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Donor Lymphocyte Infusion in Treating Patients With Recurrent or Persistent Hematologic Cancer After Donor Stem Cell Transplant

Cellular Infusions in Patients With Recurrent or Persistent Hematologic Malignancies After Allogeneic Stem Cell Transplant

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00534118
Enrollment
39
Registered
2007-09-24
Start date
2003-10-01
Completion date
2018-07-26
Last updated
2020-08-26

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes

Keywords

accelerated phase chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, childhood chronic myelogenous leukemia, previously treated myelodysplastic syndromes, recurrent adult acute lymphoblastic leukemia, recurrent childhood acute lymphoblastic leukemia, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), recurrent adult acute myeloid leukemia, recurrent childhood acute myeloid leukemia, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma, recurrent adult Hodgkin lymphoma, recurrent/refractory childhood Hodgkin lymphoma, recurrent adult Burkitt lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent mantle cell lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, recurrent adult grade III lymphomatoid granulomatosis, Waldenstrom macroglobulinemia, recurrent childhood grade III lymphomatoid granulomatosis, recurrent childhood large cell lymphoma, recurrent childhood lymphoblastic lymphoma, childhood diffuse large cell lymphoma, childhood immunoblastic large cell lymphoma, recurrent childhood small noncleaved cell lymphoma, de novo myelodysplastic syndromes, secondary acute myeloid leukemia, secondary myelodysplastic syndromes, splenic marginal zone lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, recurrent cutaneous T-cell non-Hodgkin lymphoma, recurrent mycosis fungoides/Sezary syndrome, cutaneous B-cell non-Hodgkin lymphoma

Brief summary

RATIONALE: Giving an infusion of donor lymphocytes may be able to kill cancer cells in patients with hematologic cancer that has come back after a donor stem cell transplant. PURPOSE: This clinical trial is studying how well donor lymphocyte infusion works in treating patients with recurrent or persistent hematologic cancer after donor stem cell transplant.

Detailed description

OBJECTIVES: Primary * Determine if the complete response rate exceeds 10% in patients with recurrent or persistent hematologic malignancies treated with donor lymphocyte infusion. Secondary * Estimate the complete response rate in these patients. * Assess the toxicity of donor lymphocyte infusion in these patients. OUTLINE: Patients receive up to four donor lymphocyte infusions at least 1 month apart in the absence of disease progression, unacceptable toxicity, or uncontrolled graft-versus-host disease.

Interventions

Given IV

Sponsors

Roswell Park Cancer Institute
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
No minimum to 76 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Has undergone allogeneic stem cell transplantation (ASCT) for hematologic malignancy at least 30 days ago * No failure to engraft following transplant * No active acute or chronic graft-versus-host disease (GVHD) * Minimal GVHD allowed * Persistent or relapsed disease after ASCT, including 1 of the following: * Chronic myelogenous leukemia (CML), meeting any of the following criteria: * Molecular relapse (may be treated with imatinib mesylate after transplant), as defined by any of the following: * ASCT was non-T-cell depleted, a negative bcr/abl was documented by PCR post-transplant, and bcr/abl is now detectable by 2 consecutive PCR determinations \> 30 days apart * ASCT was non-T-cell depleted and bcr/abl is detectable by PCR at any time after day 180 post-transplant * Cytogenetic relapse after 3-6 months of imatinib mesylate * Relapsed chronic phase, accelerated phase, or blastic phase CML after 3-6 months of imatinib mesylate * Must currently be in chronic phase or accelerated phase CML only * Patients with blastic phase CML must attain a second chronic phase * Acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndromes, meeting any of the following criteria: * Molecular relapse, as evidenced by \< 5% blasts in the bone marrow and the patient's leukemia-specific molecular abnormality detectable by PCR * Cytogenetic relapse, as evidenced by \< 5% blasts in the bone marrow and the patient's leukemia-specific chromosome abnormality detectable by standard cytogenetics at any time after day 60 post-transplant * Hematologic relapse, as evidenced by \> 20% blasts in bone marrow or soft tissue recurrence * Must be treated with chemotherapy after transplant, but before study donor lymphocyte infusion (DLI) * Multiple myeloma * Relapsed disease or recurrence of M-protein after thalidomide or other salvage treatment * Prior post-transplant documentation of disappearance of M-protein by immunofixation * Residual or progressive disease * Rising M-protein level at any time post-transplant (measured at 3-month intervals) * Original M-protein detectable at 6 months post-transplant * Immune protein electrophoresis (IPEP) is required to show that M-component is the same on day 60 post-transplant as pre-transplant * Residual (\> 5%) plasma cells in bone marrow * Relapsed non-Hodgkin lymphoma or Hodgkin lymphoma * Relapse or progression of disease must be evidenced within 3 months prior to donor lymphocyte infusion by physical exam, radiographic studies, or molecular studies * Tumor should be re-biopsied to determine histology * If Epstein-Barr virus (EBV) lymphoma is suspected, peripheral blood must be assayed for EBV genome (i.e., EBV DNA testing by PCR) within the past 30 days * EBV infection with associated pancytopenia * Persistent or refractory pancytopenia with EBV genome detected by PCR in the peripheral blood * Refractory pancytopenia is defined as pancytopenia that is poorly responsive to growth factors and/or transfusions * EBV lymphoproliferative disorder * Clonal lymphadenopathy that is refractory to standard therapy with acyclovir and immunoglobulin (DLI may be given with rituximab) * Not a candidate for repeat ASCT * Chimerism status is not required for determining eligibility for DLI * Patients eligible for allogeneic ASCT, but for whom DLI is offered as the first option, should have full donor chimerism at relapse or after therapy for relapsed disease * Patients with relapsed underlying disease after transplant who achieved remission after chemotherapy are allowed * No CNS recurrence that is not cleared by standard chemotherapy * CNS remission status must be maintained for 2 weeks * Original hematopoietic progenitor stem cell donor must be available for cell donation * No syngeneic donors PATIENT CHARACTERISTICS: * Karnofsky performance status 60-100% * Life expectancy ≥ 8 weeks * Creatinine \< 3 mg/dL * ABO/Rh and CMV IgG/IgM status known * No HIV1 and HIV2 antibody * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for 3 months (males) or 6 months (females) after completion of study treatment PRIOR CONCURRENT THERAPY: * See Disease Characteristics

Design outcomes

Primary

MeasureTime frameDescription
Complete Remission Rate100 days post DLIcontinued or induced complete remission after DLI
Duration of Complete Response in Months (Maximum 12)1 year post DLIFor participants who achieve a complete remission after DLI, the duration of time until 1) relapse or 2) death in remission or 3) subsequent DLI or 4) last followup (at 1 year after DLI)

Secondary

MeasureTime frameDescription
Acute Graft-versus-host Disease100 days post DLIdevelopment of grade III-IV acute graft-versus-host disease (GVHD) per Glucksberg criteria

Countries

United States

Participant flow

Participants by arm

ArmCount
Multiple DLI
Accruals where the patient received 2-4 donor lymphocyte infusions Arm includes total number of infusions
15
Single DLI
Accruals where the patient received only one donor lymphocyte infusion
12
Total27

Baseline characteristics

CharacteristicMultiple DLISingle DLITotal
Age, Categorical
<=18 years
1 Participants1 Participants2 Participants
Age, Categorical
>=65 years
2 Participants2 Participants4 Participants
Age, Categorical
Between 18 and 65 years
12 Participants9 Participants21 Participants
Age, Continuous45 years53.5 years51 years
Disease
Acute Lymphoblastic Leukemia
1 Participants0 Participants1 Participants
Disease
Acute Myeloid Leukemia
8 Participants9 Participants17 Participants
Disease
Chronic Myeloid Leukemia
1 Participants1 Participants2 Participants
Disease
Hodgkin Lymphoma
1 Participants0 Participants1 Participants
Disease
Myelodysplastic Syndrome
2 Participants0 Participants2 Participants
Disease
Non Hodgkin Leukemia
2 Participants1 Participants3 Participants
Disease
Prolymphocytic Leukemia
0 Participants1 Participants1 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
15 Participants12 Participants27 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Asian
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
13 Participants12 Participants25 Participants
Region of Enrollment
United States
15 participants12 participants27 participants
Sex: Female, Male
Female
5 Participants2 Participants7 Participants
Sex: Female, Male
Male
10 Participants10 Participants20 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
10 / 157 / 12
other
Total, other adverse events
0 / 150 / 12
serious
Total, serious adverse events
10 / 157 / 12

Outcome results

Primary

Complete Remission Rate

continued or induced complete remission after DLI

Time frame: 100 days post DLI

Population: Each accrual is evaluable independently, some patients in both the Multiple and Single DLI are accrued more than once; total unique patients in multiple DLI is 15 and in single DLI is 12

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Multiple DLIComplete Remission Rate8 Participants
Single DLIComplete Remission Rate6 Participants
Primary

Duration of Complete Response in Months (Maximum 12)

For participants who achieve a complete remission after DLI, the duration of time until 1) relapse or 2) death in remission or 3) subsequent DLI or 4) last followup (at 1 year after DLI)

Time frame: 1 year post DLI

Population: Accruals which achieved a continued or induced complete remission at Day +100 after DLI, patients are censored at death in remission or at time of subsequent DLI

ArmMeasureValue (MEDIAN)
Multiple DLIDuration of Complete Response in Months (Maximum 12)10.1 months
Single DLIDuration of Complete Response in Months (Maximum 12)9 months
Secondary

Acute Graft-versus-host Disease

development of grade III-IV acute graft-versus-host disease (GVHD) per Glucksberg criteria

Time frame: 100 days post DLI

Population: Each accrual is evaluable for acute GVHD grade III-IV

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Multiple DLIAcute Graft-versus-host Disease0 Participants
Single DLIAcute Graft-versus-host Disease4 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026