Epstein-Barr Virus Infections, Lymphoma, Post-Transplant Lymphoproliferative Disorder
Conditions
Keywords
Allogeneic Transplantation, T cell, Epstein-Barr Virus
Brief summary
This study evaluates the safety and efficacy of EBV-specific T-cell lines to treat patients suffering from high EBV viral titers not responding to standard of care therapies and to treat EBV-related lymphoma. The study will recruit 6 patients to receive autologous T cells or a T cell line derived from the patient's allogeneic donor (in the case of stem cell transplant recipients), and 6 patients to receive a T-cell line prepared from a matched or partially matched related donor.
Detailed description
Epstein-Barr virus (EBV) is a member of the herpes virus family and infects up to 95% of individuals over their lifetime. Most initial infections occur in childhood and after a brief flu-like illness, the virus enters a phase of latency. Patients who receive a bone marrow transplant or an organ transplant take medications drugs that weaken their immune systems. In these contexts, the virus can reactivate and cause very serious problems, such as lymphoma. For unknown reasons, people with a normal immune system can also develop lymphoma due to EBV. The purpose of this study is to test the safety and efficacy of immune cells (T lymphocytes) that are specifically taught to recognize the virus-infected cells and to eliminate them. This education occurs is done over during a 2 weeks period (approximately), in the research laboratory. The cells are then transfused into the patient.
Interventions
BIOLOGICALGroup A
Peptide-stimulated T cells 2 x 10\^7/m\^2
BIOLOGICALGroup B
Peptide-stimulated T cells per dose-escalation protocol
Sponsors
Dr. Jean-Sebastien Delisle, MD, PhD
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Capacity to provide informed consent * Age ≥ 18 years old * Confirmed treatment-refractory EBV reactivation or EBV-related lymphoma * ECOG of 2 or less
Exclusion criteria
* Medical condition requiring a corticosteroid dose greater than Prednisone 0.5mg/kg/day (or equivalent) at the time of the infusion. * Patient has received T-cell depleting antibodies or stem cell transplantation in the 28 days prior to proposed date of anti-EBV T-cell line infusion * Patient has received a solid organ transplant in the 3 months prior to proposed date of anti-EBV T-cell line infusion. * Pregnant or nursing females * Life expectancy of less than 3 months due to a condition unrelated to the EBV- related disease. * Active uncontrolled GVHD * Active uncontrolled SOT rejection episode DONOR ELIGIBILITY: An allogeneic donor must be a first-degree relative with at least 3/6 HLA compatibility, have consented to donate peripheral blood mononuclear cells, and fulfill the same criteria for stem cell donation according to the hospital's standard operating procedure.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety: Incidence and description of CTCAE v.4.03 adverse events related to the experimental treatment | During observation period (up to 42 days post infusion) | Complications: infusional toxicity, immune-related and other |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Immune reconstitution as measured by various laboratory assays of immune cell type and function | During observation period until 12 months post infusion | ELISpot on peripheral blood is assessed at the time points mentioned above |
| All cause mortality | At 12 months | Within the 12 months observation period |
| Transplant-related outcomes | During observation period until 12 months post infusion | Incidence/severity of graft-versus-host disease, solid organ rejection episodes, relapse |
| Changes in EBV titers (viral load) for each patient | Until 12 months post infusion | As measured by PCR weekly until week 6, at 3 months, 6 months and 12 months |
| Number and severity of solid organ rejection episodes per patient among those who underwent solid organ transplant | During observation period until 12 months post infusion | Based on standardized assessments done weekly until week 6 and at 3, 6 and 12 months |
| Incidence of primary disease relapse among patients who underwent stem cell transplantation | During observation period until 12 months post infusion | Based on standardized assessments done weekly until week 6 and at 3, 6 and 12 months |
| Malignancy staging for patients with lymphoma, per internationally-accepted guidelines for the different specific lymphomas | During observation period until 12 months post infusion | As clinically indicated by the investigators and/or primary physician |
| Incidence/severity of graft-versus-host disease among patients who underwent stem cell transplantation | During observation period until 12 months post infusion | Based on standardized assessments done weekly until week 6 and at 3, 6 and 12 months |
Countries
Canada
Outcome results
None listed