Multiple Myeloma
Conditions
Keywords
Temferon, Gene Therapy, Immunotherapy, Hematological malignancy
Brief summary
This is a non-randomized, open label, phase I/II, dose-escalation study, involving a single injection of Temferon, an investigational advanced therapy consisting of autologous CD34+-enriched hematopoietic stem and progenitor cells exposed to transduction with a lentiviral vector driving myeloid-specific interferon-ɑ2 expression, which will be administered to up to 9 patients affected by multiple myeloma in early relapse after intensive front line treatment.
Detailed description
This is a non-randomized, open label, single center, phase I/II, therapeutic exploratory, dose-escalation, prospective study, involving a single intravenous infusion of Temferon, an investigational advanced therapy consisting of autologous CD34+-enriched hematopoietic stem and progenitor cells (HSPCs) exposed to transduction with a third-generation, vesicular stomatitis virus-G (VSV-G) pseudo-typed lentiviral vector driving myeloid-specific interferon-ɑ2 (IFN-ɑ2) expression, which will be administered to up to 9 patients affected by multiple myeloma in early relapse after intensive front line treatment. The study will recruit, treat and follow-up patients at a specialist hematology and bone marrow transplantation unit at Ospedale San Raffaele (OSR) in Milan, Italy. The study will enrol multiple myeloma patients that have experienced an early relapse after intensive front line treatment, have been treated with an approved second line combination treatment regimen and obtained at least a very good partial remission (VGPR) according to International Myeloma Working Group (IMWG) criteria. Once the written informed consent is obtained, and screening procedures have been completed, harvesting of HSPCs will occur. Patients will be offered maintenance treatment during Temferon production and release. Upon Temferon release for clinical use, patients will be admitted to the transplantation unit for receipt of a reduced-intensity conditioning regimen consisting of melphalan. This will be followed by autologous stem cell transplant (ASCT) and administration of Temferon. In-patient monitoring will occur until hematological recovery occurs. Thereafter, regular follow-up of patients will occur up to 2 years (+730 days). At the +730 day visit, patients will be invited to participate in a long term follow-up study which will last for an additional 6 years. 3 cohorts of 3 patients will receive escalating doses of Temferon. In the event that MM disease progression occurs, patients will be managed according to best clinical practice.
Interventions
DRUGTemferon
Genetically modified autologous HSPCs
Sponsors
IRCCS San Raffaele
Genenta Science
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Multiple myeloma patients with early relapse after intensive front-line treatment and disease measurable by serum biomarkers, who have obtained at least a VGPR after second-line salvage treatment. * Able and willing to provide written informed consent. * Able to comply with study protocol and procedures. * Performance status scores: Eastern Cooperative Oncology Group (ECOG) \< 2 and Karnofsky \> 70%. * Life expectancy of ≥ 6 months. * Adequate cardiac, renal, hepatic and pulmonary functions as evidenced by (at screening and prior to conditioning): * Left ventricular ejection fraction (LVEF) ≥ 45% by echo and normal electrocardiogram (ECG) or presence of abnormalities not significant for cardiac disease. Absence of severe pulmonary hypertension; * Diffusing capacity of the lung for carbon monoxide (DLCO) \>50% and forced expiratory volume in 1 sec (FEV1) and forced expiratory vital capacity (FVC) \> 60% predicted (if non cooperative: pulse oximetry \> 95 % in room air); * Serum creatinine \< 2x ULN and estimated glomerular filtration rate (eGFR) \> 30 ml/min/1.73m2; * Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x ULN, and total bilirubin ≤ 2.0 mg/dl. * Women of child-bearing potential enrolled in the study must have a negative pregnancy test at screening and agree to use two distinct acceptable methods of contraception during the trial. * Men enrolled in the study with partners who are women of child bearing potential, must be willing to use an acceptable barrier contraceptive method during the trial or have undergone successful vasectomy at least 6 months prior to entry into the study. Successful vasectomy needs to have been confirmed by semen analysis.
Exclusion criteria
* Use of other investigational agents within 4 weeks prior to experimental treatment (within 6 weeks if use of long-acting agents). * Severe active viral, bacterial, or fungal infection at eligibility evaluation. * Active autoimmune disease or a clinically relevant autoimmune manifestations, requiring immunosuppressive treatment, i.e. psoriasis, systemic lupus erythematosus, rheumatoid arthritis, vasculitis, immune-mediated peripheral neuropathies. * Active sarcoidosis requiring steroid or other immunosuppressive treatment. * Primary amyloidosis. * History of neuropsychiatric illness including severe depression, schizophrenia, bipolar disorders, impaired cognitive function, dementia or suicidal tendency. * Neuropathy \> grade 2. * History of severe cardiovascular disease such as prior stroke, coronary artery disease requiring intervention, unresolved arrhythmias. * Malignant neoplasia (except local skin cancer or cervical intraepithelial neoplasia) or family history of familial cancer syndromes. * Myelodysplasia, cytogenetic or molecular alterations specifically associated with clonal hematopoiesis of the myeloid lineage, or other serious hematological disorder other than the plasma cell dyscrasia. * Other clinical conditions judged by the Investigator non-compatible with the study procedures. * Positivity for HIV-1 or HIV-2 (serology or RNA), and/or Hepatitis B Virus Surface Antigen (HbsAg) and/or Hepatitis B Virus (HBV) DNA and/or Hepatitis C Virus (HCV) RNA (or negative HCV RNA but on antiviral treatment) and/or Treponema Pallidum or Mycoplasma active infection. * Active alcohol or substance abuse within 6 months of the study. * Pregnancy or lactation. * Previous allogeneic bone marrow transplantation, kidney or liver transplant, or gene therapy. * Prior to conditioning: inability to meet the target mobilization cell number needed to manufacture the Drug Product after at least 2 attempts of HSPC collection.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tolerability and Safety of Temferon Over the First 90 Days Following Administration as Determined by the Incidence of CTCAEs | 90 days | 0 participants analyzed. All the patients were withdrawn before treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Patients Achieving Hematologic Recovery by Day +30 (Defined as the First of at Least 3 Consecutive Days With a Neutrophil Count >0.5 x 10^9/L and Platelet Count >20 x 10^9/L) in the Absence of Transfusions | 30 days | — |
| Determine the Maximum Tolerated Dose of Temferon | 30 days | — |
| Identify Presence of Transduced Myeloid Cells in Bone Marrow as Determined by Vector Copy Number | Up to 2 years | — |
| Identify Presence of Transduced Myeloid Cells in Peripheral Blood as Determined by Vector Copy Number | Up to 2 years | — |
| Identify Persistence of Transduced Myeloid Cells in Bone Marrow and Peripheral Blood as Determined by Vector Copy Number | At least 12 weeks | — |
| Determine Clinical Response in Patients as Determined by IMWG Response Criteria | Up to 2 years | — |
| Long Term Tolerability and Safety of Temferon as Determined by the Incidence of CTCAEs | 2 years | 0 participants analyzed. All the patients were withdrawn before treatment |
| Determine Progression Free Survival in Patients | Up to 2 years | — |
| Determine Overall Survival in Patients | 2 years | — |
| Changes in Functional Status (Eastern Cooperative Oncology Group, ECOG) | 2 years | — |
| Changes in Functional Status (Karnofsky) | 2 years | — |
| Changes in Quality of Life: European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 | 2 years | — |
| Changes in Quality of Life: European Organisation for Research and Treatment of Cancer (EORTC) QLQ-MY20 | 2 years | — |
| Fraction of Patients Achieving Complete Response With Minimal Residual Disease (MRD) Negativity | Up to 2 years | — |
Countries
Italy
Participant flow
Recruitment details
3 patients recruited but none received Temferon. Unable to recruit additional patients due to the ongoing COVID-19 pandemic.
Participants by arm
| Arm | Count |
|---|---|
| Patient Recruitment 3 patients recruited into the study but no patients received Temferon. Study terminated due to inability to recruit additional patients in view of the ongoing COVID-19 pandemic | 0 |
| Total | 0 |
Baseline characteristics
| Characteristic | — |
|---|---|
| Region of Enrollment Italy | — participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Tolerability and Safety of Temferon Over the First 90 Days Following Administration as Determined by the Incidence of CTCAEs
0 participants analyzed. All the patients were withdrawn before treatment
Time frame: 90 days
Population: Untreated patients
Secondary
Changes in Functional Status (Eastern Cooperative Oncology Group, ECOG)
Time frame: 2 years
Secondary
Changes in Functional Status (Karnofsky)
Time frame: 2 years
Secondary
Changes in Quality of Life: European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30
Time frame: 2 years
Secondary
Changes in Quality of Life: European Organisation for Research and Treatment of Cancer (EORTC) QLQ-MY20
Time frame: 2 years
Secondary
Determine Clinical Response in Patients as Determined by IMWG Response Criteria
Time frame: Up to 2 years
Secondary
Determine Overall Survival in Patients
Time frame: 2 years
Secondary
Determine Progression Free Survival in Patients
Time frame: Up to 2 years
Secondary
Determine the Maximum Tolerated Dose of Temferon
Time frame: 30 days
Secondary
Fraction of Patients Achieving Complete Response With Minimal Residual Disease (MRD) Negativity
Time frame: Up to 2 years
Secondary
Identify Persistence of Transduced Myeloid Cells in Bone Marrow and Peripheral Blood as Determined by Vector Copy Number
Time frame: At least 12 weeks
Secondary
Identify Presence of Transduced Myeloid Cells in Bone Marrow as Determined by Vector Copy Number
Time frame: Up to 2 years
Secondary
Identify Presence of Transduced Myeloid Cells in Peripheral Blood as Determined by Vector Copy Number
Time frame: Up to 2 years
Secondary
Long Term Tolerability and Safety of Temferon as Determined by the Incidence of CTCAEs
0 participants analyzed. All the patients were withdrawn before treatment
Time frame: 2 years
Secondary
Proportion of Patients Achieving Hematologic Recovery by Day +30 (Defined as the First of at Least 3 Consecutive Days With a Neutrophil Count >0.5 x 10^9/L and Platelet Count >20 x 10^9/L) in the Absence of Transfusions
Time frame: 30 days