Immunostimulatory CpG SD-101 + RT in Recurrent/Progressive Lymphoma After Allogeneic Hematopoietic Cell Transplantation (HCT)

Robert Lowsky

Status and phase

Terminated

Phase 1

Conditions

Hodgkin Disease

Lymphoma, Non-Hodgkin

Treatments

Radiation: Local Radiation

Drug: SD-101

Study type

Interventional

Funder types

Other

Identifiers

NCT01745354

20741 (Other Identifier)

BMT235

SU-07212011-8129 (Other Identifier)

Details and patient eligibility

About

For patients with lymphoma that recurs after chemotherapy, bone marrow transplantation using cells from a healthy donor represents potentially curative treatment. In these individuals, cure is possible because transplantation of healthy donor immune cells can fight the lymphoma in the patient. The goal of this work is to test a strategy that activates the healthy donor immune cells so that they more effectively fight lymphoma and can result in an increased cure rate for these patients. Our group has previously studied CpG, an immune activating medication, in patients with lymphoma and demonstrated modest anti-tumor responses. We now have a more potent form of CpG which we intend to test to see if it will better activate the donor immune cells and result in shrinkage of tumor throughout the entire body, not just at the injected site.

Full description

Patients will receive low dose radiation to all bulky or symptomatic lymph nodes on days -2 and -1. SD-101 will be administered intratumorally to the single largest palpable node within 24 hours after completion of radiation, on day 0. Two additional intratumoral SD-101 injections will be performed on days 7 (+/- 2 days) and 14 (+/- 2 days). This is a dose ranging study using a 3+3 design with a definition of maximum tolerated dose (MTD) which our group has found acceptable in the past. The first cohort of patients will receive a SD-101 dose of 0.3 mg per injection. The dose will be escalated to 1 mg and 3 mg based on dose limiting toxicity (DLT).

Enrollment

6 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Biopsy-confirmed relapsed, refractory, or progressive NHL or HL (Refer to Section 3.2.1 for excluded subtypes)
At least 3 sites of disease
1. One for diagnosis (lymph node or bone marrow biopsy)
2. One palpable for treatment
3. One measurable radiographically
> 60 days after RIC allogeneic transplant for lymphoma
18 years of age or older
Mixed (5-95%) or complete (>95%) chimerism
Eastern Oncology Cooperative Group (ECOG) performance status ≤ 2
ANC >1000/mm3, platelets >50,000/mm3
Total bilirubin ≤ 2.5 mg/dL, AST and ALT < 3 times upper limit of normal
Serum creatinine ≤ 3 mg/dL
No chemotherapy, RT, DLI or biologic therapy for lymphoma at least 4 weeks prior to scheduled treatment
Minimal immunosuppression (defined as monotherapy with ≤ 10 mg prednisone daily, ≤ 200 mg cyclosporine daily, or ≤ 2 mg tacrolimus daily) at least 2 weeks prior to scheduled treatment

Exclusion criteria

HIV associated lymphoma
Acute GVHD at time of enrollment (history of treated and resolved GVHD is permitted)
Active infection within 14 days prior to scheduled treatment
Active Cytomegalovirus (CMV) disease at the time of enrollment
Pre-existing autoimmune or antibody mediated disease (including systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjogren's syndrome, and autoimmune thrombocytopenia)
Pregnant