This phase Ib trial evaluates the safety and most effective dose of a cytomegalovirus (CMV) pp65 peptide-loaded alpha-type-1 polarized dendritic cell (CMV-alphaDC1) vaccination in patients who are undergoing an allogeneic hematopoietic stem cell transplant. CMV is an opportunistic infection that can occur or reactivate after allogeneic hematopoietic stem cell transplant as a result of immunosuppression. The CMV-alphaDC1 vaccine is made of white blood cells that have been exposed to molecules called cytokines, as well as CMV proteins. Introducing these dendritic cells to the patients immune system may activate an immune response to CMV, protecting against infection or reactivation.
PRIMARY OBJECTIVES: I. Determine the safety of cytomegalovirus (CMV) pp65 peptide loaded alpha-type 1 polarized dendritic cell (CMV-alphaDC1) vaccination after allogeneic hematopoietic cell transplantation (alloHCT). II. Determine the immunogenicity of CMV-alphaDC1 vaccination after alloHCT. SECONDARY OBJECTIVES: I. Evaluate the effect of CMV-alphaDC1 vaccination after alloHCT on late CMV reactivation. II. Evaluate the effect of CMV-alphaDC1 vaccination after alloHCT on non-relapse mortality (NRM). EXPLORATORY OBJECTIVES: I. Assess the effect of CMV-alphaDC1 vaccination on T cell subsets. II. Assess the effect of CMV-alphaDC1 vaccination on T cell receptor diversity. OUTLINE: On day 0, patients undergo standard of care hematopoietic stem cell infusion. Patients receive CMV-alphaDC1 vaccine intradermally on days 28, 42, 56, and 70. After completion of study treatment, patients are followed up at days 84, 100, 180, and 365.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Undergo standard of care allogeneic hematopoietic stem cell transplant
Correlative studies
Given intradermally
Roswell Park Cancer Institute
Buffalo, New York, United States
Incidence of dose limiting toxicities
For each dose level of cytomegalovirus (CMV) pp65 peptide loaded alpha-type 1 polarized dendritic cell (CMV-alphaDC1) vaccination that is tested. Will be summarized by dose level using frequencies and relative frequencies.
Time frame: Up to 2 years
Number of multifunctional CMV antigen specific T cells
The number of multifunctional CMV antigen specific T cells will be determined by flow cytometry before and after vaccination with CMV-alphaDC1. Assessed by the change in the number of CMV specific T cells before and after treatment, which is compared using a one-sided paired t-test. The number of CMV specific T cells will be summarized before and after treatment using the appropriate descriptive statistics, with the mean change estimated using a 90% confidence interval.
Time frame: At days 28 (before vaccination), 42 (before vaccination), 56, 70, 84, 100, 180, 365
Number of CMV pp56 reactive T cells
The number of CMV pp65 reactive T cells will be determined by cytokine secretion (such as IFN-gamma) with ELISPOT before and after vaccination with CMV-alphaDC1. Assessed by the change in the number of CMV specific T cells before and after treatment, which is compared using a one-sided paired t-test. The number of CMV specific T cells will be summarized before and after treatment using the appropriate descriptive statistics, with the mean change estimated using a 90% confidence interval.
Time frame: At days 28 (before vaccination), 42 (before vaccination), 56, 70, 84, 100, 180, 365
Incidence of late CMV reactivation after allogeneic hematopoietic stem cell transplant
Will be summarized by dose level using the appropriate descriptive statistics; with estimates of rates obtained by 95% Jeffrey's prior confidence intervals.
Time frame: From day 85 to 365
Incidence of non-relapse mortality after allogeneic hematopoietic stem cell transplant
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Will be summarized by dose level using the appropriate descriptive statistics; with estimates of rates obtained by 95% Jeffrey's prior confidence intervals.
Time frame: Up to 2 years