Pilot/Feasibility Study To Evaluate The Safety Of Cellular Immunotherapy For CD19+ Follicular Lymphoma Using Autologous Cytolytic T Cells Genetically-Modified To Be CD19-Specific And Co-Express HyTK
16 Years
70 Years
Both
Lymphoma
Trial Information
Pilot/Feasibility Study To Evaluate The Safety Of Cellular Immunotherapy For CD19+ Follicular Lymphoma Using Autologous Cytolytic T Cells Genetically-Modified To Be CD19-Specific And Co-Express HyTK
OBJECTIVES:
Primary
- Determine the safety and feasibility of cellular adoptive immunotherapy using
autologous cytotoxic T lymphocytes genetically modified to express a CD19-specific
chimeric immunoreceptor gene and HyTK selection/suicide gene in patients with relapsed
or refractory follicular non-Hodgkin's lymphoma.
Secondary
- Determine the in vivo persistence of adoptively transferred cytolytic T cells in
patients treated with lymphodepleting therapy comprising rituximab and fludarabine.
- Assess the development of host immune responses against the CD19-specific chimeric
immunoreceptor gene and/or HyTK selection/suicide gene.
- Determine the safety of low-dose interleukin-2 in supporting in vivo persistence of
adoptively transferred cytotoxic T cells.
- Determine the anti-tumor activity of this regimen in these patients.
OUTLINE: This is a nonrandomized, open-label, pilot study.
- Leukapheresis: Patients undergo leukapheresis for collection of peripheral blood
mononuclear cells (PBMCs). CD3-positive cytotoxic T lymphocytes (CTLs) are isolated and
genetically modified to express a CD19-specific chimeric immunoreceptor and the HyTK
fusion protein, and are then expanded in vitro.
- Lymphodepleting therapy: Patients receive rituximab and fludarabine prior to T-cell
infusions.
- Cellular adoptive immunotherapy and interleukin-2 (IL-2): Patients receive a total of 5
infusions of genetically modified autologous T cells. Patients may receive low-dose
IL-2 subcutaneously after infusions 3, 4, and 5.
- Additional IL-2 therapy: After the completion of the last T-cell infusion, patients
with evidence of adoptively transferred T cells may receive additional IL-2.
After completion of study treatment, patients are followed periodically for approximately 65
days and then annually for at least 15 years.
PROJECTED ACCRUAL: At least 5 patients will be accrued for this study within 3 years.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed follicular non-Hodgkin's lymphoma (NHL)
- High-risk disease, as defined by any of the following:
- Relapsed within 6 months after the last treatment
- Failed to achieve a complete response during the last treatment
- Relapsed after prior autologous hematopoietic stem cell transplantation
(HSCT)
- No current transformation of lymphoma (e.g., elements of intermediate- or high-grade
lymphoma by biopsy)
- No active CNS disease by lumbar puncture or radiology scan NOTE: A new classification
scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of
"indolent" or "aggressive" lymphoma will replace the former terminology of "low",
"intermediate", or "high" grade lymphoma. However, this protocol uses the former
terminology.
PATIENT CHARACTERISTICS:
Age
- 16 to 70
Performance status
- Karnofsky 50-100%
Life expectancy
- More than 16 weeks
Hematopoietic
- Absolute neutrophil count > 500/mm^3
Hepatic
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)* (unless due to Gilbert's disease)
- ALT ≤ 2.5 times ULN* NOTE: *Unless due to NHL
Renal
- Creatinine ≤ 1.5 times ULN* OR
- Creatinine clearance ≥ 80 mL/min* NOTE: *Unless due to NHL
Immunologic
- HIV negative
- Epstein-Barr virus positive
- No history of allergy or intolerance to ganciclovir
Other
- Negative pregnancy test
- No history of another malignancy except basal cell skin cancer or carcinoma in situ
- No other uncontrolled or severe illness that would preclude study participation
PRIOR CONCURRENT THERAPY:
Biologic therapy
- No prior allogeneic HSCT
- No other immunotherapy during and for approximately 65 days after the last T-cell
infusion, unless approved by the Principal Investigator (PI)
Chemotherapy
- No other chemotherapy during and for approximately 65 days after the last T-cell
infusion, unless approved by the PI
- Patients may receive chemotherapy after leukapheresis while waiting for
CD19-specific T cells to be manufactured
Endocrine therapy
- No systemic corticosteroids during and for approximately 65 days after the last
T-cell infusion, unless approved by the PI
Radiotherapy
- Not specified
Surgery
- Not specified
Other
- No concurrent participation in another investigational study
- No immunosuppression agents or other investigational agents during and for
approximately 65 days after the last T-cell infusion, unless approved by the PI
Type of Study:
Interventional
Study Design:
Allocation: Non-Randomized, Masking: Open Label, Primary Purpose: Treatment
Authority:
United States: Federal Government
Study ID:
CDR0000438797
NCT ID:
NCT00182650
Start Date:
June 2004
Completion Date:
March 2008
Related Keywords:
- Lymphoma
- recurrent grade 1 follicular lymphoma
- recurrent grade 2 follicular lymphoma
- recurrent grade 3 follicular lymphoma
- Lymphoma
- Lymphoma, Follicular
- Lymphoma, Non-Hodgkin
Name | Location |
|---|---|
| City of Hope Comprehensive Cancer Center | Duarte, California 91010 |
