Ipilimumab or Nivolumab in Treating Patients With Relapsed Hematologic Malignancies After Donor Stem Cell Transplant

Study Description

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

This phase I/Ib trial studies the side effects and best dose of ipilimumab or nivolumab in treating patients with cancers of the blood and blood-forming tissues (hematologic cancers) that have returned after a period of improvement (relapsed) after donor stem cell transplant. Monoclonal antibodies, such as ipilimumab and nivolumab, may interfere with the ability of cancer cells to grow and spread.

Condition or disease	Intervention/treatment	Phase
Hematopoietic Cell Transplantation Recipient; Myelodysplastic Syndrome; Myeloproliferative Neoplasm; Previously Treated Myelodysplastic Syndrome; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Chronic Lymphocytic Leukemia; Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Recurrent Hodgkin Lymphoma; Recurrent Non-Hodgkin Lymphoma; Recurrent Plasma Cell Myeloma	Biological: Ipilimumab; Other: Laboratory Biomarker Analysis; Biological: Nivolumab	Phase 1

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the maximum-tolerated dose (MTD) of ipilimumab or nivolumab administered to patients with relapsed hematologic malignancies following allogeneic stem cell transplantation. (Phase I) II. To characterize the toxicity of ipilimumab or nivolumab administered at the MTD in this patient population. (Phase Ib)

SECONDARY OBJECTIVES:

I. To assess response rate. II. To assess progression free and overall survival.

TERTIARY OBJECTIVES:

I. To assess the phenotypic and functional effects of ipilimumab or nivolumab on immune cells.

OUTLINE: This is a dose-escalation study.

INDUCTION PHASE: Patients receive ipilimumab intravenously (IV) over 90 minutes on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients also receive nivolumab IV over 30 minutes on day 1. Treatment repeats every 14 days for 8 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE PHASE: Patients receive ipilimumab IV over 90 minutes. Treatment repeats every 12 weeks beginning at course 5 (24 weeks after the first dose of ipilimumab) for up to 4 courses in the absence of disease progression or unacceptable toxicity. Patients achieving clinical benefit will have the option to continue with ongoing maintenance dosing every 12 weeks in the absence of disease progression or unacceptable toxicity. Patients also receive nivolumab IV over 30 minutes every 2 weeks in the absence of disease progression or unacceptable toxicity. Treatment repeats every 14 days for up to a total of 60 weeks (including Induction) in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 1 year.

Study Design

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	113 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	A Phase I/IB Study of Ipilimumab or Nivolumab in Patients With Relapsed Hematologic Malignancies After Allogeneic Hematopoietic Cell Transplantation
Actual Study Start Date :	April 9, 2013
Estimated Primary Completion Date :	December 31, 2018

Arms and Interventions

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Treatment (ipilimumab, nivolumab); See Detailed Description.	Biological: Ipilimumab; Given IV; Other Names: Anti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody; BMS-734016; MDX-010; MDX-CTLA4; Yervoy Other: Laboratory Biomarker Analysis; Correlative studies Biological: Nivolumab; Given IV; Other Names: BMS-936558; MDX-1106; NIVO; ONO-4538; Opdivo

Outcome Measures

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Maximum tolerated dose (MTD) of ipilimumab according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I) [ Time Frame: At 12 weeks ]
2. Maximum tolerated dose (MTD) of nivolumab according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I) [ Time Frame: At 12 weeks ]
3. Incidence of adverse events as assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase Ib) [ Time Frame: Up to 1 year after completion of study treatment ]

Secondary Outcome Measures :

1. Clinical response [ Time Frame: Up to 1 year ]
   Summarized by simple descriptive summary statistics delineating complete, partial, and best overall response, stable and progressive disease.
2. Progression-free survival (PFS) [ Time Frame: From start of treatment to time of objective disease progression, assessed up to 1 year ]
   Using the Kaplan-Meier method. Will be analyzed and reported both for the entire cohort and within each disease group if feasible.
3. Overall survival (OS) [ Time Frame: From the start of treatment to time of death, assessed up to 1 year ]
   Using the Kaplan-Meier method. Will be analyzed and reported both for the entire cohort and within each disease group if feasible.

Other Outcome Measures:

1. Change in immune cell numbers [ Time Frame: Baseline to up to 1 year ]
   Laboratory studies will be performed to characterize the effects of ipilimumab and nivolumab in the post allogeneic stem cell transplantation (alloSCT) setting on B cells, NK, cells, or dendritic cells, both in terms of pre and post alloSCT changes in cell numbers.
2. Change in cytokine production [ Time Frame: Baseline to up to 1 year ]
   Laboratory studies will be performed to characterize the effects of ipilimumab and nivolumab in the post alloSCT setting on B cells, NK, cells, or dendritic cells, both in terms of pre and post alloSCT changes in cell numbers.

Eligibility Criteria

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

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

Criteria

Inclusion Criteria:

• Histologically or cytologically confirmed hematologic malignancy

• The following malignancies will be considered eligible if progressive or persistent:

  • Chronic lymphocytic leukemia (CLL)
  • Non-Hodgkin lymphoma (NHL)
  • Hodgkin lymphoma (HL)
  • Multiple myeloma (MM)
  • Acute leukemia (acute myeloid leukemia [AML], acute lymphoblastic leukemia [ALL])
  • Myelodysplastic syndrome (MDS)
  • Myeloproliferative neoplasms (MPN)
  • Chronic myeloid leukemia (CML)
• Life expectancy of greater than 3 months
• Must have undergone allogeneic hematopoietic stem cell transplantation (HSCT) (regardless of stem cell source)
• Must have baseline donor T cell chimerism of >= 20%
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2
• Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (unless due to Gilbert's disease or disease-related hemolysis, then =< 3.0 x ULN)
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x institutional ULN
• Creatinine =< 1.5 x institutional ULN
• Prednisone dose =< 5 mg/day and off all other systemic immunosuppressive medications for at least 4 weeks prior to study entry
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

• Participants who have had anti-tumor therapy or other investigational agents within 4 weeks prior to registration (6 weeks for nitrosoureas or mitomycin C), or those who have not recovered from adverse events due to agents administered more than 4 weeks prior to registration
• Patients with prior history of or active severe (grade 3 or 4) acute graft-versus-host disease (GVHD)
• Patients with a history of prior treatment with ipilimumab, anti-programmed cell death protein 1 (PD 1) antibody, or cluster of differentiation (CD)137 agonist therapy are ineligible for the ipilimumab arm, but are eligible for the nivolumab arm
• Patients who have had donor lymphocyte infusion (DLI) within 8 weeks prior to registration
• Autoimmune disease: Patients with a history of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, are excluded from this study, as are patients with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g., Wegener's granulomatosis]) and motor neuropathy considered of autoimmune origin (e.g. Guillain-Barre syndrome and myasthenia gravis); patients with Hashimoto's thyroiditis are eligible to go on study
• Patients with known chronic human immunodeficiency virus (HIV), hepatitis B or hepatitis C infections should be excluded
• Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant women are excluded from this study; women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study or within 23 weeks after the last dose of study drug, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and for at least 31 weeks after completion of ipilimumab or nivolumab administration

Contacts and Locations

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, California
City of Hope Comprehensive Cancer Center	Recruiting
Duarte, California, United States, 91010
Contact: Alex F. Herrera 626-256-4673 Aherrera@coh.org
Principal Investigator: Alex F. Herrera
UC San Diego Moores Cancer Center	Recruiting
La Jolla, California, United States, 92093
Contact: Caitlin Costello 858-822-6842 ccostello@ucsd.edu
Principal Investigator: Caitlin Costello
UCLA / Jonsson Comprehensive Cancer Center	Withdrawn
Los Angeles, California, United States, 90095
United States, Colorado
Colorado Blood Cancer Institute	Recruiting
Denver, Colorado, United States, 80218
Contact: Peter A. McSweeney 888-785-6789 kgeisen@co-cancerresearch.org
Sub-Investigator: Peter A. McSweeney
United States, Florida
Moffitt Cancer Center	Recruiting
Tampa, Florida, United States, 33612
Contact: Frederick L. Locke 813-745-8248 Frederick.Locke@moffitt.org
Principal Investigator: Frederick L. Locke
United States, Georgia
Blood and Marrow Transplant Group of Georgia	Recruiting
Atlanta, Georgia, United States, 30342
Contact: Asad Bashey 404-255-1930 abashey@bmtga.com
Principal Investigator: Asad Bashey
Northside Hospital	Recruiting
Atlanta, Georgia, United States, 30342
Contact: Asad Bashey 404-255-1930 abashey@bmtga.com
Principal Investigator: Asad Bashey
United States, Maine
Eastern Maine Medical Center	Recruiting
Bangor, Maine, United States, 04401
Contact: Jens Rueter 207-973-7478 jrueter@emhs.org
Principal Investigator: Jens Rueter
Lafayette Family Cancer Center-EMMC	Recruiting
Brewer, Maine, United States, 04412
Contact: Jens Rueter 800-987-3005
Sub-Investigator: Jens Rueter
United States, Massachusetts
Massachusetts General Hospital Cancer Center	Recruiting
Boston, Massachusetts, United States, 02114
Contact: Yi-Bin A. Chen 617-724-1124 yachen@partners.org
Principal Investigator: Yi-Bin A. Chen
Beth Israel Deaconess Medical Center	Recruiting
Boston, Massachusetts, United States, 02215
Contact: David E. Avigan 617-667-9920 davigan@bidmc.harvard.edu
Principal Investigator: David E. Avigan
Dana-Farber Cancer Institute	Recruiting
Boston, Massachusetts, United States, 02215
Contact: Matthew S. Davids 617-632-6331 Matthew_Davids@dfci.harvard.edu
Principal Investigator: Matthew S. Davids
Massachusetts General Hospital	Recruiting
Charlestown, Massachusetts, United States, 02129
Contact: Yi-Bin A. Chen 617-724-1124 yachen@partners.org
Principal Investigator: Yi-Bin A. Chen

Sponsors and Collaborators

National Cancer Institute (NCI)

Investigators

Principal Investigator:	Matthew Davids	Dana-Farber Cancer Institute

More Information

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Davids MS, Kim HT, Bachireddy P, Costello C, Liguori R, Savell A, Lukez AP, Avigan D, Chen YB, McSweeney P, LeBoeuf NR, Rooney MS, Bowden M, Zhou CW, Granter SR, Hornick JL, Rodig SJ, Hirakawa M, Severgnini M, Hodi FS, Wu CJ, Ho VT, Cutler C, Koreth J, Alyea EP, Antin JH, Armand P, Streicher H, Ball ED, Ritz J, Bashey A, Soiffer RJ; Leukemia and Lymphoma Society Blood Cancer Research Partnership. Ipilimumab for Patients with Relapse after Allogeneic Transplantation. N Engl J Med. 2016 Jul 14;375(2):143-53. doi: 10.1056/NEJMoa1601202.

Responsible Party:	National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:	NCT01822509 History of Changes
Other Study ID Numbers:	NCI-2013-00739; NCI-2013-00739 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ); 12-537; 9204 ( Other Identifier: Dana-Farber Cancer Institute ); 9204 ( Other Identifier: CTEP ); P30CA006516 ( U.S. NIH Grant/Contract ); R01CA183559 ( U.S. NIH Grant/Contract ); U01CA062490 ( U.S. NIH Grant/Contract ); UM1CA186709 ( U.S. NIH Grant/Contract )
First Posted:	April 2, 2013
Last Update Posted:	March 5, 2018
Last Verified:	November 2017

Additional relevant MeSH terms:

Lymphoma; Syndrome; Leukemia; Leukemia, Myeloid, Acute; Myelodysplastic Syndromes; Preleukemia; Lymphoma, Non-Hodgkin; Leukemia, Lymphoid; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myeloid; Hodgkin Disease; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Myeloproliferative Disorders; Multiple Myeloma	Neoplasms, Plasma Cell; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Disease; Pathologic Processes; Bone Marrow Diseases; Hematologic Diseases; Precancerous Conditions; Leukemia, B-Cell; Hemostatic Disorders; Vascular Diseases