Administration of TAA-Specific CTLs; Hodgkin or Non-Hodgkin Lymphoma; TACTAL
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Purpose
Patients have a type of lymph gland disease called Hodgkin or non-Hodgkin Lymphoma which has come back or may come back or has not gone away after treatment, including the standard treatment known for these diseases. This a research study using special immune system cells called tumor associated antigen (TAA)-specific cytotoxic T lymphocytes, a new experimental therapy.
This sort of therapy has been used previously to treat Hodgkin or non-Hodgkin Lymphoma that show proof of infection with the virus that causes infectious mononucleosis ("mono" or the "kissing disease") Epstein Barr virus (EBV). EBV is found in cancer cells of up to half the patients with Hodgkin's and non-Hodgkin Lymphoma. This suggests that it may play a role in causing Lymphoma. The cancer cells infected by EBV are able to hide from the body's immune system and escape being killed. Investigators tested whether special white blood cells, called T cells, that were trained to kill EBV infected cells could affect the tumor and in many patients it was found that giving these trained T cells caused a complete or partial response.
However, many patients do not have EBV in their lymphoma cells; therefore investigators now want to test if it is possible to direct these special T-lymphocytes against other types of proteins that show on the tumor cell surface can result in similar promising results. The proteins that will be targeted in this study are called tumor associated antigens (TAAs) - these are cell proteins that are specific to the cancer cell, so they either do not show or show up in low quantities by normal human cells.
In this study we will target five TAAs which commonly show on lymphoma, called: NY-ESO-1, MAGEA4, PRAME, Survivin and SSX. This will be done by using special types of T cells called cytotoxic T-lymphocytes (CTLs) generated in the lab.
| Condition | Intervention | Phase |
|---|---|---|
|
Hodgkin Lymphoma Non-Hodgkin Lymphoma Hodgkin Disease |
Biological: Antigen Escalation Stage Biological: Dose escalation study of T cells |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Endpoint Classification: Safety Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Administration of Tumor-Associated Antigen (TAA)-Specific Cytotoxic T-Lymphocytes to Patients With Active or Relapsed Hodgkin or Non-Hodgkin Lymphoma |
- Assessment of patients with adverse events [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]To determine the safety of 2 intravenous injections of autologous TAA-specific cytotoxic T-lymphocytes (CTL) in patients with Hodgkin's or non-Hodgkin's lymphoma.
- Obtain information on the expansion, persistence and anti-tumor effects of the adoptively-transferred TAA-specific CTL's [ Time Frame: 1 year ] [ Designated as safety issue: No ]Information on the expansion, persistence and anti-tumor effects of the adoptively transferred tumor-specific CTL will be analyzed for the immunological parameters based on multimer analysis, intracellular cytokine staining and ELIspot assays to assess the frequency of cells secreting γ-IFN using the descriptive statistics such as mean, median, standard deviation at each time point.
- Assessment of increasing the spectrum of epitopes/antigens [ Time Frame: 1 year ] [ Designated as safety issue: No ]To determine whether CTL infusions increase the spectrum of epitopes/antigens targeted by endogenous T cells (epitope spreading).
| Estimated Enrollment: | 60 |
| Study Start Date: | January 2012 |
| Estimated Study Completion Date: | January 2019 |
| Estimated Primary Completion Date: | January 2018 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Antigen Escalation Stage
The first stage will be an "antigen escalation" stage using a fixed total dose of cells (5x10^6 cells/m^2 x 2) to evaluate the safety of the T-cells primed against PRAME pepmix, and then SSX pepmix, and then MAGE A4 pepmix and then NY-ESO pepmix and then SURVIVIN pepmix.
|
Biological: Antigen Escalation Stage
Antigen Escalation Stage Each patient will receive 2 injections at the same dose (5x10^6 cells/m2), 28 days apart, according to the following schedules: Schedule One: Day 0: PRAME-specific T cells Day 28: PRAME and SSX specific T cells Schedule Two: Day 0: PRAME and SSX specific T cells Day 28: PRAME/SSX/MAGE/ specific T cells Schedule Three: Day 0: PRAME/ SSX/MAGE/- specific T cells Day 28: PRAME/ SSX/MAGE/NY-ESO specific T cells Schedule Four: Day 0: PRAME/ SSX/MAGE/NY-ESO- specific T cells Day 28: PRAME/ SSX/MAGE/NY-ESO/Survivin-specific T cells Other Names:
|
|
Experimental: Dose escalation study of T cells
The second stage will be a dose escalation study, beginning with the same total dose of cells used in the antigen escalation phase (5x106 cells/m2 x 2). This second stage will evaluate the safety of T cells specific for all 5 tumor associated antigens.
|
Biological: Dose escalation study of T cells
Dose Escalation Stage Four different dosing schedules will be evaluated. Each patient will receive 2 injections at the same dose, 14 days apart, according to the following dosing schedules: DL1: Day 0 and Day 14: 5 x 10^6 cells/m^2 DL2: Day 0 and Day 14: 1 x 10^7 cells/m^2 DL3: Day 0 and Day 14: 2 x 10^7 cells/m^2 DL4: Day 0 and Day 14: 4 x 10^7 cells/m^2 Other Name: TAA-CTL infusion
|
Detailed Description:
The patient will give blood to make TAA specific cytotoxic T cells in the lab. These cells will be grown and frozen. The time from the collection of the blood to make the T cells to when the cells are given back to the patient is about 1 to 2 months.
The cells will then be injected by IV into the patient over 10 minutes. Initially, two doses of T cells will be given two weeks apart. The patient may be eligible to receive up to six additional doses of the T cells at 6-8 week intervals. All of the treatments will be given by the Center for Cell and Gene Therapy at the Methodist Hospital or Texas Children's Hospital.
There are 2 stages of this study: an antigen-escalation phase and a dose-escalation stage.
The antigen-Escalation phase will be first. Patients will receive TAA-specific T cells targeting first 1 and then 2 TAAs. Once this schedule proves safe, the next group of patients will receive TAA-specific T cells targeting first 2 and then 3 TAAs. This process will continue until all 4 levels are studied. This means that the final cohort of patients will receive TAA-specific T cells targeting first 4 and then 5 TAAs. If the side effects are too severe, the number of TAAs being targeted will be lowered or the T cell injections will be stopped.
After the antigen escalation phase the dose escalation phase will begin. Patients will be started on the lowest dose (1 of 4 different levels) of T cells. Once that dose schedule proves safe, the next group of patients will be started at a higher dose. This process will continue until all 4 dose levels are studies. If the side effects are too severe, the dose will be lowered or the T cell injections will be stopped.
For both stages, patients will be followed after the injections up to one year from the last infusion.
Study Duration: Patients will be on study for approximately one year. If patients receive additional doses of the T cells as described above, the patient will be followed until 1 year after the last dose of T-cells.
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
PROCUREMENT:
Any patient, at least 18 years old regardless of sex with a diagnosis of Hodgkin's or non-Hodgkin's Lymphoma:
- Group A:
with active disease.
- in second or subsequent relapse
- in first relapse for indolent lymphoma after first line therapy for relapse
- or first relapse if immunosuppressive chemotherapy contraindicated.
- primary refractory disease or if persistent disease after first line therapy of relapse.
- or multiply relapsed patients in remission who are at a high risk of relapse
- or the Lymphoma is a second malignancy e.g. a Richters transformation of CLL after failing frontline therapy
OR
- Group B: After autologous or syngeneic SCT (as adjuvant therapy)
- Life expectancy of 6 weeks or greater.
- Hgb greater than 8.0
- Patient, parent/guardian able to give informed consent.
Inclusion Criteria:
TREATMENT:
Any patient, at least 18 yrs old regardless of sex, with a diagnosis of Hodgkin's or non-Hodgkin's Lymphoma:
Group A:
with active disease
- in second or subsequent relapse
- in first relapse for indolent lymphoma after first line therapy for relapse
- or first relapse if immunosuppressive chemotherapy contraindicated
- primary refractory disease or if persistent disease after first line therapy of relapse
- or multiply relapsed patients in remission who are at a high risk of relapse)
- or the Lymphoma is a second malignancy e.g. a Richters transformation of CLL.
OR
- Group B: After autologous or syngeneic SCT (as adjuvant therapy)
- Life expectancy of 6 weeks or greater.
- Karnofsky/Lansky score of 50 or greater.
- Bilirubin 2x or less of upper limit of normal, AST 3x or less than the upper limit of normal, and Hgb >8.0
- Creatinine 2x or less of upper limit of normal for age.
- Patients should have been off other investigational therapy for one month prior to entry in this study.
- Patients should have been off conventional therapy for at least 1 week prior to entry in this study
- Patient able to give informed consent.
- Due to unknown effects of this therapy on a fetus, pregnant women are excluded from this research. The male partner should use a condom Females of child-bearing potential should use of at least two forms of contraception unless female has had a hysterectomy or tubal ligation.
Exclusion Criteria:
PROCUREMENT:
- Patients with severe intercurrent infection.
- Donors who are HIV positive at time of procurement.
TREATMENT:
- Patients with severe intercurrent infection.
- Patients receiving systemic corticosteroids.
- Pregnant.
Contacts and Locations| Contact: Catherine M Bollard, MD | 832-824-4781 | cbollard@bcm.edu |
| Contact: Ann Leen, PhD | 832-824-4690 | amleen@txch.org |
| United States, Texas | |
| Texas Children's Hospital | Recruiting |
| Houston, Texas, United States, 77030 | |
| Contact: Catherine M Bollard, MD 832-824-4781 cbollard@bcm.edu | |
| Contact: Ann Leen, PhD 832-824-4690 amleen@txch.org | |
| The Methodist Hospital | Recruiting |
| Houston, Texas, United States, 77030 | |
| Contact: Catherine M Bollard, MD 832-824-4781 cbollard@bcm.edu | |
| Contact: Ann Leen, PhD 832-824-4690 amleen@txch.org | |
| Principal Investigator: | Catherine M Bollard, MD | Baylor College of Medicine |
More Information
No publications provided
| Responsible Party: | catherine bollard, Professor, Baylor College of Medicine |
| ClinicalTrials.gov Identifier: | NCT01333046 History of Changes |
| Obsolete Identifiers: | NCT01556269 |
| Other Study ID Numbers: | H-27471-TACTAL, TACTAL |
| Study First Received: | April 7, 2011 |
| Last Updated: | February 12, 2013 |
| Health Authority: | United States: Food and Drug Administration United States: Institutional Review Board |
Keywords provided by Baylor College of Medicine:
|
Hodgkin Lymphoma Non-Hodgkin Lymphoma CTL |
Additional relevant MeSH terms:
|
Hodgkin Disease Lymphoma Lymphoma, Non-Hodgkin Neoplasms by Histologic Type Neoplasms |
Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases |
ClinicalTrials.gov processed this record on May 19, 2013