Cytotoxic T Cells to Treat Relapsed EBV-positive Lymphoma

NCT01956084 | Completed Phase 1 DMC

• 1 other identifier: ALCI2
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

In this study, investigators are trying to see if LMP specific cytotoxic T lymphocytes (CTLs) will prevent or treat disease called Epstein Barr Virus (EBV) Disorder including either Hodgkin Lymphoma or non-Hodgkin Lymphoma or Lymphoepithelioma or severe chronic active EBV infection syndrome (SCAEBV) or Leiomyosarcoma which has come back or has not gone away after treatment, including the best treatment. Investigators are using special immune system cells called third party LMP specific cytotoxic T lymphocytes (CTLs), a new experimental therapy. Some patients with Lymphoma or SCAEBV or Leiomyosarcoma show evidence of infection with the virus that causes infectious mononucleosis Epstein Barr virus (EBV) before or at the time of their diagnosis. EBV is found in the cancer cells of up to half the patients with Hodgkin's and non-Hodgkin Lymphoma, suggesting that it may play a role in causing Lymphoma. The cancer cells (in lymphoma) and some B cells (in SCAEBV) infected by EBV are able to hide from the body's immune system and escape destruction. The investigators want to see if special white blood cells, called T cells, that have been trained to kill EBV infected cells can survive in patient's blood and affect the tumor or infection. Investigators used this sort of therapy to treat a different type of cancer that occurs after bone marrow or solid organ transplant called post transplant lymphoma. In this type of cancer the tumor cells have 9 proteins made by EBV on their surface. They grew T cells in the laboratory that recognized all 9 proteins and were able to successfully prevent and treat post transplant lymphoma. However in Hodgkin Lymphoma, the tumor cells and B cells only express 2 EBV proteins. In a previous study they made T cells that recognized all 9 proteins and gave them to patients with Hodgkin Lymphoma. Some patients had a partial response to this therapy but no patients had a complete response. They think one reason may be that many of the T cells reacted with proteins that were not on the tumor cells. In this present study the investigators are trying to find out if the investigators can improve this treatment by growing T cells that recognize proteins expressed on EBV infected Lymphoma cells and B cells called LMP-1 and LMP2. These special T cells are called third party LMP 1/2 -specific cytotoxic T-lymphocytes (CTLs). These LMP-specific cytotoxic T cells are an investigational product not approved by the Food and Drug Administration.

Conditions

Hodgkin Disease; Non Hodgkin Lymphoma; Lymphoepithelioma; Severe Chronic Active EBV Infection Syndrome (SCAEBV); Leiomyosarcoma

Outcome Measures

Primary Outcomes (1)

• Number of patients with dose limiting toxicity (DLT)

  Toxicity will be evaluated according to NCI Common Terminology Criteria for Adverse Events scale, version 2.0. DLT will be defined as development of any toxicity scored as Grade 3 or 4 and primarily related to the CTL infusion.

  6 weeks

Secondary Outcomes (1)

• Survival and Immune Function of LMP-specific CTLs

  5 years

Other Outcomes (1)

• To obtain preliminary information on the safety and response to an extended dosage regimen.

  6 weeks

Study Arms (2)

LMP1/2 CTLs (Group A)

EXPERIMENTAL

Patients receiving CTLs as adjunctive therapy following allogeneic stem transplant

Drug: LMP1/2 CTLs (Group A)

LMP1/2 CTLs (Group B)

EXPERIMENTAL

Patients receiving CTLs in relapse following allogeneic stem cell transplant

Drug: LMP1/2 CTLs (Group B)

Interventions

LMP1/2 CTLs (Group A) DRUG

Each patient will receive 2 injections, 14 days apart, according to the following dosing schedules: Dose Level One: Day 0: 1 x 107 cells/m2 Day 14: 1 x 107 cells/m2 Dose Level Two: Day 0: 2 x 107 cells/m2 Day 14: 2 x 107 cells/m2 Dose Level Three: Day 0: 5 x 107 cells/m2 Day 14: 5 x 107 cells/m2

LMP1/2 CTLs (Group A)

LMP1/2 CTLs (Group B) DRUG

Each patient will receive 2 injections, 14 days apart, according to the following dosing schedules: Dose Level One: Day 0: 1 x 107 cells/m2 Day 14: 1 x 107 cells/m2 Dose Level Two: Day 0: 2 x 107 cells/m2 Day 14: 2 x 107 cells/m2 Dose Level Three: Day 0: 5 x 107 cells/m2 Day 14: 5 x 107 cells/m2

LMP1/2 CTLs (Group B)

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Any patient, regardless of age or sex, with a diagnosis of EBV positive Hodgkin's or non-Hodgkin's Lymphoma or EBV (associated)-T/NK-LPD lymphoproliferative disease or Lymphoepithelioma/leiomyosarcoma regardless of histological subtype or Severe Chronic EBV and in remission (group A) or with detectable disease (group B) after allogeneic SCT
• Patients with life expectancy \> 6 weeks.
• Tumor tissue EBV positive
• Patients with a Karnofsky/Lansky score of \> 50
• Donor HIV negative
• must not have less than 50% donor chimerism in either peripheral blood or bone marrow
• Patients with bilirubin \<2x normal, AST \<5x normal, and Hgb \>8.0
• Patients with a creatinine \<2x normal for age
• Patients should have been off other investigational therapy for one month prior to entry in this study.
• Patient, parent/guardian able to give informed consent.

You may not qualify if:

• Donors who are HIV positive
• Patients with GVHD \> Grade II
• Due to unknown effects of this therapy on a fetus, pregnant women are excluded from this research.

Sponsors & Collaborators

• Catherine Bollard: lead

Study Sites (1)

Childrens National Medical Center

Washington D.C., District of Columbia, 20010, United States

Location

Related Publications (1)

• McLaughlin LP, Rouce R, Gottschalk S, Torrano V, Carrum G, Wu MF, Hoq F, Grilley B, Marcogliese AM, Hanley PJ, Gee AP, Brenner MK, Rooney CM, Heslop HE, Bollard CM. EBV/LMP-specific T cells maintain remissions of T- and B-cell EBV lymphomas after allogeneic bone marrow transplantation. Blood. 2018 Nov 29;132(22):2351-2361. doi: 10.1182/blood-2018-07-863654. Epub 2018 Sep 27.

  PMID: 30262660 DERIVED

MeSH Terms

Conditions

Hodgkin Disease; Lymphoma, Non-Hodgkin; Leiomyosarcoma

Condition Hierarchy (Ancestors)

Lymphoma; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Hemic and Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Neoplasms, Muscle Tissue; Neoplasms, Connective and Soft Tissue; Sarcoma

Study Officials

• Catherine Bollard, MD

  CNMC

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director- Program for Cell Enhancement and Technologies for Immunotherapy (CETI)

Study Record Dates

• First Submitted: September 25, 2013
• First Posted: October 8, 2013
• Study Start: November 1, 2013
• Primary Completion: November 19, 2017
• Study Completion: October 15, 2019
• Last Updated: December 19, 2024

Record last verified: 2024-12

Locations

US (1)