CD8+ Memory T-Cells as Consolidative Therapy After Donor Non-myeloablative Hematopoietic Cell Transplant in Treating Patients With Leukemia or Lymphoma
Condition: Acute Myeloid Leukemia; B-Cell Non-Hodgkin Lymphoma; Chronic Lymphocytic Leukemia; Hodgkin Lymphoma; Myelodysplastic Syndrome; Myeloproliferative Neoplasm; T-Cell Non-Hodgkin Lymphoma
MeSH terms: Lymphoma; Leukemia; Lymphoma, Non-Hodgkin; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, B-Cell; Lymphoma, T-Cell; Myelodysplastic Syndromes; Myeloproliferative Disorders
Intervention: Anti-Thymocyte Globulin; Cyclosporine; Mycophenolate Mofetil; Nonmyeloablative Allogeneic Hematopoietic Stem Cell Transplant; Allogeneic Cluster of Differentiation 8 (CD8)+ Memory T-cells; Total Nodal Irradiation
Intervention description: Given per standard institutional practice; Given PO; Given PO; Undergo nonmyeloablative allogeneic HSCT; Receive CD8+ memory T-cells via IV; Undergo TLI
Intervention MeSH terms: Cyclosporine; Mycophenolic Acid; Cyclosporins; Thymoglobulin; Antilymphocyte Serum
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 18.0
Sex: All
Minimum age: 18 Years
Maximum age: 80 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Healthy Stem Cell Donor

Summary:

      This phase 2 trial studies how well cluster of differentiation 8 (CD8)+ memory T-cells work
      as a consolidative therapy following a donor non-myeloablative hematopoietic cell transplant
      in treating patients with leukemia or lymphoma. Giving total lymphoid irradiation and
      anti-thymocyte globulin before a donor hematopoietic cell transplant helps stop the growth of
      cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer cells.
      When the healthy stem cells from a donor are infused into the patient they may help the
      patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.
      Sometimes the transplanted cells from a donor can make an immune response against the body's
      normal cells (called graft-versus-host disease). Giving cyclosporine and mycophenolate
      mofetil after the transplant may stop this from happening. Once the donated stem cells begin
      working, the patient's immune system may see the remaining cancer cells as not belonging in
      the patient's body and destroy them. Giving an infusion of the donor's white blood cells,
      such as CD8+ memory T-cells, may boost this effect and may be an effective treatment to kill
      any cancer cells that may be left in the body (consolidative therapy).
    

Eligibility criteria:

        Inclusion Criteria:

          -  Must have a human leukocyte antigen (HLA)-matched or single allele-mismatched adult
             sibling serving as donor

          -  Must have a myeloid or lymphoid malignant disease that is treated with TLI and ATG
             reduced intensity conditioning for allogeneic transplant (any of the following AML,
             myelodysplastic syndrome [MDS], myeloproliferative disease [MPD], CLL, B or T-cell
             NHL, HL)

          -  Patients who due to age, pre-existing medical conditions, or, prior therapy are
             considered to be at high risk for regimen related toxicity associated with fully
             ablative transplant conditioning, and therefore reduced intensity conditioning is
             recommended

          -  Ability to understand and the willingness to sign a written informed consent document;
             patients must have signed informed consent to participate in the trial

          -  DONOR: Must be an HLA-matched or single allele mismatched sibling of enrolled
             transplant patient

          -  DONOR: Must be 18-75 years of age, inclusive

          -  DONOR: Must be in a state of general good health and have completed a donor evaluation
             with history, medical examination and standard blood tests within 35 days of starting
             the hematopoietic cell collection procedure; in order to fairly represent the
             interests of the donor, the donor evaluation and consent will be performed by a study
             team member other than the recipient's attending physician

          -  DONOR: Must have a white blood cell count > 3.5 x 10^9/liter, platelets > 150 x
             10^9/liter and hematocrit > 35%

          -  DONOR: Must be capable of undergoing leukapheresis

          -  DONOR: Must be able to understand and sign informed consent

          -  DONOR: Must not be seropositive for HIV 1 and 2, hepatitis B surface antigen,
             hepatitis C antibody, human T-lymphotropic virus (HTLV) antibody, cytomegalovirus
             (CMV) immunoglobulin M (IgM), or rapid plasma reagin (RPR) (Treponema); donors with
             prior evidence of hepatitis B core antibody positivity will have a polymerase chain
             reaction (PCR) test done to evaluate for hepatitis B infection; donors with a positive
             hepatitis B PCR test are excluded

          -  DONOR: Females must not be pregnant or lactating

          -  DONOR: Must not have psychological traits or psychological or medical conditions which
             make them unlikely to tolerate the procedure

          -  DONOR: Must not have developed a new malignancy requiring chemotherapy or radiation in
             the interval since apheresis for initial hematocrit (HCT)

          -  PATIENT CRITERIA FOR PROCEEDING WITH CD8+ MEMORY T-CELL INFUSION:

          -  Patients must be beyond day 30 and before day 60 after transplant

          -  Patients must have evidence of mixed CD3 T-cell chimerism based on the day +28 (+/- 7
             days) blood sample showing >= 5% and =< 95% donor type cells

          -  Patients must have no evidence of active graft-versus-host disease at the time of the
             CD8+ memory T-cell infusion; patients with a history of acute GVHD overall grade II
             based on skin only involvement or upper gastrointestinal (GI) tract involvement only
             will be eligible; patients with a history of liver or lower GI tract GVHD will not be
             eligible

          -  Patients must be on single immune suppression therapy with either tacrolimus or
             cyclosporine at the time of CD8+ memory T-cell infusion; prednisone at a physiologic
             dose of 5 mg per day or less is allowed

          -  Patients must have a Karnofsky performance status of >= 60% at the time of the CD8+
             memory T-cell infusion

          -  Patients must not have an uncontrolled bacterial, fungal or viral infection, defined
             as progressive symptoms despite therapy, at the time of the CD8+ memory T-cell
             infusion; asymptomatic viremia is allowed

          -  Patients must have adequate organ function and performance status at the time of the
             CD8+ memory T-cell infusion, defined by the following:

               -  Total bilirubin =< 4 mg/dL

               -  SGOT or SGPT =< 4 x ULN

               -  Creatinine =< 3 mg/dL or estimated creatinine clearance >= 40ml/min

        Exclusion Criteria:

          -  Uncontrolled bacterial, viral or fungal infection defined as currently taking
             medication and progression of clinical symptoms

          -  Progressive hemato-lymphoid malignancy despite conventional therapy

          -  Acute leukemia not in remission

          -  Chronic myelogenous leukemia (CML)

          -  Active central nervous system (CNS) involvement of the underlying malignancy

          -  Human immunodeficiency virus (HIV) positive

          -  Pregnant or lactating

          -  Prior malignancy (EXCEPTION: diagnosed > 5 years ago without evidence of disease, OR
             treated =< 5 years ago but have a greater than 50% chance of life expectancy of >= 5
             years for that malignancy)

          -  Have a psychiatric disorder(s) or psychosocial circumstance(s) which in the opinion of
             the primary physician would place the patient at an unacceptable risk from transplant

          -  Ejection fraction < 30%, or uncontrolled cardiac failure

          -  Diffusing capacity of the lung for carbon monoxide (DLCO) < 40% predicted

          -  Total bilirubin > 3 mg/dL

          -  Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamate pyruvate
             transaminase (SGPT) > 4 x upper limit of normal (ULN)

          -  Creatinine > 2 mg/dL and an estimated creatinine clearance =< 40 mL/min

          -  Poorly controlled hypertension despite multiple antihypertensive medication OR

          -  Karnofsky performance status (KPS) < 60%

          -  Note: Patients positive for hepatitis B and C will be evaluated on a case by case
             basis