B-cell Chronic Lymphocytic Leukemia, Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue, Nodal Marginal Zone B-cell Lymphoma, Recurrent Grade 1 Follicular Lymphoma, Recurrent Grade 2 Follicular Lymphoma, Recurrent Mantle Cell Lymphoma, Recurrent Marginal Zone Lymphoma, Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia, Splenic Marginal Zone Lymphoma, Waldenström Macroglobulinemia
Conditions
Brief summary
This phase I trial is studying the side effects of giving genetically engineered lymphocytes together with cyclophosphamide and aldesleukin in treating patients with relapsed or refractory mantle cell lymphoma or indolent B-cell non-Hodgkin lymphoma. Placing a gene that has been created in the laboratory into white blood cells may make the body build an immune response to kill cancer cells. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Aldesleukin may stimulate the white blood cells to kill lymphoma cells. Giving genetically engineered lymphocytes together with cyclophosphamide and aldesleukin may be an effective treatment for mantle cell lymphoma and B-cell non-Hodgkin lymphoma
Detailed description
PRIMARY OBJECTIVES: I. To assess the feasibility, safety and toxicity of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express a second generation' cluster of differentiation (CD)20-specific scFvFc:CD28:CD137:zeda chimeric immunoreceptor in patients with recurrent or refractory CD20+ mantle cell or indolent lymphoma. SECONDARY OBJECTIVES: I. To determine the duration of in vivo persistence of adoptively transferred CD20-specific T cells transfected with a CD20-specific scFvFc:CD28:CD137:zeda chimeric immunoreceptor. II. To assess the trafficking of CD20-specific T cells to lymphoma masses. III. To evaluate the development of host anti-CD20 scFvFc:CD28:CD137:zeda chimeric immunoreceptor and anti-neomycin-resistance gene (NeoR) immune responses in study subjects. OUTLINE: CHEMOTHERAPY: Patients receive cyclophosphamide IV over 60 minutes. IMMUNOTHERAPY: Beginning 2 days after completion of cyclophosphamide, patients receive autologous CD20-specific T-cells IV over 30 minutes. Treatment repeats every 2-5 days for 3 courses. MAINTENANCE THERAPY: Beginning 2 hours after the last T-cell infusion, patients receive low-dose aldesleukin subcutaneously twice daily for 14 days. Treatment continues in the absence of disease progression or unacceptable toxicity. Subjects who have achieved at least a partial remission lasting a minimum of 6 months may, on a case-by-case basis, receive additional stored T cells following relapse. After completion of study treatment, patients are followed up weekly for one month, monthly for 1 year, and then annually for up to 2 years.
Interventions
BIOLOGICALtherapeutic autologous lymphocytes
Given IV
DRUGcyclophosphamide
Given IV
BIOLOGICALaldesleukin
Given subcutaneously
GENETICpolymerase chain reaction
Correlative studies
GENETICgene rearrangement analysis
Correlative studies
PROCEDURElymph node biopsy
Optional correlative studies
Receive genetically modified T cells
PROCEDUREbone marrow aspiration
Optional correlative studies
OTHERflow cytometry
Correlative studies
OTHERlaboratory biomarker analysis
Correlative studies
OTHERenzyme-linked immunosorbent assay
Correlative studies
Sponsors
National Cancer Institute (NCI)
Fred Hutchinson Cancer Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Male or female subjects with immuno histopathologically documented CD20+ mantle cell lymphoma, follicular non-Hodgkin lymphoma (NHL), small lymphocytic lymphoma/chronic lymphocytic leukemia, marginal zone, or lymphoplasmacytic NHL of any age, gender, or ethnic group who have relapsed or are refractory to conventional chemotherapy and who are not eligible for Fred Hutchinson Cancer Research Center (FHCRC)/University of Washington Medical Center (UWMC) transplant protocols (or who refuse participation in transplant protocols) * Willingness to sign an informed consent and undergo study tests * Willingness to receive cytoreductive chemotherapy, if necessary to debulk tumors prior to T cell administration, and to receive cyclophosphamide for lymphodepletion * Serologic evidence of prior exposure to Epstein-Barr virus (EBV) * Meets safety criteria to undergo leukapheresis * Hemoglobin \> 9.0 gm/dL * White blood cell (WBC) \> 2500 per microliter * Alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase \[SGPT\]) =\< 2.5 x Upper Limit of Normal * Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) =\< 2.5 x Upper Limit of Normal * Creatinine =\< 1.6 mg/dL * Willingness to use acceptable (barrier or hormonal methods) birth control as appropriate during the course of the study
Exclusion criteria
* Treatment with fludarabine or cladribine within the previous 2 years prior to apheresis * Known central nervous system involvement with NHL * Pulmonary involvement with NHL; a diagnosis of pulmonary lymphoma will be based in part on findings from chest computed tomography (CT) and, if clinically appropriate, lung biopsy * Exposure to chemotherapeutic agents (standard or experimental) or other immunosuppressive therapies less than four weeks prior to apheresis; patients must have recovered from acute side effects of such therapy * Positive serology for human immunodeficiency virus (HIV) * Active Hepatitis B or Hepatitis C infection * History of hypersensitivity reactions to murine proteins or seropositivity for human anti-mouse antibody (HAMA) * Requirement for corticosteroid therapy during the study period unless used specifically for amelioration of toxicity induced by transferred cells * Treatment with anti-CD20 antibodies (rituximab, tositumomab, ibritumomab) within 4 months prior to start of T cell infusions * Patients with lymph nodes in excess of 5 cm in diameter at time of T cell infusion * Patients with \> 5000 circulating CD20+ lymphocytes per mm\^3 at time of T cell infusion * Previous allogeneic stem cell transplantation * Life expectancy less than 90 days * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of transfecting and expanding the necessary numbers of T cells and the types of problems and toxicities which might be encountered, graded according the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 | Up to 2 years after final T cell infusion | A true grade 3 or higher toxicity rate in excess of 20% attributed to T cell infusions will be considered grounds for stopping the study and amending the protocol to lower the cell infusion doses. If there ever exists sufficient evidence to suggest that the true T cell-related toxicity rate (grade 3 or higher, with the exception of fever \> 40 degrees Celsius lasting less than 24 hours) exceeds 20%, the study will be stopped. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of the percentages of CD20-specific T cells and malignant B cells present in the blood before and after each T cell infusion | Up to 4 weeks after the third infusion | Numbers and percentages of CD20-specific T cells and of malignant B cells will also be quantified in lymph node (LN) and bone marrow (BM). |
| Immune response as assessed by ELISA and percent chromium release in cytotoxicity assays | Up to 12 months following treatment | Means, medians and standard deviation (S.D.) of the Ab titers observed will be computed. |
| Absolute numbers of T cells expressing the chimeric T Cell receptor (cTCR) per cubic uL of blood | Up to 1 year | — |
Countries
United States
Outcome results
None listed