Combined Infusion of Cytotoxic T-Lymphocytes and Vaccination

University of Sydney12 enrolled

Overview

To assess the safety and biological efficacy of prophylactically administered donor-derived multi-infection specific cytotoxic T lymphocytes (CTLs) (targeting cytomegalovirus (CMV), Adenovirus (Adv), Epstein Barr virus (EBV), Varicella-Zoster virus (VZV), Influenza (Flu), BK virus (BKV), and Aspergillus (Asp)) combined with early immunisation with Influenza and VZV vaccines for the prevention of viral and fungal infection following allogeneic blood or marrow stem cell transplantation.

The study will analyse the safety and biological efficacy of administering the investigational products (donor-derived T cells stimulated with viral and fungal antigen expressing DC combined with Flu and VZV immunisation), for the prophylaxis of viral and fungal reactivation and/or infection following allogeneic blood or marrow transplantation. The cells will be given prophylactically a minimum of 28 days after transplantation followed by administration of the Flu and VZV vaccines 24 to 72 hours later. The AIMS are to study the safety of combining CTL infusions and vaccination as well as their effect on reconstitution of infection-specific immunity, viral and Aspergillus reactivation and infection rates after transplantation, viral load, and use of antiviral and antifungal pharmacotherapy for specific infections. The investigators will also evaluate the safety of infusions and vaccinations with respect to the development adverse events within the first 12 months post transplant.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Complication of Transplant

Interventions

T-cell infusion, influenza vaccinationBIOLOGICAL

Donor derived infection-specific T-cells (with activity against CMV,adenovirus, EBV, VZV, Influenza, BKV and Aspergillus) and vaccination (with Fluvax)

Eligibility

Sex: ALLHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients undergoing myeloablative or non-myeloablative allogeneic transplantation from an HLA (A, B and DR) identical or 1-3 antigen mismatched family or unrelated donor. * Transplant performed for any type of non-malignant condition or haematological malignancy including but not limited to acute and chronic leukaemia, myelodysplasia, non Hodkgins and Hodgkin lymphoma or myeloma. * Recipients of peripheral blood or bone marrow stem cells. * Adequate hepatic and renal function (\< 3 x upper limit of normal for AST (SGOT), ALT (SGPT), \< 2 x upper limit of normal for total bilirubin, serum creatinine). * Estimated life expectancy of at least 6 months. * Patient (or legal representative) has given informed consent Exclusion Criteria: * Use of anti-lymphocyte globulin (ALG, ATG, Campath or other broad spectrum lymphocyte antibody) given in the 4 weeks immediately prior to infusion or planned within 4 weeks after infusion. * Grade II or greater graft versus host disease within 1 week prior to infusion. * Prednisone or methylprednisone at a dose of \> 1 mg/kg (or equivalent in other steroid preparations) administered within 72 hours prior to cell infusion. * Allergies to eggs or components of the Fluvax or Varivax vaccines. * Privately insured in or outpatients

Locations (1)

Westmead Hospital Department of Haematology

Westmead, Sydney, New South Wales, Australia

Outcomes

Primary Outcomes

Safety of infection-specific T-cell infusion and vaccination

Presence of acute infusion related toxicities

Time frame: 1 week

Secondary Outcomes

Change in infection specific immune reconstitution

Time frame: 1 week, 2 weeks, 3 weeks, 4 weeks, 3 months, 6 months, 9 months, 12 months (post T-cell infusion)

Change in CMV, EBV and BKV load based on quantitive PCR

Time frame: 1 week, 2 weeks, 3 weeks, 4 weeks, 3 months, 6 months, 9 months, 12 months (post T-cell infusion)

Use of specific anti-viral pharmacotherapy

Time frame: 12 months (post T-cell infusion)

Use of systemic anti-fungal drugs including amphotericin and azoles

Time frame: 12 months (post T-cell infusion)

Incidences of GVHD

Time frame: 12 months (post T-cell infusion)

Number of in-hospital days following first discharge post transplant

Time frame: 12 months (post T-cell infusion)

Data from ClinicalTrials.gov

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