Study of KIR-Ligand Mismatched Haplo-Identical Natural Killer Cells Transfused Before Autologous Stem Cell Transplant

Study Overview
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Brief Summary
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The purpose of this study is to induce anti-myeloma responses in patients with high risk or relapsed myeloma using combination chemo- and immunotherapy comprising sequentially: 1) lymphoid and myeloid suppressive conditioning, 2) adoptive transfer of purified KIR-ligand mismatched Natural Killer cells from a haplo-identical donor, and 3) autografting two weeks after infusion of NK cells to ensure autologous reconstitution. Other objectives include establishing the response rate, disease free survival, progression free survival and toxicity of regimen. Secondary objectives are to monitor the persistence of haplo-identical purified KIR-ligand mismatched Natural Killer cells by molecular methods, select haplo-identical purified KIR-ligand mismatched donors and predict prior to therapy which donor will induce a response, monitor Natural Killer cell reconstitution prior to and after autografting, and establish Natural Killer cell clones after autografting and determine origin and specificity.

Detailed Description
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This study will induce anti-myeloma responses in patients with high risk or relapsed myeloma using combination chemo- and immunotherapy comprising sequentially: 1) lymphoid suppressive conditioning to avoid rejection of the donor NK cells, 2) adoptive transfer of purified KIR-ligand mismatched Natural Killer cells from a haplo-identical donor, and 3) autografting two weeks after infusion of NK cells to ensure autologous reconstitution.

Official Title
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UARK 2003-18, A Phase II Study of KIR-Ligand Mismatched Haplo-Identical Natural Killer Cells Transfused Before Autologous Stem Cell Transplant in Relapsed Multiple Myeloma

Conditions
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Multiple Myeloma

Intervention / Treatment
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* Drug: Dexamethasone
* Drug: Cyclophosphamide
* Drug: Melphalan
* Drug: Fludarabine
* Drug: Bortezomide
* Procedure: Leukapheresis
* Drug: Interleukin
* Procedure: Infusion #1
* Procedure: Leukapheresis #2
* Procedure: Infusion #2
* Procedure: Auto Graft


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: MM in frank relapse after a single or tandem transplant or high risk Myeloma Patients with prior transplant must be more than 4 months after the last transplant Karnofsky performance score >or =70, or a performance score of 50-70 exclusively due to bone pain caused by myeloma 18 years of age or older An expected survival greater than 3 months ANC >1,000/microliters, platelet count > 100,000/microliters Donor and patient must have signed an IRB-approved consent and been informed about the investigational nature of the study Donor must have negative serology for HIV Available haplo-identical family donor fit to undergo leukapheresis and mismatched for KIR-ligand(s) with the patient in the graft-versus host direction. Stored cells for autografting of at least 30 million CD34+ cells/kg Back-up cells of at least 20 million CD34+ cells/kg in case of non-engraftment. There must be an unambiguous marker for response to therapy in the first ten patients. Therefore the patient must have detectable and quantifiable M-protein or light chain excretion in urine, light chain quantification in serum (FREELITE) or clear radiological signal lesion(s) in order to be eligible After 10 relapsed patients have been treated and toxicity is deemed acceptable, high-risk myeloma (defined as the presence of abnormal cytogenetics or metaphase analysis) patients without relapse can be entered Exclusion Criteria: Intravenous chemotherapy or antibody therapy affecting T-lymphocytes and/or natural killer cells e.g. cyclophosphamide, melphalan, ATG, Campath-1H etc. within the past 2 weeks prior to commencement of conditioning. Last therapy is less than 14 days prior to starting fludarabine Fever or active infection, requiring IV antibiotics Liver function: total bilirubin > 2xULN or AST/ALT >3xULN Renal function: patients on dialysis

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Dexamethasone|Dexamthasone 40mg every day, days -5 to -1 only will be given.|
|Drug: Cyclophosphamide|A dose of 60mg/kg (using calculated body weight - see appendix A.) will be infused on day-3, and -2. Cyclophosphamide is administered by intravenous infusion over 2-4 hrs in 250 mLs of Normal Saline (0.9%) or D5W Standard MESNA (60% or 36mg/kg) protection to prevent hemorrhagic cystitis will be given on day -3, -2 and -1.|
|Drug: Melphalan|Melphalan will be given as a single dose of 140mg/m2 on day -1. Subject weighing more than 60kg will be dosed according to their calculated body weight.Melphalan will be diluted in normal saline(0.9%NaCl) to a concentration of 1.5mg/ml. A dose of 140mg/m2 will be administered intravenously over a period <or= 20 minutes on day -1.|
|Drug: Fludarabine|dose of 1.0mg/m2 on days -8,-5,-2.|
|Drug: Bortezomide|A dose of 1.0mg/m2 will be given as a bolus dose on day-8, day-5 and day-2 as per standard practice|
|Procedure: Leukapheresis|On day 0 to collect donor cells for NK cell isolation|
|Drug: Interleukin|2 at 3x10x6 IU on days +1 to 13.|
|Procedure: Infusion #1|Infusion of donor NK Cells #1 on day 0|
|Procedure: Leukapheresis #2|on day +2|
|Procedure: Infusion #2|on day +2|
|Procedure: Auto Graft|on day +14|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To induce anti-myeloma responses in patients with high risk or relapsed myeloma using combination chemo- and immunotherapy comprising sequentially. |  | annually | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To establish the response rate, disease free survival , overall survival , and toxicity of regimen. |  | annually | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myeloma, Transplant, Relapsed, Donor, Stem Cell, Thalidomide, Dexamethasone, Cisplatin, Adriamycin, Cyclophosphamide, Etoposide, Melphalan