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Adoptive Cellular Immunotherapy for Progressive Multifocal Leukoencephalopathy With Ex Vivo Generated Polyomavirus-Specific T-Cells

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ClinicalTrials.gov Identifier: NCT02694783
Recruitment Status : Completed
First Posted : March 1, 2016
Last Update Posted : November 13, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )

Brief Summary:

Background:

Progressive Multifocal Leukoencephalopathy (PML) is a brain infection in people with a weakened immune system. Researchers think polyoma virus specific T cells (PyVST) therapy can treat PML. The PyVST cells are made from blood cells of a healthy relative. They are grown in a lab to expand the virus-killing cells, then given to the person with PML.

Objective:

To test whether PyVST safely treats PML.

Eligibility:

  • Adults ages 18 and older with PML
  • Healthy adults ages 18 and older who have:

    • Been screened under protocol 97-H-0041
    • A sibling, parent, or child with PML and matching cells

Design:

  • Participants will be screened with:

    • Medical history
    • Physical exam
    • Blood and urine tests
  • PML participants will also be screened with:

    • Cerebrospinal fluid removed by needle in the back.
    • MRI: A dye is injected in a vein. They lie on a table that slides into a cylinder.
    • Questionnaires

Healthy participants will have apheresis: Blood flows through a needle in one arm into machine that separates blood cells needed for donation. The rest of the blood is returned by needle to the other arm. Some participants may have a central line placed in a vein instead. They can have apheresis up to 3 times, at least 28 days apart.

Participants with PML will receive the PyVST cells by needle in the arm. They will stay in the hospital 1 week. They can do this up to 3 times, at least 28 days apart. After each infusion, they will have weekly visits for 1 month. Then they will have 4 visits over 1 year. Visits include repeats of screening tests.


Condition or disease Intervention/treatment Phase
Progressive Multifocal Leukoencephalopathy Biological: PyVST Early Phase 1

Detailed Description:

Objective

This pilot clinical trial will aim to determine the feasibility and potential toxicities associated with treating patients with progressive multifocal leukoencephalopathy (PML) with polyomavirus (PyV)-specific partially matched polyclonal allogeneic T cells. It will further provide initial efficacy data for this indication.

Study Population

Up to 18 subjects with definite PML, defined as clinical signs and MRI compatible with active PML and the presence of JCV by PCR in CSF. Subjects must be 18 years of age or older and must have a first degree, partially HLA- matched relative able and willing to act as a donor of lymphocytes. Subjects with underlying reversible immunosuppression (i.e.- HIV or MS status post treatment with natalizumab), or subjects with uncontrolled malignancy will be excluded. Subjects with evidence of active CNS inflammation as determined by presence of significant contrast enhancement within the PML lesions by MRI will also be excluded because it is assumed such patients are already mounting an adequate immune response against the infection.

Design

This will be a first-in-human pilot study assessing the feasibility and toxicity profile of NIH PyVST cellular product in subjects with PML. Subjects will be screened under the existing NIH Natural History study of PML (13-N-0017). Sequential enrollment will be spaced at least 28 days apart. An initial fixed dose PyVST infusion (target dose of 1 x 10(6) PyVST/kg (+/- 10%)) will be administered by intravenous (IV) infusion, followed by 2x 10(6) PyVST/kg (+/-10%) up to 2 times to each subject if needed.

Outcome Measures

Safety will be monitored to 28 days continuously with stopping rules based on the treatment-related serious adverse event rate. Secondary outcomes include survival, assessed at day 28 and at 1 year following the last infusion. CSF viral titers, MR imaging, and clinical disability scales will also be collected.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot Study of Adoptive Cellular Immunotherapy for Progressive Multifocal Leukoencephalopathy With Ex Vivo Generated Polyomavirus-Specific T-cells
Actual Study Start Date : March 28, 2016
Actual Primary Completion Date : March 6, 2020
Actual Study Completion Date : March 11, 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment Arm
ex vivo generated polyomavirus-specific T cells from HLAmatched donor
Biological: PyVST
ex vivo generated polyomavirus-specific T cells from HLAmatched donor




Primary Outcome Measures :
  1. Characterization of the safety and feasibility of PyVST infusion for the treatment of PML based on development of Treatment Limiting Toxicity [ Time Frame: ongoing ]
    Characterization of the safety and feasibility of PyVST infusion for the treatment of PML based on development of Treatment Limiting Toxicity


Secondary Outcome Measures :
  1. PML lesion volume [ Time Frame: change from baseline to day 28 ]
    Change from baseline to day 28 in PML lesion volume, as seen on brain MRI

  2. Gadolinium enhancement [ Time Frame: Change in pattern of gadolinium enhancement from baseline to day 3, day 7, day 14, and day 28 ]
    Change in pattern of gadolinium enhancement from baseline to day 3, day 7, day 14, and day 28 MRI scans of participants' brains

  3. Modified Rankin Score [ Time Frame: Change from baseline to day 28 ]
    Change from baseline to day 28 in the modified Rankin Score (mRS).

  4. JC viral load in CSF [ Time Frame: Change from baseline to day 28 ]
    Change from baseline to day 28 in JC viral load in CSF



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA - PATIENT:
  • Clinically definite PML, defined as clinical signs and MRI compatible with active PML and the presence of JCV by PCR in CSF
  • Modified Rankin Scale 1-4, inclusive
  • Age 18 or older
  • Patient medically stable and able to tolerate travel to NIH
  • Available PyVST
  • Subjects of childbearing or child-fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while they are being treated on this study
  • Willing and able to participate in all aspects of trial design and follow-up
  • Able to provide informed consent at the time of study enrollment (not required for reinfusions).

EXCLUSION CRITERIA - PATIENT:

  • Patients with human immunodeficiency virus (HIV infection)
  • Patients who have been treated with natalizumab
  • Patients with readily reversible immunosuppressive state
  • Patients receiving immunosuppressive or immunomodulatory therapies within 28 days of screening for enrollment that could interfere with PyVST function
  • Patients with other uncontrolled infections. For bacterial infections, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to enrollment. For fungal infections, patients must be receiving definitive systemic anti-fungal therapy and have no signs of progressing infection for 1 week prior to enrollment.
  • Patients who have received donor lymphocyte infusion (DLI) within 28 days
  • Uncontrolled relapse of malignancy
  • Patients with any other associated CNS disease that might confound outcomes
  • Patients with contraindication to MRI (including cardiac pacemakers and some infusion pumps, other metallic implants, metallic foreign objects)
  • MRI findings consistent with immune system reconstitution inflammatory syndrome (IRIS) and determined to be mounting an adequate immune response to the infection
  • Patients with medical contraindication to LP
  • For subjects who have previously received PyVST infusions, any treatment-limiting toxicity (defined in Section 8.3) to previous infusions
  • Subjects with a positive pregnancy test or who are nursing.

INCLUSION CRITERIA - DONOR:

  • Ability to provide informed consent at the time of enrollment
  • First degree relative of patient (sibling, parent/child)
  • Age 18 or older

EXCLUSION CRITERIA - DONOR:

  • Sickling hemoglobinopathies including HbSS and HbSC by history and peripheral blood smear; donors with HbAS are acceptable
  • HbsAg, anti-HBc, anti-HCV, anti-HIV, anti-HTLV, and RPR
  • Cardiovascular instability, severe anemia, inadequate venous access, severe coagulation disorder or any other medical condition that the Principal Investigator or Apheresis Unit staff considers a contraindication to the apheresis procedure or research blood draw.
  • Positive pregnancy test

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02694783


Locations
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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
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Principal Investigator: Irene CM Cortese, M.D. National Institute of Neurological Disorders and Stroke (NINDS)
Additional Information:
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Responsible Party: National Institute of Neurological Disorders and Stroke (NINDS)
ClinicalTrials.gov Identifier: NCT02694783    
Other Study ID Numbers: 160072
16-N-0072
First Posted: March 1, 2016    Key Record Dates
Last Update Posted: November 13, 2020
Last Verified: November 10, 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) ):
HLA Matched
JCV
Donor
PyVST
PML
Additional relevant MeSH terms:
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Leukoencephalopathy, Progressive Multifocal
Leukoencephalopathies
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Encephalitis, Viral
Central Nervous System Viral Diseases
Virus Diseases
Polyomavirus Infections
DNA Virus Infections
Slow Virus Diseases
Infectious Encephalitis
Encephalitis
Central Nervous System Infections
Demyelinating Diseases