Most Closely Matched 3rd Party Rapidly Generated LMP, BARF1 And EBNA1 Specific CTL, EBV-Positive Lymphoma (MABEL)
Most Closely Matched 3rd Party Rapidly Generated LMP, BARF1 And EBNA1 Specific CTL, EBV-Positive Lymphoma (MABEL)
The subject has a type of cancer or lymph gland disease associated with a virus called
 Epstein Barr Virus (EBV), which has come back, is at risk of coming back, or has not gone
 away after standard treatments. This research study uses special immune system cells called
 LMP, BARF-1 and EBNA1- specific cytotoxic T lymphocytes (MABEL CTLs).

 Some patients with Lymphoma (such as Hodgkin (HD) or non-Hodgkin Lymphoma (NHL)),
 T/NK-lymphoproliferative disease, or CAEBV, or solid tumors such as nasopharyngeal carcinoma
 (NPC), smooth muscle tumors, and leiomyosarcomas show signs of a virus called EBV before or
 at the time of their diagnosis. EBV causes mononucleosis or glandular fever ("mono" or the
 "kissing disease"). EBV is found in the cancer cells of up to half the patients with HD and
 NHL, suggesting that it may play a role in causing Lymphoma. The cancer cells (in lymphoma)
 and some immune system cells (in CAEBV) infected by EBV are able to hide from the body's
 immune system and escape destruction. EBV is also found in the majority of NPC and smooth
 muscle tumors, and some leiomyosarcomas. We want to see if special white blood cells (MABEL
 CTLs) that have been trained to kill EBV infected cells can survive in your blood and affect
 the tumor.

 In previous studies, EBV CTLs were generated from the blood of the patient, which was often
 difficult if the patient had recently received chemotherapy. Also, it took up to 1-2 months
 to make the cells, which is not practical when a patient needs more urgent treatment. To
 address these issues, the MABEL CTLs were made in the lab in a simpler, faster, and safer
 way. The MABEL CTLs will still see LMP proteins but also two other EBV proteins called EBNA-1
 and BARF. To ensure these cells are available for use in patients in urgent clinical need, we
 have generated MABEL CTLs from the blood of healthy donors and created a bank of these cells,
 which are frozen until ready for use. We have previously successfully used frozen T cells
 from healthy donors to treat EBV lymphoma and virus infections and we now have improved our
 production method to make it faster.

 In this study, we want to find out if we can use banked MABEL CTLs to treat HD, NHL,
 T/NK-lymphoproliferative disease, CAEBV, NPC, smooth muscle tumors or leiomyosarcoma. We will
 search the bank to find a MABEL CTL line that is a partial match with the subject.

 MABEL CTLs are investigational and not approved by the Food and Drug Administration.
A healthy donor has given blood to make LMP/BARF1/EBNA-1 MABEL CTLs in the lab. We made the
 cells by first growing a special type of cells called activated T cells to stimulate the T
 cells. We then added specially produced mixtures of proteins that include the LMP, EBNA1 and
 BARF proteins. These were used to stimulate T cells. As the T cells grew, we added some of
 the healthy donor cells expressing these proteins to stimulate them. We also added a cell
 called K562 that has had new genes put inside it so it expresses proteins that stimulate the
 immune system to encourage the T cells to grow. K562 cells are cancer cells that have been
 treated with radiation so they cannot grow. This stimulation trained the MABEL CTLs to kill
 cells with EBV proteins on their surface. These cells were grown and frozen.

 For the subject's treatment, the MABEL CTLs will be thawed and infused into the subject over
 1-10 minutes. Initially, two doses of MABEL CTLs will be given two weeks apart. Subjects may
 be eligible to receive additional doses of the MABEL CTLs up to 6 times.

 All of the treatments will be given by the Center for Cell and Gene Therapy at Texas
 Children's Hospital or Houston Methodist Hospital.

 Medical tests before treatment:

 Before being treated, the subject will receive a series of standard medical tests:

 Physical exam; Blood tests to measure blood cells, kidney and liver function; Tumor
 measurements by routine imaging studies: Computer Tomogram (CT), Magnetic Resonance Imaging
 (MRI), or Positron Emission Tomography (PET/CT); Pregnancy test for females who are able to
 have children.

 Several studies suggest that the infused T cells need room to be able to proliferate and
 accomplish their functions and that this may not happen if there are too many other T cells
 in circulation. Because of that, if the patient's level of circulating T cells is relatively
 high, s/he may require treatment with cyclophosphamide (Cytoxan) and fludarabine before s/he
 receives MABEL CTLs.

 Medical tests during and after treatment:

 Blood tests to measure blood cells, kidney and liver function; Imaging study 8 weeks after
 the 1st CTL infusion. If the subject receives additional doses they will also have an imaging
 study at 1 to 3 months after their final dose.

 Subjects will either be seen in the clinic or will be contacted by research staff yearly for
 5 years.
Inclusion Criteria:

 SCREENING

 1. Any patient regardless of age or sex, with diagnosis of either:

 -  EBV positive Hodgkin's lymphoma

 -  EBV Positive non-Hodgkin's Lymphoma (regardless of histologic subtype)

 -  EBV (associated)-T/NK-lymphoproliferative disease

 -  Severe Chronic Active EBV (CAEBV) -- CAEBV is defined as patients with high EBV
 viral load in plasma or PBMC (>4000 genomes per ug PBMC DNA) and/or biopsy tissue
 positive for EBV

 -  Other EBV positive malignancies (e.g. nasopharyngeal carcinoma, smooth muscle
 tumors, etc.)

 AND

 -  in first or subsequent relapse (Group A)

 -  with active disease persisting despite therapy (Group B)

 -  with active disease if immunosuppressive chemotherapy is contraindicated e.g.
 patients who develop Hodgkin disease after solid organ transplantation or if the
 lymphoma is a second malignancy e.g. a Richter's transformation of CLL. (Group C)

 2. EBV positive tumor

 3. Weighs at least 12kg

 4. Informed consent (and assent as applicable) obtained from patient/guardian.

 TREATMENT

 1. Any patient regardless of age or sex, with diagnosis of either:

 -  EBV positive Hodgkin's lymphoma

 -  EBV Positive non-Hodgkin's Lymphoma (regardless of histologic subtype)

 -  EBV (associated)-T/NK-lymphoproliferative disease

 -  Severe Chronic Active EBV (CAEBV) -- CAEBV is defined as patients with high EBV
 viral load in plasma or PBMC (>4000 genomes per ug PBMC DNA) and/or biopsy tissue
 positive for EBV

 -  Other EBV positive malignancies (e.g. nasopharyngeal carcinoma, smooth muscle
 tumors, etc.)

 AND

 -  in first or subsequent relapse (Group A)

 -  with active disease persist despite therapy (Group B)

 -  with active disease if immunosuppressive chemotherapy is contraindicated e.g.
 patients who develop Hodgkin disease after solid organ transplantation or if the
 lymphoma is a second malignancy e.g. a Richter's transformation of CLL. (Group C)

 2. EBV positive tumor

 3. Patients with life expectancy greater than or equal to 6 weeks

 4. Patients with bilirubin less than or equal to 3x upper limit of normal

 5. AST less than or equal to 5x upper limit of normal

 6. Hemoglobin greater than or equal to 7.0 (may be a transfused value)

 7. Patients with a creatinine less than or equal to 2x upper limit of normal for age

 8. Pulse oximetry of > 90% on room air

 9. Patients should have been off other investigational therapy for 30 days prior to
 infusion.

 10. Patients with a Karnofsky/Lansky score of more than or equal to 50.

 11. Sexually active patients must be willing to utilize one of the more effective birth
 control methods during the study and for 6 months after the study is concluded. The
 male partner should use a condom.

 12. Informed consent (and assent as applicable) obtained from patient/guardian.

 Exclusion Criteria:

 TREATMENT

 1. Pregnant or lactating

 2. Severe intercurrent infection

 3. Current use of systemic corticosteroids more than 0.5 mg/kg/day

 4. Patients receiving ATG, Campath, or other immunosuppressive T cell monoclonal
 antibodies within 30 days.