IFN-γ to Treat Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) That Has Relapsed After Allogeneic Hematopoietic Stem Cell Transplantation
Study Details
Study Description
Brief Summary
This study proposes a safe dosing regimen IFN-γ that is sufficient to stimulate IFN-γ receptors on malignant blasts in patients who developed relapsed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) after alloSCT with no active or history of III-IV acute graft-versus-host disease (GVHD). It is hypothesized that IFN-γ will promote graft-vs-leukemia (GVL) in patients with AML/MDS that has relapsed after alloSCT.
Condition or Disease | Intervention/Treatment | Phase |
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Early Phase 1 |
Detailed Description
Allogeneic hematopoietic stem cell transplantation (alloSCT) can cure patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). However, relapsed AML/MDS is the most significant single cause of treatment failure, and the majority of relapsed patients ultimately succumb. Alloreactive T cells in the donor graft can kill residual leukemia cells, mediating the graft-vs-leukemia (GVL) effect. Consistent with this, recipients of T cell-depleted grafts have higher rates of relapse. GVL is more potent against chronic leukemias than acute myeloblastic diseases, and the higher incidence of relapse in patients with AML/MDS reflects a failure in GVL.
The central goal of this pilot trial will be to explore whether IFN-γ in this setting is safe and whether it has the desired biological activities on malignant blasts in vivo. IFN-γ will be tested in relapsed patients as monotherapy and in conjunction with donor leukocyte infusions (DLI). The clinical and biological information from this study is essential to design a phase II trial with a therapeutic endpoint.
Treatment will be initiated at 100mcg (almost equal to the dose of 50 mcg/m2 for an adult) three times a week, with the potential to deescalate the frequency of injection for unacceptable toxicity. To explore whether this dosing regimen is sufficient to activate myeloblasts, pre- and post-treatment bone marrow specimens will be harvested to analyze for IFN-γ action (upregulation of HLA class I; HLA class II, ICAM-1 and phosphorylation of STAT1). The primary safety concern is the development of GVHD, which is routinely monitored for all alloSCT patients.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: IFN-γ 100mcg IFN-γ subcutaneously three times per week (Weeks 0-7), once per week (Weeks 8-12) (or per protocol guidance based on tolerability, response, or DLI infusions) |
Drug: IFN-γ (interferon gamma-1b) injection
Dosage form: 100 mcg (2 million International Units) per 0.5 mL solution, administered subcutaneously Dose regimen: three times weekly (Weeks 0-7), once weekly (Weeks 8-12)
Other Names:
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Outcome Measures
Primary Outcome Measures
- Upregulation HLA l (HLA-ABC) [Up to 6 months]
Upregulation of HLA l (HLA-ABC) in bone marrow malignant blasts post-IFN-γ treatment, measured by the change in mean florescent intensity by flow cytometry.
- Upregulation of HLA ll (HLA-DR/DQ) [Up to 6 months]
Upregulation of HLA ll (HLA-DR/DQ) in bone marrow malignant blasts post-IFN-γ treatment, measured by the change in mean florescent intensity by flow cytometry.
- Upregulation of ICAM-1 [Up to 6 months]
Upregulation of ICAM-1 in bone marrow malignant blasts post-IFN-γ treatment, measured by the change in mean florescent intensity by flow cytometry as a percentage of positive cells.
- Adverse events related to IFN-γ [Up to 6 months]
Adverse events of IFN-γ in relapsed patients after alloSCT per CTCAE v5.0.
- Generation of phosphorylated-STAT1 [Up to 6 months]
Generation of phosphorylated-STAT1 in bone marrow malignant blasts post-IFN-γ treatment, measured by the change in mean florescent intensity by flow cytometry as a percentage of positive cells.
Secondary Outcome Measures
- Malignant Blast Burden [Up to 6 months]
Change in malignant blasts number after IFN-γ therapy and subsequent donor lymphocyte infusion.
- Incidence of GVHD [Up to 6 months]
Incidence of Graft Versus Host Disease (GVHD) progression or de novo GVHD after INF-g therapy and subsequent donor lymphocyte infusion.
- Incidence of de novo GVHD [Up to 6 months]
Incidence of graft-versus-host disease (GVHD) progression after IFN-γ therapy and subsequent DLI.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Recipients of allogeneic stem cell transplantation for acute myeloid leukemia or myelodysplastic syndrome from a human leukocyte antigen (HLA) matched donor
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Relapsed of primary disease with 5% to 20% of blasts in the bone marrow by flow cytometry in the bone marrow with an clear leukemia-associated immunophenotype (If the patient received therapy to treat the relapse, he or she must have 5-20% residual blasts prior to enrollment on this study)
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Performance status KPS score >60% (ECOG 0-2)
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No increases in systemic immunosuppression in the prior four weeks other than to maintain therapeutic levels
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No systemic corticosteroid with a dose higher than 0.5mg/kg/day prednisone or equivalent
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No history of grade IV acute GVHD
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No new systemic immunosuppressive medications in the prior two weeks initiated due to GVHD
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Willingness to have bone marrow and peripheral blood collected as per the study protocol
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Must be able to give informed consent
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Age 18 or older
Exclusion Criteria:
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Contraindication to receive IFN-γ including known hypersensitivity to interferon-gamma, E. coli derived products or any component of the product
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Subjects with a positive pregnancy test or who are breastfeeding
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For men or women of childing bearing potential (age < 50 without hysterectomy or oophorectomy or documented menopause), unwilling to use effective contraception for the duration of the study.
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Primary engraftment failure
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Active cardiac arrhythmias not controlled by medical management or current NYHA class II or higher congestive heart failure
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Active ischemic heart disease not well controlled with medications
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A seizure disorder not well controlled by medications
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Estimated GFR <30 mL/min
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AST/SGOT or ALT/SPOT > 5 x ULN
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Total bilirubin > 3 x ULN
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Chemotherapy (other than hypomethylating and/or venetoclax therapy) within the prior 4 weeks
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Body surface area at or less than 1.5 m2, or greater than 2.5 m2 so as to minimize the variation in IFN-γ exposure based on differences in BSA.
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Patients less than 18 years old.
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Pregnant or breastfeeding patients.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | UPMC Hillman Cancer Center | Pittsburgh | Pennsylvania | United States | 15232 |
Sponsors and Collaborators
- Sawa Ito, MD
- Horizon Pharma USA, Inc.
Investigators
- Principal Investigator: Sawa Ito, MD; PhD, University of Pittsburgh
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HCC 20-092