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Patients receiving haplo-SCT are at high-risk of relapse. Vγ9Vδ2 T cells exhibit is a well-known population able to exert cytotoxicity toward a large range of tumor in vitro or in vivo. Activating and expanding Vγ9Vδ2 T cells early after haplo-SCT by using a combination of Zoledronic acid and low-dose interleukine (IL) -2 may be of benefit for patients by reducing incidence of relapse. The optimal dose of IL-2 to use remains to be determined.
This will be a Phase 1 3+3 escalation study. Three to 15 patients are planned. It will be proposed to Patients who refuse to participate to have samples collected until day +70 to study immune and gamma/delta T cells reconstitutions after haplo-transplant.
Zoledronic acid will be administered as a single dose according to marketing and regulatory authorization at the dose of 4 mg over 15 min intravenously at day+15 post-transplant. Zoledronic acid infusion must be stopped in case of grade 3/4 adverse events during infusion.
IL-2 will be administered at a unique low-dose level 5 days per week for 4 consecutive weeks from Monday to Friday subcutaneously . IL-2 has already marketing authorization for various indications.
Three IL2 levels will be tested:
Level 1: 2 millions UI/Infusion Level 2: 4 millions UI/Infusion Level 3: 6 millions UI/Infusion Zoledronic acid and IL2 have to start at day+15 if it is a Monday or the first Monday following day+15 in order to avoid administration on week-end.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| experimental group | Experimental | Zoledronic acid and IL-2 Zoledronic acid: 4 mg Three IL2 levels will be tested: Level 1: 2 millions UI/Infusion Level 2: 4 millions UI/Infusion Level 3: 6 millions UI/Infusion |
|
| control group | No Intervention | no experimental treatment |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| IL2 | Drug | Three IL2 levels will be tested: Level 1: 2 millions UI/Infusion Level 2: 4 millions UI/Infusion Level 3: 6 millions UI/Infusion 4 weeks, 5 days per week from day + 15 post graft to day + 40 |
| Measure | Description | Time Frame |
|---|---|---|
| determine the maximum tolerated dose (MTD) of early administration of increasing doses of low-dose IL-2 in combination with a fixed dose of Zoledronic acid after haplo-SCT | A dose-limiting toxicity (DLT) will be defined as:
| 28 days after the last injection of IL2 |
| Measure | Description | Time Frame |
|---|---|---|
| Engraftment | Concentration of sustained neutrophil recovery (>500 Giga/L) with full or mixed donor chimerism documentation | day 30, 60,90/100, 6 months and 1 year post-transplant |
| Chimerism (mixed, full or uncompleted) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Nantes Uh | Nantes | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38165016 | Derived | Jullien M, Guillaume T, Le Bourgeois A, Peterlin P, Garnier A, Eveillard M, Le Bris Y, Bouzy S, Tessoulin B, Gastinne T, Dubruille V, Touzeau C, Mahe B, Blin N, Lok A, Vantyghem S, Sortais C, Antier C, Moreau P, Scotet E, Bene MC, Chevallier P. Phase I study of zoledronic acid combined with escalated doses of interleukine-2 for early in vivo generation of Vgamma9Vdelta2 T-cells after haploidentical stem cell transplant with posttransplant cyclophosphamide. Am J Hematol. 2024 Mar;99(3):350-359. doi: 10.1002/ajh.27191. Epub 2024 Jan 2. |
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| ID | Term |
|---|---|
| D007376 | Interleukin-2 |
| D000077211 | Zoledronic Acid |
| ID | Term |
|---|---|
| D007378 | Interleukins |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
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a group of patient will received IL2+ zoledronic acid a group of patient will not received IL2+ zoledronic acid
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| Zoledronic Acid | Drug | 4 mg at day +15 post graft |
|
Evaluation of CD3+ T-cell chimerism
| day 30, 60,90/100, 6 months and 1 year post-transplant |
| overall survival | the time from day 0 of allo-SCT to death or last follow-up for surviving patients | last patient follow up : 36 months |
| disease-free survival | time from day 0 of allo-SCT to time without evidence of relapse or disease progression censored at the date of death or last follow-up. | last patient follow up : 36 months |
| relapse rate | any event related to re-occurrence of the disease. | last patient follow up : 36 months |
| Non relapse mortality | death from any cause without previous relapse or progression | day 100 post transplant and one year post-transplant |
| Incidence of acute GVHD | Acute GVHD: Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, et al. International, Multicenter Standardization of Acute Graft-versus-Host Disease Clinical Data Collection: A Report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016 Jan;22(1):4-10. | day 100 post transplant one year post-transplant |
| Hematologic and immune reconstitutions post-transplant | median time for neutrophils recovery (first day with >0.5 Giga/L for three consecutive days) and platelets recovery >20, 50 and 100 Giga/L; T CD3, CD4, CD8, NK, B, Tregs, g/d T cells | before the graft and at days 15, 22, 29, 36, 45, 70 |
| Complete remission (CR) rate for lymphoma patients | Cheson criteria | day 100 post transplant |
| g/d T cells detection after haplo-SCT | Evaluation of T CD3, CD4, CD8, NK, B, Tregs, g/d T cells | before the graft and at days 15, 22, 29, 36, 45, 70 |
| Perturbation of ionic metabolism | Evaluation of Vitamin D, Ca, Ph, Na, K, serum creatinine, bilirubin (direct and total), alkaline phosphatase, gammaGT, ALAT, ASAT | before the graft and at days 15, 22, 29, 36, 45, 70 |
| Detection of dysthyroid disease | Dosage of T3 T4 TSH | before the graft and at day 70 |
| Incidence of acute and chronic GVHD | Chronic GVHD: Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56. | one year post-transplant |
| D000602 |
| Amino Acids, Peptides, and Proteins |
| D008222 | Lymphokines |
| D011506 | Proteins |
| D001685 | Biological Factors |
| D004164 | Diphosphonates |
| D063065 | Organophosphonates |
| D009943 | Organophosphorus Compounds |
| D009930 | Organic Chemicals |
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |