This phase I/2 trial studies the side effects and best dose of activated natural killer cells in treating patients with relapsed or refractory acute myeloid leukemia and myelodysplastic syndromes. Giving chemotherapy before a donor natural killer cell infusion helps stop the growth of cancer cells and stops the patient's immune system from rejecting the donor's natural killer cells. Modified natural killer cells may help the body build an immune response to kill cancer cells. Aldesleukin (interleukin-2) may stimulate the white blood cells (including natural killer cells) to kill leukemia cells. In the phase II and pediatric portion of the study, the investigators intend to use maximal tolerated or tested (MT/TD) CIML NK cell dose as determined from the phase I part of this study. The phase II portion of the study also replaces IL-2 with ALT-803. The rationale for this change is to support the donor derived NK cells in vivo after adoptive transfer. With amendment 16, the decision was made to return to the use of rhIL-2 support instead of ALT-803.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
89
-Screening, Day 0 prior to CIML NK infusion, Day 1, Day 3, Day 7, Day 8, Day 10, Day 14, Day 21, Day 28, Day 42, Day 60, Day 100, 6 months, 9 months, 12 months, and at disease relapse
-Screening, Day 8, Day 14, Day 28, Between Day 42 and 60, Day 100, at disease relapse
Washington University School of Medicine
St Louis, Missouri, United States
Maximal Tolerated or Tested Dose (MT/TD) of CIML-NK Cells (Phase I)
Defined as the dose level immediately below the dose level at which 2 patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity (DLT) or the maximum dose if less than or equal to 1 patient suffers a DLT at the maximum dose.
Time frame: 35 days
Complete Remission Rate (CR/CRi) in Participants With Relapsed or Refractory AML Following CIML NK Therapy (Phase II)
* Complete remission rate (CR): Morphologically leukemia free state (i.e. bone marrow with \<5% blasts by morphologic criteria and no blasts with Auer rods, no evidence of extramedullary leukemia) and absolute neutrophil count ≥1000 /μL and platelets ≥100,000 /μL. Patient must be independent of transfusions * Complete Remission with Incomplete Blood Count Recovery (CRi): All of the above criteria for CR must be met, except that absolute neutrophils \<1000 /μL or platelets \<100,000 /μL in the blood.
Time frame: Up to 3 years
Safety of CIML NK Cells as Measured by the Number of Participants With Treatment Related Adverse Events (Pediatric Cohort)
* Graded using the National Cancer (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Related indicates possibly, probably, or definitely related to study treatment. * Adverse events will be collected from Day 0 to Day +35; however, bone marrow suppression (ANC \< 500/uL/µL) and AEs of GVHD involving the liver, skin, or GI tract will be recorded to Day 100.
Time frame: Through Day 100
Response Assessed According to IWG Criteria (Phase 1, Phase II, and Pediatric)
Time frame: 35 days
Duration of Remission (DOR) (Phase I, Phase II, and Pediatric)
DOR is defined only for patients who achieve a complete remission (CR), complete remission with incomplete blood count recovery (CRi), marrow complete response (mCR), or partial remission (PR), and is measured from the first date of attaining CR or PR until the date of disease progression or death.
Time frame: Up to 3 years
Time to Progression (Phase I, Phase II, and Pediatric)
TTP is defined as the time from date of first dose of fludarabine until evidence of disease progression.
Time frame: Up to 3 years
Disease Free Survival (DFS) (Phase I, Phase II, and Pediatric)
DFS is defined as the time from the day CR, mCR, or CRi is documented until disease progression or death.
Time frame: Up to 3 years
Overall Survival (OS) (Phase I, Phase II, and Pediatric)
OS is defined from the date of first dose of fludarabine on this study until death.
Time frame: Up to 3 years
Toxicity as Measured by the Number of Participants With Treatment Related Adverse Events (Phase I and Phase II)
* Graded using the National Cancer (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Related indicates possibly, probably, or definitely related to study treatment. * AEs will be collected from Day 0 to Day +35; however, bone marrow suppression (ANC \< 500/uL/µL) and AEs of GVHD involving the liver, skin, or GI tract will be recorded to Day 100.
Time frame: Through Day 100
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