Immune Reconstitution After Autologous Hematopoietic Stem Cell Transpl for High-Risk Lymphoma

Study Overview
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Brief Summary
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RATIONALE: Vaccines may help the body build an effective immune response to kill cancer cells. Giving vaccine therapy after an autologous stem cell transplant may kill any cancer cells that remain after transplant. PURPOSE: This clinical trial is studying how well vaccine therapy works in treating patients who have undergone autologous stem cell transplant for high-risk lymphoma or multiple myeloma.

Detailed Description
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OBJECTIVES: Primary Assess immune reconstitution as measured by response to pneumococcal polyvalent vaccine, NK-cell activity against autologous lymphoblastoid cell lines, and cytomegalovirus and Epstein-Barr virus tetramer responses in patients who have undergone autologous hematopoietic stem cell transplantation for high-risk lymphoma or multiple myeloma. Secondary Assess the absolute number of circulating regulatory T-cells and the function of these cells as measured by their expression of TGFβ and interleukin-10 (IL-10). Evaluate the effect of conditioning therapy on quality of life, including functional status, fatigue, and depression, in these patients. Correlate quality of life with inflammatory cytokine production of peripheral blood monocytes at specified time points. Provide baseline immune reconstitution and quality of life pilot data for comparison in future post-transplant immunotherapy trials. OUTLINE: Patients receive pneumococcal polyvalent vaccine intramuscularly once in weeks 9, 17, and 25 after autologous hematopoietic stem cell transplantation. Blood samples are collected periodically for correlative and immunological studies. Quality of life (QOL) is assessed periodically using the QOL short form (SF-36, 4-week version), the Center for Epidemiologic Studies Depression scale (CES-D), and the Multidimensional Fatigue Symptom Inventory (MFSI-30).

Official Title
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Immune Reconstitution After Autologous Hematopoietic Stem Cell Transplantation for High-Risk Lymphoma and Myeloma

Conditions
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Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Small Intestine Cancer

Intervention / Treatment
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* Biological: Streptococcus pneumoniae
* Other: laboratory correlative studies
* Other: quality-of-life assessment


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma OR any of the following high-risk lymphomas: Diffuse large B-cell lymphoma meeting any of the following criteria: Failed induction therapy but responded to salvage therapy Relapsed < 1 year after completion of induction therapy Elevated lactic dehydrogenase (LDH) at relapse Stage III or IV disease at relapse Positive PET scan after induction or salvage therapy Age 60 to 75 years Follicular lymphoma meeting any of the following criteria: Progressive disease after two or more prior regimens Transformed to aggressive diffuse large B-cell lymphoma but is still chemotherapy sensitive Not considered to be a good candidate for allogeneic stem cell transplantation Hodgkin lymphoma meeting any of the following criteria: Primary refractory disease Relapsed < 1 year after completion of induction therapy Relapsed with PET positive disease after salvage therapy Relapsed refractory disease and is not considered to be a good candidate for allogeneic stem cell transplantation Mantle cell lymphoma meeting any of the following criteria: Chemotherapy sensitive disease after induction therapy Chemotherapy sensitive relapsed disease and is not considered to be a good candidate for allogeneic stem cell transplantation T-cell non-Hodgkin lymphoma (NHL) meeting any of the following criteria: Peripheral T-cell lymphoma, not otherwise specified meeting at least one of the following criteria: High LDH at diagnosis Marrow involvement at diagnosis Age > 60 years at diagnosis Low platelet count at diagnosis Chemotherapy sensitive relapsed disease Angioimmunoblastic lymphadenopathy with dysproteinemia ALK-negative anaplastic NHL Enteropathy-associated T-cell NHL Stage III or IV NK-/T-cell NHL at diagnosis NK-blastic NHL Has undergone autologous hematopoietic stem cell transplantation and received 200 mg/m² of melphalan (for multiple myeloma) OR BEAM chemotherapy comprising carmustine, etoposide, cytarabine, and methotrexate (for high-risk lymphoma) as conditioning therapy PATIENT CHARACTERISTICS: ECOG or WHO performance status 0-2 ANC ≥ 1,000/μL Platelet count ≥ 75,000/μL Total bilirubin ≤ 1.5 mg/dL Alkaline phosphatase ≤ 2 times upper limit of normal (ULN) AST and ALT ≤ 2 times the ULN Not pregnant or nursing No severe or uncontrolled systemic illness No currently active second malignancy, other than nonmelanoma skin cancer or carcinoma in situ of the cervix Patients are not considered to have a currently active malignancy if they completed therapy for the malignancy, are disease free from the malignancy for > 5 years, and are considered by their physician to be at < 30% risk of relapse No significant history of uncontrolled cardiac disease including, but not limited to, any of the following: Uncontrolled hypertension Unstable angina Recent myocardial infarction (within the past 6 months) Uncontrolled congestive heart failure No active bacterial, fungal, or viral infection No known HIV infection or active hepatitis B and/or hepatitis C infection No other medical condition, including mental illness or substance abuse, deemed by the investigator(s) to likely interfere with the patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the study results PRIOR CONCURRENT THERAPY: No concurrent biologic therapy, chemotherapy, or other antineoplastic therapy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prevnar<br>The conjugate vaccine for Streptococcus pneumoniae will be administered during weeks 9, 17, and 25 after autologous HSCT - the study nurse will arrange for the vaccine to be administered at the specified time and the patient will be instructed to notify an investigator or study nurse of any side effects of vaccine administration. At the specified times, patients will fill out the quality-of-life assessment. All patients enrolled on this trial will have samples procured for all proposed laboratory correlative studies. | Biological: Streptococcus pneumoniae<br>* Patients will receive 0.5 mL Prevnar in the deltoid muscle during weeks 9, 17, and 25 after autologous hematopoietic stem cell transplantation (HSCT)<br>* Other names: PCV7;Other: laboratory correlative studies<br>* Approximately 30-mL of blood will be collected and sent to the appropriate research lab(s) for processing.<br>* Other names: blood samples;Other: quality-of-life assessment<br>* Responses to Hospital Anxiety and Depression Scale, 9-item brief fatigue inventory 57, brief pain inventory, and the FACT-G. This should take each patient approximately 10-15 minutes to fill out all these surveys per instance.<br>* Other names: QOL;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Experiencing Immune Reconstitution | Immune reconstitution as measured by response to conjugate vaccine to Streptococcus pneumoniae (Prevnar, PCV7), NK cell activity against autologous lymphoblastoid cell lines, and CMV & EBV tetramer responses after autologous transplant for myeloma | Up to 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serial Assessment of the Absolute Number of Circulating Regulatory T-cells and the Function of These Cells as Measured by Their Expression of TGFβ and Interleukin-10 (IL-10) |  | Up to 3 years | 
| Correlation of Quality of Life With Inflammatory Cytokine Production of Peripheral Blood Monocytes |  | Up to 3 years | 
| Quality of Life, Including Brief Pain Inventory | The Brief Pain Inventory - Short Form (BPI-SF) asks respondents to rate the severity of their current, least, average, and worst pain over the previous 24 hours on a scale of 0 to 10. The BPI-SF also asks respondents to rate on a scale of 0 to 10 the degree to which pain interfered with seven different areas of their life (e.g., general activity, normal work, etc.)Scale 0-10 with 0 being no pain and 10 being pain as bad as you can imagine. | Up to 3 years | 
| Quality of Life, Including Fatigue | Brief Fatigue Inventory is a 9-item BFI assessing the severity of fatigue and the impact of fatigue on daily function. Scale 0-10 with 0 being no fatigue and 10 being as bad as you can imagine. | Up to 3 years | 
| Collection of Baseline Immune Reconstitution and Quality of Life Pilot Data for Comparison in Future Post-transplant Immunotherapy Trials |  | Up to 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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contiguous stage II mantle cell lymphoma, noncontiguous stage II mantle cell lymphoma, recurrent mantle cell lymphoma, stage I mantle cell lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, recurrent adult diffuse large cell lymphoma, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, contiguous stage II grade 1 follicular lymphoma, contiguous stage II grade 2 follicular lymphoma, contiguous stage II grade 3 follicular lymphoma, noncontiguous stage II grade 1 follicular lymphoma, noncontiguous stage II grade 2 follicular lymphoma, noncontiguous stage II grade 3 follicular lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, stage I grade 1 follicular lymphoma, stage I grade 2 follicular lymphoma, stage I grade 3 follicular lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, stage IV grade 3 follicular lymphoma, recurrent adult Hodgkin lymphoma, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma, contiguous stage II adult diffuse large cell lymphoma, noncontiguous stage II adult diffuse large cell lymphoma, stage I adult diffuse large cell lymphoma, adult nasal type extranodal NK/T-cell lymphoma, angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, small intestine lymphoma