Adoptive T Lymphocyte Administration for Chronic Norovirus Treatment in Immunocompromised Hosts

Eligibility Criteria

• 1. Participants must meet one of the following criteria:
• 1. Recipient of prior myeloablative or non-myeloablative allogeneic hematopoietic stem cell transplant using either bone marrow or peripheral blood stem cells or single or double cord blood OR
• 2. Primary immunodeficiency disorder (as defined by clinical and laboratory evaluations)81 and have not undergone HSCT, OR
• 3. Recipients of solid organ transplant.
• 2. Documentation of chronic norovirus infection:
• 3. Participants receiving steroids for treatment of GVHD or for other reasons, dosage must have been tapered to \<0.5 mg/kg/day of prednisone (or equivalent) a minimum of 7 days prior to infusion.
• 4. For participants who have undergone HSCT, participants must have stable donor chimerism within the 30 days prior to NST infusion.
• 5. For recipients of solid organ transplants, participants must have stable graft function on maintenance immunosuppression, without evidence of rejection in the past 2 months prior to infusion, as defined by:
• 6. Karnofsky/Lansky score \>50
• 7. 3 months to 80 years of age at enrollment.
• 8. ANC ≥500/ul.
• 9. Hemoglobin ≥7.0g/dl (level can be achieved with transfusion).
• 10. Platelets ≥20 K/ul (level can be achieved with transfusion).
• 11. Bilirubin ≤2x upper limit normal.
• 12. AST ≤3x upper limit normal.
• 13. Serum creatinine ≤2x upper limit normal OR estimated GFR ≥30 ml/hr.
• 14. Pulse oximetry of ≥90% on room air.
• 15. Negative pregnancy test in female participant of childbearing age.
• 16. Written informed consent and/or signed assent line from participant, parent or guardian.
• 1. Participants receiving biological or immunosuppressive monoclonal antibodies targeting T cells within 28 days prior to NST infusion, including ATG, Alemtuzumab, Basiliximab, Tocilizumab, Brentuximab, or other medications under this category as determined by the investigators.
• 2. Participants who have received donor lymphocyte infusion (DLI), chimeric antigen receptor T cell infusion, or other experimental cellular therapies within 28 days prior to NST infusion.
• 3. Participants with SCID who have undergone α/β TCR depleted HSCT within the past 100 days post-transplant.
• 4. Participants who have received ruxolitinib or other JAK inhibitors within 7 days prior to NST infusion.
• 5. Participants with uncontrolled or progressing infections other than norovirus. Uncontrolled infections are defined as bacterial, fungal, or non-targeted viral infections with either clinical signs of worsening despite standard therapy, or chronic gastrointestinal symptoms that may be attributed to the uncontrolled infection. Progressing infection is defined as hemodynamic instability, worsening physical signs, or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
• 1. For bacterial infections, participants must be receiving definitive therapy and have no signs of progressing infection within 7 days prior to NST infusion and or no chronic gastrointestinal symptoms associated with this bacterial infection.
• 2. For fungal infections, participants must be receiving definitive systemic anti-fungal therapy and have no signs of progressing infection within 7 days prior to NST infusion.
• 6. Participants must not have other active gastrointestinal infections to which symptoms may be attributable, including parasitic infections (cryptosporidium, giardiasis), viral infections aside from norovirus (CMV colitis, rotavirus, adenovirus), or bacterial infections with C. difficile, Yersinia, Campylobacter, Salmonella, Shigella, or enteroinvasive or enterotoxigenic E. coli.
• 7. Participants with active and uncontrolled relapse of malignancy (if applicable).
• 1. Failure of primary engraftment is defined as failure to achieve platelet and/or neutrophil engraftment (ANC \<500/ul and/or platelets \<20 K/ul) following HSCT.
• 2. Secondary graft failure is defined as \<5% donor chimerism (CD3+ or CD34+) or permanent loss of neutrophil and/or platelet engraftment (ANC \<500/ul and/or platelets \<20 K/ul) at any time after primary engraftment.
• 8. Participants with symptomatic gastrointestinal conditions aside from norovirus, including active inflammatory bowel disease or graft versus host disease (grades 2 to 4).
• 9. Participants who have received a small bowel transplant.
• 10. Participants receiving checkpoint inhibitors within the previous 3 months prior to NST infusion, including nivolumab, pembrolizumab, or other related medications.
• 11. For SOT recipients, alteration in immunosuppression as follows:
• 1. Any intensification of immunosuppression (including but not limited to pulse dose corticosteroids or new biologic therapies) in the previous 2 months,
• 2. Alteration of maintenance immunosuppression (including changes in the number of agents or dosing goals) in the previous month.
• 12. Participants who have received enteral immunoglobulin, nitazoxanide, or other experimental therapies for norovirus infection within 28 days prior to NST infusion.
• 13. Co-enrollment in other trials is restricted, other than enrollment on natural history or observational studies. Study staff should be notified of co-enrollment as it may require the approval of the investigator or sponsor.