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    Clinical Trial Results:
    In vivo expansion and efficacy of adoptive natural killer cell-based immunotherapy for high-risk myeloid diseases

    Summary
    EudraCT number
    2011-003181-32
    Trial protocol
    SE  
    Global end of trial date
    30 Jun 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Dec 2021
    First version publication date
    13 Dec 2021
    Other versions
    Summary report(s)
    journal article

    Trial information

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    Trial identification
    Sponsor protocol code
    CIMNK1001
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Karolinska Univeristy Hospital
    Sponsor organisation address
    Hälsovägen 13, Huddinge, Sweden, 14157
    Public contact
    Andreas Björklund, Center for Hematology, Karolinska University Hospital, +46 (0)78112312, andreas.bjorklund@ki.se
    Scientific contact
    Andreas Björklund, Center for Hematology, Karolinska University Hospital, +46 (0)78112312, andreas.bjorklund@ki.se
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Jun 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Jun 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine the safety and in vivo expansion of allogeneic NK cells following titrated intermediate intensity conditioning regims.
    Protection of trial subjects
    Treatment was performed at a single trial site, a university hospital hematology in-patient ward, and thereafter carefully followed at a single outpatient ward to track, monitor and treat all types of complications.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jun 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Sweden: 18
    Worldwide total number of subjects
    18
    EEA total number of subjects
    18
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    10
    From 65 to 84 years
    8
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients with chemotherapy refractory AML or MDS and not eligible for allogeneic stem cell transplantation were recruited at the Hematology clinic at Karolinska University Hospital between June 2012 and Feb 2015.

    Pre-assignment
    Screening details
    20 patients were screened whereof 2 failed inclusion due to rapid deterioration of the original disease.

    Pre-assignment period milestones
    Number of subjects started
    18
    Number of subjects completed
    18

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Primary
    Arm description
    -
    Arm type
    main study arm

    Investigational medicinal product name
    NK cells
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    All available cells from one leucapheresis product

    Arm title
    Re-treatment
    Arm description
    -
    Arm type
    Retreatment

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Primary Re-treatment
    Started
    16
    2
    Completed
    16
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Primary
    Reporting group description
    -

    Reporting group title
    Re-treatment
    Reporting group description
    -

    Reporting group values
    Primary Re-treatment Total
    Number of subjects
    16 2 18
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    9 1 10
        From 65-84 years
    7 1 8
    Age continuous
    Units: years
        median (standard deviation)
    63 ± 11 54 ± 18 -
    Gender categorical
    Units: Subjects
        Female
    6 0 6
        Male
    10 2 12
    Disease type
    Units: Subjects
        Primary AML
    3 1 4
        MDS-AML
    8 0 8
        MDS
    5 1 6

    End points

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    End points reporting groups
    Reporting group title
    Primary
    Reporting group description
    -

    Reporting group title
    Re-treatment
    Reporting group description
    -

    Primary: Safety

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    End point title
    Safety [1]
    End point description
    Stopping Rules for excessive toxicity: > 20% grade 4 non-hematologic and non-infectious toxicity using the NCI toxicity tables (except for fevers alone), severe persistent neutropenia (more than 35 days and not due to hematological disease) or grade III/IV GvHD enrollment to the trial will be suspended and the study re-evaluated.
    End point type
    Primary
    End point timeframe
    0-3 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This was a pilot study to assess feasibility and safety, therefore no pre-defined statistical analysis was included in the protocol.
    End point values
    Primary Re-treatment
    Number of subjects analysed
    16
    2
    Units: Adverse Events
        Grade 4-5 non-hematologic, non-infectious toxicity
    2
    0
        Neutropenia day 35 & absent hematological disease
    0
    0
        Grade III/IV acute GVHD
    0
    0
    No statistical analyses for this end point

    Primary: In Vivo Expansion

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    End point title
    In Vivo Expansion [2]
    End point description
    End point type
    Primary
    End point timeframe
    Within 14 days
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This was a pilot study to assess feasibility and safety, therefore no pre-defined statistical analysis was included in the protocol.
    End point values
    Primary Re-treatment
    Number of subjects analysed
    16
    2
    Units: >100 NK cells/ul
    0
    0
    No statistical analyses for this end point

    Secondary: Response Evaluation

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    End point title
    Response Evaluation
    End point description
    End point type
    Secondary
    End point timeframe
    Within 12 weeks
    End point values
    Primary Re-treatment
    Number of subjects analysed
    16
    2
    Units: Subjects
        Objective response <12 w
    6
    0
        CR <12w
    4
    0
        PR <12w
    1
    0
        SD <12w
    1
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Within 12 weeks
    Adverse event reporting additional description
    NCI CTCAE grade 1-2
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    NCI CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Serious adverse events
    Overall trial
    Total subjects affected by serious adverse events
         subjects affected / exposed
    13 / 18 (72.22%)
         number of deaths (all causes)
    2
         number of deaths resulting from adverse events
    2
    Investigations
    ALT increased
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    AST increased
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypoxia
    Additional description: NCI CTCAE grade 3
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Chills
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Cytokine release syndrome (inkl. HLH)
    Additional description: NCI CTCAE grade 4-5
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    1 / 1
    Gastrointestinal disorders
    Nausea
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash maculo-papular
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Febrile neutropenia
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    6 / 18 (33.33%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Lung Infection
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    4 / 18 (22.22%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Catheter-related Infection
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    4 / 18 (22.22%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Sepsis
    Additional description: NCI CTCAE grade 4
         subjects affected / exposed
    3 / 18 (16.67%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Peripheral nerve infection
    Additional description: NCI CTCAE grade 3-4
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Encephalitis Infection
    Additional description: NCI CTCAE grade 5
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Overall trial
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    18 / 18 (100.00%)
    Investigations
    Fever
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    6 / 18 (33.33%)
         occurrences all number
    6
    ALT increased
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    AST increased
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Hypokalemia
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Hypomagnesemia
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    INR increased
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Creatinine increased
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Cardiac disorders
    Sinus tachycardia
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences all number
    2
    Nervous system disorders
    Insomnia
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Headache
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Oral hemorrage
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    4 / 18 (22.22%)
         occurrences all number
    4
    Purpura
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    4 / 18 (22.22%)
         occurrences all number
    4
    Hemolysis
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Eye disorders
    Vitreous Hemorrage
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Gastrointestinal disorders
    Nausea
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    8 / 18 (44.44%)
         occurrences all number
    8
    Vomiting
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    4 / 18 (22.22%)
         occurrences all number
    4
    Diarrhea
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    3 / 18 (16.67%)
         occurrences all number
    3
    Oral pain
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Abdominal pain
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Rash maculo-papular
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    5 / 18 (27.78%)
         occurrences all number
    5
    Node in breast
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Urticaria
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Oedema limb
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Psychiatric disorders
    Fatigue
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Bone pain
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences all number
    2
    Pain in extremity
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences all number
    2
    Non-cardiac chest pain
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Infections and infestations
    Lung Infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Peripheral nerve infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    2 / 18 (11.11%)
         occurrences all number
    2
    Soft tissue infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Skin infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Urinary tract infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1
    Anorectal infection
    Additional description: NCI CTCAE grade 1-2
         subjects affected / exposed
    1 / 18 (5.56%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    26 Feb 2013
    Inclusion halted due to SUSAR-evaluation after a heavily pretreated patient died. 10 days after NK infusion the patient caught Influensa-A, H1N1, that were followed by a secondary HLH, thereafter the patients condition deteriorated and he was diagnosed with a HHV-6 encephalitis. A bone marrow examination also confirmed an active leukemia at the time of death. The patient did not have an NK cell expansion. Since HHV-6 is uncommon outside allogeneic stem cell transplantation this complication had a possible relation to the study treatment, but not directly coupled to the infused NK cell product.
    01 Mar 2013

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/29444931
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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