CTL Therapy for BK Virus Infection

(BK-CTLs Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Caitlin Elgarten, MD

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase < 1

Recruiting

Sponsor: Children's Hospital of Philadelphia

Must not be taking: Steroids, Thymoglobulin, Campath, others

Disqualifiers: Acute GVHD, HIV, Pregnancy, others

No Placebo Group

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This is a pilot study using cytotoxic T lymphocytes (CTLs) manufactured with the Miltenyi CliniMACS Prodigy Gamma-capture system will be effective in decreasing specific viral load in patients with BK virus viremia and BK virus-associated symptoms post-allogeneic hematopoietic stem cell transplantation (HSCT), renal transplantation, and chemotherapy.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you cannot participate if you are on certain steroids or immunosuppressive drugs close to the time of the infusion.

What data supports the effectiveness of this treatment for BK virus infection?

Research shows that using virus-specific T cells (VSTs) to treat BK virus infection in transplant patients is promising, with an overall response rate of 86% for BK viremia and 100% for hemorrhagic cystitis. This suggests that VSTs can be a safe and effective treatment option for managing BK virus-related complications in these patients. ^{1 2 3 4 5}

Is CTL therapy for BK virus infection safe for humans?

Research shows that CTL therapy for BK virus infection is generally safe in humans, with no significant side effects like infusional toxicity or organ rejection reported in studies involving transplant recipients. ^{1 2 4 6 7}

How is the CTL therapy for BK virus infection different from other treatments?

CTL therapy for BK virus infection is unique because it uses virus-specific T cells (VSTs) to target and eliminate the virus, offering a highly specific and effective treatment option, especially for immunocompromised patients, unlike traditional antiviral drugs which are limited in effectiveness. ^{1 2 3 5 8}

Research Team

Caitlin Elgarten, MD

Principal Investigator

Children's Hospital of Philadelphia

Eligibility Criteria

This trial is for immunocompromised transplant patients aged 0.1 to 25 years with BK virus infections post-transplant or chemotherapy, experiencing symptoms like blood in urine and pain during urination. Participants need a related donor with T-cell response to the virus, must not be on certain steroids or other experimental treatments for BK virus, and should have a performance status over 30%. Pregnant women and those unwilling to use birth control are excluded.

Inclusion Criteria

I am between 1 month and 25 years old.

I need a new donor because my original one can't help. The new donor matches me closely.

I am a woman who can have children and my pregnancy test is negative.

Exclusion Criteria

Known human anti-mouse antibodies

I am taking steroids equivalent to more than 0.5 mg/kg of prednisone at the time of or within 3 days before my planned infusion.

I am not pregnant, breastfeeding, and willing to use birth control during the study.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive BK virus-specific CTLs to decrease viral load

8 weeks

Regular visits for CTL infusions and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 weeks

Monitoring visits for viral load assessment

Treatment Details

Interventions

• BK-virus specific CTLs (CAR T-cell Therapy)

Trial Overview The study tests whether special immune cells called BK-virus specific CTLs can reduce viral load in patients with BK Virus after stem cell or kidney transplants, or chemotherapy. These CTLs are made using a system called Miltenyi CliniMACS Prodigy Gamma-capture.

Participant Groups

Group I: BK cystitis and/or nephropathy Experimental Treatment 1 Intervention

All patients with symptoms that are consistent with BK cystitis and/or nephropathy (frequency, dysuria, hematuria, elevated creatinine) will have serum quantitative DNA PCR for BK virus level measured in log copies per mL (results also expressed in copies per milliliter), performed in the Children's Hospital of Philadelphia Infectious Disease Diagnostics Laboratory

Who Is Running the Clinical Trial?

Children's Hospital of Philadelphia

Lead Sponsor

Trials

749

Recruited

11,400,000+

Joseph W. St. Geme III

Children's Hospital of Philadelphia

Chief Medical Officer since 2021

MD, PhD, MPH

Madeline Bell

Children's Hospital of Philadelphia

Chief Executive Officer since 2015

BSc in Nursing from Villanova University, MSc in Organizational Dynamics from the University of Pennsylvania

Findings from Research

In a study of 17 hematopoietic stem cell transplant recipients with BKV-related cystitis, 71% showed specific T-cell responses to the BK virus, indicating a strong immune reaction.

Virus-specific T cell (VST) therapy was effective, with 6 out of 7 patients treated showing specific T-cell responses, suggesting that VSTs may enhance the immune response against BKV compared to other treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-Term Follow-Up after Adoptive Transfer of BK-Virus-Specific T Cells in Hematopoietic Stem Cell Transplant Recipients. Koldehoff, M., Eiz-Vesper, B., Maecker-Kolhoff, B., et al.[2023]

BKV-specific CD8(+) T cells are present in low frequencies in healthy individuals and have a unique memory phenotype, which suggests they may play a role in controlling BK virus reactivation in immunocompromised patients.

These T cells exhibit limited direct cytotoxic capacity but are polyfunctional, capable of producing key cytokines like IL-2 and IFN-γ, indicating their potential importance in antiviral immune responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phenotypic and functional characterization of circulating polyomavirus BK VP1-specific CD8+ T cells in healthy adults. van Aalderen, MC., Remmerswaal, EB., Heutinck, KM., et al.[2021]

The study identifies a method to effectively capture and expand BKV-specific CD4(+) T cells from kidney transplant patients, which is crucial for improving immune responses against BK virus reactivation.

BKV-specific CD4(+) T cells were found to be multifunctional and cytolytic, indicating their significant role in controlling BKV replication, thus highlighting their potential for use in adoptive immunotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of CD4(+) T cells in BKV-specific T cell immunity. Weist, BJ., Schmueck, M., Fuehrer, H., et al.[2021]

A study involving 41 patients (38 HSCT and 3 SOT recipients) showed that T cell therapy targeting BK polyomavirus (BKPyV) resulted in an impressive overall response rate of 86% for BK viremia and 100% for hemorrhagic cystitis, indicating its efficacy in managing BKPyV-related complications.

The treatment was found to be safe, with no significant side effects such as infusional toxicity or graft-versus-host disease, suggesting that virus-specific T cell therapy could be a promising option for immunocompromised patients at risk for BKPyV complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virus-specific T-cell therapy to treat BK polyomavirus infection in bone marrow and solid organ transplant recipients. Nelson, AS., Heyenbruch, D., Rubinstein, JD., et al.[2022]

In a phase II clinical trial involving 38 patients, the use of banked virus-specific T cells (VSTs) showed a remarkable 92% overall response rate in treating severe viral infections after hematopoietic stem-cell transplantation, with complete responses for BKV and EBV infections.

The treatment was safe, with only two mild cases of graft-versus-host disease reported, and the VSTs demonstrated persistence for up to 12 weeks, providing broad antiviral protection against multiple viral pathogens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Off-the-Shelf Virus-Specific T Cells to Treat BK Virus, Human Herpesvirus 6, Cytomegalovirus, Epstein-Barr Virus, and Adenovirus Infections After Allogeneic Hematopoietic Stem-Cell Transplantation. Tzannou, I., Papadopoulou, A., Naik, S., et al.[2022]

A new cellular immunotherapy approach was developed to reactivate BKV-specific cytotoxic T cells from kidney transplant recipients, which could help prevent BKV-associated interstitial nephritis, a serious complication after transplantation.

The reactivated T cells showed strong specificity for BKV-infected cells while sparing healthy cells, indicating a targeted and potentially safer treatment option for managing BKV infections in immunocompromised patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dendritic cells pulsed with polyomavirus BK antigen induce ex vivo polyoma BK virus-specific cytotoxic T-cell lines in seropositive healthy individuals and renal transplant recipients. Comoli, P., Basso, S., Azzi, A., et al.[2022]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Long-Term Follow-Up after Adoptive Transfer of BK-Virus-Specific T Cells in Hematopoietic Stem Cell Transplant Recipients. [2023]

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

Phenotypic and functional characterization of circulating polyomavirus BK VP1-specific CD8+ T cells in healthy adults. [2021]

3. Germany pubmed.ncbi.nlm.nih.gov

The role of CD4(+) T cells in BKV-specific T cell immunity. [2021]

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

Virus-specific T-cell therapy to treat BK polyomavirus infection in bone marrow and solid organ transplant recipients. [2022]

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

BK virus-specific T-cell immune reconstitution after allogeneic hematopoietic cell transplantation. [2021]

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

Off-the-Shelf Virus-Specific T Cells to Treat BK Virus, Human Herpesvirus 6, Cytomegalovirus, Epstein-Barr Virus, and Adenovirus Infections After Allogeneic Hematopoietic Stem-Cell Transplantation. [2022]

7. Denmark pubmed.ncbi.nlm.nih.gov

Viral specific T cell therapy in kidney transplant recipients - A single-center experience. [2023]

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

Dendritic cells pulsed with polyomavirus BK antigen induce ex vivo polyoma BK virus-specific cytotoxic T-cell lines in seropositive healthy individuals and renal transplant recipients. [2022]