Clinical Trial: Evaluation of Recovery From Drug-Induced Lymphopenia Using Cytomegalovirus-specific T-cell Adoptive Transfer

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Evaluation of Recovery From Drug-Induced Lymphopenia Using Cytomegalovirus-specific T-cell Adoptive Transfer

Brief Summary:

The purpose of this research study is to learn if your own immune cells can be activated and multiplied in order to help your body fight off the tumor cells in your brain. The safety of this procedure will also be studied. This procedure, called CMV-autologous lymphocyte transfer or CMV-ALT is investigational which means that it is not approved by the US Food and Drug Administration (FDA) and is still being tested in research studies. Autologous lymphocyte transfer or ALT means that you will receive your own immune cells back (and not from another donor) as a treatment after they have been activated and grown to large numbers in a clinical lab.

It is believed that the body's immune (protection) system can attack tumor cells and kill them. Immune cells called T-lymphocytes (T-cells) can recognize special proteins on the surface of tumors as a signal to attack and fight the cancer. In most patients with advanced cancer, the immune system does not adequately destroy the tumor because the white blood cells or T-cells are not stimulated enough.

Before your T-cells can become active against tumor cells, they require strong stimulation. There are special "stimulator" cells in the body called Dendritic Cells (DCs) that can take up proteins released from cancer cells and present pieces of these proteins to T lymphocytes to create this strong stimulation. Dendritic cells taken from your blood will be "pulsed" or loaded with genetic material called RNA (ribonucleic acid), which stimulates the DC to change the RNA into a protein called pp65. This protein is produced by a common virus called Cytomegalovirus (CMV) that 70-80% of us have been exposed to in our lifetime. Recently, we have found that this virus is present in many malignant brain tumors. Brain tumors are very aggressive and, for reasons we do not yet und

Detailed Summary:

Six CMV seropositive patients with newly-diagnosed GBM will be randomized to receive CMV-ALT (3 x 107/Kg) with or without vaccine with CMV-DCs (2 x 107). All patients will undergo a leukapheresis after resection for harvest of PBLs for CMV-ALT and CMV-DC generation. Patients will then receive RT and concurrent TMZ at a standard targeted dose of 75 mg/m2/d. Patients with histologically or clinically-proven progressive disease during radiation, dependent on steroid supplements above physiologic levels at time of vaccination, and are unable to tolerate TMZ will be replaced. If sufficient CMV-specific T-cells can't be expanded or ALT doesn't meet release criteria, the patient will be replaced and their cells may be used to offer them another DC vaccination study, such as ATTAC Pro00003877. Remaining patients will then receive the initial cycle of TMZ at a standard targeted dose of 200mg/m2/d for 5 days 3 + 1 weeks after completing RT and will be randomized to receive CMV-DCs or saline simultaneous with CMV-ALT as vaccine #1. While the standard targeted dose of 200mg/m2/d for 5 days TMZ treatment is recommended, TMZ regimen may be adjusted at the discretion of the treating neuro-oncologist. Patients with MRI changes consistent with pseudoprogression who continue on TMZ will receive CMV-ALT with vaccinations as scheduled. Peripheral blood will be drawn at 0 hours, 24 hours, 48 hours, 72 hours, and 1 week post vaccine #1 for T-cell kinetics. DCs or saline will be given intradermally and divided equally to both inguinal regions. Vaccines #2 and #3 will occur at 2 week intervals. All patients will then undergo leukapheresis again for immunologic monitoring with specific assessment of baseline antigen-specific cellular and humoral immune responses.

If the initial dose of CMV-ALT is safe and the combination of CMV-DCs is safe and does not produce an inferior CMV pp65-specific immune
Sponsor: John Sampson

Current Primary Outcome: To evaluate if vaccinating adult patients with newly-diagnosed GBMs using CMV-DCs during recovery from therapeutic TMZ-induced lymphopenia with ALT in patients that are seropositive for CMV enhances the T-cell response. [ Time Frame: 4 months after enrollment ]

Original Primary Outcome: Same as current

Current Secondary Outcome: To evaluate the safety of ALT with CMV pp65-activated T-cells in adult patients with newly-diagnosed GBMs during recovery from therapeutic TMZ-induced lymphopenia. [ Time Frame: 4 months from time of enrollment ]

Original Secondary Outcome: Same as current

Information By: Duke University

Dates:
Date Received: June 3, 2008
Date Started: September 2008
Date Completion:
Last Updated: January 20, 2016
Last Verified: January 2016