Natural Killer (NK) Cells With HLA Compatible Hematopoietic Transplantation for High Risk Myeloid Malignancies
Central Venous Catheter:
If you choose to take part in this study, the chemotherapy, some of the other drugs in this
study, the NK cells, and the stem cell transplant will be given by vein through your central
venous catheter (CVC). A CVC is a sterile flexible tube and needle that will be placed into
a large vein while you are under local anesthesia. Blood samples will also be drawn through
your CVC. The CVC will remain in your body during treatment. Your doctor will explain this
procedure to you in more detail, and you will be required to sign a separate consent form.
NK Cell Dose Levels:
You will be assigned to a dose level of NK cells based on when you joined this study. Up to
4 dose levels of NK cells will be tested. The first group of participants will receive the
lowest dose level. Each new group will receive a higher dose than the group before it, if
no intolerable side effects were seen. This will continue until the highest tolerable dose
of NK cell is found.
Chemotherapy, NK Cell infusion, and Stem Cell Transplant:
For a stem cell transplant, the days before you receive your stem cells are called minus
days. The day you receive the stem cells is called Day 0. The days after you receive the
stem cells are called plus days.
You will receive a dose of busulfan by vein over about 3 hours as an outpatient within 2
weeks of your hospital admission or as an inpatient on Day -15. With the first busulfan
infusion, about 11 samples of blood (about 1 teaspoon each time) will be drawn for
pharmacokinetic (PK) testing at various time points before and after you receive your first
dose of busulfan. The study staff will tell you the blood testing schedule. PK testing
measures the amount of study drug in the body at different time points. The PK testing will
help the doctor decide your dose of busulfan for Days -13 through -10.
A heparin lock line will be placed in your vein to lower the number of needle sticks needed
for these draws. If it is not possible for the PK tests to be performed, you will receive
the standard dose of busulfan.
On Days -13 through -10, you will receive fludarabine by vein over 1 hour, then busulfan by
vein over 3 hours.
On Day -9, you will rest.
On Day -8, you will receive NK cells by vein over about 1 hour.
On Days -8 through -4, you will receive IL-2 as an injection under your skin.
On Days -3, -2, and -1, you will receive antithymocyte globulin (ATG) by vein over 3-4
hours. ATG is given to stop your immune system from working, so your body will not fight
against the stem cell transplant.
Beginning on Day -2, you will receive tacrolimus nonstop by vein. This will continue until
you are able to take it by mouth. Tacrolimus is given to help prevent transplant rejection.
On Day 0, you will receive the stem cell transplant by vein.
On Days +1, +3, +6, and +11, you will receive methotrexate by vein over 30 minutes.
Methotrexate is given to help prevent graft versus host disease (GVHD).
When you are able to take tacrolimus by mouth, you will take it 1 time or 2 times a day for
about 6 months and then your doctor will tell you how to taper it off (gradually stop taking
You will receive filgrastim as an injection under the skin 1 time a day, starting 1 week
after the transplant, until your blood cell levels return to normal. Filgrastim is designed
to help with the growth of white blood cells.
You will be given standard drugs to help decrease the risk of side effects. You may ask the
study staff for information about how the drugs are given and their risks.
On Day -4, +7, and +14, blood (2 teaspoons each time) will be drawn to check the level of
the infused NK cells and to check your immune system.
After you finish chemotherapy and the cell infusion, your follow-up care will be the
standard of care for stem cell transplants. Before you are able to go home from the
hospital, you will be given written information and be taught how often you will come to the
hospital/clinic, take drugs at home, and what side effects you may have and what to do for
The study staff will also stay in contact with your local doctor to find out if the disease
comes back and to check how you are doing.
Length of Study:
You will be on active study for up to about +30 days. You may be taken off study early if
the disease gets worse, if you are unable to receive the NK cell infusion due to product
contamination or insufficient cell dose, if your transplant does not "take" (graft failure),
if you have any intolerable side effects, if you are unable to follow study directions, if
your doctor thinks it is in your best interest, if the study is stopped, or if you choose to
leave the study early.
You should talk to the study doctor if you want to leave the study early. If you are taken
off study early, you still may need to return for routine post-transplant follow-up visits,
if your transplant doctor decides it is needed.
If you are thinking about dropping out of this study, please tell the study doctor. The
doctor can tell you about the effects of stopping treatment. You and the doctor can talk
about what follow-up care and testing would help you the most.
If you leave the study, your test results and information cannot be removed from the study
This is an investigational study. Busulfan, fludarabine, and IL-2 are FDA approved and
commercially available for the treatment of other types of cancer. Their use for the
treatment of AML and MDS is investigational. The use of NK cells is investigational. The
NK cell process is not FDA approved or commercially available. It is currently being used
for research purposes only.
Up to 72 patients will take part in this study. All will be enrolled at MD Anderson.
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Maximum Tolerated Natural Killer (NK) Cell Dose
Optimal NK cell dose determined in each of three distinct patient subgroups, A = KIR mismatched haplo donors, B = KIR mismatched cord blood donors, C = matched SIB donors. Same dose-finding design used within each subgroup. Four NK cell doses studied are: 106, 107, 3 x 107, and 108 NK cells. Cohorts of 2 patients used, starting at lowest NK cell dose level. Dose-limiting toxicity (DLT) defined as any of the events graft failure, severe (grade 3,4) infusional toxicity, severe grade 4 organ toxicity, or death by day 42.
Richard E. Champlin, MD, BS
UT MD Anderson Cancer Center
United States: Food and Drug Administration
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