Administration of Tumor-Associated Antigen (TAA)-Specific Cytotoxic T-Lymphocytes to Patients With Active or Relapsed Hodgkin or Non-Hodgkin Lymphoma
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 36
- 试验地点
- 4
- 主要终点
- Number of Patients with treatment related Serious Adverse Events
研究概览
简要总结
Patients have a type of lymph gland disease called Hodgkin or non-Hodgkin lymphoma which has come back, or may come back, or has not gone away after treatment, including the standard treatment known for these diseases. This a research study using special immune system cells called tumor associated antigen (TAA)-specific cytotoxic T lymphocytes, a new experimental therapy.
This sort of therapy has been used previously to treat Hodgkin or non-Hodgkin lymphomas that show proof of infection with Epstein-Barr virus (EBV), the virus that causes infectious mononucleosis ("mono" or the "kissing disease"). EBV is found in cancer cells of up to half of all patients with Hodgkin's and non-Hodgkin lymphoma. This suggests that it may play a role in causing lymphoma. The cancer cells infected by EBV are able to hide from the body's immune system and escape being killed. Investigators tested whether special white blood cells, called T cells, that were trained to kill EBV-infected cells could affect these tumors, and in many patients it was found that giving these trained T cells caused a complete or partial response.
However, many patients do not have EBV in their lymphoma cells; therefore investigators now want to test whether it is possible to direct these special T cells against other types of proteins on the tumor cell surface with similar promising results. The proteins that will be targeted in this study are called tumor associated antigens (TAAs) - these are cell proteins that are specific to the cancer cell, so they either do not show or show up in low quantities on normal human cells.
In this study, we will target five TAAs which commonly show on lymphoma, called: NY-ESO-1, MAGEA4, PRAME, Survivin and SSX. This will be done by using special types of T cells called cytotoxic T lymphocytes (CTLs) generated in the lab.
In addition, some adult patients will receive a drug called azacytidine before giving the T cells. We hope that the combination helps the T cells work better.
详细描述
The patient will give blood to make TAA-specific cytotoxic T cells in the lab. These cells will be grown and frozen. If the TAA-specific cytotoxic T cells can be made, the time from collection of the blood to manufacture of T cells for administration to the patient is about 1 to 2 months.
There are 4 stages of this study: an antigen-escalation phase, a dose-escalation stage, aza stage and pediatric patients stage.
The antigen-escalation phase will be first. Patients will receive TAA-specific T cells targeting first 1 and then 2 TAAs. Once this schedule proves safe, the next group of patients will receive TAA-specific T cells targeting first 2 and then 3 TAAs. This process will continue until all 4 levels are studied. This means that the final cohort of patients will receive TAA-specific T cells targeting first 4 and then 5 TAAs. If the side-effects are too severe, the number of TAAs being targeted will be lowered or the T cell injections will be stopped. Each patient will receive 2 infusions at the same dose 28 days apart
After the antigen-escalation phase, the dose-escalation phase will begin. Patients will be started on the lowest dose (1 of 3 different levels) of T cells. Once that dose schedule proves safe, the next group of patients will be started at a higher dose. This process will continue until all 3 dose levels are studied. If the side-effects are too severe, the dose will be lowered or the T cell injections will be stopped. Each patient will receive 2 infusions at the same dose 14 days apart
After the dose escalation stage, adult patients will be enrolled on the aza stage where they will receive the drug aza followed by two infusions of T cells on dose level 2. Patients will be given 3 cycles of aza (administered daily through a vein for 5 days, every 28 days) followed by 2 doses of multiTAA-specific T cells administered 14 days apart. Before the patient is given the aza they will be given a drug to help prevent nausea and vomiting.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non 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 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •PROCUREMENT:
- •Any patient regardless of sex, with a diagnosis of Hodgkin or non-Hodgkin lymphoma.
- •Life expectancy of 6 weeks or greater.
- •Hgb greater than or equal to 7.0
- •Patient and,or parent,guardian able to give informed consent.
- •Any patient regardless of sex, with a diagnosis of Hodgkin or non-Hodgkin lymphoma:
- •Group A: Patients greater than or equal to 18 years old
- •with active disease:
- •in second or subsequent relapse.
- •in first relapse for indolent lymphoma after first-line therapy for relapse.
- •or first relapse if immunosuppressive chemotherapy contraindicated.
- •primary refractory disease or if persistent disease after first-line therapy of relapse.
- •or multiply relapsed patients in remission who are at a high risk of relapse.
- •or the lymphoma is a second malignancy e.g. a Richters transformation of CLL after failing front line therapy.
- •Group B: Patients greater than or equal to 18 years old after autologous or syngeneic SCT (as adjuvant therapy).
- •Group C: azacytidine plus multiTAA-T cells Patients greater than or equal to 18 years old
- •with active disease in:
- •second or subsequent relapse
- •first relapse for indolent lymphoma after first line therapy for relapse
- •first relapse if immunosuppressive chemotherapy contraindicated
- •with primary refractory disease or persistent disease after first line therapy of relapse
- •or lymphoma as a second malignancy e.g. a Richters transformation of CLL after failing front line therapy
- •GROUP D: Patients less than 18 yrs old
- •with active disease in:
- •second or subsequent relapse
- •first relapse for indolent lymphoma after first line therapy for relapse
- •first relapse if immunosuppressive chemotherapy contraindicated
- •with primary refractory disease or persistent disease after first line therapy of relapse
- •with lymphoma as a second malignancy e.g. a Richters transformation of CLL after failing front line therapy
- •Life expectancy of 6 weeks or greater.
- •Pulse oximetry of more than 95 percent on room air in patients who previously received radiation therapy.
- •Karnofsky,Lansky score of 50 or greater.
- •Creatinine 2X or less of upper limit of normal for age.
- •Patients should have been off other investigational therapy for one month prior to entry in this study.
- •Patients should have been off conventional therapy for at least 1 week prior to entry in this study, including rituximab.
- •Patient and,or parent,guardian able to give informed consent.
- •Due to unknown effects of this therapy on a fetus, pregnant women are excluded from this research. The male partner should use a condom. Females of child-bearing potential should use of at least two forms of contraception unless female has had a hysterectomy or tubal ligation.
- •Bilirubin 2X or less of upper limit of normal, AST 3X or less than the upper limit of normal, and Hgb greater than or equal to 7.0
- •GROUP C (aza) Only:
- •Platelets greater than 25,000
排除标准
- •PROCUREMENT:
- •Patients with severe intercurrent infection.
- •Patients with active HIV infection at time of procurement (can be pending at the time of blood draw).
- •Patients receiving systemic corticosteroids.
- •Patients with severe intercurrent infection.
- •Patients receiving systemic corticosteroids.
- •Pregnant breastfeeding.
- •Active viral infection with HIV or hepatitis type B or C. "Active" infection defined as infectious disease testing indicating that patient blood is reactive for Hep B, C and/or HIV and confirmed using PCR to measure viral load.
- •GROUP C (aza) Only:
- •Abnormal coagulation parameters (PT greater than 15 seconds, PTT greater than 40 seconds, and/or INR greater than 1.5)
- •Significant active cardiac disease within the previous 6 months including:
- •NYHA class 4 CHF
- •Unstable angina
- •Myocardial infarction
- •Known or suspected hypersensitivity to azacitidine or mannitol
- •Patients with advanced malignant hepatic tumors.
研究组 & 干预措施
Antigen-Escalation Stage
The first stage will be an "antigen-escalation" stage using a fixed total dose of cells (5 x 10^6 cells/m^2 x 2) to evaluate the safety of the T cells primed against PRAME pepmix, and then SSX pepmix, and then MAGE A4 pepmix, and then NY-ESO pepmix, and then SURVIVIN pepmix.
干预措施: Antigen-Escalation Stage (Biological)
Dose-Escalation Study Stage
In the dose escalation stage, three dose levels will be studied. Patients in the dose escalation portion of the study will be entered and stratified separately to the following two groups:
Group A: Patients receiving CTLs as therapy for Hodgkin's or non-Hodgkin's lymphoma.
Group B: Patients receiving CTLs as adjunctive therapy following autologous or syngeneic transplant.
干预措施: Dose-Escalation Stage (Biological)
azacytidine and multiTAA T cells Stage
This phase will administer aza intravenously at a dose of 75 mg/m2 after premedication with an anti-emetic such as ondansetron po or IV (up to a maximum dose of 16 mg ondansetron or equivalent). This phase will determine whether infusion of TAA-specific T cells (at dose level 2 - 1x10^7) targeting multiple tumor antigens in combination with azacytidine is safe, and whether CTL infusions (with or without azacytidine) increase the spectrum of epitopes/antigens targeted by endogenous T cells (epitope spreading).
干预措施: azacytidine and multiTAA T cells Stage (Biological)
Pediatric multiTAA T cells Stage
This phase will give patients < 18 years old two infusions (on Day 0 and Day 14) of multi-TAA specific T cells at a fixed dose of 1x10^7 cells/m2. This phase will test the safety and efficacy of multiTAA-specific T cells in pediatric patients with active HL/NHL.
干预措施: Pediatric multiTAA T cells Stage (Biological)
结局指标
主要结局
Number of Patients with treatment related Serious Adverse Events
时间窗: 8 weeks
To determine whether infusion of TAA-specific T cells targeting multiple tumor antigens in combination with azacytidine is safe
Assessment of patients with adverse events
时间窗: 8 weeks
To determine the safety of 2 intravenous injections of autologous TAA-specific cytotoxic T lymphocytes (CTLs) in patients with Hodgkin or non-Hodgkin lymphoma.
次要结局
- Assessment of increasing the spectrum of epitopes/antigens(1 year)
- Obtain information on the expansion, persistence and anti-tumor effects of the adoptively-transferred TAA-specific CTLs(1 year)
研究者
George Carrum
Professor
Baylor College of Medicine