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Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality for recipients of allogeneic hematopoietic stem cell transplantation(HSCT). Recently, strategies based on immunotherapy adoptive cells (IAC) with anti-CMV Cytolitic T Lymphocytes (CMV-CTLs) has been incorporated to prevent or treat CMV after HSCT. The aim to study donor derived CMV-CTLs after haploidentical HSCT (HAPLO) as prophylaxis for CMV infection in transplant patients. CMV-CTLs will be administer at day 21 (+-7 days) post-HAPLO. CMV DNA levels with quantitative PCR will be weekly monitored.
In HAPLO, CMV infection and disease are more frequent than in other type of HSCT, this is related to delayed immune reconstitution after transplant increasing post-transplant infectious complications. Approximately 60% of patients reactivated CMV infection after HAPLO and 15%, developed CMV disease afecting organs and causing the death of the patient in 8% of CMV disease cases.
If patient and donor are eligible, it will take 1x10^9 cells from donor leukapheresis. Donor cells will be selected and procesed by CliniMACs PRODIGY and after 12h it will obtain 7mL of CMV-CTLs. It will use 6mL of CMV-CTLs to infused a dose of 1x10^5 cells/kg in our patient. The donor derived CMV-CTL cells will be transfused into the patients' intravenous line. The patients will receive the dose of CMV-CTL cells when they are sero-positive for CMV-DNA 21 (+- 7 days) days after transplant.
The CMV-DNA levels will be monitored weekly for at least 100 days after the transplant. If after the initial dose of CMV-CTL cells the patient develops a viral infection, then the patient will receive treatment with anti-CMV comercial drugs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CMV CTLs | Experimental | 1x10^5 CMV-CTLs/kg |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CMV CTLs | Biological | The donor derived cytomegalovirus specific T lymphocytes (CMV-CTL) will be transfused to the patients. The patients will receive CMV-CTL cells when their donors are sero-positive for CMV-DNA 21 days after transplant. The CMV-DNA levels will be monitored weekly for at least 100 days after the HAPLO. If after the initial dose of CMV-CTL cells the patient develops a viral infection, then they may be eligible to receive a CMV specific antiviral drug. |
| Measure | Description | Time Frame |
|---|---|---|
| 100-days incidence of CMV infection | Viral load >200 copies in 1 sample | From date of CMV-CTLs infusion to 100 days after transplant |
| Measure | Description | Time Frame |
|---|---|---|
| 1-year incidence of CMV specific antiviral drug use | If viral load >200 copies in 2 samples or >1000 in 1 sample, treatment with valganciclovir will be started. Time from CMV-CTLs infusion until valganciclovir start and days of valganciclovir. | From date of CMV-CTLs infusion to 1 year after transplant |
| Measure | Description | Time Frame |
|---|---|---|
| 1-year incidence of CMV-CTLs adverse events | Infusion reactions, causes of death, secondary graft failures and graft versus host disease (GVHD). | From date of CMV-CTLs infusion to 1 year after transplant |
| CMV-CTLs persistence |
Inclusion Criteria:
Adult patients who received an alogeneic stem cell transplantation from haploidentical donors (HAPLO).
Any source of stem cells (peripheral blood or bone marrow).
CMV-seropositive donors.
Negative pregnancy test in women.
Signed writen informed consent.
DONORS:
Exclusion Criteria:
CMV-CTLs Infusion Criteria:
CMV-CTLs NON-Infusion Criteria:
Patients who don´t fill infusion criteria, after day 28 post-HAPLO, will be considered screening failures and will be out of the study.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Miriam Sanchez-Escamilla, MD | Contact | +34646393234 | msanchez@idival.org | |
| Lucía Lavín Alconero, Phd | Contact | eclinicos5@idival.org |
| Name | Affiliation | Role |
|---|---|---|
| Galo Peralta Fernandez, MD | Instituto de Investigación Marqués de Valdecilla | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Marques de Valdecilla | Recruiting | Santander | Spain |
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|
| 1-year incidence of CMV disease |
CMV disease P.Lungman criteria. CMV as primary cause of death. |
| From date of CMV-CTLs infusion to 1 year after transplant |
Expansion of CMV-CTLs detected by flow cytometry.
| From date of CMV-CTLs infusion to 2 months after infusion |
| Immune reconstitution post-HAPLO | CD3, CD4, CD8, B and NK lymphocyte counts in patient peripheral blood post-transplant (day 30, 60, 90 and 180) detected by flow cytometry. | From date of transplant to day 180 post-transplant |