💬In plain words
What the trial is, and whether it could suit you
This is a Phase I dose-escalation study to evaluate the safety of norovirus -specific T-cell (NST) therapy for chronic norovirus infection in participants following hematopoietic stem cell transplantation (HSCT) or who are immunocompromised due to PID and have not undergone HSCT, or Solid Organ Transplant (SOT) recipients.
Sign in to get the eligibility rules as simple questions to take to your doctor.
📋 Eligibility rules (as published)
Inclusion Criteria:
Participant Inclusion Criteria for NST Infusion:
1. Participants must meet one of the following criteria:
1. Recipient of prior myeloablative or non-myeloablative allogeneic hematopoietic stem cell transplant using either bone marrow or peripheral blood stem cells or single or double cord blood OR
2. Primary immunodeficiency disorder (as defined by clinical and laboratory evaluations)81 and have not undergone HSCT, OR
3. Recipients of solid organ transplant.
2. Documentation of chronic norovirus infection:
a. Chronic norovirus infections will be defined as having consecutive positive norovirus stool tests (2 or more) spanning a minimum three-month period with attributable signs and symptoms of norovirus disease.
3. Participants receiving steroids for treatment of GVHD or for other reasons, dosage must have been tapered to \<0.5 mg/kg/day of prednisone (or equivalent) a minimum of 7 days prior to infusion.
a. Treatment with enteral topical steroids such as Budesonide at standard doses may be continued if previously utilized but should not be newly initiated in the 3 months after NST therapy.
4. For participants who have undergone HSCT, participants must have stable donor chimerism within the 30 days prior to NST infusion.
a. Stability will be defined as i. \>95% donor chimerism in CD33 and/or whole blood chimerism. OR ii. \>90% donor chimerism with \<5% change between subsequent tests separated by at least 1 week.
5. For recipients of solid organ transplants, participants must have stable graft function on maintenance immunosuppression, without evidence of rejection in the past 2 months prior to infusion, as defined by:
a. Stability of relevant functional testing in the previous 2 months, defined as: i. Renal transplant: renal function ≥ grade 3 per the National Kidney Foundation K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease (2002) ii. Cardiac transplant: maintenance of LVEF \>40% iii. Lung transplant: lack of baseline oxygen requirement iv. Liver transplant: AST/ALT ≤3x upper limit normal and bilirubin ≤2x upper limit normal b. Donor-derived cell free DNA \<2x upper limits for assay in the previous 2 months, c. Stable donor-specific antibody profile in the previous 2 months. i. No increase in antibody titers between most recent testing in the previous 2 months and prior testing.
6. Karnofsky/Lansky score \>50
7. 3 months to 80 years of age at enrollment.
8. ANC ≥500/ul.
9. Hemoglobin ≥7.0g/dl (level can be achieved with transfusion).
10. Platelets ≥20 K/ul (level can be achieved with transfusion).
11. Bilirubin ≤2x upper limit normal.
12. AST ≤3x upper limit normal.
13. Serum creatinine ≤2x upper limit normal OR estimated GFR ≥30 ml/hr.
14. Pulse oximetry of ≥90% on room air.
15. Negative pregnancy test in female participant of childbearing age.
16. Written informed consent and/or signed assent line from participant, parent or guardian.
Donor Inclusion Criteria:
1. Donors who have fulfilled eligibility as per United States Food and Drug Administration (FDA) regulations outlined in 21 Code of Federal Regulations (CFR) 1271 subpart C. This includes that donors have been deemed in good health by donor physician based on physical examination and laboratory testing. If a donor has been chosen for the transplant based on urgent medical need, that same donor will also be used for NST generation provided that there are no new reasons for ineligibility since the stem cell collection.
2. For third-party banking, donors must be between 2 to 35 years of age (females) or 2 to 40 years of age (males).
3. Donor or guardian of pediatric donor capable of providing informed consent.
4. Donor (related or unrelated) must have completed Infectious Disease (ID) testing up to 7 days before or after the collection of blood for NST manufacturing. The following tests will be performed:
* HBsAg
* HBc Antibody
* HCV Antibody
* HIV 1/2 Antibody
* HTLV I/II Antibody
* T. Cruzi Antibody (Chagas)
* CMV Total Antibody
* Syphilis (T. Pallidum IgG and IgM)
* HBV, HCV, HIV Nucleic Acid testing (NAT)
* WNV NAT
5. Female donors of childbearing age must have a negative pregnancy test and not be lactating.
Exclusion Criteria:
Participants Exclusion Criteria for NST Infusion:
1. Participants receiving biological or immunosuppressive monoclonal antibodies targeting T cells within 28 days prior to NST infusion, including ATG, Alemtuzumab, Basiliximab, Tocilizumab, Brentuximab, or other medications under this category as determined by the investigators.
a) If alemtuzumab has been received within 6 weeks prior to NST infusion, plasma levels should be obtained to ensure drug clearance (≤0.16 pg/ml).
2. Participants who have received donor lymphocyte infusion (DLI), chimeric antigen receptor T cell infusion, or other experimental cellular therapies within 28 days prior to NST infusion.
3. Participants with SCID who have undergone α/β TCR depleted HSCT within the past 100 days post-transplant.
4. Participants who have received ruxolitinib or other JAK inhibitors within 7 days prior to NST infusion.
5. Participants with uncontrolled or progressing infections other than norovirus. Uncontrolled infections are defined as bacterial, fungal, or non-targeted viral infections with either clinical signs of worsening despite standard therapy, or chronic gastrointestinal symptoms that may be attributed to the uncontrolled infection. Progressing infection is defined as hemodynamic instability, worsening physical signs, or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
1. For bacterial infections, participants must be receiving definitive therapy and have no signs of progressing infection within 7 days prior to NST infusion and or no chronic gastrointestinal symptoms associated with this bacterial infection.
2. For fungal infections, part