CMV CTLs in Neonates With CMV Infection

Официальное название

A Phase II Open-Label Randomized Study of Anti-Viral Antibiotic Therapy With and Without Familial (Maternal) Cytomegalovirus (CMV) Cytotoxic T Lymphocytes (CTLs) in Neonates With Moderate/Severe Maternal Acquired CMV Infection

Обзор

Patients with moderate or severe CMV disease less than 21 days old who have a maternal donor who has a CMV response to the peptivators will be screened. All patients will receive treatment with valganciclovir or ganciclovir. There is a safety run in with treatment with CMV CTLs in cohort 1 and if found to be safe, will proceed to cohort 2 for randomization to receive antiviral therapy with or without CMV CTLs. Funding source: FDA OOPD

Подробное описание

Given the vulnerability and poor outcomes of preterm neonates and neonates in general to viral infection, including the need for prolonged antiviral therapy for 6 or more months to achieve just modest improvements in sensorineural functions, CMV CTL therapy offers a promising alternative. CMV CTL treatment will build on the hosts innate immune capacity to create a more effective and permanent defense against collateral injury arising from CMV infections.

Patients who meet all inclusion/exclusion criteria with a maternal donor who meet all donor criteria will be enrolled onto study.

Cohort 1 is a safety run-in; the first 3 patients enrolled will be treated with anti-viral and CMV CTLs. The external DSMB will review the data from the first patient, and if there are no adverse events or dose-limiting toxicities observed, approve patient 2, and then 3, 28 days after the prior patients last CTL infusion. Assuming there are no adverse events in any of the first 3 patients, the study will proceed to Cohort 2.

Cohort 2 will be randomized 1:1 to either anti-viral treatment alone or anti-viral treatment plus CMV CTLs.

Patients who are randomized to receive CMV CTLs will get their first infusion on Day 0. If the patient fails to achieve a CR, they may receive one infusion every 2 weeks up to 5 maximum CMV CTL infusions as long as there are no DLTs or AEs observed

Вмешательства

• Биопрепарат CMV Cytotoxic T-Lymphocytes
  Patients will receive maternal CMV CTLs on day 0. Additional doses of CMV CTLs may be re-infused at a minimum of every two weeks for a maximum of five total infusions (maximum 2.5 x 104 CD3/kg) only in patients not achieving a CR and no prior dose limiting toxicity of any prior dose.
• Препарат Anti-viral Therapy
  All patients will receive anti-viral therapy with one of the following: 4.2.2 Valganciclovir Dosing: 16 mg/kg/dose PO q12h OR 4.2.3 Ganciclovir Dosing: 6 mg/kg/dose IV q12h Dose adjustments: * Reduce dose by 50% for ANC less than 500 cells/mm3 * Hold the dose if ≤ 200 cells/mm3 until recovery ≥ 500 cells/mm3 * Treatment will continue for 6 months

Первичные конечные точки

• To determine the safety of giving CMV CTLs combined with anti-viral therapy in neonates with CMV [Срок оценки: 12 weeks]
• To determine response rates to treatment with CMV CTLS and anti-viral medication [Срок оценки: 12 weeks]

Критерии участия

Критерии включения

• Age: ≤ 21 days of life
• Birth Weight: ≥ 2500 gms
• Gestational age: ≥ 34 weeks of age
• Diagnosis of CMV viremia, viruria, and/or infection:Either one or more:

Elevated CMV by RT-PCR in urine, saliva, CSF, or plasma; and/or Positive urine culture for CMV

\- Moderate or Severe CMV Disease

Any one or more of the following attributable to congenital CMV infection:

• Thrombocytopenia (≤ 50,000 mm3)
• Multiple petechiae
• Hepatomegaly
• Splenomegaly
• Intrauterine growth retardation
• Increased transaminases
• Increased bilirubin
• Microcephaly
• Ventriculomegaly
• Intracerebral calcifications
• Periventricular echogenicity
• Cortical or cerebral malformation
• Chorioretinitis
• Severe neonatal hearing loss
• CMV DNA by PCR in CNS
• Increased WBC for age in CNS

• Minimal Organ Criteria Hematological: ANC ≥ 750/mm3, HgB ≥ 8gm/dl, Platelets ≥ 20,000/kmm3 Renal: Serum creatinine ≤ 1.0 mg/dl Hepatic: ALT/SGOT ≤3x upper normal limits
• Donor Availability: Maternal donor available with a T-cell response CMV MACS® PepTivators. the donor is considered suitable if the percentage of IFN-gamma+ T cells is > 0.01% after stimulation with PepTivators.

Exclusion Criteria -

• Patient receiving steroids (> 0.5 mg/kg prednisone equivalent) on the same day of CMV CTL infusion. Antenatal steroids for lung maturation will have been cleared prior to CMV diagnosis.
• Concomitant enrollment in another experimental clinical trial investigating the treatment of neonatal CMV viremia and/or infection.
• Any medical condition that could compromise participation in the study according to the investigator's assessment.
• Known history of HIV infection in the mother.
• Patient's legally authorized representative unwilling or unable to comply with the protocol or unable to give informed consent.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

США · 4 центра

• Children's Hospital Los Angeles — Los Angeles
• Washington University — St Louis
• New York Medical College — Valhalla
• Nationwide Children's Hosptial — Columbus

Идентификаторы

NCT: NCT05564598 · NYMC 597 · 1R01FD007837-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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