Cytokine-induced Memory-like NK Cells in Relapsed/Refractory AML and MDS

The Washington University

Status and phase: Withdrawn; Phase 2

Conditions: Refractory Acute Myeloid Leukemia; Myelodysplastic Syndromes; Relapsed Acute Myeloid Leukemia

Treatments: Procedure: Donor Leukapheresis; Drug: Cyclophosphamide; Drug: Fludarabine; Biological: Cytokine-induced memory-like NK cells; Drug: Interleukin-2

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT04893915

202106075

Details and patient eligibility

About

Patients with relapsed/refractory acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) will receive lymphodepleting chemotherapy (Flu/Cy) and two infusions of cytokine-induced memory-like NK cells at the previously defined maximum tolerated dose (MTD), fourteen days apart. Low dose rhIL-2 will be administered to patients for in vivo expansion following cell infusion. Patients will be assessed for anti-leukemic efficacy and safety. Re-infusion of patients who relapsed after clinical response will be considered.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Refractory AML without CR after induction therapy (primary induction failure); relapsed AML after obtaining a CR; progressive AML after non-intensive therapy (e.g., HMA + venetoclax or targeted therapy); Intermediate risk to very-high-risk MDS by IPSS-R that is relapsed or refractory after prior therapy with an HMA-containing regimen

• At least 18 years of age.

• Available allogeneic donor that meets the following criteria:

  • Able and willing to undergo multiple rounds of leukapheresis
  • At least 18 years of age
  • In general good health, and medically able to tolerate leukapheresis required for harvesting the NK cells for this study.
  • Negative for hepatitis, HTLV, and HIV on donor viral screen
  • Not pregnant
  • Voluntary written consent to participate in this study
  • All HLA-match/mismatch statuses will be included, with preference for unmatched donors all else being equal

• Patients with known CNS involvement with AML are eligible provided that they have been treated and CSF is clear for at least 2 weeks prior to enrollment into the study. CNS therapy (chemotherapy or radiation) should continue as medically indicated during the study treatment.

• Karnofsky/Lansky performance status > 50 %

• Adequate organ function as defined below:

  • Total bilirubin < 2 mg/dL
  • AST(SGOT)/ALT(SGPT) < 3.0 x ULN
  • Creatinine within normal institutional limits OR creatinine clearance ≥ 40 mL/min by Cockcroft-Gault Formula
  • Oxygen saturation ≥90% on room air
  • Ejection fraction ≥35%

• Able to be off corticosteroids and any other immune suppressive medications beginning on Day -3 and continuing until 30 days after the last infusion of the NK cell product. However, use of low-level corticosteroids is permitted if deemed medically necessary. Low-level corticosteroid use is defined as 10mg or less of prednisone (or equivalent for other steroids) per day.

• Women of childbearing potential must have a negative pregnancy test within 28 days prior to study registration. Female and male patients (along with their female partners) must agree to use two forms of acceptable contraception, including one barrier method, during participation in the study and until 30 days after the last NK cell product infusion.

• Ability to understand and willingness to sign an IRB approved written informed consent document

Exclusion criteria

• Relapsed after allogeneic transplantation.
• Circulating blast count >30,000/µL by morphology or flow cytometry (cytoreductive therapies including leukapheresis or hydroxyurea are allowed).
• Uncontrolled bacterial or viral infections, or known HIV, Hepatitis B or C infection.
• Uncontrolled angina, severe uncontrolled ventricular arrhythmias, or EKG suggestive of acute ischemia or active conduction system abnormalities.
• New progressive pulmonary infiltrates on screening chest x-ray or chest CT scan that have not been evaluated with bronchoscopy. Infiltrates attributed to infection must be stable/ improving after 1 week of appropriate therapy (4 weeks for presumed or proven fungal infections).
• Known hypersensitivity to one or more of the study agents.
• Received any investigational drugs within the 14 days prior to the first dose of fludarabine.
• Pregnant and/or breastfeeding.
• Any condition that, in the opinion of the investigator, would prevent the participant from consenting to or participating in the study

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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0 participants in 3 patient groups

Lead In Cohort Recipient: Cytokine-induced memory-like NK cells

Experimental group

Description:

* Fludarabine and cyclophosphamide beginning on Day -6. * NK cell product will be infused on Day 0. * IL-2 will begin 2-4 hours after infusion and will continue every other day through Day 12 for a total of 7 doses. * NK cell product will be infused into the recipient on Day +14. * IL-2 will begin 2-4 hours after infusion and will continue every other day through Day 26 for an additional 7 doses, and a total of 14 doses, to a maximum of two vials of rhIL-2 per IL-2 course. * In the Lead-in Cohort, three patients will receive NK cell product on Day 0 and Day +14, receiving the maximum NK cells generated, capped at 20x10\^6/kg. * Patients that have an initial response but then subsequently relapse or progress will be able to receive a third dose of NK cell product with or without lymphodepleting chemotherapy depending on the interval duration between the second dose and relapse, after approval by the study PI. The third dose should be administered not less than 45 days from Day 0.

Treatment:

Drug: Interleukin-2

Drug: Cyclophosphamide

Biological: Cytokine-induced memory-like NK cells

Drug: Fludarabine

Phase II Recipient: Cytokine-induced memory-like NK cells

Experimental group

Description:

* Fludarabine and cyclophosphamide beginning on Day -6. * NK cell product will be infused on Day 0. * IL-2 will begin 2-4 hours after infusion and will continue every other day through Day 12 for a total of 7 doses. * NK cell product will be infused into the recipient on Day +14. * IL-2 will begin 2-4 hours after infusion and will continue every other day through Day 26 for an additional 7 doses, and a total of 14 doses, to a maximum of two vials of rhIL-2 per IL-2 course. * Will receive the NK cell product on Day 0 and Day +14, receiving the maximum NK cells generated, capped at 20x10\^6/kg. * Patients that have an initial response but then subsequently relapse or progress will be able to receive a third dose of NK cell product with or without lymphodepleting chemotherapy depending on the interval duration between the second dose and relapse, after approval by the study PI. The third dose should be administered not less than 45 days from Day 0.

Treatment:

Drug: Interleukin-2

Drug: Cyclophosphamide

Biological: Cytokine-induced memory-like NK cells

Drug: Fludarabine

Donor

Experimental group

Description:

* The allogeneic donor will undergo non-mobilized large volume (20-L) leukapheresis on Day -1. * On Day +13 the allogeneic donor will again undergo non-mobilized large volume (20-L) leukapheresis

Treatment:

Procedure: Donor Leukapheresis