Efficacy Study on the Strategy of HSV-Tk Engineering Donor Lymphocytes to Treat Patients With High Risk Acute Leukemia

Overview

The main objective of this randomized trial is to compare disease-free survival (DFS) in high risk leukemia patients who underwent haploidentical HCT followed by an add back strategy of HSV-Tk donor lymphocytes or standard haploidentical HCT

Full Title of Study: “TK008: Randomized Phase III Trial of Haploidentical HCT With or Without an Add Back Strategy of HSV-Tk Donor Lymphocytes in Patients With High Risk Acute Leukemia”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: November 30, 2019

Detailed Description

Delayed immune-reconstitution remains one of the main limitation of haploidentical stem cell transplantation. The risk of severe infections remains high for several months and CD3+ reconstitution could take more than 10 months. The low number of lymphocytes infused with the graft, the degree of HLA (Human Leukocyte Antigen) disparity, and a reduced thymic function in adults and differences in host/donor antigen presenting cells are contributing causes. The infusions of HSV-TK engineered lymphocytes may represent a significant therapeutic improvement in haploidentical HCT (hematopoietic cell transplantation), because it remarkably may enhance both GvL (Graft versus Leukemia) activity, thus reducing the occurrence of disease relapse, and post-transplant immune reconstitution in the absence of chronic immune suppression, thus decreasing the rate of both post-transplant opportunistic infections and transplant-related mortality. Furthermore, the efficient control of GvHD achieved via the suicide mechanism allows also the multiple infusion of HSV-TK-treated donor lymphocytes, when needed, that might further improve post-transplant host immune reconstitution, and survival in patients receiving haplo-HCT. Finally, this therapeutic approach can become a valuable option for all candidates, including patients with advanced disease and older age. The proposed clinical trial represents an innovative therapeutic treatment for patients affected by high risk acute leukemia, who have undergone haploidentical stem cell transplantation.

Interventions

  • Genetic: HSV-Tk
    • Infusion of approximately 1±0.2 x 10^7 HSV-Tk genetically modified CD3+ cells/Kg between day +21 and day +49 after haploidentical HCT; in absence of immune reconstitution and GvHD further infusions up to 4 will be administered on monthly basis.
  • Other: T-cell depleted or T-cell replete strategies
    • Haploidentical HCT with the infusion of CD34+ cells plus a fixed dose of T cells (1 x 10^4/Kg) or unmanipulated haploidentical stem cell transplantation followed by high-dose cyclophosphamide as part of GvHD prophylaxis

Arms, Groups and Cohorts

  • Experimental: A
    • HSV-TK engineering donor Lymphocytes
  • Active Comparator: B
    • T-cell depleted or T-cell replete strategies

Clinical Trial Outcome Measures

Primary Measures

  • Disease-free Survival (DFS)
    • Time Frame: From the date of randomization, assessed up to 12 months
    • Defined as the measure from the date of randomization until the date of relapse (or progression), or death from any cause, whichever occurs first. Disease relapse or progression was determined by the Investigator based on the following disease examination: Morphology (bone marrow or peripheral blood) Confirmation of mixed or full chimerism (evaluation of the degree of chimerism between donor/host, according to institutional clinical practice, on bone marrow or peripheral blood) Cytogenetic and/or molecular and/or other tests, according to institutional clinical practice (bone marrow or peripheral blood).

Secondary Measures

  • Overall Survival (OS)
    • Time Frame: From the date of randomization to the date of death, assessed up to 12 months
    • any death without previous occurrence of a documented relapse (or progression).Patients alive or without any follow up will be censored.
  • Immune Reconstitution (IR)
    • Time Frame: Weekly up to IR after engraftment of HCT, monthly for 6 months from date of IR and then at month 9 and 12
    • Assess how many patients experience IR. For the assessment, competing risk analysis was performed considering death, relapse, and disease progression as competing events. Patients who were still alive and had no recovery (IR) nor relapse (or progression) were censored.IR is defined as achieving a level of circulating CD3+ ≥ 100/μL for two consecutive observations. The following laboratory examinations are performed: Hematology: WBC (full and differential), RBC, platelets, Hb, Htc, MCV, MPV, serology CMV (PCR and antigenemia). Blood chemistry: AST, ALT, γGT, total bilirubin, LDH.
  • Engraftment Rate
    • Time Frame: At day 15 after HCT, monthly for 6 months after HCT and then at month 9 and 12
    • Defined as the persistent blood cells count above predefined level.
  • Cumulative Incidence of Grade 2, 3, or 4 Acute GvHD (aGvHD)
    • Time Frame: from the date of HCT until the date of the first occurrence of aGvHD, assessed up to 6 months
    • Diagnosed and graded according to standard criteria. Grade 1: Skin: Stage 1-2: Rash on < 25% of skin or Rash on 25-50% of skin Liver: Stage 1-2: Bilirubin 2-3 mg/dl or Bilirubin 3-6 mg/dl Gastrointestinal: Stage 1-2: Diarrhoea > 500 ml/day or persistent nausea or Diarrhoea > 1000ml/day
  • Cumulative Incidence of Chronic GvHD (cGvHD)
    • Time Frame: From the date of HCT until the date of the first occurrence of cGvHD, assessed up to 12 months
    • Diagnosed and graded according to standard NIH consensus criteria
  • Duration of GvHD Episodes
    • Time Frame: From the date of start until the date of resolution and duration of immunosuppressive treatments administered for controlling GvHD assessed up to 12 months
    • Diagnosed and graded according to standard NIH consensus criteria
  • Cumulative Incidence of Relapse (CIR)
    • Time Frame: from the date of randomization to the date of the first occurrence of relapse, assessed up to 12 months
    • Defined on the basis of morphologic evidence of leukaemia in bone marrow or other sites. Gray’s test was used to compare the sub-distribution functions of relapse (or progression) events in the two treatment groups. Patients alive without relapse (or regression) will be censored
  • Incidence and Duration of Infectious Episodes and Infectious Disease Mortality
    • Time Frame: From randomization to the date of resolution, assessed up to 12 months
    • Diagnosis, monitoring and treatment of infectious relevant events
  • Evaluate the Acute and Long-term Toxicity Related to the HSV-Tk Infusions
    • Time Frame: From HSV-Tk infusions to the date of resolution, assessed up to 12 months
    • Toxicity profile of HSV-Tk infusions
  • Quality of Life (QoL) and Medical Care Utilization (MCU) in Both Arms
    • Time Frame: from randomization up to 12 months
    • Medical resource use data collected will be used in health economic analyses where it may be combined with other data from other sources such as cost data or other clinical parameters.
  • Non-relapse Mortality (NRM)
    • Time Frame: From the date of randomization to the date of death, assessed up to 12 months.
    • Defined for all patients as any death without previous occurrence of a documented relapse (or progression). Absence of relapse was determined by the Investigator based on the following disease examination: Morphology (bone marrow or peripheral blood) Confirmation of mixed or full chimerism (evaluation of the degree of chimerism between donor/host, according to institutional clinical practice, on bone marrow or peripheral blood) Cytogenetic and/or molecular and/or other tests, according to institutional clinical practice (bone marrow or peripheral blood). Gray’s test was used to compare the sub-distribution functions of the death without previous relapse (or progression) and relapse (or progression) events in the two treatment groups.

Participating in This Clinical Trial

Inclusion Criteria

  • Age ≥ 18 years – Any of the following conditions: 1. AML and ALL in 1st complete remission (CR1) 2. AML and ALL in 2nd or subsequent CR 3. secondary AML in CR 4. AML and ALL in 1st or 2nd relapse or primary refractory – Family donor with patient-donor number of HLA mismatches ≥ 2 (full haploidentical), or family donors sharing one HLA-haplotype with the patient – Stable clinical conditions and life expectancy > 3 months – PS ECOG < 2 – Serum creatinine < 1.5 x ULN – Bilirubin < 1.5 x ULN; transaminases < 3 x ULN – Left ventricular ejection fraction > 45% – QTc interval < 450 ms – DLCO > 50% – Patients, or legal guardians, and donors must sign an informed consent indicating that they are aware this is a research study and have been told of its possible benefits and toxic side effects Exclusion Criteria:

  • Patients with life-threatening condition or complication other than their basic condition – Contraindication to haploidentical HCT as defined by the Investigator – Patients with active CNS disease – Pregnant or lactation. Exclusion criteria for HSV-Tk infusion: – Infections requiring administration of ganciclovir or valganciclovir at the time of infusion – GvHD requiring systemic immunosuppressive therapy – Ongoing systemic immunosuppressive therapy after haploidentical HCT – Administration of G-CSF after haploidentical HCT HSV-Tk cells can be administered after an adequate patient wash-out period (24 hours)

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • AGC Biologics S.p.A.
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Antonio Lambiase, MD, Study Director, AGC Biologics S.p.A.

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.