Myelodysplastic Syndrome Clinical Trial

Phase 1-2 MAHCT w/ TCell Depleted Graft w/ Simultaneous Infusion Conventional and Regulatory T Cell

Summary

For patients with hematologic malignancies undergoing allogeneic myeloablative (MA) HCT with a T cell depleted graft, the infusion of naturally occurring regulatory T cells with conventional T cells (T cell add back) in pre-defined doses and ratios will reduce the incidence of acute graft vs host disease while augmenting the graft vs leukemia effect and improving immune reconstitution.

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Full Description

Primary Objectives:

To determine the efficacy, safety and feasibility of administration of several dose combinations of conventional T cells (Tcon) and regulatory T cells (Treg) in patients undergoing allogeneic hematopoietic cell transplantation (HCT) with HLA matched donors (related or unrelated) using a T cell depleted graft [CD34+ hematopoietic progenitor cells ("CD34+ HSPC")], without immune suppression.
To determine the maximum tolerated dose of infused regulatory and conventional T cells in the matched donor setting
To determine 1 year event free survival (EFS) post HCT

Secondary Objectives:

To determine the 1 year OS in patients undergoing allogeneic HCT with matched donors.
To measure the incidence and severity of acute and chronic graft vs host disease (GvHD)
To measure incidence of serious infections

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Eligibility Criteria

Recipient Inclusion Criteria

Patients with the following diseases that are histopathologically confirmed are eligible

Acute leukemia, primary refractory or beyond CR1, or minimal residual disease (MRD) positivity.
High risk acute myeloid leukemia in CR1 with any of the following features:
Complex karyotype(≥3 clonal chromosomal abnormalities)

Any of the following high risk chromosomal abnormalities:

Monosomal karyotype (-5, 5q-, -7, 7q-)
t(11q23), t(9;11), inv(3), t(3;3) t(6;9) t(9;22)
Normal karyotype with fms-like tyrosine kinase 3 (FLT3)-ITD mutation
Other high risk features as determined by molecular studies, or clinical presentation as assessed by the treating physician
Chronic myelogenous leukemia (accelerated, blast or second chronic phase)
Myelodysplastic syndromes
Myeloproliferative syndromes
Non-Hodgkin lymphoma with poor risk features not suitable for autologous HCT
Age ≥18 yo and ≤ 60 yo for patients in Cohort 1 only. At the start of Cohort 2A and beyond, eligibility will be expanded to allow pediatric patients age ≥ 13 yo.
Cardiac ejection fraction ≥ 45%
Lung diffusion capacity ≥ 50%
Calculated creatinine clearance ≥ 50 cc/min
Serum glutamic-pyruvic transaminase( SGPT) and serum glutamic-oxaloacetic transaminase (SGOT) ≤ 3.0 x ULN (Upper limit of normal), unless elevated secondary to disease.
Total bilirubin ≤ 2 x ULN (patients with Gilbert's syndrome may be included at the discretion of the PI or where hemolysis has been excluded
Availability of a HLA matched donor (related or unrelated) defined by Class I (HLA-A and B) serologic typing (or higher resolution) and Class II (HLA DRB1) molecular typing. An HLA matched donor is defined for this study to be a sibling that is HLA matched 6/6; or an unrelated donor that is HLA matched 6/6 or 5/6. A sibling may be a "half sibling."
Karnofsky performance status ≥70%

Recipient Exclusion Criteria

Seropositive for any of the following:

HIV ab; hepatitis B sAg; hepatitis C ab

Prior myeloablative therapy or hematopoietic cell transplant
Candidate for autologous transplant
HIV positive
Active uncontrolled bacterial, viral or fungal infection, defined as currently taking antimicrobial therapy and progression of clinical symptoms.
Uncontrolled central nervous system (CNS) disease involvement
Pregnant or a lactating female
Positive serum or urine beta human chorionic gonadotropin (HCG) test in females of childbearing potential within 3 weeks of registration
Psychosocial circumstances that preclude the patient being able to go through transplant or participate responsibly in follow up care

Donor Inclusion Criteria

Age ≥13 yo and ≤ 75 years
Karnofsky performance status of ≥ 70% defined by institutional standards

Seronegative for HIV 1 RNA (polymerase chair reaction (PCR); HIV 1 and HIV 2 ab (antibody); HTLV 1 and HTLV 2 ab; PCR+ or sAg (surface antigen) hepatitis B ; or PCR+ or sAg for hepatitis C; negative for the Treponema pallidum antibody Syphilis screen; and negative for HIV 1 and hepatitis C by nucleic acid testing (NAT) within 30 days of apheresis collection. In the case that T pallidum antibody tests are positive, donors must:

Be evaluated and show no evidence of syphilis infection of any stage by physical exam and history
Have completed effective antibiotic therapy to treat syphilis
Have a documented negative non treponemal test (such as RPR) or in the case of a positive non treponemal test must be evaluated by an infectious disease expert to evaluate for alternative causes of test positivity and confirm no evidence of active syphilitic disease
Must be 6/6 matched sibling donor as determined by HLA typing
Female donors of child-bearing potential must have a negative serum or urine beta-HCG test within three weeks of mobilization
Capable of undergoing leukapheresis, have adequate venous access, and be willing to undergo insertion of a central catheter should leukapheresis via peripheral vein be inadequate
Agreeable to 2nd donation of Peripheral blood stem cell (PBPC) (or bone marrow harvest) in the event of graft failure
The donor or legal guardian greater than 18 years of age, capable of signing an institutional review board (IRB-approved consent form.

Donor Exclusion Criteria

Evidence of active infection or viral hepatitis
HIV positive
Medical, physical, or psychological reason that would place the donor at increased risk for complications from growth factor or leukapheresis
Lactating female

Study is for people with:

Myelodysplastic Syndrome

Phase:

Phase 1

Estimated Enrollment:

68

Study ID:

NCT01660607

Recruitment Status:

Completed

Sponsor:

Everett Meyer

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There is 1 Location for this study

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Stanford University School of Medicine Palo Alto, California, United States
Palo Alto California, 94305, United States

How clear is this clinincal trial information?

Study is for people with:

Myelodysplastic Syndrome

Phase:

Phase 1

Estimated Enrollment:

68

Study ID:

NCT01660607

Recruitment Status:

Completed

Sponsor:


Everett Meyer

How clear is this clinincal trial information?

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