Accelerated Immunization to Induce Cytomegalovirus Immunity in Stem Cell Donors

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Minoo Battiwalla, M.D., National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier:
NCT00353977
First received: July 18, 2006
Last updated: June 5, 2014
Last verified: June 2014
  Purpose

This study will evaluate the safety and effectiveness of a new vaccine, ALVAC-pp65, in boosting immunity to cytomegalovirus (CMV) infection in stem cell transplant donors. CMV is a member of the herpesvirus group, which includes herpes simplex virus types 1 and 2, varicella-zoster virus (which causes chickenpox), and Epstein-Barr virus (which causes infectious mononucleosis). Most adults are infected with CMV, but a healthy immune system keeps the virus in check, so that it does not cause harm. In people with a weakened immune system, such as transplant recipients, the virus can become reactivated. Medications for treating the infection may cause low blood counts and kidney damage, and, in some cases, the virus may cause death. The ALVAC-pp65 vaccine is intended to improve immunity against CMV in stem cell donors and thereby prevent its reactivation in recipients. It is made from a virus that ordinarily infects canaries. The virus is weakened so that it cannot infect the person who receives it, and it is modified to carry a copy of a CMV gene called pp65. This gene instructs cells to make CMV proteins that the vaccine recipient's immune system can produce antibodies to, thus conferring immunity to the disease.

Persons 18 years of age or older who are scheduled to donate stem cells for a patient in an NIH protocol and who are not allergic to eggs, egg products, or other vaccines, may be eligible for this study. Candidates are screened with a medical history, physical examination, and blood tests.

Participants receive three vaccinations one week apart beginning at least 3 weeks before the scheduled stem cell donation. They are observed for 30 minutes after each vaccination to look for any immediate side effects of the vaccine. Approximately 3 tablespoons of blood are drawn before each vaccination and 1 week after the last vaccination to evaluate vaccine safety. Blood samples are also collected at the screening evaluation, 3 weeks after the start of vaccination, and 3 months after the last vaccination to check for CMV immunity.

Participants keep a diary, recording any reactions to the vaccine and any change in medications. They are contacted by telephone for follow-up 3 months after the last vaccination to report any additional symptoms.


Condition Intervention Phase
Cytomegalovirus Infections
Biological: ALVAC-CMV (vCP260)
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: A Pilot Trial of an Accelerated Immunization Schedule With ALVAC-pp65 (vCP260) for Inducing CMV-Specific Immunity in Stem Cell Allotransplant Donors and Healthy Volunteers

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Cellular Immune Response in Vaccine Recipients [ Time Frame: Day 45 ] [ Designated as safety issue: No ]
    Evaluate the efficacy of an accelerated ALVAC-pp65 immunization schedule in generating cytomegalovirus (CMV)-specific immunity in seronegative transplant donors and healthy volunteers (HV) and augmenting CMV-specific immunity in seropositive transplant donors.


Enrollment: 38
Study Start Date: May 2004
Study Completion Date: March 2008
Primary Completion Date: March 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: ALVAC-CMV (vCP260) Vaccinated group
Patients who were vaccinated with ALVAC-CMV (vCP260)
Biological: ALVAC-CMV (vCP260)

ALVAC-pp65 (vCP260), an attenuated canary pox-based vaccine (Aventis Sanofi Pasteur, Lyon, France), 3 doses (1.0 ml each) delivered intramuscularly in the deltoid muscle.

Sero-negative subjects will receive a total of 3 immunizations to be given day 0, 5 and 10.

Sero-positive subjects will receive a total of 2 immunizations to be given day 0 and 5. (Protocol amendment after findings from the 9/6/2006 interim analysis demonstrated that in the sero-positive group, only 2 vaccinations were required to generate maximum immune response.)

Other Name: Canary Pox CMV vaccine

Detailed Description:

Cytomegalovirus (CMV) infection is a major complication following allogeneic stem cell transplantation (SCT). The risk of CMV infection after SCT is inversely related to the number of CMV-specific cytotoxic T-lymphocytes (CTLs) present in the allograft. CMV-specific lymphocytes can be readily detected and quantified in the blood by sensitive in vitro techniques that measure T cell cytokine secretion following antigen stimulation. A previous phase I clinical trial has demonstrated that CMV-specific T cells can be safely generated in normal CMV-seronegative (naive) subjects after immunization with the CMV vaccine, ALVAC-pp65 (vCP260), an attenuated canary pox-based vaccine Sanofi Pasteur (formerly known as Aventis Pasteur, Lyon, France).

We propose a clinical trial to evaluate an accelerated immunization schedule with the same vaccine. Study participants will be 1) SCT donors and their matched recipients participating in intramural NIH allogeneic SCT protocols and 2) CMV sero-negative normal volunteers. Donors will receive two or three immunizations prior to allograft collection, and followed for 45 days for the development of CMV immunity. Normal volunteers will receive two or three immunizations and followed similarly to the donors. CMV sero-positive subjects will receive two immunizations; CMV sero-negative subjects will receive three. Transplant (SCT) recipients will be evaluated for incidence of CMV infection and disease.

The study is designed as a two-stage phase II trial with stopping rules at each stage. The primary outcome measures are the effectiveness of the vaccine in (a) generating cellular immunity in CMV-seronegative (naive) donors or CMV sero-negative normal volunteers and (b) boosting the cellular immune response in CMV-seropositive (sensitized) donors and healthy volunteers. Secondary outcomes include the clinical safety profile of the vaccine in vaccine recipients and the incidence of CMV infection/disease in transplant recipients. Since the cellular immune response to CMV is a standard model for immune reconstitution post transplant, our study may also provide important information on the feasibility of immunizing stem cell transplant donors with other microbial and tumor vaccines.

  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

- INCLUSION CRITERIA: VACCINE RECIPIENT

  • Under evaluation for enrollment as a donor on a stem cell transplant protocol at the NIH Clinical Center, Or
  • CMV sero-negative or sero-positive healthy volunteer
  • Age greater than or equal to 18 years, but less than or equal to 80 years
  • Ability to comprehend the investigational nature of the study and provide informed consent
  • All subjects (men and women) must agree to practice abstinence or effective contraception during the study period
  • Baseline laboratory evaluations are within normal limits
  • For woman, negative urinary pregnancy test
  • Informed consent from transplant recipients obtained
  • INCLUSION CRITERIA:

STEM CELL TRANSPLANT RECIPIENT

  • Under evaluation for enrollment as a recipient on a stem cell transplant protocol at the NIH
  • Age greater than or equal to 18 years, and less than or equal to 75 years
  • Ability to comprehend the investigational nature of the study and provide informed consent
  • EXCLUSION CRITERIA:

VACCINE RECIPIENT

  • History of severe adverse reaction or allergy to any vaccine
  • Known or suspected allergies to vaccine constituents - eggs, mono-sodium glutamate or neomycin
  • Acute febrile illness within the 72 hours preceding the vaccination
  • History of any immunosuppressive disease or major chronic disorder
  • History of treatment with immunosuppressive medications in the past 6 months
  • Pregnant or breast feeding
  • Enrolled or planning to enroll in another drug or vaccine clinical trial during the study period (other than the stem cell transplant when applicable)
  • EXCLUSION CRITERIA:

STEM CELL TRANSPLANT RECIPIENT

- There are no exclusion criteria for stem cell transplant recipients

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00353977

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
Investigators
Principal Investigator: Minocher Battiwalla, MD National Institutes of Health- NHLBI
  More Information

Additional Information:
Publications:
Responsible Party: Minoo Battiwalla, M.D., Principal Investigator, National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT00353977     History of Changes
Other Study ID Numbers: 040198, 04-H-0198
Study First Received: July 18, 2006
Results First Received: April 30, 2013
Last Updated: June 5, 2014
Health Authority: United States: Federal Government
United States: Food and Drug Administration

Keywords provided by National Institutes of Health Clinical Center (CC):
Cytomegalovirus
Vaccine
CMV
Immunization
Peripheral Blood Stem Cell Transplantation
Stem Cell Allotransplant

Additional relevant MeSH terms:
Cytomegalovirus Infections
Herpesviridae Infections
DNA Virus Infections
Virus Diseases

ClinicalTrials.gov processed this record on August 27, 2014