Intentional Rejection of the Donor Graft Using Recipient Leukocyte Infusion(s) Following Nonmyeloablative Allogeneic Stem Cell Transplant (RLI)
The proposed study is based on our observation of paradoxical tumor regression after rejection of the donor graft in conjunction with the results of our murine experiments. We hypothesize that clinically meaningful responses can be achieved in patients with advanced malignancies with a transplant strategy using nonmyeloablative conditioning and related mismatched donor stem cell transplant where the intention will be to initially achieve mixed chimerism which will be followed by recipient lymphocyte infusion (RLI) in an attempt to deliberately reject the donor graft. This will lead to the development of novel transplant strategies for achieving antitumor effects without the risk of graft versus host disease (GVHD). This proposed protocol is a Pilot Study that will evaluate the safety of this outpatient transplant strategy, i.e., establishment of initial mixed chimerism followed by RLI for donor graft rejection, in patients with advanced lymphomas, and multiple myeloma.
In addition, because RLI have been reported to reverse ongoing GVHD, this approach might potentially reverse GVHD while achieving antitumor responses if this complication unexpectedly occurs.
|Non Hodgkin's Lymphoma Hodgkin Disease Multiple Myeloma||Other: Fludarabine and total body irradiation Radiation: Total body irradiation||Phase 1|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
|Official Title:||Intentional Rejection of the Donor Graft Using Recipient Leukocyte Infusion(s) Following Nonmyeloablative Allogeneic Stem Cell Transplant|
- To determine the safety at ≤100 days of a non myeloablative mismatched related HCT when followed by recipient leukocyte infusion to induce deliberate rejection of the donor graft. [ Time Frame: 100 days post transplant ]
- To evaluate the incidence of acute and chronic GVHD [ Time Frame: Up to 2 years post transplant ]
- To evaluate the incidence of loss of donor grafts [ Time Frame: Up to 2 years post transplant ]
- To evaluate progression-free and overall survival [ Time Frame: Up to 2 years post transplant ]
- To evaluate antitumor responses following this transplant strategy [ Time Frame: Up to 2 years post transplant ]
|Study Start Date:||November 2008|
|Estimated Study Completion Date:||November 2018|
|Estimated Primary Completion Date:||November 2018 (Final data collection date for primary outcome measure)|
Active Comparator: Fludarabine
The patients in this cohort will receive fludarabine 30 mg/m2/day on days -4 to -2 and 200 cGy TBI on day 0.
Other: Fludarabine and total body irradiation
The patients in the second cohort will receive fludarabine 30 mg/m2/day on days -4 to -2 and 200 cGy TBI on day 0.
Active Comparator: TBI only
Patients will be given 200 centiGray (cGy) total body irradiation (TBI) in one fraction. TBI will be given on day 0, 4 to 6 hours prior to HCT.
Radiation: Total body irradiation
Patients will receive 200 cGy TBI on day 0,4-6 hours prior to HCT.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00909948
|Contact: Bimalangshu R Dey, MD, PhDfirstname.lastname@example.org|
|United States, Massachusetts|
|Massachusetts General Hospital||Recruiting|
|Boston, Massachusetts, United States, 02114|
|Contact: Bimalangshu R Dey, MD, PhD 617-724-5255 email@example.com|
|Sub-Investigator: Thomas R Spitzer, MD|
|Sub-Investigator: Steven L McAfee, MD|
|Sub-Investigator: Karen Ballen, MD|
|Sub-Investigator: Eyal Attar, MD|
|Sub-Investigator: Yi-Bin Chen, MD|
|Sub-Investigator: Megan Sykes, MD|
|Principal Investigator:||Bimalangshu R Dey, MD, PhD||MGH|