Vaccine Therapy in Treating Patients With Acute Lymphoblastic Leukemia
Vaccine Therapy in Treating Patients With Acute Lymphoblastic Leukemia
The prognosis for children and adults with acute lymphoblastic leukemia (ALL) has improved
 significantly over the years. Nevertheless, patients who experience disease relapse or
 induction failure along with patients having unfavorable genetics [t(4;11) or t(9;22)] have
 dismal prognosis. For these patients, novel therapeutic approaches such as immunotherapy are
 needed. In this clinical trial, investigators evaluate whether it is feasible to make a
 vaccine from leukemia cells and whether this vaccine enables direct immunity against cancer
 cells in patients.
OBJECTIVES Primary

 -  To determine feasibility of generating a cellular vaccine composed of CD40-activated
 autologous ALL cells

 -  To determine feasibility of vaccine administration according to the proposed schedule

 -  To determine toxicity of vaccination with CD40-activated autologous ALL cells

 Secondary

 -  To assess ALL-specific immunity following vaccination

 -  To assess the generation of immunity to control antigens

 -  To develop preliminary information on effect vaccination on tumor response
Inclusion Criteria

 -  B-cell acute lymphoblastic leukemia

 -  Disease involving at least 30% of bone marrow or circulating blasts

 -  In first relapse with at least 1 of the following high-risk features:

 -  Age under 1 year at diagnosis

 -  Age over 18 years at diagnosis

 -  t(9;22)

 -  Occurrence of first relapse less than 18 months after diagnosis

 -  In second relapse or beyond

 -  Refractory disease

 -  Successful generation of adequate CD40 ligand-activated autologous tumor cell vaccine

 -  Less than 1 year since tumor cell collection

 -  Patients in first relapse or beyond must be ineligible for or have declined allogeneic
 bone marrow transplantation in order to receive study vaccine

 -  Patients need not be in complete remission to receive study vaccine

 -  Patients may have received an allogeneic hematopoetic stem cell transplant in the past

 -  No chemotherapy, radiotherapy, immunotherapy or immunosuppressive treatment or within
 3 weeks of vaccination

 -  Adequate hepatic function as defined by: Bilirubin < 2x normal; AST < 3x normal; ALT <
 6x normal

 -  Adequate renal function defined by: Creatinine < 2x normal

 -  <1 year since tumor cell collection

 Exclusion Criteria

 -  Concurrent treatment as part of another therapeutic research protocol

 -  Pregnancy or nursing mothers

 -  Clinically significant pulmonary or cardiac disease

 -  Clinically significant autoimmune disease

 -  Documented infection that is active and/or not responding to therapy

 -  Evidence of HIV infection or known positive HIV serology

 -  Lansky performance scale (if <18yo) <60%, Karnofsky performance scale (if >18yo) >60%

 -  Once vaccination course has started: patients may not receive chemotherapy,
 radiotherapy, immunotherapy or immunosuppressive treatment, hematopoetic growth
 factors. However between tumor cell collection and vaccine administration, patients
 may receive non-protocol chemotherapy.

 ********************************************NOTE*******************************************
 ********

 It is anticipated that there will be a number of patients at first relapse who are eligible
 for tumor cell collection and vaccine preparation but who are not eligible to receive the
 vaccination course. These patients will be evaluable for Objective 3.1.1 (feasibility of
 vaccine preparation). Patients at first relapse who are eligible for vaccine preparation
 but not administration should instead be treated with standard salvage regimens which may
 include allogeneic bone marrow transplantation according to the judgement of their primary
 oncologist. However, these patients represent a population at extremely high risk for
 progression of their disease following salvage therapy. Many of these patients will
 therefore be likely to fulfill eligibility criteria for vaccination in the future (i.e.

 should they relapse again, or fail to enter 2nd complete remission). The majority of those
 patients who relapse for a second time will do so within 1 year. Those patients who become
 eligible for vaccination because of 2nd relapse within 1 year of tumor cell collection will
 receive the original vaccine and will not have further vaccine made from tumor cells
 collected at the time of 2nd relapse. Given the proliferative thrust of the disease in many
 patients, it will be advantageous to have vaccines already prepared for these patients to
 reduce the amount of time from 2nd relapse to vaccination.***