RECRUITING

Safety and Efficacy of Expanded, Universal Donor Natural Killer Cells for Relapsed/Refractory AML

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This is a phase I/II dose escalation study designed to determine the safety and estimate the efficacy of UD-NK cells combined with FLA chemotherapy in patients age 1-24.99 with relapsed or refractory acute myeloid leukemia. PRIMARY OBJECTIVE: I. To determine the safety and recommended phase II dose of adoptive NK cell therapy using UD-NK cells in pediatric and young adult patients with relapsed/refractory AML. SECONDARY OBJECTIVES: I. To estimate the efficacy of UD- NK cells with FLA chemotherapy in pediatric and young adult patients with relapsed/refractory AML. EXPLORATORY OBJECTIVES: I. To determine the immunophenotype and function of UD-NK cells II. To characterize in vivo expansion of UD-NK cells III. To determine the persistence of UD-NK cells Six doses of universal donor mbIL-21 expanded NK cells (UD-NK) given thrice weekly for two weeks. Days may vary and NK cells can be given from days 0 to 21. Patients may receive up to 2 cycles of fludarabine/cytarabine (FLA) + NK cells (up to 12 NK cell infusions) if they do not achieve CR after cycle 1 or if necessary to bridge to transplant.

Official Title

Killer Cells Against Relapsed/Refractory Myeloid Acute Leukemia (KARMA): a Clinical Trial Evaluating the Safety and Efficacy of Expanded, Universal Donor Natural Killer Cells for Treatment of Relapsed/Refractory Acute Myeloid Leukemia

Quick Facts

Study Start:2022-02-14

Study Completion:2027-02

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT05503134

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:1 Year to 24 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:CHILD, ADULT

Inclusion Criteria	Exclusion Criteria
* Patients with relapsed or primary refractory AML, including: * Patients with relapsed AML (Any patient in first or subsequent relapse are eligible. Patients with relapse after HSCT are eligible) * Primary refractory AML defined as failure to achieve a complete response after 2 cycles of induction chemotherapy, including persistent MRD positivity * Patients with isolated CNS or extramedullary disease are eligible Note: a response monitoring plan must be developed a priori for subjects with extramedullary disease * Patient age 1-24.99 years old * Negative serum test to rule out pregnancy within 2 weeks prior to enrollment in females of childbearing potential * Negative serology for human immunodeficiency virus (HIV) * Both males and females and members of all races and ethnic groups are eligible * Organ function requirements: * Renal function: Creatinine ≤ 2 mg/dl OR creatinine clearance \> 60 ml/min/1.73m2. * Liver function: Total bilirubin ≤ 2 mg/dl (unless Gilbert's syndrome), AST and ALT ≤ 5 times the upper limit of normal (unless related to leukemic involvement). Upper limit of normal should be determined by the institutional defined normal laboratory range. * Cardiac function: left ventricular ejection fraction ≥ 40% or shortening fraction ≥20%. May be eligible after cardiology clearance if qualitatively normal function or repeat measures are normal. * CNS: Patients with seizure disorder may be eligible if seizures well controlled * All prior treatment related non-hematologic toxicities must have resolved to ≤ Grade 2 prior to enrollment unless granted approval by study PI and/or Co-Is. * All patients and/or their legal guardians must be able to understand and willing to sign a written informed consent document	* AML directed therapies in the 2 weeks prior to beginning treatment on this protocol (except for hydroxyurea) * Patients on immunosuppressive therapy * Patients with a history of donor lymphocyte infusion or cellular therapy within the last 30 days are not eligible for this study * Allogeneic SCT \< 3 months prior to study enrollment * Any comorbidities that in the opinion of the investigator will preclude receiving study therapy * Performance status: Karnofsky or Lansky Performance Scale (PS) \< 50 * Uncontrolled infection, defined as an infection which has not resolved or does not show evidence of significant resolution after initiating appropriate therapy * Uncontrolled arrhythmias or uncontrolled symptomatic cardiac disease * History of autoimmune disease * Active GVHD at the time of enrollment * Patients with a history of adoptive cell therapy are excluded unless at least 30 days from infusion and with evidence of recovery of normal hematopoiesis (ANC ≥ 500/μL, platelet count ≥ 50,000/μL).

Inclusion Criteria

Exclusion Criteria

* Patients with relapsed or primary refractory AML, including:
* Patients with relapsed AML (Any patient in first or subsequent relapse are eligible. Patients with relapse after HSCT are eligible)
* Primary refractory AML defined as failure to achieve a complete response after 2 cycles of induction chemotherapy, including persistent MRD positivity
* Patients with isolated CNS or extramedullary disease are eligible Note: a response monitoring plan must be developed a priori for subjects with extramedullary disease
* Patient age 1-24.99 years old
* Negative serum test to rule out pregnancy within 2 weeks prior to enrollment in females of childbearing potential
* Negative serology for human immunodeficiency virus (HIV)
* Both males and females and members of all races and ethnic groups are eligible
* Organ function requirements:
* Renal function: Creatinine ≤ 2 mg/dl OR creatinine clearance \> 60 ml/min/1.73m2.
* Liver function: Total bilirubin ≤ 2 mg/dl (unless Gilbert's syndrome), AST and ALT ≤ 5 times the upper limit of normal (unless related to leukemic involvement). Upper limit of normal should be determined by the institutional defined normal laboratory range.
* Cardiac function: left ventricular ejection fraction ≥ 40% or shortening fraction ≥20%. May be eligible after cardiology clearance if qualitatively normal function or repeat measures are normal.
* CNS: Patients with seizure disorder may be eligible if seizures well controlled
* All prior treatment related non-hematologic toxicities must have resolved to ≤ Grade 2 prior to enrollment unless granted approval by study PI and/or Co-Is.
* All patients and/or their legal guardians must be able to understand and willing to sign a written informed consent document

* AML directed therapies in the 2 weeks prior to beginning treatment on this protocol (except for hydroxyurea)
* Patients on immunosuppressive therapy
* Patients with a history of donor lymphocyte infusion or cellular therapy within the last 30 days are not eligible for this study
* Allogeneic SCT \< 3 months prior to study enrollment
* Any comorbidities that in the opinion of the investigator will preclude receiving study therapy
* Performance status: Karnofsky or Lansky Performance Scale (PS) \< 50
* Uncontrolled infection, defined as an infection which has not resolved or does not show evidence of significant resolution after initiating appropriate therapy
* Uncontrolled arrhythmias or uncontrolled symptomatic cardiac disease
* History of autoimmune disease
* Active GVHD at the time of enrollment
* Patients with a history of adoptive cell therapy are excluded unless at least 30 days from infusion and with evidence of recovery of normal hematopoiesis (ANC ≥ 500/μL, platelet count ≥ 50,000/μL).

Contacts and Locations

Study Contact

Melinda C Triplet

CONTACT

6147226039

Melinda.Triplet@nationwidechildrens.org

Principal Investigator

Margaret Lamb, MD

PRINCIPAL_INVESTIGATOR

Nationwide Children's Hospital

Study Locations (Sites)

Nationwide Children's Hospital

Columbus, Ohio, 43205

United States

Collaborators and Investigators

Sponsor: Nationwide Children's Hospital

Margaret Lamb, MD, PRINCIPAL_INVESTIGATOR, Nationwide Children's Hospital

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2022-02-14

Study Completion Date2027-02

Study Record Updates

Study Start Date2022-02-14

Study Completion Date2027-02

Terms related to this study

Keywords Provided by Researchers

Additional Relevant MeSH Terms

Acute Myeloid Leukemia