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| ID | Type | Description | Link |
|---|---|---|---|
| NCI-2023-08318 | Other Identifier | NCI-CTRP Clinical Registry |
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To find the recommended dose of NY-ESO-1 TCR/IL-15 NK cells that can be given to patients with relapsed or refractory MM.
To learn if the dose of NY-ESO-1 TCR/IL-15 NK cells found in Part A can help to control the disease.
Primary Objectives:
Secondary Objectives:
Secondary end points
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment (lymphodepletion, NY-ESO-1 TCR/IL-15 NK cells) | Experimental | Patients receive fludarabine IV over 1 hour and cyclophosphamide IV over 3 hours on days -5, -4, and -3, followed by NY-ESO-1 TCR/IL-15 NK cells IV over 1-40 minutes on day 0. Patients who fail to achieve CR after receiving NY-ESO-1 TCR/IL-15 NK cells may receive up to 3 additional doses of NY-ESO-1 TCR/IL-15 NK cells and preceding lymphodepleting chemotherapy at 12 to 16 week intervals from day +0 of the previous cycle until the patient achieves CR or has completed a total of 4 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo chest x-ray and ECHO or MUGA at screening, and undergo collection of blood samples, PET/CT scans and bone marrow aspiration/biopsy throughout the trial. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fludarabine phosphate | Drug | Given by (IV) vein |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of dose-limiting toxicities (Part A) | Characterized by stringent complete response + complete response + very good partial response + partial response. Will provide an estimate of the objective response rate along with a 95% exact confidence interval. | Within 28 days of the natural killer (NK) cell infusion |
| Overall response rate (Part B) | Characterized by stringent complete response + complete response + very good partial response + partial response. Will provide an estimate of the objective response rate along with a 95% exact confidence interval. | At day 30 following NK cell infusion |
| Measure | Description | Time Frame |
|---|---|---|
| Progression free survival (PFS) rate | PFS will be estimated using the Kaplan-Meier method. Log-rank test will be performed to test the difference in survival between groups, where appropriate. | Time between cell infusion and disease progression or death, assessed at day 180 following NK cell infusion |
| NY-ESO-1 T-cell receptor (TCR)/IL-15 NK cell number |
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Inclusion criteria:
1. Patients with multiple myeloma with an expression of NY-ESO-1 by immunohistochemistry in the pre-screening or screening tumor sample or PCR NY-ESO-1 testing by Pathology. CD138 by immunostains will be performed to identify plasma cells before testing for NY-ESO-1 2. Patients are HLA-A*02:01, HLA-A*2:05, or HLA-A*2:06 positive on human leukocyte antigen (HLA) typing at any time.
3. Patients with relapsed or refractory multiple myeloma (MM) (patients with solitary plasmacytoma are not eligible) who meet the following criteria:
> or = 2 prior lines of therapy (including exposure to at least one proteasome inhibitor, immunomodulatory imide drug [ImiD], and anti-cd38 antibody and refractory to the last line of therapy)
Have measurable disease (serum monoclonal [M] protein level ≥ 0.5 g/dL, and/or urine M protein level ≥ 200 mg/24hrs, and/or involved serum free light chain [FLC] level ≥10 mg/dL provided the serum-free light-chain ratio is abnormal) ** Refractory is defined as a documented progressive disease during or within 60 days (measured from the last dose of any drug within the regimen) of completing treatment with the last anti-myeloma regimen before study entry 4. No anti-myeloma therapy within 7 days of lymphodepleting therapy. Note: Steroids are allowed at any time up until lymphodepletion. Localized radiation for palliation is allowed at any time up until NK cell infusion 5. Prior autologous/allogeneic transplants are allowed. 6. Prior cell therapy is allowed against targets other than NY-ESO-1. 7. Patients must have recovered from systemic toxicity of prior anti-myeloma therapy at the start of lymphodepletion 8. Eastern Cooperative Oncology Group (ECOG) performance status <= 2 9. Estimated glomerular filtration rate (eGFR using the Chronic Kidney Disease Epidemiology Collaboration [CKI-EPI] equation) >= 30 ml/min/1.73 m^2 10. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) =< 2.5 x upper limit of normal (ULN) or =< 5 x ULN if documented liver metastases 11. Total bilirubin =< 1.5 mg/dL, except in subjects with Gilbert's syndrome in whom total bilirubin must be =< 3.0 mg/dL 12. No history of liver cirrhosis 13. No ascites 14. Cardiac ejection fraction >= 50% 15. No clinically significant pericardial effusion as determined by an ECHO or MUGA 16. No uncontrolled arrhythmias or symptomatic cardiac disease 17. No clinically significant pleural effusion (per principal investigator [PI] discretion) 18. Baseline oxygen saturation > 92% on room air 19. Able to provide written informed consent 20. 18-80 years of age 21. Weight ≥ 40 kg 22. Absolute neutrophil count (ANC) ≥ 1000 /
CRITERIA FOR LYMPHODEPLETION:
Patient should continue to meet eligibility criteria above with the following exceptions:
* Platelet count >/= 25,000 /μL
** Note: Growth factor support is allowed prior to LD chemo. Transfusion support is allowed at any time. If cytopenias are related to multiple myeloma, the patient may proceed without meeting above hematologic parameters only if bone marrow plasma cells are >= 50%
CRITERIA FOR CELL INFUSION:
Patients who meet one of the following criteria on the day of infusion will have their administration delayed for 24 hours. If these problems persist beyond 24 hours, patients will not receive their cell infusion.
Exclusion Criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Muzaffar Qazilbash, M D | Contact | (713) 745-3458 | mqazilba@mdanderson.org |
| Name | Affiliation | Role |
|---|---|---|
| Muzaffar Qazilbash, M D | M.D. Anderson Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| M D Anderson Cancer Center | Recruiting | Houston | Texas | 77030 | United States |
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| Label | URL |
|---|---|
| M D Anderson Cancer Center | View source |
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| Cyclophosphamide | Drug | Given by (IV) vein |
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| Allogeneic Anti-NY-ESO-1-TCR-IL-15-transduced Cord Blood-derived Natural Killer Cells | Drug | Given by (IV) vein |
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Will be evaluated in peripheral blood versus time profile. Will show the distributions of NY-ESO-1 TCR/IL-15 NK cell numbers in peripheral blood by utilizing box-plots at different assessment days. |
| Up to 24 months following NK cell infusion |
| Lymphocyte populations | The characterization and trend of lymphocyte populations at various time points will be displayed using line charts. | Up to 24 months following NK cell infusion |
| Patient Reported Outcomes Measurement Information System-29 quality of life questionnaire score | Score will be summarized using frequencies and percentages. | Up to 24 months following NK cell infusion |
| Duration of response | The time between initial response and disease progression or death. Patients who do not experience an initial response will not be included in this analysis. Patients who experience a response but not disease progression or death will be censored at the last contact date at which they were known to be alive and progression-free. | Time between initial response and disease progression or death, assessed up to 24 months following NK cell infusion |
| ID | Term |
|---|---|
| D054219 | Neoplasms, Plasma Cell |
| ID | Term |
|---|---|
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| C042382 | fludarabine phosphate |
| C024352 | fludarabine |
| D003520 | Cyclophosphamide |
| ID | Term |
|---|---|
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
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