A Pilot Trial of WT1 Peptide-Loaded Allogeneic Dendritic Cell Vaccine and Donor Lymphocyte Infusion for WT1-Expressing Hematologic Malignancies
Background:
- Efforts to incorporate anti-tumor immunotherapy at stages of minimal residual disease
(MRD) burden are limited by profound host immune depletion associated with standard
anti-cancer therapies.
- Allogeneic blood and marrow stem cell transplantation (SCT) can be curative for a
number of hematologic malignancies. Part of the success of this approach is an
allogeneic immunologic reaction that has been demonstrated to play a role in the
eradication of residual malignant disease after transplant in certain cancers (the so
called graft-versus-leukemia, GVL, or graft-versus-tumor, GVT, effect). Nonetheless,
relapse remains the primary cause of treatment failure after allogeneic SCT.
- The Wilm's tumor 1 (WT1) gene product is a tumor-associated antigen that represents a
potential target for immunotherapy in a wide array of cancers. WT1 is expressed in most
cases of acute leukemia and in many cases of chronic myelogenous leukemia and
myelodysplastic syndromes. Importantly, WT1 has limited expression in normal tissues
beyond embryogenesis. This trial represents an attempt to incorporate antigen-specific
immunotherapy in the setting of allogeneic adoptive cell transfer.
Objectives:
- To determine the safety, toxicity, and feasibility of donor-derived dendritic cell
vaccination and donor lymphocyte infusions (DLI) after allogeneic SCT.
- To determine the frequency and severity of graft-vs.-host disease (GVHD) in patients
treated with peptide-loaded donor-derived dendritic cell vaccination and DLI.
- To evaluate whether immunologic responses to WT1-specific peptides can be generated by
peptide-loaded donor-derived dendritic cell vaccination and DLI after allogeneic SCT.
- To evaluate whether clinical responses to WT1-specific peptides can be generated by
peptide-loaded donor-derived dendritic cell vaccination and DLI after allogeneic SCT.
- To evaluate whether immunologic and/or clinical responses may be associated with the
degree of WT1 expression by malignant cells or pre-existing donor anti-WT1 immunity.
Eligibility:
- HLA-A2 plus patients may be enrolled on this trial if they have relapsed or residual
disease following allogeneic SCT for a WT1 expressing hematologic malignancy.
- Donors from the previous SCT, related or unrelated, must be 5- or 6- antigen genotypic
HLA-matched (single HLA-A or B locus mismatch allowed) and HLAA2 plus.
Design:
- This is a pilot study, the primary aim of which is to assess safety and feasibility of
this novel vaccine strategy aimed to enhance the GVL effect after allogeneic SCT.
- Donor-derived dendritic cells prepared from peripheral blood monocytes will be loaded
with a combination of three WT1-derived peptides. These peptides are each comprised of
one WT1-derived oligomeric epitope known to bind to HLA-A2 and an 11-mer protein
transduction epitope known to enhance peptide loading and antigen presentation.
- Patients will receive donor-derived dendritic cell vaccines every 14 days for 6 doses.
Donor leukocyte infusions (DLI) will also be administered with the vaccine.
- Study endpoints will include toxicity, feasibility, antigen-specific immunity, and
disease response.
- This is an exploratory pilot trial. Up to 12 patients will be treated.
- Stopping rules will take effect if excessive toxicity (e.g., GVHD) or inability to
generate vaccines are observed.
- INCLUSION CRITERIA:
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Safety, toxicity, feasibility.
Alan S Wayne, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
080051
NCT00923910
January 2008
November 2015
Name | Location |
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National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |