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Immunotherapy of leukaemia using suicide gene transduced donor lymphocytes in the context of allogeneic bone marrow transplantation

Objectif

- To demonstrate
1.1. the ability to transduce and select donor Iymphocytes in conditions required for a clinical study;
1.2. the safety of genetically modified donor lymphocytes in the context of allo-BMT;
1.3. the survival and immunocompetence of transduced donor lymphocytes in vivo;
1.4. the in vivo selective elimination of transduced cells by ganciclovir treatment;
1.5. the in vivo safety and efficacy of secondary infusions of transduced donor Iymphocytes after selective elimination of previously infused cells
- To verify
2.1 the effects of transduced cells on the incidence and severity of GvHD;
2.2. ganciclovir response of GvHD secondary to the infusion of transduced donor cells;
2.3. the impact of this strategy on leukemic relapse and overall disease-free survival

The aim of the proposed project is to demonstrate the viability and benefits of the use of donor lymphocytes transduced with a suicide gene, to prevent and treat leukemic relapse occurring after allogeneic Bone Marrow Transplantation (allo-BMT). Allo-BMT is the treatment of choice for many patients with hematological malignancies. The therapeutic impact of allo-BMT is mainly mediated by an allogeneic immune mediated effect (graft versus leukemia-GvL) largely mediated by donor-derived T Iymphocytes. Unfortunately, the therapeutic benefits of allo-BMT are limited by a variety of complications including life-threatening infections and graft versus host disease (GvHD), also mediated by donor-derived T-lymphocytes. GvHD can be prevented by the removal of T lymphocytes from the donor marrow prior to infusion. However, T-cell depletion increases the incidence of graft rejection, reactivation of endogenous viral infections, and recurrence of disease, and does not result in an improvement in the disease free survival We propose to use donor-derived T-lymphocytes transduced with retroviral vectors containing the Herpes Simplex virus thymidine kinase (HSV-tk) gene, thus rendering the cells susceptible to selective killing by the drug ganciclovir. The expression of a suicide gene in donor lymphocytes could take full advantage of the anti-leukemic effect of these effector cells while providing an efficacious tool for elimination of severe GvHD, should this complication occur. Additionally, it may be possible to use these cells for the modulation of donor anti-tumor responses in vivo, and so separate the GvL from GvHD. Finally, the marking of donor lymphocytes will enable us to address important and unresolved questions concerning the survival and function of these cells in vivo. Pre-clinical studies have demonstrated the feasibility of generating ganciclovir sensitive transduced T-cells. In 1993, approval was given for a pilot study for the treatment of six patients with post-transplant leukemic relapse or development of Epstein Barr virus induced lymphoproliferative disorders, with the infusion of HSV-tk transduced donor T-cells However, the demonstration of the viability and benefits of this approach in the management of patients undergoing allo-BMT for the treatment of leukemia will only be achieved by its evaluation in a multicenter clinical study The proposed clinical and molecular studies within this project will allow a critical assessment of the different treatment strategies. Objectives of the proposed project can only be achieved by the collaboration, coordination and interaction between the European Institutions involved in pilot clinical studies and a Company which will provide clinical-grade vectors This project introduces a new health technology which offers a novel treatment for the management of the major complications of allogeneic bone marrow transplantation leukemic relapse and GvHD Companies, currently interested in the "scale up" of gene therapy technology for clinical use, together with the medical community, patients associations, and regulatory agencies will form the extended audience of this demonstration project.

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Coordinateur

Fondazione Centro San Raffaele del Monte Tabor - Istituto di Ricovero e Cura a Carattere Scientifico
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Adresse
58,Via Olgettina
20132 Milano
Italie

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