Donor Lymphocyte Infusion After Stem Cell Transplant in Treating Patients With Haematological Cancers (ProT4)
RATIONALE: Giving low doses of chemotherapy, such as fludarabine and melphalan, before a donor stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Giving an infusion of the donor's T cells (donor lymphocyte infusion) that have been treated in the laboratory after the transplant may help increase this effect. Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving alemtuzumab before transplant and cyclosporine after transplant, may stop this from happening.
PURPOSE: This randomized phase II trial is studying donor lymphocyte infusion after stem cell transplant in preventing cancer relapse or cancer progression in patients with follicular lymphoma, small lymphocytic non-Hodgkin lymphoma, or chronic lymphocytic leukemia.
|Graft Versus Host Disease Leukemia Lymphoma Myeloma Myelodysplastic Syndrome||Other: CD4 DLI Other: No DLI||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Multicenter Randomized Phase II Study to Evaluate the Efficacy of Prophylactic Transfer of CD4 Lymphocytes After T-cell Depleted Reduced Intensity HLA-Identical Sibling Transplantation for Haematological Cancers|
- Progression-free survival at 1 year post-transplant [ Time Frame: during the study and end of study ]
- Proportion of patients attaining multi-lineage full donor chimerism in peripheral blood [ Time Frame: End of study ]
- Incidence of infection requiring inpatient treatment [ Time Frame: during the study and end of study ]
- Rate of reconstitution of T-cell subsets and viral-specific immunity [ Time Frame: End of study ]
- Cumulative incidence of non-relapse mortality at 1 year [ Time Frame: End of study ]
- Overall survival and non-relapse mortality [ Time Frame: End of study ]
- Incidence, grade, or pattern of graft-versus-host disease [ Time Frame: during the study and end of study ]
|Study Start Date:||November 2011|
|Estimated Study Completion Date:||November 2019|
|Estimated Primary Completion Date:||November 2017 (Final data collection date for primary outcome measure)|
Patients will receive trial product manipulated CD4 DLI post transplant as trial treatment.
Other: CD4 DLI
Patients will receive CD4 DLI between day 70 to 115 post transplant
Patients will receive no DLI post transplant as trial treatment.
Other: No DLI
Patients will not receive DLI as trial treatment
- To evaluate the effect of prophylactic transfer of donor CD4 cells after T-cell depleted reduced-intensity HLA-identical sibling transplantation upon the risk of relapse or progression in patients with haematological cancers (e.g. NHL, HL, CLL/PLL, PCM, AML, ALL, MDS or CMML depending on the disease status).
- To evaluate the effect of prophylactic transfer of donor CD4 cells upon the risk of graft-versus-host disease (GvHD) in these patients.
- To evaluate the effect of prophylactic transfer of donor CD4 cells upon the rates of conversion to full donor chimerism in peripheral blood in these patients.
- To determine the effect of prophylactic transfer of donor CD4 cells upon immune reconstitution in these patients.
- To evaluate the impact of prophylactic transfer of donor CD4 cells upon non-relapse mortality and overall survival of these patients.
OUTLINE: This is a multicenter study.
Patients receive fludarabine IV, melphalan IV, and alemtuzumab IV as reduced intensity conditioning for T-cell depletion followed by a reduced-intensity HLA-identical sibling stem cell transplantation on day 0. Withdrawal of cyclosporine immunosuppression therapy commence at day 40 with tapering over a period of 3-4 weeks, according to the discretion of the PI. Patients are reassessed between day 70-90 post-transplantation. Patients with stable engraftment, no significant graft-versus-host disease, and no early relapse or progression are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive an allogeneic CD4 donor lymphocyte infusion (DLI) at a dose of 1 x10^6 CD4 cells/kg body weight without any other medication once between day 100-120.
- Arm II: Patients receive no further treatment.
Patients undergo blood sample collection for chimerism studies and translational research.
After completion of study treatment, patients are followed up periodically for 1 years and then annually.
Peer Reviewed and Funded or Endorsed by Leukaemia & Lymphoma Research (LLR)
Please refer to this study by its ClinicalTrials.gov identifier: NCT01240525
|Contact: Ka Man Condne, BSc, MScfirstname.lastname@example.org|
|Contact: Haematology Trials Groupemail@example.com|
|Royal Free Hospital||Recruiting|
|London, England, United Kingdom, NW3 2PF|
|Contact: Contact Person 44-207-679-7513 firstname.lastname@example.org|
|Birmingham Heartlands Hospital||Recruiting|
|Birmingham, United Kingdom|
|Principal Investigator: Richard Lovell, Dr|
|Bristol Royal Hospital for Children||Recruiting|
|Bristol, United Kingdom|
|Principal Investigator: Stephen Robinson, Dr|
|Cambridge, United Kingdom|
|Principal Investigator: Ben Uttenthal, Dr|
|Beatson West of Scotland Cancer Centre||Recruiting|
|Glasgow, Scotland, United Kingdom|
|Principal Investigator: Andrew Clark, Dr|
|St James's University Hospital||Recruiting|
|Leeds, United Kingdom|
|Principal Investigator: Maria Gilleece, Dr|
|Leicester Royal Infirmary||Recruiting|
|Leicester, United Kingdom|
|Principal Investigator: Ann Hunter, Dr|
|University College Hospital London (UCLH)||Recruiting|
|London, United Kingdom|
|Principal Investigator: Ronjon Chakraverty, Dr|
|Manchester, United Kingdom|
|Principal Investigator: Adrian Bloor, Dr|
|Nottingham City Hospital||Recruiting|
|Nottingham, United Kingdom|
|Principal Investigator: Nigel Russell, Prof|
|Royal Hallamshire Hospital||Recruiting|
|Sheffield, United Kingdom|
|Principal Investigator: John Snowden, Professor|
|University Hospitals Southampton||Recruiting|
|Southampton, United Kingdom|
|Principal Investigator: Debbie Richardson, Dr|
|Principal Investigator:||Ronjon Chakraverty, Professor||University College Hospital London; UCL Cancer Institute|