T Cell Therapy for Cytomegalovirus

Overseen By Mari H Dallas, MD

Age: Any Age

Sex: Any

Trial Phase: Phase < 1

Sponsor: Mari Dallas

Must not be taking: Antithymocyte globulin, Virus-specific T cells

Disqualifiers: Pregnancy, Other viral infections, GVHD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 day

20 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, it mentions that patients with certain conditions requiring high doses of steroids or recent treatment with specific therapies are excluded, which might imply some restrictions. It's best to discuss your current medications with the trial team.

What data supports the effectiveness of the treatment T Cell Therapy for Cytomegalovirus?

Research shows that using CMV-specific T cells can help rebuild the body's defense against the virus after stem cell transplants, reducing the need for antiviral drugs and preventing further virus reactivation in most patients. This approach has been effective and safe, even when using T cells from partially matched donors. ^{1 2 3 4 5}

Is T Cell Therapy for Cytomegalovirus safe for humans?

The safety of T Cell Therapy for Cytomegalovirus is not directly addressed in the provided research articles, which focus on CAR-T cell therapy for other conditions. However, CAR-T cell therapy can have serious side effects, including infections and immune-related issues, which may be relevant to consider. ^{6 7 8 9 10}

How is the T cell therapy for cytomegalovirus different from other treatments?

This treatment uses specially engineered T cells to target and fight the cytomegalovirus, offering a personalized approach that can restore long-lasting immunity without the need for antiviral drugs. Unlike traditional treatments, it involves the rapid generation and expansion of virus-specific T cells from the patient's own blood, making it a unique and effective option for patients who have undergone stem cell transplants. ^{1 2 3 11 12}

What is the purpose of this trial?

The purpose of this study is to determine if a specific type of cell-based immunotherapy, using T-cells from a donor that are specific against cytomegalovirus (CMV) is feasible to treat infections by CMV. Adoptive T-cell therapy is an investigational (experimental) therapy that works by using the blood of a donor and selecting the T-cells that can respond against a specific infectious entity. These selected T-cells are then infused to the patient, to try to give the immune system the ability to fight the infection. Adoptive T-cell therapy is experimental because it is not approved by the Food and Drug Administration (FDA).

Research Team

Mari H Dallas, MD

Principal Investigator

University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center

Eligibility Criteria

This trial is for patients who've had a bone marrow transplant and are over 30 days post-transplant, with CMV infections not improving after antiviral therapy or those experiencing side effects from such treatments. Participants need to be able to consent and use contraception if applicable. Excluded are pregnant/breastfeeding women, recent recipients of certain immune therapies, those with other viral infections or active severe graft vs. host disease.

Inclusion Criteria

My viral load hasn't improved after 2 weeks of antiviral treatment, or I've had new or ongoing symptoms, or I can't tolerate the medication, or my CMV infection has come back twice.

I am capable of limited self-care and spend more than half of my waking hours out of bed.

I agree to use birth control during the study.

Exclusion Criteria

I am currently experiencing severe graft vs. host disease or need high doses of steroids.

I have a viral infection that is not CMV.

I have not received virus-specific T cell therapy in the last 6 weeks.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a one-time infusion of CMV-specific adoptive T-cells

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Regular monitoring visits

Extended Follow-up

Participants are monitored for adverse events and response rate up to 100 days after transplant

Up to 100 days

Treatment Details

Interventions

• CMV specific adoptive t-cells

Trial Overview The study tests the feasibility of using donor-derived T-cells that target cytomegalovirus (CMV) in patients who have received a bone marrow transplant. This cell-based immunotherapy aims to bolster the patient's immune response against CMV infection.

Participant Groups

Group I: CMV specific adoptive t-cells Experimental Treatment 1 Intervention

This study involves a one-time infusion of the experimental CMV specific adoptive t-cells. After this infusion, patients will be followed for 4 weeks.

CMV specific adoptive t-cells is already approved in United States, European Union, China for the following indications:

Approved in United States as CMV-specific T-cells for:

• Investigational for CMV infections post-transplant

Approved in European Union as CMV-specific T-cells for:

• Investigational for CMV infections post-transplant

Approved in China as CMV-specific T-cells for:

• Investigational for CMV infections post-transplant

Who Is Running the Clinical Trial?

Mari Dallas

Lead Sponsor

Trials

2

Recruited

40+

Findings from Research

In a study involving 16 patients, treatment with polyclonal CMV-specific T-cell lines led to significant in-vivo expansion of these immune cells, effectively reconstituting viral immunity against CMV infection after transplantation.

The use of these T-cell lines was shown to be effective, as eight patients did not require antiviral drugs, and only two experienced subsequent reactivation of the virus, highlighting the potential of this therapy in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adoptive cellular therapy for early cytomegalovirus infection after allogeneic stem-cell transplantation with virus-specific T-cell lines. Peggs, KS., Verfuerth, S., Pizzey, A., et al.[2023]

CMV infection is a major risk after allogeneic stem cell transplantation, but reconstituting CMV-specific T cell responses can help protect patients from developing CMV disease.

Two strategies to enhance T cell immunity against CMV include transferring selected CMV-specific T cells directly from the donor to the patient and expanding these T cells in vitro using antigen presenting cells, both of which aim to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CMV-specific T cell therapy. Einsele, H., Kapp, M., Grigoleit, GU.[2007]

A novel method using synthetic CpG oligodeoxynucleotides and modified vaccinia Ankara (MVA) to expand CMV-specific CD4(+) and CD8(+) T cells resulted in a 30-fold increase in T cell populations within 10 days, demonstrating high efficacy for potential therapeutic use.

The expanded T cells showed minimal alloreactivity and strong cytotoxic activity against CMV, making this approach promising for managing CMV viremia in patients undergoing hematopoietic stem cell transplantation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

In vitro expansion of polyclonal T-cell subsets for adoptive immunotherapy by recombinant modified vaccinia Ankara. La Rosa, C., Wang, Z., Lacey, SF., et al.[2008]

In a study of 104 patients receiving CMV-specific cytotoxic T lymphocytes (CMV-CTLs) for CMV viremia after allogeneic transplant, the source of CMV-CTLs (either from primary or third-party donors) did not affect the likelihood of achieving important immune recovery milestones.

Patients with higher baseline CD4+ T cell counts (>50 × 10^6/L) showed better responses to CMV-CTL therapy, leading to improved overall survival and reduced risk of CMV-related death, highlighting the importance of baseline immunity in treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adoptive therapy with CMV-specific cytotoxic T lymphocytes depends on baseline CD4+ immunity to mediate durable responses. Fabrizio, VA., Rodriguez-Sanchez, MI., Mauguen, A., et al.[2021]

The study successfully isolated CMV-specific cytotoxic T lymphocytes (CTLs) from donor leukocytes using a novel MHC class I peptide streptamer method, achieving a median purity of 90.2% and yielding 7.77 million functional CTLs.

This approach provides a promising non-toxic alternative for restoring CMV immunity in patients after hematopoietic stem cell transplantation, with the isolated CTLs demonstrating excellent viability and cytotoxicity for at least 72 hours post-collection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical-scale isolation of 'minimally manipulated' cytomegalovirus-specific donor lymphocytes for the treatment of refractory cytomegalovirus disease. Odendahl, M., Grigoleit, GU., Bönig, H., et al.[2014]

CAR-T therapy is highly effective in treating certain cancers, but it is associated with significant complications, particularly cytokine release syndrome and neurotoxicity.

In addition to the well-known side effects, there are various other CAR-T-specific adverse events that require careful management based on clinical experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Management of adverse events of CAR-T therapy]. Arai, Y.[2023]

CAR-T cell therapy has shown remarkable effectiveness in treating difficult cases of cancers like acute lymphoblastic leukemia and lymphomas, but it can also lead to serious side effects such as cytokine release syndrome and neurological toxicities.

These adverse events, while potentially life-threatening, can be managed effectively with early recognition and treatment by trained medical teams, highlighting the importance of proper preparation and training in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Consensus on genetically modified cells. I: Structuring centers for the multidisciplinary clinical administration and management of CAR-T cell therapy patients. Clé, DV., Hirayama, AV., Alencar, AJ., et al.[2021]

A 21-year-old male patient developed possible CMV pneumonia three months after receiving CAR-T cell therapy for relapsed B-ALL, highlighting the risk of late-phase viral reactivation in immunocompromised patients.

Despite initial improvement with antiviral treatment, the patient's condition worsened after stopping one of the medications, leading to respiratory failure and death, emphasizing the need for careful monitoring and management of viral infections post-CAR-T therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case Report: Fatal cytomegalovirus pneumonia after CAR-T cell therapy in the long-term follow-up. Cheng, J., Huang, J., Cao, W., et al.[2023]

CAR T-cell therapy is an effective treatment for blood cancers but can lead to serious side effects like cytokine release syndrome and prolonged immunosuppression, increasing the risk of infections.

In a case study of a 64-year-old man with multiple myeloma, a history of cytomegalovirus (CMV) infection worsened after CAR T-cell therapy, highlighting the need for better strategies to prevent and manage CMV infections in patients undergoing this treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cytomegalovirus infection in chimeric antigen receptor T-cell recipients. Abreu, M., Varghese, J., Santiago, M., et al.[2023]

CAR-T therapy has shown significant promise in treating patients with relapsed or refractory hematological cancers, but it can lead to severe immunological toxicities that require careful management.

Common toxicities associated with CAR-T therapy include cytokine-release syndrome and neurotoxicity, which can result in serious complications, highlighting the need for a multidisciplinary approach to patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toxicities following CAR-T therapy for hematological malignancies. Hernani, R., Benzaquén, A., Solano, C.[2022]

A new clinical-scale protocol was developed to generate CMV-specific T cells from a single 500-mL blood draw, allowing for a more efficient and less time-consuming method compared to traditional techniques that require live virus and leukapheresis.

The generated CMV-specific T cells effectively lysed CMV-infected cells and showed reduced alloreactivity, indicating that this method not only produces a high quantity of functional T cells but also minimizes the risk of unwanted immune responses in transplant recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rapid generation of combined CMV-specific CD4+ and CD8+ T-cell lines for adoptive transfer into recipients of allogeneic stem cell transplants. Rauser, G., Einsele, H., Sinzger, C., et al.[2022]

An innovative in vitro system was developed to generate human cytomegalovirus (CMV)-specific cytotoxic T cells (CTL) using autologous donor leucocytes coated with CMV antigens, effectively producing CTLs from seropositive donors.

The study demonstrated that CMV-specific CTLs could be inhibited by monoclonal antibodies targeting CMV-related proteins, indicating a potential mechanism for regulating CTL activity in therapeutic settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Definition of human cytomegalovirus-specific target antigens recognized by cytotoxic T cells generated in vitro by using an autologous lymphocyte system. Charpentier, B., Michelson, S., Martin, B.[2006]

References

1. England pubmed.ncbi.nlm.nih.gov

Adoptive cellular therapy for early cytomegalovirus infection after allogeneic stem-cell transplantation with virus-specific T-cell lines. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

CMV-specific T cell therapy. [2007]

3. Netherlands pubmed.ncbi.nlm.nih.gov

In vitro expansion of polyclonal T-cell subsets for adoptive immunotherapy by recombinant modified vaccinia Ankara. [2008]

4. United States pubmed.ncbi.nlm.nih.gov

Adoptive therapy with CMV-specific cytotoxic T lymphocytes depends on baseline CD4+ immunity to mediate durable responses. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Clinical-scale isolation of 'minimally manipulated' cytomegalovirus-specific donor lymphocytes for the treatment of refractory cytomegalovirus disease. [2014]

6. Japan pubmed.ncbi.nlm.nih.gov

[Management of adverse events of CAR-T therapy]. [2023]

7. Brazil pubmed.ncbi.nlm.nih.gov

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Consensus on genetically modified cells. I: Structuring centers for the multidisciplinary clinical administration and management of CAR-T cell therapy patients. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Case Report: Fatal cytomegalovirus pneumonia after CAR-T cell therapy in the long-term follow-up. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Cytomegalovirus infection in chimeric antigen receptor T-cell recipients. [2023]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Toxicities following CAR-T therapy for hematological malignancies. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Rapid generation of combined CMV-specific CD4+ and CD8+ T-cell lines for adoptive transfer into recipients of allogeneic stem cell transplants. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Definition of human cytomegalovirus-specific target antigens recognized by cytotoxic T cells generated in vitro by using an autologous lymphocyte system. [2006]