Clinical trial NCT02528682: MiHA-loaded PD-L-silenced DC Vaccination After Allogeneic SCT
Official title: Vaccination With PD-L1/L2-silenced Minor Histocompatibility Antigen-loaded Donor DC Vaccines to Boost Graft-versus-tumor Immunity After Allogeneic Stem Cell Transplantation (a Phase I/II Study)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Hematological Malignancies
Keywords: dendritic cells
PD-L1/L2 silencing
vaccination
stem cell transplantation
minor histocompatibility antigens
Lead sponsor: Radboud University Medical Center
Sponsor class: OTHER
Collaborators: name: ZonMw: The Netherlands Organisation for Health Research and Development
name: Dutch Cancer Society
First posted: 2015-08-19
Enrollment: 10
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Allogeneic stem cell transplantation (allo-SCT) is a potent treatment, and sometimes the only curative treatment for aggressive hematological malignancies. The therapeutic efficacy is attributed to the graft-versus-tumor (GVT) response, during which donor-derived CD8+ T cells become activated by recipient minor histocompatibility antigens (MiHA) presented on dendritic cells (DC). Consequently, these alloreactive donor T cells clonally expand, acquire effector functions and kill MiHA-positive malignant cells. However, in a substantial number of patients persistence and recurrence of malignant disease is observed, indicating that insufficient GVT immunity is induced. This is reflected by our observation that not all patients develop a productive CD8+ T cell response towards MiHA mismatched between the recipient and donor. We found that the PD-1/PD-L1 co-inhibitory pathway is involved in dampening MiHA-specific CD8+ T cell expansion and function post-transplantation. Therefore, a promising strategy to induce or boost GVT immune responses is pre-emptive or therapeutic vaccination with ex vivo-generated donor DCs loaded with MiHA that are exclusively expressed by recipient hematopoietic cells and their malignant counterparts. In contrast to pre-emptive donor lymphocyte infusion (DLI) with polyclonal donor T cells, this MiHA-DC vaccination approach has less risk of inducing graft-versus-host disease (GVHD) and the potency to induce more efficient GVT-associated T cell immunity. In addition, the potency of this DC vaccine will be further enhanced by interference with the PD-1/PD-L1 co-inhibitory pathway, using siRNA mediated PD-L1/PD-L2 silencing.


Eligibility criteria: Inclusion Criteria:

* Patients with AML, myelodysplasia (MDS), ALL, CML (accelerated or blast phase), CLL, MM, malignant NHL or HL, who underwent HLA-matched allo-SCT
* Patients positive for HLA-A2 and/or HLA-B7
* Patients positive for HA-1, LRH-1 and/or ARHGDIB transplanted with corresponding MiHA-negative donor
* Patients ≥18 years of age
* WHO performance 0-2
* Witnessed written informed consent

Exclusion Criteria:

* Life expectancy \< 3 months
* Severe neurological or psychiatric disease
* Progressive disease needing cytoreductive therapy
* HIV positivity
* Patients with acute GVHD grade 3 or 4
* Patients with severe chronic GVHD
* Patients with active infections (viral, bacterial or fungal) that require specific therapy. Acute anti-infectious therapy must have been completed within 14 days prior to study treatment
* Severe cardiovascular disease (arrhythmias requiring chronic treatment, congestive heart failure or symptomatic ischemic heart disease)
* Severe pulmonary dysfunction
* Severe renal dysfunction (serum creatinine \> 3 times normal level)
* Severe hepatic dysfunction (serum bilirubin or transaminases \> 3 times normal level)
* Patients with known allergy to shell fish

Primary outcomes:
measure: Evaluation of toxicity
timeFrame: From day 0 until day 84
measure: Development of GVHD
timeFrame: From day 0 until day 84
measure: The generation and magnitude of an immunological response
timeFrame: From day 0 until day 84
Secondary outcomes:
measure: Changes in chimerism
timeFrame: day 0, day 14, day 28, day 64, day 84
measure: Disappearance of residual disease
timeFrame: day 0, day 14, day 28, day 64, day 84
Other outcomes:
Locations:
city: Nijmegen
country: Netherlands
facility: Trialoffice Haematology-Oncology
state: Gelderland
Study officials:
affiliation: Radboud University Medical Center
name: Nicolaas Schaap, MD/PhD
role: PRINCIPAL_INVESTIGATOR
References: