Ex Vivo-activated Autologous Lymph Node Lymphocytes in Treating Patients With Chronic Lymphocytic Leukemia

Study Overview
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Brief Summary
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This phase II trial studies the side effects of ex vivo-activated autologous lymph node lymphocytes infusion and to see how well they work in treating patients with chronic lymphocytic leukemia. Biological therapies, such as ex vivo-activated autologous lymph node lymphocytes, use substances made from living organisms that may stimulate or suppress the immune system in different ways and stop tumor cells from growing.

Detailed Description
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PRIMARY OBJECTIVES: I. To assess the feasibility and safety of infusion of autologous activated T-cells (ex vivo-activated autologous lymph node lymphocytes) in patients with chronic lymphocytic leukemia. SECONDARY OBJECTIVES: I. To study immune reconstitution following infusion of activated T-cells in patients with chronic lymphocytic leukemia. II. To study the incidence of infections for up to 1 year following activated T cell infusion. III. To study the overall response rates. OUTLINE: Patients receive infusion of ex vivo-activated autologous lymph node lymphocytes intravenously (IV) over 10-30 minutes on day 0. Patients who have been previously treated on study, and subsequently need additional infusions, may be retreated with previously cryopreserved expanded cells at the same or lower dose level 6-12 months after the first infusion. After completion of study treatment, patients are followed up at 1.5 years and then every 6 months for up to 5 years.

Official Title
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Trial of Immune Reconstitution With Activated T-Cells in Patients With Chronic Lymphocytic Leukemia (CLL)

Conditions
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Anemia, Cancer Fatigue, Chronic Lymphocytic Leukemia, Fever, Infectious Disorder, Lymphadenopathy, Lymphocytosis, Night Sweats, Prolymphocytic Leukemia, Recurrent Chronic Lymphocytic Leukemia, Richter Syndrome, Secondary Malignant Neoplasm, Thrombocytopenia, Weight Loss

Intervention / Treatment
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* Biological: Ex Vivo-activated Autologous Lymph Node Lymphocytes
* Other: Laboratory Biomarker Analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients must have a diagnosis of chronic lymphocytic leukemia (CLL) by immunophenotyping and flow cytometry analysis of blood or bone marrow Patients must meet criteria for treatment based on the criteria proposed by National Cancer Institute (NCI)-sponsored CLL Working Group to include at least one of the following: Weight loss of more than 10% over the preceding 6 months; or Extreme fatigue attributable to progressive disease; or Fever or night sweats without evidence of infection; or Worsening anemia (Rai stage Ill) or thrombocytopenia (Rai stage IV); or Massive lymphadenopathy (> 10 cm) or rapidly progressive lymphocytosis (lymphocyte doubling time < 6 months); or Prolymphocytic or Richter's transformation; or Patients with CLL who have received at least one prior line of therapy; or Patients with CLL who have frequent infections and/or recurrent secondary cancers No active central nervous system (CNS) disease All patients must have a Karnofsky performance score > 60% Calculated creatinine clearance (by Cockcroft-Gault) of > 50 ml/min Patients must not have untreated or uncontrolled life-threatening infection Patients must sign informed consent Exclusion Criteria: Receipt of glucocorticoids (with the exception of inhaled glucocorticoid steroids for the use of allergic rhinitis or pulmonary disease) within 2 weeks of registration Autoimmune disease related to CLL, e.g., idiopathic thrombocytopenic purpura (ITP) or autoimmune hemolytic anemia, is permitted if not requiring active treatment
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: Treatment (ex vivo autologous lymph node lymphocytes)<br>Patients receive infusion of ex vivo-activated autologous lymph node lymphocytes IV over 10-30 minutes on day 0. | Biological: Ex Vivo-activated Autologous Lymph Node Lymphocytes<br>* Given IV<br>* Other names: X-ACT Autologous Lymph Node Lymphocytes;Other: Laboratory Biomarker Analysis<br>* Correlative studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment Success and Feasibility of Autologous Activated T-cells Infusion, Determined by Number of Participants That Achieved Target-Activated T-cell Dose Without DLT. | Success will be defined as achievement of a target activated T-cell dose of 1x108 +/-20% without DLT and the lack of dose limiting toxicity (DLT). DLT for this trial is defined as any Grade 4 or higher non-hematologic toxicity or grade 3 or 4 allergy/immunology toxicity, allergic reaction or urticaria grade 3 or higher by +90 days after T cell infusion, Grade 2 or greater autoimmune phenomena, or Grade 4 or higher hematologic toxicity (with the exception of any preexisting AE due to prior treatment or due to disease) deemed related to T cells and occurring by day +90 after T cell infusion. Feasibility is defined as achievement of the target T-cell dose (1x108 +/-20% ) without DLT in >50% of patients enrolled. | Enrollment up to day 100 post T cell infusion for each arm. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Immune Reconstitution | To study immune reconstitution following infusion of activated T-cells in patients with chronic lymphocytic leukemia | Up to 1 year | 
| Overall Response Rates | The overall response rates between the lenalidomide and non-lenalidomide arms. For response to treatment, it was measured by International Workshop on CLL (iwCLL), criteria 2008 guidelines. | Up to 1 year | 
| Incidence of Infections | To study the incidence of infections for up to 1 year following activated T cell infusion | Up to 1 year |