Pilot Study Of Unrelated UCB Transplant for Non-Malignant Hematologic Conditions

June 10, 2010 updated by: Case Comprehensive Cancer Center

A Pilot Study of Unrelated Umbilical Cord Blood Transplantation in Patients With Severe Aplastic Anemia, Inborn Errors in Metabolism, or Inherited Hematologic Stem Cell Disorders

RATIONALE: Umbilical cord blood transplantation may allow doctors to give higher doses of chemotherapy or radiation therapy and kill more cancer cells.

PURPOSE: This phase II trial is studying how well umbilical cord blood transplantation works in treating patients with severe aplastic anemia, malignant thymoma, or myelodysplasia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

OBJECTIVES:

  • Determine the rates of durable engraftment in patients with severe aplastic anemia, myelodysplastic syndrome, inborn errors of metabolism, or inherited hematopoietic disorders, refractory to medical management, who are undergoing high-dose chemoradiotherapy followed by unrelated cord blood (UCB) transplantation.
  • Evaluate the rate and quality of immunologic reconstitution in this patient population.

OUTLINE: Patients are stratified according to weight (under 45 kg vs over 45 kg).

Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT). The regimen varies according to the underlying cause of the anemia, but could include busulfan, cyclophosphamide or melphalan, anti-thymocyte globulin or methylprednisolone, and/or radiation therapy. One day after the conditioning regimen is completed, patients receive the UCBT.

Patients are followed weekly for 3 months, at 6 months, then every 6 months for 2.5 years, then annually thereafter.

PROJECTED ACCRUAL: A total of 4-90 patients will be accrued for this study within 5 years.

Study Type

Interventional

Enrollment (Actual)

6

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Ohio
      • Cleveland, Ohio, United States, 44106-7284
        • Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 55 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

DISEASE CHARACTERISTICS:

  • Histologically confirmed diagnosis of severe aplastic anemia based on bone marrow cellularity of less than 20%

  • Must meet at least two of the following criteria:

    • Granulocyte count less than 500/mm^3
    • Platelet count less than 20,000/mm^3
    • Reticulocyte count less than 50,000/mm^3

  • Following etiologies eligible:

    • Fanconi's anemia
    • Hypoplastic leukemia
    • Monosomy 7
    • Drug exposure (chloramphenicol, NSAIDS)
    • Viral exposure (EBV, hepatitis, parvovirus, HIV)
    • Nutritional deficiencies
    • Thymoma
    • Paroxysmal nocturnal hemoglobinuria
    • Amegakaryocytic thrombocytopenia OR
  • Histologically confirmed myelodysplastic syndrome (MDS) that is refractory to medical management or with cytogenic abnormalities predictive of transformation into acute leukemia, including 5q-, 7q-, monosomy 7, or trisomy 8

  • The following etiologies only are eligible:

    • Refractory anemia
    • Refractory anemia with ringed sideroblasts
    • De novo primary MDS
    • Therapy-related secondary MDS OR
  • Confirmed diagnosis of inherited hematopoietic disorder that is refractory to medical management

  • Following etiologies eligible:

    • Severe combined immunodeficiency
    • Familial erythrophagocytic lymphohistiocytosis
    • Wiskott-Aldrich syndrome
    • Kostmann's syndrome (infantile histiocytosis)
    • Chronic granulomatous disease
    • Leukocytic adhesion deficiency
    • Chediak-Higashi syndrome
    • Paroxysmal nocturnal hemoglobinuria
    • Fanconi's anemia
    • Dyskeratosis congenita
    • Diamond-Blackfan anemia
    • Amegakaryocytic thrombocytopenia
    • Osteopetrosis
    • Gaucher's disease
    • Lesch-Nyhan syndrome
    • Mucopolysaccharidoses
    • Lipodoses
  • Autologous or haploidentical related peripheral blood stem cells available as backup
  • Serologically matched umbilical cord blood unit available in the New York Blood Center's Placental Blood Project, or other acceptable umbilical cord blood registry

PATIENT CHARACTERISTICS:

Age:

  • 55 and under

Performance status:

  • Zubrod 0-1
  • Karnofsky 80-100%

Life expectancy:

  • At least 3 months

Hematopoietic:

  • See Disease Characteristics

Hepatic:

  • ALT/AST no greater than 4 times normal
  • Bilirubin no greater than 2.0 mg/dL

Renal:

  • Creatinine no greater than 2.0 mg/dL
  • Creatinine clearance at least 50 mL/min

Cardiovascular:

  • Normal cardiac function by echocardiogram or radionuclide scan
  • Shortening fraction or ejection fraction at least 80% normal for age
  • Non-Fanconi patients with acquired or congenital cardiomyopathy may receive melphalan as a substitute for cyclophosphamide

Pulmonary:

  • FVC and FEV_1 at least 60% of predicted for age
  • DLCO at least 60% of predicted in adult patients

Other:

  • No active concurrent malignancy
  • No active infection
  • Not pregnant or nursing
  • HIV negative
  • Must have an available serologic matched Umbilical Cord Blood Unit (UCBU) in the New York Blood Center's Placental Blood Project, or other acceptable Umbilical Cord Blood (UCB) registry

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • Not specified

Chemotherapy:

  • No concurrent cytotoxic chemotherapy

Endocrine therapy:

  • No concurrent immunosuppressive medications

Radiotherapy:

  • No concurrent radiotherapy

Surgery:

  • Not specified

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Event-free survival by disease assessment
Time Frame: at 100 days and at 6, 9, 12, 18, and 24 months
at 100 days and at 6, 9, 12, 18, and 24 months

Secondary Outcome Measures

Outcome Measure
Time Frame
Umbilical cord blood donor engraftment by chimerism and complete blood count (CBC) at time of myeloid recovery.
Time Frame: 100 days and at 6, 9, 12, 18, and 24 months
100 days and at 6, 9, 12, 18, and 24 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Case Comprehensive Cancer Center

Collaborators

National Cancer Institute (NCI)

Investigators

  • Principal Investigator: Mary J. Laughlin, MD, Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 1998

Primary Completion (Actual)

December 1, 2005

Study Completion (Actual)

February 1, 2006

Study Registration Dates

First Submitted

November 1, 1999

First Submitted That Met QC Criteria

January 26, 2003

First Posted (Estimate)

January 27, 2003

Study Record Updates

Last Update Posted (Estimate)

June 11, 2010

Last Update Submitted That Met QC Criteria

June 10, 2010

Last Verified

June 1, 2010

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CWRU5Y97
  • P30CA043703 (U.S. NIH Grant/Contract)
  • CASE-CWRU-5Y97
  • NCI-G98-1431
  • CASE-5Y97

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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