Cytomegalovirus Infections Clinical Trial
— ACESOfficial title:
Antiviral Cellular Therapy for Enhancing T-cell Reconstitution Before or After Hematopoietic Stem Cell Transplantation (ACES) PBMTC SUP1701
Verified date | December 2023 |
Source | Children's Hospital Los Angeles |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The purpose of this study is to evaluate whether virus-specific T cell lines (VSTs) are safe and can effectively control three viruses (EBV, CMV, and adenovirus) in patients who have had a stem cell transplant and also in patients that have a primary immunodeficiency disorder with no prior stem cell transplant.
Status | Active, not recruiting |
Enrollment | 60 |
Est. completion date | February 2024 |
Est. primary completion date | January 31, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A and older |
Eligibility | Inclusion Criteria Patients who have received any type of allogeneic transplant or who have a primary immunodeficiency disorder will be eligible if they have CMV, adenovirus, and/or EBV infection/disease with failure of treatment after 7 days of standard therapy OR if unable to tolerate standard therapy. - Patients must meet one of the following criteria: - Recipient of prior myeloablative or non-myeloablative allogeneic hematopoietic stem cell transplant using either bone marrow or peripheral blood stem cell or single or double cord blood within the previous 18 months, OR - Have a diagnosed primary immunodeficiency disorder (as defined by clinical and laboratory evaluations) and not undergone HSCT. - Treatment of the following persistent or relapsed infections despite standard therapy: - CMV: Treatment of persistent or relapsed CMV disease or infection after standard therapy. For CMV infection, standard therapy is defined as antiviral therapy with ganciclovir, foscarnet or cidofovir for at least 14 days. - Adenovirus: Treatment of persistent or relapsed adenovirus infection or disease despite standard therapy. Standard therapy is defined as antiviral therapy with cidofovir or brincidofovir. - EBV: Treatment of persistent or relapsed EBV infection despite standard therapy. For EBV infection, standard therapy is defined as rituximab given at 375 mg/m2 in patients for 1-4 doses with a CD20+ tumor. Additional Inclusion Criteria: - Patients with simultaneous infections with CMV, EBV and/or Adenovirus infections are eligible if one or more infection(s) is persistent or relapsed despite standard therapy as defined above. Patients with multiple infections with one or more reactivation and one or more controlled infection are eligible to enroll. - Clinical status at enrollment that allows tapering of steroids to equal or less than 0.5 mg/kg/day prednisone (or equivalent) prior to infusion of the VST doses. - Negative pregnancy test in female patients if applicable (childbearing potential who have received a reduced intensity conditioning regimen). - Written informed consent and/or signed assent line from patient, parent or guardian. Exclusion Criteria - Patients receiving ATG, Campath, Basiliximab or other immunosuppressive monoclonal antibodies targeting T-cells within 28 days of screening for enrollment. - Patients who have received donor lymphocyte infusion (DLI) or other experimental cellular therapies within 28 days. - Current therapy with ruxolitinib or other JAK inhibitors within the previous 3 days. - Patients with other uncontrolled infections, defined as bacterial or fungal infections with clinical signs of worsening despite standard therapy. 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. - Progressing infection is defined as hemodynamic instability, worsening physical signs, or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection. - Patients with active and uncontrolled relapse of malignancy (if applicable). |
Country | Name | City | State |
---|---|---|---|
United States | University of Michigan | Ann Arbor | Michigan |
United States | Emory University/Children's Healthcare of Atlanta | Atlanta | Georgia |
United States | Children's Hospital Colorado | Aurora | Colorado |
United States | Dana-Farber Cancer Institute/ Boston Children's Hospital | Boston | Massachusetts |
United States | Tufts Medical Center | Boston | Massachusetts |
United States | Roswell Park Comprehensive Cancer Center | Buffalo | New York |
United States | Medical University of South Carolina | Charleston | South Carolina |
United States | Ann & Robert H. Lurie Children's Hospital of Chicago | Chicago | Illinois |
United States | UT Southwestern Medical Center | Dallas | Texas |
United States | City of Hope | Duarte | California |
United States | Duke University Medical Center | Durham | North Carolina |
United States | Spectrum Health - Helen DeVos Children's Hospital | Grand Rapids | Michigan |
United States | Riley Hospital for Children - Indiana University | Indianapolis | Indiana |
United States | Children's Hospital Los Angeles | Los Angeles | California |
United States | University of California, Los Angeles | Los Angeles | California |
United States | St. Jude | Memphis | Tennessee |
United States | University of Minnesota | Minneapolis | Minnesota |
United States | Yale | New Haven | Connecticut |
United States | Columbia University Medical Center | New York | New York |
United States | Stanford Lucile Packard Children's Hospital | Palo Alto | California |
United States | The Children's Hospital | Philadelphia | Pennsylvania |
United States | Phoenix Children's Hospital | Phoenix | Arizona |
United States | Oregon Health & Science University | Portland | Oregon |
United States | Virginia Commonwealth University | Richmond | Virginia |
United States | Washington University | Saint Louis | Missouri |
United States | Children's Mercy | San Antonio | Texas |
United States | Methodist Healthcare System of San Antonio | San Antonio | Texas |
United States | UCSF Medical Center | San Francisco | California |
United States | Fred Hutchinson Cancer Research Center/Seattle Chlindren's/University of Washington School of Medicine | Seattle | Washington |
United States | Children's National Medical Center | Washington | District of Columbia |
Lead Sponsor | Collaborator |
---|---|
Michael Pulsipher, MD |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Feasibility to identify suitable HLA matched VST products | Feasibility will be defined as the ability of the investigators to identify suitable partially HLA- matched VST products from the VST bank at Children's National Medical Center for referred study subjects. The percentage of referred patients with potential partially-matched VST products identified will be recorded, as will timing between patient referral and treatment. | 30 days | |
Primary | Incidence of Treatment-Emergent Adverse Events | The safety endpoint, dose-limiting toxicity (DLT), will be defined as acute GvHD grades III-IV or grades 3-5 infusion-related adverse events or grades 4-5 non-hematological adverse events related to the T cell product within 30 days of each VST dose and that are not due to the pre-existing infection or the original malignancy or pre-existing co-morbidities as defined by the NCI Common Terminology Criteria for Adverse Events (CTCAE), Version 4.03. | 30 days | |
Primary | Efficacy of VST at 30 days as measured by viral load | Peripheral blood and, where relevant, stool and urine will be monitored for CMV, EBV, and/or adenovirus viral load. For patients with multiple viral infections, the response against the primary viral target will determine the classification. For the infection under treatment response in viral load will be assessed at 30 days after the first VST infusion | 30 days | |
Secondary | Reconstitution of Antiviral Immunity following VST infusions | Patient serum and peripheral blood mononuclear cells will be monitored for virus-specific activity during the 3 months following VST infusion by the following measures:
T cell phenotyping by flow cytometry (including % CD3, CD4, CD8, TCRalpha/beta and CD45RA-/CCR7+, among other markers) Antiviral T cell responses to CMV, EBV, and/or Adenovirus antigens by IGN-g ELIspot (spot forming units) and Intracellular cytokine staining ( %IFN-gamma and TFNa+ of CD4 and CD8 cells) T cell repertoire and antiviral specificity by TCR sequencing (%clonotype frequencies) |
3 months | |
Secondary | Persistence of infused VSTs | Persistence of infused T cells will be monitored at 1 month and 3 months following VST infusion using deep sequencing and additional tests as indicated to track the TCR v-beta repertoire in the patient peripheral blood prior to and post-infusion. | 1 month and 3 months | |
Secondary | Effects on Clinical Signs of Viral Infection | If a patient has organ involvement, clinical response will be monitored. For patients with EBV lymphoma and measurable disease, response will be assessed by RECIST criteria. | 3 months | |
Secondary | Survival | Overall survival at 6 and 12 months post VST infusion will be computed. | 6 months and 12 months |
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