Donor Natural Killer Cells and Donor Stem Cell Transplant in Treating Patients With High Risk Myeloid Malignancies
Study Details
Study Description
Brief Summary
This phase I/II trial studies the side effects and best dose of donor natural killer cells when given together with donor stem cell transplant and to see how well they work in treating patients with myeloid malignancies that are likely to come back or spread. Giving chemotherapy, such as busulfan and fludarabine phosphate, before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells and natural killer cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.
Detailed Description
PRIMARY OBJECTIVES:
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Assess the safety of infusing ex vivo expanded natural killer (NK) cells in patients receiving busulfan-fludarabine phosphate (fludarabine) with an allogeneic human leukocyte antigen (HLA) matched hematopoietic transplantation for myeloid malignancies. Two sources of NK cells could be studied, depending on what donor source is available: cells from the HLA matched related donor or cells from an unrelated cord blood unit.
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For each source of NK cells: the maximum tolerated cell dose; the phenotype and function of the ex vivo expanded NK cells and their survival in vivo; the rate of engraftment, graft-vs.-host disease (GVHD), immune reconstitution, relapse rates and survival for patients receiving this regimen will be determined.
OUTLINE: This is a phase I, dose-escalation study of NK cells followed by a phase II study.
Patients receive fludarabine phosphate intravenously (IV) over 1 hour and busulfan IV over 3 hours on days -13 to -10. Patients then receive allogeneic CD56-positive CD3-negative natural killer cells IV over 1 hour on day -8. Patients also receive aldesleukin subcutaneously (SC) once daily (QD) on days -8 to -4. Patients then undergo allogeneic peripheral blood stem cell (PBSC) transplant on day 0.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Treatment (NK cells, PBSC transplant) Patients receive fludarabine phosphate IV over 1 hour and busulfan IV over 3 hours on days -13 to -10. Patients then receive allogeneic CD56-positive CD3-negative natural killer cells IV over 1 hour on day -8. Patients also receive aldesleukin SC QD on days -8 to -4. Patients then undergo allogeneic PBSC transplant on day 0. |
Biological: Aldesleukin
Given SC
Other Names:
Biological: Allogeneic CD56-positive CD3-negative Natural Killer Cells
Given IV
Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
Undergo allogeneic PBSC transplant
Other Names:
Drug: Busulfan
Given IV
Other Names:
Drug: Fludarabine Phosphate
Given IV
Other Names:
Other: Laboratory Biomarker Analysis
Correlative studies
Procedure: Peripheral Blood Stem Cell Transplantation
Undergo allogeneic PBSC transplant
Other Names:
Other: Pharmacological Study
Correlative studies
|
Outcome Measures
Primary Outcome Measures
- Optimal natural killer cell dose based on incidence of dose-limiting toxicity [Up to 42 days]
The Bayesian model averaging (BMA)-continual reassessment method (CRM) will be applied. The data will be analyzed by fitting the CRM model to the final data and summarizing the posterior distributions of the probability of overall toxicity and of each adverse event in the definition of toxicity at the maximum tolerated dose and at the other doses, by tabulating the counts and rates of all secondary events both overall and cross-tabulated with dose, and fitting appropriate logistic or ordinal outcome regression models to assess possible patterns of change with dose.
Secondary Outcome Measures
- Overall survival time [Up to 5 years]
Will assess overall survival time.
- Disease-free survival time [Up to 5 years]
Will assess disease-free survival time.
- Incidence of graft versus host disease [Up to 5 years]
Will assess incidence of graft versus host disease.
- Incidence of grade 3 toxicities [Up to 5 years]
It will be determined if any grade 3 toxicities occur in increased frequency compared to historical experience with this regime without natural killer cells.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Acute myeloid leukemia who fail to achieve complete remission with one course of induction chemotherapy or after relapse; patients must have less than 20% bone marrow or peripheral blood blasts
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Acute myeloid leukemia in first remission with any of the following high risk features defined as:
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Adverse cytogenetics: -5, deletion (del) 5q, -7, del7q, abnormalities involving 3q, 9q, 11q, 20q, 21q, 17, +8 or complex karyotype (> 3 abnormalities)
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Preceding myelodysplastic or myeloproliferative syndrome
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Presence of high risk molecular abnormalities including FLT3 mutations, DNMT3A, TET2; ras; kit
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French-American-British (FAB) monosomy (M)6 or M7 classification
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Treatment related acute myeloid leukemia (AML)
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Residual cytogenetic or molecular abnormalities
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Myelodysplastic syndromes with intermediate, high or very high risk Revised International Prognostic Scoring System (R-IPSS) score, chronic myelomonocytic leukemia (CMML) or therapy related myelodysplastic syndromes (MDS)
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Chronic myeloid leukemia (CML) which:
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Failed to achieve a cytogenetic remission to tyrosine kinase inhibitor treatment or has a cytogenetic relapse
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Has ever been in accelerated phase or blast crisis
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Patient must have an identified HLA (A,B,C,DR) compatible related or unrelated donor who is age 16 years of age or older and weighs at least 110 pounds for the stem cell donation
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Zubrod performance status 0 to 2 or Karnofsky of at least 60
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Left ventricular ejection fraction >= 45%; no uncontrolled arrhythmias or uncontrolled symptomatic cardiac disease
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Forced expiratory volume in one second (FEV1) >= 50% of expected, corrected for hemoglobin
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Forced vital capacity (FVC) >= 50% of expected, corrected for hemoglobin
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Diffusing capacity of the lung for carbon monoxide (DLCO) >= 50% of expected, corrected for hemoglobin
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Bilirubin =< 1.5 mg/dl (unless Gilbert's syndrome)
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Serum glutamate pyruvate transaminase (SGPT) =< 200 IU/ml unless related to patient malignancy
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Hepatitis B surface antigen negative and hepatitis C antibody negative
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No evidence of chronic active hepatitis or cirrhosis
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Patients with a history of hepatitis C, but have a negative viral load, are eligible
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The protocol chairman will determine the eligibility of patients related to hepatic abnormalities
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Serum creatinine < 1.5 mg%
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Patient or patient's legal representative, parent(s) or guardian able to sign informed consent; patients aged 7 to < 18 to provide assent
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Pediatric patients (age 7-18 years) will be entered only after 3 adult patients have been entered without dose limiting toxicity
Exclusion Criteria:
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Uncontrolled infection, not responding to appropriate antimicrobial agents after seven days of therapy; the protocol principal investigator (PI) is the final arbiter of eligibility
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Pleural/pericardial effusion or ascites > 1 L
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Patients who are known to be human immunodeficiency virus (HIV)-seropositive
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Pregnancy: positive pregnancy test in a woman with child bearing potential defined as not post-menopausal for 12 months or no previous surgical sterilization
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Women of child bearing potential not willing to use an effective contraceptive measure while on study
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Patients who are known to have allergy to mouse proteins
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | M D Anderson Cancer Center | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- M.D. Anderson Cancer Center
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Richard E Champlin, M.D. Anderson Cancer Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 2012-0819
- NCI-2013-00993
- RP110553-P3
- 2012-0819