Full Text View  
  Tabular View  
  Contacts and Locations  
  No Study Results Posted  
  Related Studies  
Natural Killer Cells and Donor Bone Marrow Transplant in Treating Patients With Hematologic Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
Sponsors and Collaborators: Fred Hutchinson Cancer Research Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00789776
  Purpose

RATIONALE: Giving chemotherapy, such as fludarabine and cyclophosphamide, and total-body irradiation before a donor bone marrow transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Giving an infusion of the donor's natural killer cells (donor lymphocyte infusion) after the transplant may help increase this effect. Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclophosphamide, mycophenolate mofetil, and tacrolimus after transplant may stop this from happening.

PURPOSE: This phase I/II trial is studying the best dose of natural killer cells given after donor bone marrow transplant in treating patients with hematologic cancer.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Drug: cyclophosphamide
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Drug: tacrolimus
Procedure: allogeneic bone marrow transplantation
Procedure: natural killer cell therapy
Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation
Procedure: total-body irradiation
Phase I
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Bone Marrow Transplantation Cancer Hodgkin's Disease Leukemia, Adult Acute Leukemia, Adult Chronic Leukemia, Childhood Lymphoma Multiple Myeloma
Drug Information available for: Cyclophosphamide Fludarabine Fludarabine monophosphate Tacrolimus Mycophenolate Mofetil Mycophenolate mofetil hydrochloride Tacrolimus anhydrous
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: A Phase I/II Study Evaluating the Safety and Efficacy of Adding a Single Prophylactic Donor Lymphocyte Infusion (DLI) of Natural Killer Cells Early After Nonmyeloablative, HLA-Haploidentical Hematopoietic Cell Transplantation

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Non-relapse mortality [ Designated as safety issue: No ]
  • Relapse as assessed by marrow and peripheral blood morphology, immunophenotyping, cytogenetics, molecular assays, peripheral blood counts, tumor markers, radiological evaluation (i.e., CT, MRI, PET scans), and biopsy-proven disease [ Designated as safety issue: No ]
  • Disease progression [ Designated as safety issue: No ]
  • Acute graft-versus-host-disease (GVHD) [ Designated as safety issue: No ]
  • Chronic GVHD as assessed by extent (limited or clinical extensive), duration of immune suppression in months after diagnosis, number of cycles of immune suppressant therapy, and need for immune suppressive agents other than first line therapy [ Designated as safety issue: No ]
  • Engraftment (chimerism) [ Designated as safety issue: No ]

Estimated Enrollment: 35
Study Start Date: October 2008
Estimated Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • Identification of the maximal feasible dose (MFD) of NK cells that can be infused one week after nonmyeloablative, related allogeneic HLA-haploidentical bone marrow transplantation in patients with hematological malignancies. (Phase I)
  • To determine incidence of relapse, incidence of grades III-IV acute graft-versus-host disease, and incidence of non-relapse mortality in patients receiving the MFD of NK cells, once the MFD has been identified. (Phase II)

OUTLINE: This is a phase I dose escalation study of NK cells followed by a phase II study.

  • Conditioning regimen: Patients receive fludarabine phosphate IV over 30 minutes on days -6 to -2, cyclophosphamide IV over 1 hour on days -6 and -5, and total-body irradiation on day -1.
  • Related allogeneic HLA-haploidentical bone marrow transplantation (BMT): Patients receive allogeneic BMT on day 0.
  • Graft-versus-host-disease (GVHD) prophylaxis: Patients receive cyclophosphamide IV over 1 hour on day 3. They also receive oral mycophenolate mofetil on days 4-84 and tacrolimus* as a continuous infusion over 22-24 hours or IV over 1-2 hours on days 4-180 in the absence of GVHD.

NOTE: *Tacrolimus can be given orally twice daily once oral medication can be tolerated.

  • Post-transplant donor NK cell infusion: Patients receive a single prophylactic donor lymphocyte infusion of NK cells on day 7.

After completion of study therapy, patients are followed at 6 months and at every year thereafter.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosed with any of the following hematologic malignancies:

    • Non-Hodgkin lymphomas (NHL), meeting any of the following criteria:

      • Aggressive NHL and other histologies such as diffuse large B-cell NHL

        • Not eligible for autologous hematopoietic cell transplantation (HCT), high-dose HCT, or after failed autologous HCT
        • Patients with aggressive lymphomas (such as diffuse large B-cell NHL) must not have bulky, rapidly progressive disease immediately prior to HCT
      • Mantle cell NHL beyond first complete response (CR)
      • Low-grade* NHL with < 6 month duration of CR between courses of conventional therapy
      • Waldenstrom's macroglobulinemia that failed 2 courses of therapy NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses both terminology.
    • Hodgkin lymphoma

      • Must have received and failed frontline therapy and either failed or not eligible for autologous HCT
    • Leukemia

      • Chronic lymphocytic leukemia (CLL), meeting 1 of the following criteria:

        • Failed to meet NCI Working Group criteria for complete or partial response after therapy with a regimen containing fludarabine (or another nucleoside analog [e.g., 2-CDA, pentostatin])
        • Experienced disease relapse within 12 months after completing therapy with a regimen containing fludarabine (or another nucleoside analog)
        • Failed fludarabine, cyclophosphamide, and rituximab (FCR) combination chemotherapy at any time point
        • Have "17p deletion" cytogenetic abnormality and relapsed at any time point after any initial chemotherapy
      • Chronic myelogenous leukemia (CML), meeting all of the following criteria:

        • Beyond chronic phase 1
        • Received previous myelosuppressive chemotherapy or HCT and have < 5% marrow blasts at time of transplant
        • Must not have presence of circulating leukemic blasts detected by standard pathology
      • Acute myeloid leukemia (AML), meeting all of the following criteria:

        • Must have < 5% marrow blasts at the time of HCT
        • Must not have presence of circulating leukemic blasts detected by standard pathology
      • Acute lymphocytic leukemia (ALL)

        • Must have < 5% marrow blasts at the time of HCT
        • Must not have presence of circulating leukemic blasts detected by standard pathology
    • Multiple myeloma

      • Must have received more than one line of prior chemotherapy

        • Consolidation of chemotherapy by autografting prior to nonmyeloablative HCT is permitted
    • Myelodysplasia (MDS)/myeloproliferative syndrome (MPS)

      • IPSS score > intermediate 1 after ≥ 1 prior cycle of induction chemotherapy
      • Must have < 5% marrow blasts at time of transplant
      • Must not have presence of circulating leukemic blasts detected by standard pathology
  • Not eligible for a curative autologous hematopoietic cell transplantation (HCT)
  • Must be expected to have disease controlled for ≥ 60 days after HCT
  • No HLA-matched related or unrelated marrow donors available
  • No CNS involvement with disease refractory to intrathecal chemotherapy
  • Has a related donor that meets the following criteria:

    • At least 12 years old
    • Must be HLA-haploidentical donors who are identical for one HLA haplotype and mismatched for any number of HLA-A, -B, -C, DRB1 or DQB1 loci of the unshared haplotype
    • Marrow is the only allowed hematopoietic stem cell source

PATIENT CHARACTERISTICS:

  • Karnofsky performance status (PS) 60-100% or Lansky PS 60-100%
  • No life expectancy severely limited by diseases other than malignancy
  • Not pregnant or nursing
  • Fertile patients must use 2 effective forms of contraception during and for 12 months following treatment
  • No significant organ dysfunction that would prevent compliance with conditioning, graft-versus-host disease (GVHD) prophylaxis, or would severely limit the probability of survival, including any of the following:

    • Symptomatic coronary artery disease or ejection fraction < 35% or other cardiac failure requiring therapy
    • DLCO < 40%, total lung capacity < 40%, FEV1 < 40%
  • No liver function abnormalities including any of the following:

    • Fulminant liver failure
    • Cirrhosis of the liver with evidence of portal hypertension
    • Alcoholic hepatitis
    • Esophageal varices
    • History of bleeding esophageal varices
    • Hepatic encephalopathy
    • Uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time
    • Ascites related to portal hypertension
    • Bacterial or fungal liver abscess
    • Biliary obstruction
    • Chronic viral hepatitis with total serum bilirubin > 3mg/dL
    • Symptomatic biliary disease
  • No HIV seropositivity
  • No poorly controlled hypertension despite multiple antihypertensive medications
  • No active infectious disease concerns

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No concurrent aspirin or nonsteroid anti-inflammatory medications (e.g., Ibuprofen, Motrin, Advil)
  • No concurrent continuous supplementary oxygen
  • At least 21 days since immunosuppressive therapy for active graft-versus-host disease (GVHD) for patients who have received prior allogeneic hematopoietic cell transplantation
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00789776

Locations
United States, Washington
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98109-1024
Contact: Monica S. Thakar, MD     206-667-5946     msthakar@fhcrc.org    
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: Monica S. Thakar, MD Fred Hutchinson Cancer Research Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: Fred Hutchinson Cancer Research Center ( Monica S. Thakar )
Study ID Numbers: CDR0000618531, FHCRC-2230.00, IR-6771
Study First Received: November 12, 2008
Last Updated: December 9, 2008
ClinicalTrials.gov Identifier: NCT00789776  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage III adult Burkitt lymphoma
stage III adult diffuse large cell lymphoma
stage III adult diffuse mixed cell lymphoma
stage III adult Hodgkin lymphoma
stage III adult immunoblastic large cell lymphoma
stage III adult lymphoblastic lymphoma
stage III grade 1 follicular lymphoma
stage III grade 2 follicular lymphoma
stage III grade 3 follicular lymphoma
stage III mantle cell lymphoma
stage III small lymphocytic lymphoma
stage IV adult Burkitt lymphoma
stage IV adult diffuse large cell lymphoma
stage IV adult diffuse mixed cell lymphoma
stage IV adult Hodgkin lymphoma
stage IV adult immunoblastic large cell lymphoma
stage IV adult lymphoblastic lymphoma
stage IV grade 1 follicular lymphoma
stage IV grade 2 follicular lymphoma
stage IV grade 3 follicular lymphoma
stage IV mantle cell lymphoma
stage IV small lymphocytic lymphoma
recurrent adult Burkitt lymphoma
recurrent adult diffuse large cell lymphoma
recurrent adult diffuse mixed cell lymphoma
recurrent adult Hodgkin lymphoma
recurrent adult immunoblastic large cell lymphoma
recurrent adult lymphoblastic lymphoma
recurrent childhood large cell lymphoma
recurrent childhood lymphoblastic lymphoma

Study placed in the following topic categories:
Chronic myelogenous leukemia
Hodgkin lymphoma, adult
Lymphoma, Mantle-Cell
Lymphoma, small cleaved-cell, diffuse
Tacrolimus
Small non-cleaved cell lymphoma
Lymphoma, large-cell, immunoblastic
Preleukemia
Hemorrhagic Disorders
Multiple myeloma
Leukemia, Lymphocytic, Chronic, B-Cell
Mycophenolate mofetil
Neoplasm Metastasis
Acute myeloid leukemia, adult
Hodgkin Disease
Chronic lymphocytic leukemia
Myelodysplastic syndromes
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Leukemia, B-cell, chronic
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative
Blood Coagulation Disorders
Acute myelogenous leukemia
Myeloproliferative Disorders
Leukemia, Myeloid
Multiple Myeloma
Myelodysplastic myeloproliferative disease
Waldenstrom Macroglobulinemia

Additional relevant MeSH terms:
Antimetabolites
Antimetabolites, Antineoplastic
Neoplasms by Histologic Type
Disease
Molecular Mechanisms of Pharmacological Action
Immune System Diseases
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Pathologic Processes
Syndrome
Therapeutic Uses
Myeloablative Agonists
Cardiovascular Diseases
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Alkylating Agents

ClinicalTrials.gov processed this record on January 16, 2009