Graft-versus-Host Disease, GvHD, Leukemia, Lymphoma, Myelodysplastic Syndromes, Opportunistic Infections
Conditions
Keywords
CD45RA-depletion, TCR-alpha/beta depletion, Hematopoietic Stem Cell Transplantation
Brief summary
The purpose of this prospective randomized study is to determine whether infusions of T-memory cells prevent infections in children with leukemia after allogeneic alpha, beta T-cell receptor (TcRab)/CD19-depleted hematopoietic stem cell transplantation (HSCT).
Detailed description
Graft-versus-host disease (GVHD) remains the most important direct complication of hematopoietic stem cell transplantation. Methods used to prevent GVHD include diverse pharmacologic interventions and ex vivo methods of T-cell depletion, the latter being the most effective ones. Historically depletion of T-cells from the graft is associated with increased rate of graft failure, relapse of malignant disease and prolonged immune deficiency. Selective depletion of TCR-alpha/beta T-lymphocytes is a new method of hematopoietic stem cell graft manipulation, which is thought to conserve important cell populations, e.g. NK cells and gamma/delta T cells within the graft. Preliminary results suggest that TCR alpha/beta depletion ensures high engraftment rate, low early mortality and good control of GVHD. The problem of delayed immune reconstitution and life-threatening viral infections remains incompletely resolved. Depletion of naive (CD45RA-positive) T-cells was developed as a new method of graft manipulation to prevent GVHD. Research data indicate that alloreactivity is associated mainly with naive T-cell fraction. In vitro depletion of CD45RA lowers significantly the alloreactive response while retaining reactivity to pathogens. In previous pilot protocol the investigators confirmed that infusion after TCR-alpha/beta depleted transplantation of low doses of CD45RA-depleted mononuclear cells are safe and potentially protective against viral infections. The biologic readout for the protocol was a quantitative assessment of T-cell reactivity to common pathogens after infusion and owing to the trial results expansion of CMV-specific CD8 T-cells was discovered in most of the patients. In current randomized protocol the investigators are posing a question if donor lymphocytes infusion (DLI) of low doses of CD45RA-depleted mononuclear cells are effective in viral prophylaxis after TCR-alpha/beta depleted transplantation.
Interventions
Infusion of escalating doses of CD45RA-depleted donor-derived allogeneic peripheral blood mononuclear cells
Sponsors
Federal Research Institute of Pediatric Hematology, Oncology and Immunology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 25 Years
Healthy volunteers
No
Inclusion criteria
* Patients who are considered candidates for allogeneic hematopoietic stem cell transplantation and have one of the following diagnoses: * Acute lymphocytic leukemia (ALL) * Acute myeloid leukemia * Acute biphenotypic leukemia * Acute bilinear leukemia * Lymphoma * Myelodysplastic syndrome * Chronic myeloid leukemia * Transplant processing: TCR ab/CD19-depletion * Donors: * HLA-match unrelated volunteers * Partly and haploidentical relative
Exclusion criteria
* ALL patients not in remission * Patients with uncontrolled infections * Clearance of creatinine \< 70 ml/min * Cardiac ejection fraction \< 40% * Patients who can perform pulmonary function tests will be excluded if they have a diffusing capacity of the lung for carbon monoxide (DLCO) (corrected for hemoglobin) of \< 50% predicted; patients who are unable to perform pulmonary function tests will be excluded if the oxygen (O2) saturation is \< 92% on room air * Patients who have liver function test (LFTs) (including total bilirubin, aspartate aminotransferase \[AST\] and alanine aminotransferase \[ALT\]) \>= twice the upper limit of normal * Mental disease of both patient, patient's tutor (if patient is under age 18) and donor, that hinder understanding of main point of the study and keeping treatment plan, hygiene and sanitation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| cumulative incidence of the probability of CMV-reactivation after HSCT | 120 days after HSCT |
| cumulative incidence of acute GVHD grade II-IV. | 150 days after HSCT |
Secondary
| Measure | Time frame |
|---|---|
| Event-free survival at 365 days after HSCT | 365 days after HSCT |
| cumulative incidence of relapse at 6 months and 365 days after HSCT | 6 months and 365 days |
| cumulative incidence of of CMV-disease at 100,180 and 365 days after HSCT | 100, 180 and 365 days after HSCT |
| cumulative incidence of chronic GvHD | 1 year after HSCT |
| cumulative incidence of neutrophil and platelets engraftment at 14 and 30 days after HSCT | 14 and 30 days |
| cumulative incidence of transplant-related mortality at 6 months after HSCT | 6 months |
| overall survival at 365 days after HSCT | 365 days after HSCT |
Countries
Russia
Outcome results
None listed