ECT-001 (UM171) Expanded Cord Blood Transplant to Treat High-risk Multiple Myeloma

Official Title

A Phase I-II Open-label Study of Non-myeloablative-allogeneic Transplant of ECT-001 (UM171/ Fed-batch Culture System) Expanded Cord Blood in Patients With High-risk Multiple Myeloma

Summary:

MM is a morbid disease associated with a poor outcome and while current therapies with new drugs have improved survival, MM still remains incurable in most patients. The only potential curative treatment remains allogeneic HSCT, as shown by our cohort of 92 NDMM patients who received a sibling tandem auto-allo Hematopoietic stem cell transplant (HSCT) with an estimated 10-year progression free survival (PFS) of 43%. However, the high incidences of toxicities including chronic graft-versus-host-disease (GVHD) (up to 79%) and disease progression (up to 49%) impair improvement in cure rate. Using umbilical cord blood (CB) as an alternative source of hematopoietic stem cells (HSC) could be superior biologically because of their increased proliferative capacity, greater number of progeny with longer telomeres and better anti-tumour efficacy in presence of positive residual disease. Moreover, using CB has been shown to decrease incidence of chronic GVHD. However, CBs have the disadvantage of having a limited HSC dose leading to prolonged cytopenia and higher risk of infections.

In a first in-human trial using CB expanded with the ECT-001 (UM171) molecule (clinicaltrial.gov # NCT02668315), the median net expansion of HSC was 36 fold, which allows for the selection of better HLA matched CB regardless of their lower HSC dose. Moreover, the ECT-001 expanded CBs have a different cell composition than regular CBs, with more than 25% of dendritic cell precursors. This, combined to better HLA matched CBs, may reduce chronic GVHD incidence and improve immune reconstitution. To date, 22 patients received an ECT-001 expanded CB and the procedure proved to be safe and feasible.

In this new trial, the goal is to evaluate the safety and efficacy of ECT-001 expanded CB transplant in high risk MM patients.

Trial Description

Primary Outcome:

• Safety of ECT-001 expanded CB expansion as measured by toxicity evaluation
• Feasibility of ECT-001 expanded CB expansion
• Measure of the kinetics of donor lymphoid cells recovery
• Measure of the kinetics of donor myeloid cells recovery
• Incidence of chronic GVHD by grade at 1 years by NIH criteria.
• Incidence of chronic GVHD by grade at 2 years by NIH criteria.

Secondary Outcome:

• Correlation between neutrophil and CD34+ doses infused
• Correlation between neutrophil and CD34+CD45RA+ doses infused
• Incidence of graft failure
• Evaluation of T Cells reconstitution
• Evaluation of B cells reconstitution
• Evaluation of NK Cells reconstitution
• Evaluation of expanded HSC activity in vivo
• Incidence of acute GVHD at day +120
• Incidence of acute GVHD at 6 month
• Incidence of acute GVHD at 1 year
• Incidence of grade >=3 infectious complications
• Incidence of engraftment syndrome requiring therapy
• Duration of hospitalization
• Non relapse mortality at day +120
• Non relapse mortality at 1 year
• Non relapse mortality at 2 year
• Progression free survival at 2 years
• Overall survival at 2 years
• Response to treatment at 1 year after allogeneic transplant
• Response to treatment at 2 year after allogeneic transplant
• Best response achieve at 1 year after allogeneic transplant
• Best response achieve at 2 year after allogeneic transplant
• Minimal residual disease post transplant
• Patient's quality of life
• Pharmaco-economic evaluation of the proposed treatment

This is a single institution, prospective, phase I/II open-label study in a maximum of 20 patients evaluating a novel treatment strategy in NDMM patients with high-risk disease who do not have a 6/6 compatible sibling donor. Participating patients will be from Hôpital Maisonneuve-Rosemont (HMR) or referred to HMR for this protocol. Newly diagnosed multiple myeloma patients will be evaluated for eligibility before or during the autologous stem cell transplant (ASCT) period. After a Bortezomib-based induction treatment (VTD, CyBorD, RVD or PAD [in patients with plasma cell leukemia]) for a minimum of 4 cycles, followed by Melphalan ≥ 140 mg/m2 and ASCT, eligible patients who accept to participate will undergo screening evaluation to receive a non myeloablative (NMA) allogeneic HSCT with ECT-001 expanded CB. It is estimated that 18 months will be necessary to enroll the targeted sample size.

Once eligibility has been confirmed, study treatment will begin. After an ASCT, eligible patients will receive a conditioning regimen before receiving an outpatient NMA allogeneic HSCT with an ECT-001 expanded CB on day 0. Patients will be followed at least every week for the first 3 months, then every month, in the absence of GVHD, for disease evaluation and adverse events. Occurrence and severity of acute GVHD will be evaluated using the modified Glucksberg176 and IBMTR177 criteria, while chronic GVHD will be evaluated using the NIH178 criteria.

The trial will be terminated when all patients have been followed for 5 years after allogeneic HSCT.

View this trial on ClinicalTrials.gov