CXCR4 Antagonist BL-8040 in Mobilizing Stem Cells for Donor Transplant in Healthy Donors and Patients with Advanced Hematological Malignancies
This phase II trial studies the side effects and how well CXCR4 antagonist BL-8040 works in mobilizing stem cells for donor transplant in healthy donors and patients with hematological malignancies that have spread to other places in the body and usually cannot be cured or controlled with treatment. CXCR4 antagonist BL-8040 may help donors produce enough stem cells from the bone marrow into blood after one dose compared to other drugs used for the same purpose, which require multiple doses.
Inclusion Criteria
- DONOR: Age 18 to 70 years of age
- DONOR: Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- DONOR: * PART 1: Donor must be a 5/6 or 6/6 human leukocyte antigen (HLA)-matched sibling willing to donate PBSC for transplant * PART 2: Donor must be a 5/6 or 6/6 HLA-matched sibling or >= 3/6 HLA haploidentical donor willing to donate PBSC for transplant; haploidentical donors will be allowed to participate upon investigator decision and based on the data reached from 5/6 or 6/6 HLA matched transplant done during Part 1 of the study
- DONOR: Serum creatinine within normal limits or a minimum creatinine clearance (CrCl) value of >= 60 ml/min calculated using the Modification of Diet in Renal Disease (MDRD) study equation
- DONOR: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2 x institutional upper limit of normal
- DONOR: Total bilirubin =< 2x institutional upper limit of normal
- DONOR: Women of childbearing potential and men must agree to use adequate contraception with two different forms, including one barrier method, during participation in the study and for 2 weeks following dosing with BL-8040; abstinence is acceptable if this is the established and preferred contraception for the subject
- DONOR: Female subjects must have a negative urine or serum pregnancy test within 10 days prior to taking study medication if of childbearing potential or must be of non-childbearing potential; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required; the serum pregnancy test must be negative for the subject to be eligible; non-childbearing potential is defined as: * >= 45 years of age and has not had menses for > 2 years * Amenorrheic for > 2 years without a hysterectomy and oophorectomy and a follicle-stimulating hormone (FSH) value in the postmenopausal range upon pretrial (screening) evaluation * Post-hysterectomy, oophorectomy, or tubal ligation
- DONOR: Able and willing to comply with the requirements of the protocol
- DONOR: Able to understand and willing to sign an Institutional Review Board (IRB)-approved written informed consent document
- RECIPIENTS
- ECOG performance status of 0-2 (inclusive)
- One of the following diagnoses: * Acute myelogenous leukemia (AML) in 1st or subsequent remission * Acute lymphoblastic leukemia (ALL) in 1st or subsequent remission * Chronic myelogenous leukemia (CML) in chronic or accelerated phase * Non-Hodgkin lymphoma (NHL) or Hodgkin’s disease (HD) in 2nd or greater complete remission, partial remission * Chronic lymphocytic leukemia (CLL) * Multiple myeloma (MM) * Myelodysplastic syndrome (MDS) * Myeloproliferative neoplasm (MPN) excluding primary or secondary myelofibrosis
- Creatinine clearance (CrCl) value of >= 60 ml/min by MDRD study equation
- AST and ALT =< 2 x institutional upper limit of normal
- Total bilirubin =< 2 x institutional upper limit of normal
- Adequate cardiac function with a left ventricular ejection fraction >= 40%
- Adequate pulmonary function defined as NO severe or symptomatic restrictive or obstructive lung disease, and formal pulmonary function testing showing an forced expiratory volume in 1 second (FEV1) >= 50% of predicted and a diffusion capacity of the lungs for carbon monoxide (DLCO) >= 40% of predicted, corrected for hemoglobin
- Female subjects must have a negative urine or serum pregnancy test if of childbearing potential or be of non-childbearing potential; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required; the serum pregnancy test must be negative for the subject to be eligible; non-childbearing potential is defined as: * >= 45 years of age and has not had menses for > 2 years * Amenorrheic for > 2 years without a hysterectomy and oophorectomy and a FSH value in the postmenopausal range upon pretrial (screening) evaluation * Post-hysterectomy, oophorectomy, or tubal ligation
- Able to understand and willing to sign an IRB-approved written informed consent document
Exclusion Criteria
- DONOR: Received any investigational agent within 30 days and/or 5 half-lives (of the other investigational agent), whichever is longer, of receiving BL-8040
- DONOR: Active human immunodeficiency virus (HIV) or hepatitis B or C infection
- DONOR: Pregnant or breastfeeding
- DONOR: Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- DONOR: Known allergy or hypersensitivity to any of the test compounds, materials, or contraindication to test products
- DONOR: Any malignancies in the 2 years prior to baseline, excluding: basal cell carcinoma, in situ malignancy, low-risk prostate cancer, cervix cancer after curative therapy
- DONOR: A comorbid condition which, in the view of the investigators, renders the subject at high risk from treatment complications
- RECIPIENTS:
- Recipient must not have received any investigational drug within 30 days of starting conditioning treatment
- Pregnant or breastfeeding
- Active HIV or hepatitis B or C infection
- Any medical condition which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient; subjects with a clinically significant or unstable medical or surgical condition or any other condition that cannot be well-controlled by the allowed medications permitted in the study protocol that would preclude safe and complete study participation, as determined by medical history, physical examinations, electrocardiogram (ECG), laboratory tests, or chest-X-ray and according to the investigator’s judgment
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT02639559.
PRIMARY OBJECTIVES:
I. To assess the efficacy of a single injection of CXCR4 antagonist BL-8040 (BL-8040) to mobilize >= 2 x 10^6 CD34+ cells/kg of recipient weight after no more than two leukapheresis collections from healthy donors.
SECONDARY OBJECTIVES:
I. To assess the safety and tolerability of BL-8040 in healthy donors.
II. To assess the kinetics of neutrophil and platelet recovery post-transplant in patients undergoing allogeneic stem cell transplant.
III. To determine the incidence of primary and secondary graft failure up to one year after transplantation of hematopoietic cells mobilized with BL-8040.
IV. To determine the incidence of grade 2-4 acute graft versus host disease (GvHD) in patients who have undergone transplantation of hematopoietic cells mobilized with BL-8040.
V. To determine the incidence of chronic GvHD at 1 year in patients who have undergone transplantation of hematopoietic cells mobilized with BL-8040.
VI. To determine the proportion of subjects who collect 5 x 10^6 CD34+ cells/kg of recipient weight in a single leukapheresis and in 2 leukapheresis sessions.
VII. To determine the incidence of cytomegalovirus (CMV) reactivation after transplantation of hematopoietic cells mobilized with BL-8040 in CMV seropositive recipients.
VIII. To determine the incidence of treatment-related mortality and disease relapse/progression after transplantation of hematopoietic cells mobilized with BL-8040.
IX. To determine the probability of event free and overall survival after transplantation of hematopoietic cells mobilized with BL-8040.
X. To determine the change in peripheral blood CD34+ cells concentration from baseline throughout day 1 and day 2 (if a second leukapheresis is required).
XI. To assess the pharmacokinetic profile of BL-8040.
TERTIARY OBJECTIVES:
I. To measure alterations in CXCR4 expression and receptor occupancy in the peripheral blood of healthy donors following treatment with BL-8040.
II. To determine the kinetics of mobilization of CD34+ cells and characterize CD34+ subsets mobilized by BL-8040.
III. To characterize the cellular composition of the hematopoietic stem progenitor cell (HSPC) graft including T-cell subpopulations in peripheral blood and in the stem cell product.
OUTLINE:
DONOR MOBILIZATION: Donors receive CXCR4 antagonist BL-8040 subcutaneously (SC) on day 1 and undergo leukapheresis over 180-270 minutes after the injection per institutional protocol. If the donor does not reach the collection goal for mobilization, donors undergo a second leukapheresis on day 2.
STEM CELL TRANSPLANT: Patients undergo allogeneic peripheral blood stem cell transplant (PBSCT) on day 0.
After completion of study treatment, donors are followed up at 7 and 30 days and then annually for 5 years and recipients for 12 months.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationSiteman Cancer Center at Washington University
Principal InvestigatorGeoffrey L. Uy
- Primary ID201602037
- Secondary IDsNCI-2016-00197
- ClinicalTrials.gov IDNCT02639559