T-cel and B-cell Depletion in Allogeneic Peripheral Blood Stem Cell Transplantation by Using Immunomagnetic Negative and Positive Selection Procedures
试验速览
- 阶段
- 3 期
- 状态
- 终止
- 入组人数
- 250
- 试验地点
- 2
- 主要终点
- survival
研究概览
简要总结
T-cell and B-cell depletion in allogeneic peripheral blood stem cell transplantation by using immunomagnetic negative and positive selection procedures
Background:
Removal of T-cells from the donor graft (T-cell depletion) offers the possibility for prevention of GVHD and subsequently less transplant related morbidity and mortality after allogeneic stem cell transplantation (SCT). There are several techniques to deplete T-cells from the stem cell grafts e.g. physical, immunological and combined physical / immunological separation methods. All these techniques result in a stem cell graft with sufficient CD34+ stem cells combined with an adequate depletion of T and B cells. CD34+ selected stem cell grafts are very pure and do not contain any additional cell populations. In contrast, CD3+/CD19+ depleted grafts still contain NK-cells, monocytes and dendritic cells that are part of the innate immune system. Theoretically,the presence of these cells may positively influence immunological reconstitution and the graft-versus-leukaemia (GVL) effect, respectively, resulting in improved outcome after SCT
Objectives:
To evaluate the differences in immunological reconstitution, transplant related mortality, disease-free survival and overall survival after T-cell depleted allogeneic SCT for haematological malignancies using either immunomagnetic CD34+ selection or immunomagnetic CD3+/CD19+ depletion using the CliniMACS system in approximately 270 consecutive patients.
Additionally in this study in 20 consecutive patients the kinetics of NK-cel reconstitution and differences in NK-cell repertoire will be monitored. NK-cell mediated anti-tumor reactivity will be monitored in patients transplanted with and without NK-cells in the stem cell graft (CD3+/CD19+ depletion, versus CD34+ selection). Secondary objectives are to evaluate the clinical relevance of minor histocompatibility-specific cytotoxic T-cell responses for the GVL effect, the kinetics of NK-cell reconstitution and differences in NK-cell repertoire using the different T-cell depletion protocols.
Design:
Single center prospective randomised phase III study
Population:
Patients eligible for allogeneic SCT according to the standard criteria of our institution who will receive an allogeneic T- and B-cell depleted SCT with peripheral stem cells of an HLA-identical sibling donor or an HLA-identical unrelated voluntary (VUD) donor.
Intervention:
T-cell depletion will be conducted using two different techniques: either immunomagnetic CD34+ selection or immunomagnetic CD3+/CD19+ depletion.
Endpoints:
Primary endpoints are immunological reconstitution, relapse, disease free survival and overall survival. Secondary endpoints: NK-cell reconstitution and NK-cell mediated anti-tumour reactivity. Cytotoxic T-cell responses for the GVL effect.
Estimated efforts and risks for participating patients:
We don't expect any extra patient efforts or risks because T-cell depletion is a standard procedure in our clinic for many years. There is extensive experience with immunological T-cell depletion techniques. We hypothesize CD3+/CD19+ depletion will favour stem cell transplant outcome. Immunological and molecular biological studies will be performed on blood samples already obtained as part of the standard protocol.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with the diagnosis of:
- •De novo acute myeloid leukaemia in first or second remission.
- •Secondary acute myeloid leukaemia in first or second remission supervening after myelodysplastic syndrome or cytotoxic / immunosuppressive therapy.
- •Acute lymphoblastic leukaemia in first or second remission.
- •Myelodysplastic syndrome.
- •Chronic myeloid leukaemia, patients who are candidate for SCT.
- •Malignant lymphoma following relapse or first line therapy resistant.
- •Aggressive mantle cell lymphoma in first complete remission.
- •Age 18-65 years.
- •WHO performance 0-1 (see appendix ).
- •Availability of an HLA-identical sibling or HLA, A, B, DRB, DQB -identical VUD donor.
- •Life expectancy > 3 months.
- •Witnessed written informed consent.
排除标准
- •Patients with severe cardiac dysfunction (NYHA-classification II-IV)
- •Patients with severe pulmonary dysfunction (vital capacity or diffusion < 70% of predicted value).
- •Patients with hepatic dysfunction, bilirubin or transaminases > 2.5 x upper normal limit
- •Patients with renal dysfunction, serum creatinin > 150 umol/liter or clearance < 40 ml/minute.
- •Patients with a history of moderate ore severe CNS disturbances and psychiatric problems.
- •Prior treatment with chemotherapy, immunotherapy, radiation therapy or surgery within the last 3 weeks before entering the study.
- •Patients with active uncontrolled infections.
- •Patients who are poor medical risks because of non malignant systemic disease.
- •Patients with severe coagulopathy.
- •Patients to be known HIV positive.
结局指标
主要结局
survival
relapse
event-free survival
次要结局
- clinical relevance of mHag-specific CTL responses for the GVL effect
- NK cell mediated anti tumor reactivity
- Kinetics of NK-cel reconstitution
- Differences in NK-cell repertoire