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Mismatched Donor Cells to Treat Acute Myeloid Leukemia (ATAC-AML-01)

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ClinicalTrials.gov Identifier: NCT01793025
Recruitment Status : Recruiting
First Posted : February 15, 2013
Last Update Posted : August 30, 2017
Sponsor:
Information provided by (Responsible Party):
Elizabeth Krakow, Maisonneuve-Rosemont Hospital

Brief Summary:
The purpose of this study is to assess the safety and efficacy of infusing immune cells from a donor as treatment for patients with acute myeloid leukemia that is resistant to chemotherapy or who have experienced relapse. Unlike standard bone marrow or stem cell transplantation which uses donors who are well 'matched' to the patient, this study uses donors whose immune cells are not compatible with the patient. With standard stem cell or bone marrow transplantation, the well-matched immune cells will attack the leukemia but they also attack the patient's organs (a situation called graft-versus-host disease, which can persist in the long term). Our hypothesis is that the mismatched donor cells will fight the leukemia but will then be eliminated from the patient's body, so long-term side effects like graft-versus-host disease should not occur.

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Biological: ATAC Therapy Phase 1

Detailed Description:
The ATAC cell therapy product contains unselected, non-mobilized peripheral blood mononuclear cells from related donors who are mismatched to the recipients at 3 or more (out of 6) HLA loci. Cohorts of 3 patients will be treated at each of four pre-specified dose levels (T cells per kg recipient weight). One ATAC infusion is administered 24-48 hours following re-induction chemotherapy (for relapsed or primary refractory AML patients not in remission). In situations where ATAC infusion is not available immediately following re-induction chemotherapy and patients nonetheless achieve complete remission, one ATAC infusion is given 24-48 hours after consolidation chemotherapy.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 12 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Adoptive Transfer of Alloreactive Cells to Treat Patients With Poor-Prognosis Acute Myeloid Leukemia-01
Study Start Date : September 2012
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2018


Arm Intervention/treatment
Experimental: ATAC Therapy Biological: ATAC Therapy
Unselected peripheral blood mononuclear cells given 24-48 hours after induction or consolidation chemotherapy
Other Name: Unselected Peripheral Blood Mononuclear Cells




Primary Outcome Measures :
  1. Safety [ Time Frame: 60 days (up to 2 years) ]
    Maximum tolerated cell dose: Dose at which < 33% of patients experienced dose-limiting toxicity. If no DLT occurs, then dose titration will stop at a pre-specified number of T cells/kg. Four dose-level cohorts are planned.


Secondary Outcome Measures :
  1. Treatment-related mortality [ Time Frame: Continuous up to 2 years ]
  2. Non-relapse mortality [ Time Frame: Continuous up to 2 years ]
  3. Incidence of graft-versus-host disease [ Time Frame: Continuous up to 2 years ]
  4. Duration of cytopenias [ Time Frame: Monitored continuously from ATAC infusion until peripheral blood count recovery or maximum 2 years (whichever is earlier) ]
  5. Overall survival [ Time Frame: Continuous up to 2 years ]
  6. Complete and incomplete remissions (CR, CRi) [ Time Frame: Day 60 post cell infusion ]
  7. Relapse-free survival [ Time Frame: Continuous up to 2 years ]


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Recipient Inclusion Criteria:

  • Age ≥ 18 years (no upper age limit, but physician discretion is advised)
  • AML that is refractory to 2 courses of induction therapy (that together constitute the 'first-line' therapy) or that has relapsed after a period of morphologic complete remission or morphologic remission with incomplete blood count recovery (CRi)
  • Candidacy for intense induction chemotherapy (ECOG 0-2, adequate renal, liver and cardiac function, absence of uncontrolled infections)
  • Availability of parents, siblings or children who are HLA haploidentical (and not homozygous for the shared haplotype), who are deemed suitable donors after medical evaluation, and who complete peripheral blood mononuclear cell collection
  • No history of autologous or allogeneic stem cell transplant, purine analog chemotherapy or cyclophosphamide, or total body irradiation
  • Ability to comprehend the investigational nature of the study and provide informed consent

Recipient Exclusion Criteria:

  • Acute promyelocytic leukemia (including those with non-classical rearrangements of RARα)
  • History of severe myelodysplastic syndrome clearly preceding the diagnosis of AML (i.e., red cell transfusion dependence or erythropoietin dependence over a 4-month period, or in the absence of a clear cause, any of the following: hemoglobin consistently below 9 g/dL or platelets below 50 x 10^9/L or ANC below 1000/uL on 2 or more occasions 2 weeks apart, or use of G-CSF to maintain the ANC threshold in the absence of infection, in the 3 months preceding the diagnosis of AML). Exception: If ATAC therapy is being considered as a bridge to stem cell transplantation in patients with an available standard transplant donor (familial, unrelated, or cord blood), this exclusion criterion does not apply.
  • Grade 2-3/3 fibrosis in the diagnostic bone marrow biopsy
  • DLCO < 40% predicted
  • Left ventricular ejection fraction < 40% (evaluated by ECHO or MUGA)
  • AST/SGOT > 2.5 x ULN
  • Bilirubin > 1.5 x ULN
  • Creatinine > 1.5 x ULN
  • Creatinine clearance < 50 mL/min
  • HIV positive
  • Major anticipated illness or organ failure incompatible with survival from chemotherapy
  • Concurrent second primary cancer or a prior malignancy that required cytotoxic treatment within the past 12 months, other than cervical carcinoma in-situ or prostate cancer in-situ
  • Severe psychiatric illness or mental deficiency sufficiently severe as to make compliance with the treatment unlikely and informed consent impossible
  • Any congenital or acquired immunodeficiency that would possibly permit permanent engraftment of donor cells
  • Receiving systemic steroid therapy or systemic immunosuppression such as cyclosporine or TNF-inhibitors
  • Prior or concurrent receipt of any marketed or investigational agent deemed on an ad hoc basis to cause immunomodulation, pose a threat of permanent engraftment or increase the risk of GVHD.

Donor inclusion criteria:

  • Mismatched family donor (incompatibility at 3 loci HLA-A, B and DR of the unshared haplotype, or higher-order incompatibility)
  • Age ≥ 16 and ≤ 80 years
  • Fit to undergo apheresis (normal blood counts, normotensive and no history of stroke).
  • Donor has been tested negative for HIV-1, HIV-2, hepatitis B virus (HBV, surface and core antigen), hepatitis C virus, human T-lymphotropic virus types I/II, and Treponema pallidum (syphilis).
  • ECOG performance status of 2 or less.
  • Adequate veins for leukapheresis or agree to placement of a temporary central venous catheter.
  • Donor must provide written informed consent.
  • Where multiple equally-suitable donors are available, sex mismatched donors will be preferred.

Donor exclusion criteria:

  • Medically uncontrolled coronary heart disease
  • Myocardial infarction within the last 3 months
  • History of seizure
  • History of stroke
  • History of malignancy (except basal cell or squamous carcinoma of the skin, or positive PAP smear and subsequent negative follow-up)
  • Presence of a transmissible disease (such as HIV seropositivity)
  • Presence of a major illness or a suspected systemic dysfunction
  • Presence of an an active inflammatory or autoimmune disorder
  • Female donors who are pregnant or nursing

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01793025


Contacts
Contact: Jean-Sébastien Delisle, MD,PhD (514) 252-3404 js.delisle@umontreal.ca
Contact: Jean Morin (514) 252-3404 jmorin.hmr@ssss.gouv.qc.ca

Locations
Canada, Quebec
Hôpital Maisonneuve-Rosemont Recruiting
Montreal, Quebec, Canada, H1T 3M4
Sponsors and Collaborators
Maisonneuve-Rosemont Hospital
Investigators
Study Chair: Jean-Sébastien Delisle, MD,PhD Hôpital Maisonneuve-Rosemont and Université de Montréal
Principal Investigator: Elizabeth Krakow, MD Hôpital Maisonneuve-Rosemont and Université de Montréal

Responsible Party: Elizabeth Krakow, Fellow, Hematopoietic Cell Transplantation, Maisonneuve-Rosemont Hospital
ClinicalTrials.gov Identifier: NCT01793025     History of Changes
Other Study ID Numbers: ATAC-AML-01
First Posted: February 15, 2013    Key Record Dates
Last Update Posted: August 30, 2017
Last Verified: August 2017

Keywords provided by Elizabeth Krakow, Maisonneuve-Rosemont Hospital:
leukemia
myeloid
acute
acute myeloid leukemia
allogeneic
transient chimerism
cell therapy
immunotherapy

Additional relevant MeSH terms:
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Neoplasms by Histologic Type
Neoplasms