting regimen and the NK infusion
- Zubrod performance scale </= 2 or Lansky performance scale >/= 60
- Adequate renal function defined as: Serum creatinine (Cr), for adults </= 2 mg/dL, for children </= 2 mg/dL or </= 2 times upper limit of normal (ULN) for age (whichever is less). If abnormal renal function, then Cr clearance >/= 60 mL/min/1.73 m^2
- Adequate liver function defined as: Total bilirubin </= 2 mg/dL and serum glutamic-pyruvic transaminase (SGPT)/ alanine transaminase(ALT) </= 5 * ULN for age (unless Gilbert's disease or abnormal liver function due to primary disease)
- Pulmonary symptoms controlled by medication and pulse oximetry >/= 92% room air
- Negative serum test to rule out pregnancy within 2 weeks prior to registration in females of childbearing potential (non childbearing is defined as greater than one year post-menopausal or surgically sterilized
- Requirement of sexually active females and males to use any form of contraception considered effective and medically acceptable by the Investigator. [Acceptable forms: birth control implants, birth control pills, a vasectomy (male surgical sterilization), or a double-barrier method (any 2 of the following in combination: intrauterine device (IUD), male or female condom with spermicidal gel, a diaphragm, a sponge, and/or cervical cap)]
- Negative serology for human immunodeficiency virus (HIV)
- Donor must be related to recipient and is predicted to be alloreactive based upon the presence of the relevant KIR genes and incompatibility with the recipient for HLA C or Bw antigens
- Donor must have infectious disease marker testing [Hepatitis B, C, HIV, CMV, Syphilis (RPR), Chagas, HTLV, and West Nile Virus] and CBC differential and platelet studies that meet standard medical eligibility criteria for allogeneic blood stem cell donation within 7 days of apheresis
- Donor, if a female of childbearing potential (non-childbearing is defined as greater than one year post-menopause or surgically sterilized), must have a negative serum test to rule out pregnancy within 14 days of apheresis
- Donor must meet standard medical eligibility criteria for allogeneic stem cell donation
Exclusion Criteria:
- Exclusion criteria applies to both the initiation of conditioning regimen and to the NK infusion
- Active central nervous system (CNS) leukemia
- Active infection (defined as on antimicrobial therapy and or febrile)
- Breast-feeding females
- Currently using a ventilator or requiring supplemental oxygen
- Currently undergoing dialysis
- Currently using a Phase I, II, or III investigational agent. These agents should be stopped within 21 days of NK infusion
- New detected cardiac arrhythmia not controlled with medical management within prior 72 hour period.
- Hypotension requiring pressor support within prior 72 hour period
- Uncontrolled infection defined as daily fever greater than or equal to 38.2°C within prior 24 hours and new positive culture for bacteria, fungus, or virus within 72 hours prior to NK -cell infusion, if clinically indicated
- Taking corticosteroids by mouth or intravenously within prior 72 hour period
- Ascites requiring paracentesis within prior 72 hour period. (If the patient requires paracentesis within 72 hours of NK cell infusion, they will not be eligible to receive the infusion.)
- Seizure activity or clinically detectable encephalopathy or new focal neurologic deficits within prior 72 hour period
- Donor has active infection (defined as on antimicrobial therapy and/or febrile) within 7 days of apheresis
- Donor is pregnant female or breast-feeding female (within 7 days of apheresis)
Contacts and Locations| United States, Texas | |
| UT MD Anderson Cancer Center | |
| Houston, Texas, United States, 77030 | |
| Study Chair: | Anna Franklin, MD | UT MD Anderson Cancer Center |
More Information
Additional Information:
No publications provided
| Responsible Party: | M.D. Anderson Cancer Center |
| ClinicalTrials.gov Identifier: | NCT00941928 History of Changes |
| Other Study ID Numbers: | 2007-0160 |
| Study First Received: | July 16, 2009 |
| Last Updated: | October 22, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by M.D. Anderson Cancer Center:
|
Blood And Marrow Transplantation Relapsed Acute Lymphoblastic Leukemia ALL Leukemia Pediatrics Haploidentical NK cells Cyclophosphamide Cytoxan Neosar Epratuzumab Fludarabine |
Fludarabine Phosphate Fludara Interleukin-2 IL-2 Proleukin Low-dose interleukin Mesna Mesnex Natural Killer Cells NK Cells Transplant |
Additional relevant MeSH terms:
|
Leukemia Leukemia, Lymphoid Precursor Cell Lymphoblastic Leukemia-Lymphoma Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Mesna Cyclophosphamide Fludarabine monophosphate Fludarabine Aldesleukin Interleukin-2 |
Vidarabine Protective Agents Physiological Effects of Drugs Pharmacologic Actions Immunosuppressive Agents Immunologic Factors Antirheumatic Agents Therapeutic Uses Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists Analgesics, Non-Narcotic Analgesics |
ClinicalTrials.gov processed this record on May 22, 2013