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A Phase 1/2a, Open-Label, Multicenter, Dose-Escalation Study to Evaluate the Safety and Tolerability of Intravenous Administration of RGI-2001 in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT)


Phase 1/Phase 2
18 Years
N/A
Open (Enrolling)
Both
Prevention of GvHD in Patients With Hematological Malignancies Undergoing AHSCT

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Trial Information

A Phase 1/2a, Open-Label, Multicenter, Dose-Escalation Study to Evaluate the Safety and Tolerability of Intravenous Administration of RGI-2001 in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT)


The clinical trial is a Phase 1/2a, open-label, multi-center, dose-escalation study to
evaluate the safety, tolerability and pharmacokinetic profile of RGI-2001 in patients
undergoing AHSCT, with radiation or non-radiation myeloablative preparative treatment.

In Part 1 (Phase 1: Dose Escalation Phase), patients will receive a single intravenous
administration of RGI-2001 approximately 30 minutes after completion of the transplant
(either allogeneic PBSCs or allogenic bone marrow transplantation (unmodified)) with the
dosage based upon the assigned treatment cohort. Eligible patients will be enrolled in five
to seven centers in the United States. Patients who are undergoing AHSCT will be enrolled in
a sequential group dose-escalating fashion to determine the safety, tolerability,
pharmacokinetic profile, and the MTD or MFD of RGI-2001. It is anticipated that up to six
dose levels will be evaluated in Part 1, with an option for an additional cohort (Cohort 7)
if the MTD is not reached and pharmacodynamic markers suggest higher doses are warranted.

In Part 2 (Expansion Phase), one or more doses below the MTD or MFD will be selected based
on a potential correlation between GvHD and biological activity to further assess safety and
biologic activity. Approximately 30 patients who are undergoing either allogeneic PBSCs or
allogenic bone marrow transplantation (unmodified) will be enrolled in Part 2 of the study.

Patients will be monitored for safety for 29 days after the transplant procedure.

All patients will be followed for 100 days following transplant procedure for the incidence
of acute GvHD, according to the Modified Keystone Criteria for grading acute GvHD
(Przepiorka D, et al)


Inclusion Criteria:



1. Subject has a hematological malignancy or aplastic anemia (AA) and is undergoing a
first allogeneic transplant procedure.

2. Meet one of the following underlying disease criteria:

a. Acute myelogenous leukemia (AML) i. First or subsequent morphologic remission b.
Acute lymphoblastic leukemia (ALL) i. First or subsequent morphologic remission c.
Chronic myelogenous leukemia (CML) i. Chronic phase; or ii. Accelerated phase d.
Multiple Myeloma (MM) i. Not more than 20% plasma cells in the bone marrow e.
Myelodysplastic syndrome (MDS), including chronic myelomonocytic leukemia (CMML), who
have received at least one previous induction regimen and have <10% blasts f.
Myeloproliferative disorder (MPD), including; i. myeloid metaplasia, and ii.
myelofibrosis g. Non-Hodgkin's Lymphoma (NHL) i. High-risk NHL in first remission; or
ii. Relapsed or refractory NHL h. Hodgkin's lymphoma (HL) beyond first remission i.
Aplastic anemia (AA)

3. Male or female, age ≥18 years of age

4. Reasonable expectation of survival for at least 3 months, if the transplant procedure
is successful

5. Eastern Cooperative Oncology Group (ECOG) status of 0-2 or Karnofsky Performance
Status (KPS) of > 60

6. Transplant Donor

1. Part 1 (Phase 1: Dose Escalation Phase):

Unrelated transplant donor with no more than 1 HLA allele or antigen mismatch,
defined as loci A, B, C and DR (note: DQ is excluded)

2. Part 2 (Phase 2a: Expansion Phase):Related or unrelated transplant donor, with
no more than 1 HLA allele or antigen mismatch, defined as loci A, B, C and DR
(note: DQ is excluded).

7. Source of the allograft

1. Part 1 (Phase 1: Dose Escalation Phase):Unmodified (non-manipulated) bone
marrow, or mobilized peripheral blood stem cell (PBSC) transplant, using G-CSF
as the mobilizing agent.

2. Part 2: (Phase 2a: Expansion Phase) Unmodified (non-manipulated) bone marrow, or
mobilized peripheral blood stem cell (PBSC) transplant, using G-CSF as the
mobilizing agent.

8. Anti-graft-versus-host disease (GvHD) prophylaxis:

A calcineurin inhibitor [either tacrolimus (FK506) or cyclosporin A)], in combination
with either methotrexate (MTX), mycophenolate mofetil (MMF) or sirolimus (RAPA) all
at doses as per the institutional protocols

9. Adequate hepatic function, with bilirubin not exceeding the upper limit of normal
(except when attributed to Gilbert's Disease), and AST and ALT of less than 1.5 times
the upper limit of normal

10. No clinically significant cardiac conduction disorder on screening ECG

11. Serum creatinine ≤ 2.0 mg/dL

12. Female patients of childbearing potential must have a negative serum pregnancy test
prior to enrollment and must agree to use dual method of contraception for 30 days
after study drug administration. Approved methods of contraception include, an IUD
with spermicide, a female condom with spermicide, a diaphragm with spermicide, a
cervical cap with spermicide, use of a condom with spermicide by sexual partner or a
sterile sexual partner.

13. If male, subjects must be sterile or willing to use an approved method of
contraception from the time of Informed Consent to 30 days after study drug
treatment. Males must be willing to refrain from sperm donation within 30 days after
study drug treatment.

14. No clinically significant acute or chronic medical condition that in the opinion of
the investigator will interfere with study participation

15. No clinically significant laboratory abnormalities as determined by the Principal
Investigator, in consultation with the Sponsor's Medical Monitor

16. No active infection

17. Have signed written informed consent before undergoing any study related procedures
and is willing to comply with all study procedures

Exclusion Criteria:

1. Female subjects who are pregnant or lactating

2. Subjects about to undergo a non-ablative or non-myeloablative transplant

3. AML or ALL patient who are in relapse (>5% blasts) or who are defined as primary
refractory

4. Blast crisis CML

5. Radiation, chemotherapy, immunotherapy in the previous 3 weeks, unrelated to the
transplant procedure

6. Subjects who, in the judgment of the Investigator have not recovered from the effects
of previous therapy

7. Subject who is about to undergo cord blood transplantation

8. Procedures that are intended to deplete regulatory T-cells from donor transplant
materials

9. Known or suspected HIV infection

10. Active hepatitis A, B, or C infection in recipient or donor

11. Uncontrolled active infection requiring IV antibiotics in recipient or donor

12. Major surgery within 1 month before Day 0

13. Participation in an investigational study within 1 month prior to Day 0

14. Prior treatment with anti-CD3 antibodies

15. Treatment with anti-CD20 antibodies or anti-thymocyte globulin (ATG) within 3 months
of the AHSCT procedure (i.e. infusion of transplant material and RGI-2001).

16. Vaccination within the preceding 2 weeks prior to the planned dose of RGI-2001

17. Planned vaccination within 2 months after study drug administration

18. Known history of cardiac dysfunction (e.g. <50% ejection fraction), ischemia,
conduction abnormalities, or myocardial infarction in the previous six months

19. Cardiac pacemaker or automatic implantable cardioverter-defibrillator

20. Marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a
QTc interval >450 ms

21. Congenital long QT syndrome or family history of long QT syndrome

22. History of additional risk factors for torsades de pointes (TdP) (e.g., heart
failure, hypokalemia)

23. Bundle branch block

24. Connective tissue/rheumatologic disorders

25. History of autoimmune disease

26. History of solid tumor, excluding non-melanoma skin or cervical carcinoma after
curative resection, within the preceding 5 years

27. Uncontrolled diabetes

28. Prior allogeneic hematopoietic stem cell transplantation

29. Any other prior organ transplant

30. Psychiatric or addictive disorders that preclude obtaining reliable informed consent

31. Any other condition that, in the opinion of the investigator, renders the subject
unsuitable for study participation

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

The maximum tolerated dose (MTD) or maximum feasible dose (MFD) of RGI-2001

Outcome Description:

The primary outcome measures are: The incidence and severity of adverse events The maximum tolerated dose (MTD) or maximum feasible dose (MFD) of RGI-2001, administered as a single intravenous infusion approximately 30 minutes after AHSCT

Outcome Time Frame:

By day 29

Safety Issue:

Yes

Authority:

United States: Food and Drug Administration

Study ID:

RGI-2001-02

NCT ID:

NCT01379209

Start Date:

September 2011

Completion Date:

August 2013

Related Keywords:

  • Prevention of GvHD in Patients With Hematological Malignancies Undergoing AHSCT
  • AHSCT
  • Bone Marrow Transplant
  • Leukemia
  • myelodysplastic syndrome
  • hematological malignancies
  • Graft-versus-host-disease
  • GvHD
  • Hematopoietic Stem Cell Transplantation
  • Stem Cell
  • Transplantation
  • Neoplasms
  • Hematologic Neoplasms

Name

Location

Fred Hutchinson Cancer Research Center Seattle, Washington  98109
H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida  33612
UCSD Moores Cancer Research Institute San Diego, California  93093
Stanford School of Medicine Stanford, California  94305
Ohio State University Comprehensive Cancer Center - The James Columbus, Ohio  43210
Methodist Healthcare System San Antonio, Texas  78229