RATIONALE: Vaccines made from a person's white blood cells and tumor cells may help the body build an effective immune response to kill tumor cells. Giving vaccine therapy after surgery may be a more effective treatment for malignant glioma.

PURPOSE: This phase I trial is studying the side effects and best dose of vaccine therapy in treating young patients who are undergoing surgery for malignant glioma.

Condition	Treatment or Intervention	Phase
high-grade childhood cerebral astrocytoma low-grade childhood cerebral astrocytoma recurrent childhood cerebral astrocytoma Childhood Oligodendroglioma	Drug: autologous dendritic cells  Drug: autologous tumor cell vaccine  Procedure: adjuvant therapy  Procedure: biological response modifier therapy  Procedure: conventional surgery  Procedure: tumor cell derivative vaccine  Procedure: vaccine therapy	Phase I

Further Study Details: 

OBJECTIVES: Primary

• Determine the dose-limiting toxicity of adjuvant vaccination with autologous tumor lysate-pulsed dendritic cells after surgical resection in pediatric patients with malignant glioma.
• Determine the maximum tolerated dose of this vaccine in these patients.

Secondary

• Determine, preliminarily, the survival of patients treated with this vaccine.
• Determine, preliminarily, the time to tumor progression in patients treated with this vaccine.
• Determine cellular immune response in patients treated with this vaccine.
• Determine age-dependent differences in response to this vaccine, in terms of immunocompetence, in these patients.

OUTLINE: This is a dose-escalation study.

Patients undergo surgical resection to obtain tumor tissue for production of tumor lysate. Patients then undergo leukapheresis to obtain peripheral blood mononuclear cells (PBMC) for generation of dendritic cells (DC). DC are pulsed with tumor lysate to produce an autologous dendritic cell vaccine. Approximately 10-30 days after leukapheresis, patients receive vaccination with autologous tumor lysate-pulsed dendritic cells intradermally on days 0, 14, and 28 in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of vaccine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

After completion of study treatment, patients are followed at 2 weeks and then every 2 months for 1 year.

PROJECTED ACCRUAL: A total of 3-18 patients will be accrued for this study within 2-4.5 years.

Ages Eligible for Study:  1 Year   -   18 Years,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed* WHO grade III or IV malignant glioma of 1 of the following subtypes:
• Anaplastic astrocytoma
• Anaplastic oligodendroglioma
• Glioblastoma multiforme NOTE: *Must be confirmed after surgery
• Newly diagnosed OR recurrent disease
• Bidimensionally measurable disease by contrast-enhancing pre-operative MRI
• Surgically accessible tumor for which surgical resection is indicated at the time of initial pre-operative evaluation
• Must have undergone standard surgery* AND either radiotherapy* or chemoradiotherapy*
• Objective evidence of disease by contrast-enhanced brain MRI after completion of standard therapy NOTE: *Completed after study entry but before assignment to study treatment cohorts

PATIENT CHARACTERISTICS: Age

• 1 to 18

Performance status

• Karnofsky 60-100%

Life expectancy

• Not specified

Hematopoietic

• Hemoglobin ≥ 10 g/dL
• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3

Hepatic

• SGPT and SGOT ≤ 2 times normal
• Alkaline phosphatase ≤ 2 times normal
• Bilirubin ≤ 1.5 mg/dL
• Hepatitis B and C negative

Renal

• BUN ≤ 1.5 times normal OR
• Creatinine ≤ 1.5 times normal

Immunologic

• HIV negative
• Syphilis negative
• No history of immunodeficiency or autoimmune disease that may be exacerbated by immunotherapy, including any of the following:
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Vasculitis
• Polymyositis
• Dermatomyositis
• Scleroderma
• Multiple sclerosis
• Juvenile-onset insulin-dependent diabetes
• No active infection
• No fever
• No allergy to study reagents

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, localized prostate cancer, or carcinoma in situ of the cervix
• No unstable or severe medical or psychiatric condition, as determined by the investigator
• No underlying condition that would preclude study participation

PRIOR CONCURRENT THERAPY: Biologic therapy

• Not specified

Chemotherapy

• See Disease Characteristics
• More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas) and recovered
• No chemotherapy during and for 4 weeks* after the final dose of study vaccine

Endocrine therapy

• No corticosteroids for at least 10 days before leukapheresis
• No concurrent corticosteroids

Radiotherapy

• See Disease Characteristics
• At least 2 weeks since prior radiotherapy and recovered
• No concurrent radiotherapy

Surgery

• See Disease Characteristics
• No prior organ allograft

Other

• More than 72 hours since prior systemic antibiotics
• No antihistamines for 5 days before and for 5 days after administration of study vaccine
• No concurrent strong painkillers
• No other concurrent immune-suppressing medications
• No other concurrent investigational agents
• No other adjuvant treatment for 4 weeks* after the final dose of study vaccine NOTE: *Unless there is evidence of tumor progression necessitating additional clinically-indicated treatment; patients requiring treatment due to tumor progression are removed from the study

Study chairs or principal investigators

Theodore B. Moore, MD,  Study Chair,  Jonsson Comprehensive Cancer Center   

Study ID Numbers:  CDR0000420930; UCLA-0410044-01
Record last reviewed:  March 2005
Last Updated:  April 5, 2005
Record first received:  April 5, 2005
ClinicalTrials.gov Identifier:  NCT00107185
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08