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Each patient will receive up to 12 cycles of TGFβi NK cell infusions. Each cycle will be of 4 weeks duration. During the first 3 weeks, TGFβi NK cells will be infused once weekly. The 4th week will be a rest week. TGFβi NK cell infusions should be delivered at least 3 days apart (e.g., Friday of Week 1 and Monday of Week 2). Dose will be escalated in an inter-patient stepwise fashion consisting of 3 dose levels.
A cycle is 28 days (4 weeks) consisting of weekly infusions of UD TGFβi NK cells via Ommaya or a programable ventriculoperitoneal (VP) shunt for three weeks followed by one week of rest. The dose-limiting toxicity (DLT) period is the first 28 days (4 weeks). A DLT is defined as any event that is at least possibly attributable to the TGFβi NK cell product and that occurs from the time of initial NK cell infusion through the end of the first cycle (28 days). Patients with stable or improved disease will receive up to 12 cycles of TGFβi NK cell infusions.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NK cell infusion | Experimental | The TGFβi NK cell product on this trial will be manufactured in the Cell Based Therapy (CBT) Core facility at Nationwide Children's Hospital. Donors have been identified with specific universal-donor NK cell characteristics. The NK cells are collected from these donors via apheresis and then undergo CD3 depletion followed by a 2-week expansion. TGFβi NK cells are then generated by weekly stimulation with feeder cells and cultured in IL-2 and TGFβ. After 2 weeks, the TGFβi NK cells are washed and cryopreserved for future use. The expanded donor NK cell product will be manufactured prior to subject enrollment. Patients will receive 3 cycles of NK cell infusions over 12 weeks. Each cycle will consist of three weekly injections followed by a rest week (week 4). If patients have stable or improved disease and additional doses are available, patients may continue to receive therapy for a total of 12 cycles. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NK cells | Biological | The universal donor TGFβi NK cells will be cryopreserved until they are delivered bedside for infusion. The trained staff will thaw the product by the bedside. The administration of the cells will be done via an Ommaya intra-cavitary/a programable ventriculoperitoneal (VP) shunt. Once the infusion is ready for administration patients will be admitted to the infusion unit for monitoring. NK cells will be administered through the Ommaya/VP shunt in approximately 3 milliliters over approximately 2-5 minutes; followed by 1.5-2 milliliter preservative-free normal saline flush over approximately 1 minute. |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum tolerated dose or Recommended Phase 2 Dose (RP2D) | To determine the maximum tolerated dose (MTD) and/or the RP2D of UD TGFβi NK cells that have been propagated ex vivo with genetically modified feeder cells and administered using an Ommaya reservoir (into tumor cavity) or a programable ventriculoperitoneal shunt (intraventricular). | 36 months |
| Maximum tolerated dose | To establish the maximum tolerated dose (MTD) of autologous natural killer cells that have been propagated ex vivo with genetically-modified feeder cells and administered intra-tumoral via Ommaya reservoir in patients with recurrent high-grade glioma. MTD will be the maximum dose at which fewer than one-third of patients experience a dose-limiting toxicity during cycle 1 of therapy | 36 months |
| Measure | Description | Time Frame |
|---|---|---|
| Define tumor activity in children | To preliminarily define the antitumor activity in children with recurrent, refractory, or progressive primary malignant CNS tumors with the exception of diffuse midline gliomas and or diffuse intrinsic pontine glioma as measured by objective response rate (ORR) of UD TGFβi NK cells within the confines of a Phase I study. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| NK cell antitumor activity | To assess the antitumor activity based on imaging and cytology of autologous NK cell administration directly into the tumor or the resection cavity. | 36 months |
| Assessment of the immuno-phenotype of expanded NK cells for high-grade glioma patients |
Inclusion Criteria:
Diagnosis:
Recurrent, refractory, or progressive malignant CNS tumor
Patients with a histologically confirmed diagnosis of a CNS tumor that is recurrent, progressive, or refractory with the exception of diffuse midline gliomas (DMG) or Diffuse Intrinsic Pontine Gliomas (DIPG). All tumors must have histologic verification at either the time of diagnosis or recurrence.
Patients should be deemed candidate for placement of an Ommaya reservoir placed intra-cavitary/intra-tumoral or a programable VP shunt.
Measurable residual tumor after surgery is not required for study entry.
Resection cavity needs to be at least 2 cm x 2 cm in two dimensions on imaging for patients deemed as candidates for an intratumoral infusion via an Ommaya reservoir.
Prior Therapy:
Chemotherapy
Biologic or investigational agent (anti-neoplastic, non-myelosuppressive):
Radiation Therapy
Stem Cell Transplant.
Patient must be:
≥ 6 months since allogeneic stem cell transplant prior to enrollment with no evidence of active graft vs. host disease.
≥ 3 months since autologous stem cell transplant prior to enrollment.
• Growth Factors
Patients must be off all colony- forming growth factor(s) for at least 1 week prior to enrollment (e.g., filgrastim, sargramostim or erythropoietin).
2 weeks must have elapsed if patients received long-acting formulations.
• Corticosteroids
Patients who are receiving dexamethasone must be on a stable or decreasing dose for at least 1 week prior to enrollment.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Clelie Peck | Contact | 614-722-5634 | Clelie.Peck@nationwidechildrens.org | |
| Lauren Rayman | Contact | 614-722-3729 | lauren.rayman2@nationwidechildrens.org |
| Name | Affiliation | Role |
|---|---|---|
| Sara Khan, MD | Nationwide Children's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Nationwide Children's Hospital | Recruiting | Columbus | Ohio | 43205 | United States |
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| ID | Term |
|---|---|
| D005910 | Glioma |
| ID | Term |
|---|---|
| D018302 | Neoplasms, Neuroepithelial |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
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|
To determine the persistence, immuno-phenotype and function of adoptively transferred expanded TGFβi NK cells and correlate the findings with the overall response. |
| 36 months |
| Assessment of health-related quality-of-life of patients using patient reported outcomes measurement information system (PROMIS) | To assess health-related quality-of-life of patients by parent report, and when possible patient report using PROMIS. | 36 months |
| Assessment of the immune signature based profile | To determine the gene expression-based immune profile of each patient's tumor (e.g., RNA-seq or NanoString). | 36 months |
| Changes of the T-cell Receptor (TCR) Repertoires in Tumor Tissue before and after NK Cell Treatment | The aim is to compare the mRNA expression of specific immune genes before and after NK cell treatment. By analyzing RNA from tumor tissue, we will identify and quantify immune cells in each patient's tumor. These profiles will be linked to treatment outcomes, helping understand response or non-response. For patients whose disease progresses, the goal is to study changes in their immune cells through RNA analysis. | 36 months |
| D009369 | Neoplasms |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009380 | Neoplasms, Nerve Tissue |