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ECT-001 (UM171) Expanded Cord Blood Transplant to Treat High-risk Multiple Myeloma

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ClinicalTrials.gov Identifier: NCT03441958
Recruitment Status : Recruiting
First Posted : February 22, 2018
Last Update Posted : March 12, 2018
Sponsor:
Collaborators:
ExcellThera
Centre de Commercialisation en Immunothérapie du Cancer (C3i)
Information provided by (Responsible Party):
Ciusss de L'Est de l'Île de Montréal

Brief Summary:

MM is a morbid disease associated with a poor outcome and while current therapies with new drugs have improved survival, MM still remains incurable in most patients. The only potential curative treatment remains allogeneic HSCT, as shown by our cohort of 92 NDMM patients who received a sibling tandem auto-allo Hematopoietic stem cell transplant (HSCT) with an estimated 10-year progression free survival (PFS) of 43%. However, the high incidences of toxicities including chronic graft-versus-host-disease (GVHD) (up to 79%) and disease progression (up to 49%) impair improvement in cure rate. Using umbilical cord blood (CB) as an alternative source of hematopoietic stem cells (HSC) could be superior biologically because of their increased proliferative capacity, greater number of progeny with longer telomeres and better anti-tumor efficacy in presence of positive residual disease. Moreover, using CB has been shown to decrease incidence of chronic GVHD. However, CBs have the disadvantage of having a limited HSC dose leading to prolonged cytopenia and higher risk of infections.

In a first in-human trial using CB expanded with the ECT-001 (UM171) molecule (clinicaltrial.gov # NCT02668315), the median net expansion of HSC was 36 fold, which allows for the selection of better HLA matched CB regardless of their lower HSC dose. Moreover, the ECT-001 expanded CBs have a different cell composition than regular CBs, with more than 25% of dendritic cell precursors. This, combined to better HLA matched CBs, may reduce chronic GVHD incidence and improve immune reconstitution. To date, 22 patients received an ECT-001 expanded CB and the procedure proved to be safe and feasible.

In this new trial, the goal is to evaluate the safety and efficacy of ECT-001 expanded CB transplant in high risk MM patients.


Condition or disease Intervention/treatment Phase
Multiple Myeloma Biological: ECT-001 (UM171) expanded cord blood Phase 1 Phase 2

Detailed Description:

This is a single institution, prospective, phase I/II open-label study in a maximum of 20 patients evaluating a novel treatment strategy in NDMM patients with high-risk disease who do not have a 6/6 compatible sibling donor. Participating patients will be from Hôpital Maisonneuve-Rosemont (HMR) or referred to HMR for this protocol. Newly diagnosed multiple myeloma patients will be evaluated for eligibility before or during the autologous stem cell transplant (ASCT) period. After a Bortezomib-based induction treatment (VTD, CyBorD, RVD or PAD [in patients with plasma cell leukemia]) for a minimum of 4 cycles, followed by Melphalan ≥ 140 mg/m2 and ASCT, eligible patients who accept to participate will undergo screening evaluation to receive a non myeloablative (NMA) allogeneic HSCT with ECT-001 expanded CB. It is estimated that 18 months will be necessary to enroll the targeted sample size.

Once eligibility has been confirmed, study treatment will begin. After an ASCT, eligible patients will receive a conditioning regimen before receiving an outpatient NMA allogeneic HSCT with an ECT-001 expanded CB on day 0. Patients will be followed at least every week for the first 3 months, then every month, in the absence of GVHD, for disease evaluation and adverse events. Occurrence and severity of acute GVHD will be evaluated using the modified Glucksberg176 and IBMTR177 criteria, while chronic GVHD will be evaluated using the NIH178 criteria.

The trial will be terminated when all patients have been followed for 5 years after allogeneic HSCT.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I-II Open-label Study of Non-myeloablative-allogeneic Transplant of ECT-001 (UM171/ Fed-batch Culture System) Expanded Cord Blood in Patients With High-risk Multiple Myeloma
Actual Study Start Date : March 7, 2018
Estimated Primary Completion Date : March 1, 2022
Estimated Study Completion Date : March 1, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arm Intervention/treatment
Experimental: ECT-001 (UM171) expanded cord blood
  1. Patients will receive a nonmyeloablative conditioning regimen containing Fludarabine 30 mg/m2 x 3 days and total body irradiation 200 cGy.
  2. The cord to be expanded is thawed 7 days prior to transplant and undergoes CD34+ selection. The CD34+ product will be placed in the fed-batch culture with UM171 for a 7-day expansion and is infused fresh on Day 0. The CD34- product is cryopreserved and will be thawed and infused on Day +1.
  3. Patients will receive standard supportive care and GVHD prophylaxis with Mycophenolate mofetil and Tacrolimus.
Biological: ECT-001 (UM171) expanded cord blood
Non myeloablative allogeneic transplant in an out patient setting using ECT-001 expanded cord-blood




Primary Outcome Measures :
  1. Safety of ECT-001 expanded CB expansion as measured by toxicity evaluation [ Time Frame: 5 years ]
    AEs with a CTCAE grade ≥ 3 (non hematologic) and with a grade ≥ 4 (hematologic) will be reported from the beginning of the conditioning regimen up to 5 years after CB transplant.

  2. Feasibility of ECT-001 expanded CB expansion [ Time Frame: 5 years ]
    Number of successful expansion and infusions in an outpatient nonmyeloablative transplant condition for high-risk myeloma patients

  3. Measure of the kinetics of donor lymphoid cells recovery [ Time Frame: 2 years ]
    Donor lymphocytes cells recovery assessed by chimerism analysis.

  4. Measure of the kinetics of donor myeloid cells recovery [ Time Frame: 2 years ]
    Time to neutrophils and platelets engraftment will be measured

  5. Incidence of chronic GVHD by grade at 1 years by NIH criteria. [ Time Frame: 1 year ]
    The incidence of chronic GVHD will be evaluated at 1 years using the recommendations of the NIH Consensus Conference and recently updated. Analysis by cumulative incidence

  6. Incidence of chronic GVHD by grade at 2 years by NIH criteria. [ Time Frame: 2 years ]
    The incidence of chronic GVHD will be evaluated at 1 years using the recommendations of the NIH Consensus Conference and recently updated. Analysis by cumulative incidence


Secondary Outcome Measures :
  1. Correlation between neutrophil and CD34+ doses infused [ Time Frame: 2 years ]
    Regression analysis

  2. Correlation between neutrophil and CD34+CD45RA+ doses infused [ Time Frame: 2 years ]
    Regression analysis. Time to neutrophil and platelet engraftment will be correlated to the CD34+ and the CD34+CD45RA- dose (which includes all human hematopoietic stem cells (HSCs): long term and short term repopulating cells) contained in the expanded graft. Expansion and cultures might change the characteristics and behaviour of CD34+ cells, hence the need to look at the correlation between primitive CD34+CD45RA- subpopulation and engraftment.

  3. Incidence of graft failure [ Time Frame: 2 years ]
    Cumulative incidence of graft failure by type (primary or secondary). For Primary engraftment failure will be defined as non-achieving a T lymphocyte chimerism of ≥30% at D+28 and ≥70% at D+180. Secondary graft failure will be defined as followed : ANC drops below 0.5x109/L for 14 consecutive days, unresponsive to G-CSF without any identifiable cause (medication, viral infection, vitamin deficiency or other) or <5% donor chimerism at any time point beyond initial engraftment in the absence of relapse and graft dominance by 2nd infused cord or other stem cell source.

  4. Evaluation of T Cells reconstitution [ Time Frame: 3 years ]

    Evaluation at several levels :

    • Multiparametric flow cytometry to quantify the proportion of naïve (CD45RA+/CD27+) and memory (CD45RA-/CD27+) cells.
    • TREC to measure thymic output
    • Diversity of the T cell repertoire (deep sequencing)
    • T-cell function (Elispot assays)

  5. Evaluation of B cells reconstitution [ Time Frame: 3 years ]
    B cell evaluation will be carried out prospectively using flow cytometry (CD19+), immunoglobulin (Ig) measurements, and PCR for donor B cell chimerism .

  6. Evaluation of NK Cells reconstitution [ Time Frame: 3 years ]
    NK cell evaluation will be performed by flow cytometry (CD 16+/56+) and chimerism analysis.

  7. Evaluation of expanded HSC activity in vivo [ Time Frame: 3 years ]
    Standard in vitro (long term culture-initiating cells and colony forming cells) and in vivo (the NSG mouse model) assays

  8. Incidence of acute GVHD at day +120 [ Time Frame: 4 months ]
    Analysis by cumulative incidence

  9. Incidence of acute GVHD at 6 month [ Time Frame: 6 months ]
    Analysis by cumulative incidence

  10. Incidence of acute GVHD at 1 year [ Time Frame: 1 year ]
    Analysis by cumulative incidence

  11. Incidence of grade >=3 infectious complications [ Time Frame: 5 years ]
    Analysis by cumulative incidence

  12. Incidence of engraftment syndrome requiring therapy [ Time Frame: 2 years ]
    Analysis by cumulative incidence

  13. Duration of hospitalization [ Time Frame: 6 months ]
    Number of days of hospitalization during the first 180 days post-transplant

  14. Non relapse mortality at day +120 [ Time Frame: 4 months ]
    Analysis by cumulative incidence

  15. Non relapse mortality at 1 year [ Time Frame: 1 year ]
    Analysis by cumulative incidence

  16. Non relapse mortality at 2 year [ Time Frame: 2 years ]
    Analysis by cumulative incidence

  17. Progression free survival at 2 years [ Time Frame: 2 years ]
    Kaplan Meier analysis

  18. Overall survival at 2 years [ Time Frame: 2 years ]
    Kaplan Meier analysis

  19. Response to treatment at 1 year after allogeneic transplant [ Time Frame: 1 years ]
    Evaluation of response categories according to the International Myeloma Working Group (IMWG)

  20. Response to treatment at 2 year after allogeneic transplant [ Time Frame: 2 years ]
    Evaluation of response categories according to the International Myeloma Working Group (IMWG)

  21. Best response achieve at 1 year after allogeneic transplant [ Time Frame: 1 years ]
    Evaluation of the best response during the 1 st year post-transplant

  22. Best response achieve at 2 year after allogeneic transplant [ Time Frame: 2 years ]
    Evaluation of the best response during the 2 years post-transplant

  23. Minimal residual disease post transplant [ Time Frame: 5 years ]
    Next Generation flow cytometry to determine how efficient an expanded CB is at reducing MM burden

  24. Patient's quality of life [ Time Frame: 5 years ]
    Assessment through Quality of Life questionnaires

  25. Pharmaco-economic evaluation of the proposed treatment [ Time Frame: 5 years ]
    Developement of an analysis model to determine if ECT-001 expanded CB to treat MM has a better cost-efficiency ratio than conventional chemotherapy-based treatment



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age 18-65 years.
  2. Newly diagnosed multiple myeloma using the International Myeloma Working Group criteria with measurable disease and any of the following:

    i. t(4;14), t(14;16), t(14;20), del(17p13), chromosome 1 abnormalities with ISS II or III; ii. Revised-ISS 3; iii. Primary plasma cell leukemia; iv. Refractory to first line triplet Bortezomib-based induction treatment. v. ≥ 2 cytogenetics abnormalities as defined above regardless of ISS stage

  3. Received a first line triplet Bortezomib-induction regimen for a minimum of 4 cycles with achievement of at least partial response; or received a doublet or triplet Lenalidomide-based second line induction treatment with at least partial response for patients refractory to Bortezomib in first line.
  4. Received high-dose Melphalan ≥ 140 mg/m2 followed by ASCT.
  5. Availability of a cord blood with an HLA match ≥ 5/8 and < 8/8 meeting the following requirements: CD34+ cell count ≥ 0.5 x 105/kg and nucleated cell count >= 1.5 x 107/kg.

Exclusion Criteria:

  1. Having previously received two ASCT.
  2. Having previously received autologous-allogeneic tandem transplantation.
  3. Having received more than 4 months of maintenance with Lenalidomide or Bortezomib after ASCT.
  4. Poor organ function defined as either: forced vital capacity, forced expiratory volume in 1 second or lung diffusing capacity of carbon monoxide corrected for hemoglobin < 50%, left ventricular ejection fraction < 40% (evaluated by either echocardiogram or MUGA), uncontrolled arrhythmia or symptomatic cardiac disease, creatinine clearance < 60 mL/minute.
  5. Karnofsky score < 70% or comorbidity index HCT-CI > 3.
  6. Bilirubin > 2 x upper limit of normal (ULN) unless felt to be related to Gilbert's disease or hemolysis; AST and ALT > 2.5 x ULN; alkaline phosphatase > 5 x ULN; liver cirrhosis.
  7. Non secretory disease or non-measurable disease in serum or urine at time of diagnosis.
  8. Uncontrolled infection.
  9. Active infection with any of the following viruses: HIV, HTLV-1 or 2, hepatitis B or C.
  10. Presence of another malignancy with an expected survival estimated < 75% at 5 years.
  11. Suspicion of cardiac amyloidosis.
  12. Current history of drug and/or alcohol abuse.
  13. Availability of a matched sibling donor.
  14. Pregnancy, breastfeeding or unwillingness to use appropriate contraception.
  15. Participation in a trial with an investigational agent within 30 days prior to entry in the study.
  16. Patient unable to give informed consent or unable to comply with the treatment protocol including appropriate supportive care, follow-up and tests.
  17. Any abnormal condition or laboratory result that is considered by the principal investigator capable of altering patient's condition or study outcome.

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): NCT03441958


Contacts
Contact: Severine Landais, PhD 514-252-3400 ext 3609 slandais.hmr@ssss.gouv.qc.ca

Locations
Canada, Quebec
CIUSSS de l'Est-de-l'île-de-Montréal, Installation Hôpital Maisonneuve Rosemond Recruiting
Montréal, Quebec, Canada, H1T2M4
Contact: Séverine Landais, PhD    514-252-3400 ext 3609    slandais.hmr@ssss.gouv.qc.ca   
Contact: Jean Roy, MD    514-252-3400    jroy.hmr@ssss.gouv.qc.ca   
Sponsors and Collaborators
Ciusss de L'Est de l'Île de Montréal
ExcellThera
Centre de Commercialisation en Immunothérapie du Cancer (C3i)

Responsible Party: Ciusss de L'Est de l'Île de Montréal
ClinicalTrials.gov Identifier: NCT03441958     History of Changes
Other Study ID Numbers: HMR007
First Posted: February 22, 2018    Key Record Dates
Last Update Posted: March 12, 2018
Last Verified: February 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Ciusss de L'Est de l'Île de Montréal:
hematopoietic stem cell transplant
Expanded cord blood

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Neoplasms
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases