Maintenance Therapy With Ceplene® (Histamine) and IL-2 on Immune Response and MRD in Acute Myeloid Leukemia

NCT01347996 | Completed Phase 4

• 1 other identifier: EPC2008-02
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

Ceplene/IL-2 remission maintenance therapy has been shown to significantly prolong Leukemia Free Survival in patients with Acute Myeloid Leukemia (AML) in first complete remission. This is an international, multicenter, open-label study to evaluate the effects of remission maintenance therapy with Ceplene/IL-2 in adult patients with AML in CR1 on specific immune system cells (T and NK cells) and prospectively defined markers of immune response that are known to reflect T and NK cell ability to combat AML.

Conditions

Acute Myeloid Leukemia

Keywords

AML; Leukemia; Acute Myeloid Leukemia; Minimal Residual Disease; Ceplene; Histamine; interleukin 2

Outcome Measures

Primary Outcomes (2)

• Minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2

  A second primary objective of this study is to evaluate MRD in patients who are receiving remission maintenance therapy with Ceplene/IL-2. MRD will be evaluated using RQ-PCR for molecular detection of genetic markers of AML. Patients' MRD status will be quantified at the time of enrollment (baseline) and within ten days after completion of Cycles 3, 5, 6, 7, 9 and 10 of Ceplene/IL-2 therapy, corresponding to approximately every 3 months during this immunotherapy.

  Comparison at baseline and various time points up to 2 years

• Pharmacodynamic effects of Ceplene plus low dose IL-2 (Ceplene/IL-2) by monitoring T and NK cell phenotypes and their functionality after the first and third cycles of treatment

  The quantitative and qualitative pharmacodynamic effects of Ceplene/IL-2 on the immune responses of T and NK cells will be assessed as follows: 1. Changes in T and NK cell phenotypes (CD56, CD3, CD4, CD8) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3. 2. Changes in immune response markers (CD3, NKp46 \[and other NCRs\], CD25, CD69, and IFN-γ) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3

  Baseline vs Cycle 1 and 3

Secondary Outcomes (1)

• Duration of LFS

  up to 2 years

Study Arms (1)

histamine dihydrochloride and IL-2

EXPERIMENTAL

histamine and IL-2 subcutaneous injections

Drug: histamine dihydrochloride and IL-2

Interventions

histamine dihydrochloride and IL-2 DRUG

Ceplene 0.5 mg subcutaneously twice daily and IL-2 1 µg/kg \[16,400 IU/kg\] body weight twice daily for 10, 21 day cycles

Also known as: Ceplene, Proleukin, IL-2, interleukin-2, histamine

histamine dihydrochloride and IL-2

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• AML patients in CR1 whose AML subtype has been well-characterized using conventional karyotyping and molecular genetic techniques (eg, RQ-PCR) at diagnosis. Patients may be considered eligible if they have not had this assessment performed at diagnosis provided that stored samples of diagnostic genetic material (DNA/RNA) from blood and BM are available that can be assayed for the presence of markers such as WT1 and/or AML-specific genetic markers.
• Bone marrow examination confirming CR (defined as less than 5% blasts in a normocellular bone marrow).
• Eighteen years of age or older.
• Patients have received any form of induction and consolidation therapy as per standard practice at the institution, including autologous stem cell transplantation (ASCT).
• Within 8 weeks following the date of the last dose of consolidation or conditioning chemotherapy for AML, or following ASCT.
• Patients not undergoing consolidation therapy must have been in CR1 for at least one month prior to enrollment.
• Platelet count recovered after chemotherapy to ≥75 x 109/L, and Partial Thromboplastin Time (PTT) within normal limits.
• WBC ≥1.5 x 109/L and LFTs (to include SGPT \[ALAT\] or SGOT \[AST\] and bilirubin) should not exceed twice the upper limit of normal.
• Serum creatinine less than or equal to 1.5 times the upper normal limit.
• Able to function without significant decrease in daily activities (WHO Performance Status 0 - 1 or Karnofsky ≥70).
• Life expectancy of more than three months and able to undergo routine outpatient evaluations for efficacy, safety, and/or compliance.
• Women of childbearing potential must be practicing barrier or oral contraception, for the duration of the treatment, or documented as surgically sterile or one year post-menopausal.
• If female, be non-nursing, non-pregnant and have a negative pregnancy test within two weeks of starting study drug.
• The patient must be informed of the investigational nature of the study and written informed consent obtained.

You may not qualify if:

• Patients who have undergone or are planned for allogeneic stem cell transplantation.
• Patients with M3 as an AML subtype.
• Class III or IV cardiac disease, hypotension or severe hypertension, vasomotor instability, serious or uncontrolled cardiac dysrhythmias (including ventricular arrhythmias) at any time, acute myocardial infarction within the past 12 months, active uncontrolled angina pectoris or symptomatic arteriosclerotic blood vessel disease.
• Other active malignancies except in situ carcinoma of the cervix, localized squamous or basal cell carcinoma of the skin.
• Serious concurrent or recent non-malignant medical conditions which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study.
• History of seizures, central nervous system disorders, stroke within the last 12 months, or psychiatric disability thought to be clinically significant in the opinion of the Investigator and adversely affecting compliance to protocol.
• Patients unable to undergo repeat treatments, clinical evaluations and other diagnostic procedures required by the protocol.
• Active autoimmune disease (including but not limited to systemic lupus, inflammatory bowel disease, and psoriasis).
• Patients with active peptic or esophageal ulcer disease or with past peptic ulcer or esophageal disease with a history or bleeding.
• Patients requiring active treatment for hypotension.
• Medical, sociologic, or psychological impediment to probable compliance with the protocol.
• Patients continuing systemic treatment with clonidine, steroids, and/or H2 receptor blocking agents.
• Patients with a history of histamine hypersensitivity, severe allergies to food or contrast media requiring treatment within the last five years.
• Patients unable to provide written consent.

Sponsors & Collaborators

• Cytovia, Inc.: lead
• EpiCept Corporation: collaborator

Study Sites (1)

Sahlgrenska Academy, University of Gothenburg

Gothenburg, Sweden

Location

Related Publications (7)

• Hussein BA, Hallner A, Wennstrom L, Brune M, Martner A, Hellstrand K, Bernson E, Thoren FB. Impact of NK Cell Activating Receptor Gene Variants on Receptor Expression and Outcome of Immunotherapy in Acute Myeloid Leukemia. Front Immunol. 2021 Dec 9;12:796072. doi: 10.3389/fimmu.2021.796072. eCollection 2021.

  PMID: 34956230 DERIVED

• Grauers Wiktorin H, Aydin E, Christenson K, Issdisai N, Thoren FB, Hellstrand K, Martner A. Impact of IL-1beta and the IL-1R antagonist on relapse risk and survival in AML patients undergoing immunotherapy for remission maintenance. Oncoimmunology. 2021 Jul 25;10(1):1944538. doi: 10.1080/2162402X.2021.1944538. eCollection 2021.

  PMID: 34367728 DERIVED

• Grauers Wiktorin H, Nilsson MS, Kiffin R, Sander FE, Lenox B, Rydstrom A, Hellstrand K, Martner A. Histamine targets myeloid-derived suppressor cells and improves the anti-tumor efficacy of PD-1/PD-L1 checkpoint blockade. Cancer Immunol Immunother. 2019 Feb;68(2):163-174. doi: 10.1007/s00262-018-2253-6. Epub 2018 Oct 12.

  PMID: 30315349 DERIVED

• Sander FE, Nilsson M, Rydstrom A, Aurelius J, Riise RE, Movitz C, Bernson E, Kiffin R, Stahlberg A, Brune M, Foa R, Hellstrand K, Thoren FB, Martner A. Role of regulatory T cells in acute myeloid leukemia patients undergoing relapse-preventive immunotherapy. Cancer Immunol Immunother. 2017 Nov;66(11):1473-1484. doi: 10.1007/s00262-017-2040-9. Epub 2017 Jul 18.

  PMID: 28721449 DERIVED

• Bernson E, Hallner A, Sander FE, Wilsson O, Werlenius O, Rydstrom A, Kiffin R, Brune M, Foa R, Aurelius J, Martner A, Hellstrand K, Thoren FB. Impact of killer-immunoglobulin-like receptor and human leukocyte antigen genotypes on the efficacy of immunotherapy in acute myeloid leukemia. Leukemia. 2017 Dec;31(12):2552-2559. doi: 10.1038/leu.2017.151. Epub 2017 May 22.

  PMID: 28529313 DERIVED

• Rydstrom A, Hallner A, Aurelius J, Sander FE, Bernson E, Kiffin R, Thoren FB, Hellstrand K, Martner A. Dynamics of myeloid cell populations during relapse-preventive immunotherapy in acute myeloid leukemia. J Leukoc Biol. 2017 Aug;102(2):467-474. doi: 10.1189/jlb.5VMA1116-455R. Epub 2017 Feb 24.

  PMID: 28235771 DERIVED

• Sander FE, Rydstrom A, Bernson E, Kiffin R, Riise R, Aurelius J, Anderson H, Brune M, Foa R, Hellstrand K, Thoren FB, Martner A. Dynamics of cytotoxic T cell subsets during immunotherapy predicts outcome in acute myeloid leukemia. Oncotarget. 2016 Feb 16;7(7):7586-96. doi: 10.18632/oncotarget.7210.

  PMID: 26863635 DERIVED

MeSH Terms

Conditions

Leukemia, Myeloid, Acute; Leukemia; Neoplasm, Residual

Interventions

Histamine; Interleukin-2; aldesleukin

Condition Hierarchy (Ancestors)

Leukemia, Myeloid; Neoplasms by Histologic Type; Neoplasms; Hematologic Diseases; Hemic and Lymphatic Diseases; Neoplastic Processes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Biogenic Monoamines; Biogenic Amines; Amines; Organic Chemicals; Ethylamines; Imidazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Autacoids; Inflammation Mediators; Biological Factors; Interleukins; Cytokines; Intercellular Signaling Peptides and Proteins; Peptides; Amino Acids, Peptides, and Proteins; Lymphokines; Proteins

Study Officials

• Robin FOA, MD, PhD

  Università degli Studi di Roma "La Sapienza" Dipartimento di Biotecnologie Cellulari ed Ematolgia

  STUDY CHAIR

• Mats L Brune, MD, PhD

  Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 2, 2011
• First Posted: May 5, 2011
• Study Start: July 1, 2009
• Primary Completion: June 1, 2014
• Study Completion: June 1, 2014
• Last Updated: November 29, 2017

Record last verified: 2017-11

Locations

SE (1)