The 2019 Severe Acute Respiratory Syndrome (SARS) is a global pandemic secondary to anovel coronavirus - SARS-CoV-2. The reported case-fatality ratio for SARS-CoV-2 in theUnited States is 1.8% with a current death toll of >300,000 and climbing.4 There is noaccepted standard of care or FDA approved therapies for treatment of COVID-19. Virusspecific cytotoxic T lymphocytes (CTLs) have become an important part of the treatmentlandscape for viral reactivation post hematopoietic and solid organ transplantation.Donor derived CTLs have been shown to be safe and effective against a variety of virusesincluding CMV, EBV, BK and adenovirus. We hypothesize that SARS-CoV-2 specific CTLsgenerated from a previously infected family donor will be safe and effective fortreatment of COVID-19 in family members with mild to moderate disease.
Not Provided
Other: Standard of Care
Patients will receive standard of care for COVID-19.
Biological: SARS-CoV2-CTLS
Patients may receive up to 5 CTL infusions to treat SARA-CoV-2 in combination with
standard of care.
INCLUSION CRITERIA
- Age ≥18 to 65 years. AND
- Proven infection with SARS-CoV-2, defined as detection of SARS-CoV-2 by RT-PCR from
nasopharyngeal swab or lower respiratory tract specimen AND
- Hospitalized at the time of enrollment AND
- HLA Matched Family Related donor with recent SARS-CoV-2 infection is at least 10
days out from symptom onset. A negative result for COVID-19 by a diagnostic test is
not necessary to qualify the donor AND
- In Stage I or II of disease (mild or moderate) at the time of enrollment (Table 1)
AND
- ONE of the following high-risk conditions:
- Chronic lung disease not requiring oxygen at home prior to admission (including
but not limited to COPD, cystic fibrosis, asthma and sickle cell disease);
Underlying heart disease (including hypertension); Patients with an acute
myocardial infarction within the last 3 months will require cardiology
clearance prior to enrollment; Diabetes mellitus (type I or II) ; Obesity (BMI
≥ 30); Immunosuppressed, based on investigator's assessment.
EXCLUSION CRITERIA:
- Stage III disease (severe) at the time of enrollment (see Table 1)
- Lack of an identified eligible HLA family related donor
- No high-risk comorbidities defined in the inclusion criteria (Section 5.1)
- Patient with acute GVHD > grade 2 or extensive chronic GVHD at the time of
enrollment
- Patient treated with donor lymphocyte infusion (DLI) within 4 weeks prior to CTL
Infusion
- Patients with chronic respiratory failure requiring ventilator support and/or oxygen
at home prior to admission are excluded
- Patients with stage D heart failure and/or symptoms at rest are excluded
- Renal function: patients with eGFR or CrCl <30 mL/min/1.73 m2 will be excluded from
study entry.
- Liver function: Total bilirubin > 2 mg/dl (unless Gilbert's syndrome) OR ALT/AST > 5
x ULN
- Patients currently listed for transplant or potentially eligible to receive organ
transplants are excluded from this study
- Patient with poor performance status determined by Karnofsky (patients >16 years) or
Lansky (patients ≤16 years) score ≤50%
- Female patient of childbearing age who is pregnant or breast-feeding or not willing
to use an effective method of birth control during study treatment and for at least
6 weeks after the last dose of SARS-CoV-2 CTLS.
- Male subjects with female partners of childbearing age who are not willing to use an
effective method of birth control during study treatment and for at least 6 weeks
after the last dose of SARS-CoV-2 CTLS.
- Concurrent use of following medications is prohibited:
- Steroids (>2 mg/kg/day prednisone equivalent); Immunotherapies within 4 weeks
prior to CTL infusion including checkpoint blockade, ATG, Campath, CAR T cells,
blinatumomab; Chemotherapy: Tyrosine kinase inhibitors and hydroxyurea must be
stopped > 72 hours prior to SARS-COV-2-CTL cell infusion; High dose
chemotherapy must be stopped > 2 weeks prior to SARS-CoV-2-CTLs. High dose
chemotherapy is defined in this protocol as any cancer directed therapy causing
myelosuppression; Pegylated-asparaginase must be stopped > 4 weeks prior to
SARS-COV-2-CTL infusion; Intrathecal chemotherapy must be stopped > 1 week
prior to SARS-COV-2-CTL infusion (e.g. intrathecal methotrexate); Anti T-cell
Antibodies: Administration of any T cell lytic or toxic antibody (e.g.
alemtuzumab) within 30 days prior to SARS-CoV-2-CTLs is prohibited.
New York Medical College
Valhalla, New York, United States
Nationwide Children's Hosptial
Columbus, Ohio, United States
Children's Hospital of Pennsylvania
Philadelphia, Pennsylvania, United States
Medical College of Wisconsin/Children's Hospital of Wisconsin
Milwaukee, Wisconsin, United States
Mitchell S Cairo, MD
9145942150
mitchell_cairo@nymc.edu
Lauren Harrison, RN, MSN
16172857844
lauren_harrison@nymc.edu
Mitchell S Cairo, MD, Study Chair
New York Medical College