- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00006379
Non-Ablative Allo HSCT For Hematologic Malignancies or SAA
Purine-Analog-Containing Non-Myeloablative Allogeneic Stem Cell Transplantation for Treatment of Hematologic Malignancies and Severe Aplastic Anemia
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy used to kill cancer cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by peripheral stem cell transplantation in treating patients who have hematologic cancer or aplastic anemia.
Study Overview
Status
Conditions
Detailed Description
OBJECTIVES:
- Determine the rates of durable full donor hematologic engraftment in patients with high-risk hematologic malignancies or severe aplastic anemia treated with non-myeloablative conditioning using fludarabine, cyclophosphamide, and anti-thymocyte globulin followed by allogeneic peripheral blood stem cell transplantation.
- Determine the acute and delayed toxic effects of this non-myeloablative conditioning regimen in this patient population.
- Determine the event-free and overall survival of patients treated with this regimen.
- Determine the incidence and severity of acute and chronic graft-versus-host disease in patients treated with this regimen.
- Determine the rate and quality of immune reconstitution in patients treated with this regimen.
- Determine the rate of disease relapse and incidence of post-transplantation lymphoproliferative disease in these patients.
OUTLINE: Patients are stratified according to disease category (malignant vs non-malignant) and graft source (unrelated vs HLA-matched sibling).
Beginning at least 4 weeks after conventional-dose chemotherapy, patients receive non-myeloablative conditioning comprising fludarabine IV over 30 minutes on days -8 to -4, cyclophosphamide IV over 2 hours on days -3 to -2, and anti-thymocyte globulin IV over at least 4 hours on days -2 and -1. Patients undergo filgrastim (G-CSF)-mobilized allogeneic peripheral blood stem cell transplantation on day 0.
Patients are followed weekly for 3 months, every 2 weeks for 3 months, monthly for 6 months, and then every 2 months thereafter.
PROJECTED ACCRUAL: A minimum of 30 patients will be accrued for this study within 4 years.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44106-5065
- Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
Histologically proven high-risk hematologic malignancy
Acute non-lymphocytic leukemia (ANLL) after induction failure, or in first complete remission (CR) with high-risk features, including any of the following:
- Stem cell or biphenotypic classification (AML-M0)
- Erythroleukemia (AML-M6)
- Acute megakaryocytic leukemia (AML-M7)
- Cytogenetic markers indicative of poor prognosis
- Failure to achieve CR after standard induction therapy
- Acute lymphocytic leukemia (ALL) or ANLL in relapse or second or subsequent remission
Chronic myelogenous leukemia (CML) in chronic or accelerated phase
- Patients with CML in blast crisis are eligible after reinduction chemotherapy places them in chronic phase
High-risk ALL in first CR with high risk defined by presence of t(4;11), t(9;22) translocation, hyperleukocytosis (initial WBC greater than 30,000/mm^3), or failure to achieve CR by day 28 after standard induction
- No T-cell ALL or t(8;14) positive B-cell ALL in first remission with hyperleukocytosis
Myelodysplastic syndrome by peripheral blood smear and bone marrow examination
- Refractory to medical management OR
- Cytogenetic abnormalities predictive of transformation into acute leukemia including 5q-, 7q-, monosomy 7, and trisomy 8 OR
- Evidence of evolution to AML (e.g., refractory anemia with excess blasts (RAEB) or RAEB in transformation)
Multiple myeloma, non-Hodgkin's lymphoma (NHL), ANLL, or ALL with recurrent disease after autologous stem cell transplantation (SCT)
- At least 3 months since prior autologous SCT
Hodgkin's lymphoma, NHL, or multiple myeloma beyond first CR or primary induction failures whose disease has demonstrated sensitivity to pre-transplantation cytoreduction (defined as greater than 50% reduction in tumor burden)
- Mantle zone NHL allowed after induction therapy
- Myeloproliferative disorder that is non-responsive to medical management and requires allografting, unless evidence of grade 3 or worse myelofibrosis on marrow biopsy OR
Histologically proven acquired severe aplastic anemia (SAA) that is recurrent or unresponsive after anti-thymocyte globulin and/or cyclosporine
SAA defined by at least 2 of the following conditions:
- Granulocyte count less than 500/mm^3
- Platelet count less than 20,000/mm^3
- Absolute reticulocyte count less than 20,000/mm^3 after correction for hematocrit
Ineligible for full ablative conditioning due to any of the following conditions:
- Prior extensive therapy (more than 2 salvage chemotherapy regimens and/or autologous transplantation)
- Over age 55 OR
- Under age 55 with comorbid disease (e.g., suboptimal cardiac, pulmonary, or renal function and/or prior life-threatening infection)
- HLA-A, B, and DR phenotypically identical sibling donor OR
- HLA-A, B, and DR identical genetically matched unrelated donor
- No ANLL in first CR (less than 5% blasts in marrow) with translocations t(8;21) and inv(16) unless failed first-line induction therapy OR
- No ANLL in first CR (less than 5% blasts in marrow) with translocations t(15;17) abnormality unless failed first-line induction therapy OR molecular evidence of persistent disease
- No active CNS disease
PATIENT CHARACTERISTICS:
Age:
- 0 to 70
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:
- See Disease Characteristics
- Creatinine clearance at least 50 mL/min
Cardiovascular:
- See Disease Characteristics
- Shortening fraction or ejection fraction at least 40% of normal for age by echocardiogram or radionuclide scan
- No clinically significant comorbid illnesses (e.g., myocardial infarction or cerebrovascular accident)
Pulmonary:
- See Disease Characteristics
- FVC and FEV_1 at least 60% of predicted for age
- DLCO at least 60% of predicted for adults
Other:
- No severe neurosensory symptoms (i.e., peripheral neuropathy)
- HIV negative
- Active infection allowed if controlled by appropriate drug therapy
- Not pregnant or nursing
- Negative pregnancy test
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- See Disease Characteristics
Chemotherapy:
- See Disease Characteristics
Endocrine therapy:
- Not specified
Radiotherapy:
- Not specified
Surgery:
- Not specified
Other:
- Recovered from prior therapy
- No concurrent investigational agents unless approved by protocol investigators
Study Plan
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 |
Measure Description |
Time Frame |
---|---|---|
Evaluation of Donor Engraftment
Time Frame: at 28 days
|
Peripheral blood from the donor and patient is obtained for chimerism studies.
The primary analysis will consist of estimating the graft failure proportions for each of the separate patient groups and calculating confidence intervals for these proportions.
This analysis will be done conditional on patients surviving at least 28 days.
|
at 28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Stable donor hematopoietic chimerism
Time Frame: at day 100
|
Number of Patients Transplanted More Than 100 Days Ago
|
at day 100
|
Event free and overall survival
Time Frame: to progression/death
|
to progression/death
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Tamila Kindwall-Keller, DO, Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- recurrent grade 3 follicular lymphoma
- recurrent adult diffuse large cell lymphoma
- recurrent adult immunoblastic large cell lymphoma
- recurrent adult Burkitt lymphoma
- recurrent childhood small noncleaved cell lymphoma
- recurrent childhood large cell lymphoma
- refractory anemia with excess blasts
- refractory anemia with excess blasts in transformation
- chronic myelomonocytic leukemia
- de novo myelodysplastic syndromes
- previously treated myelodysplastic syndromes
- secondary myelodysplastic syndromes
- adult acute myeloid leukemia with 11q23 (MLL) abnormalities
- adult acute myeloid leukemia with inv(16)(p13;q22)
- adult acute myeloid leukemia with t(15;17)(q22;q12)
- adult acute myeloid leukemia with t(16;16)(p13;q22)
- adult acute myeloid leukemia with t(8;21)(q22;q22)
- secondary acute myeloid leukemia
- childhood acute lymphoblastic leukemia in remission
- childhood acute myeloid leukemia in remission
- juvenile myelomonocytic leukemia
- chronic phase chronic myelogenous leukemia
- childhood chronic myelogenous leukemia
- childhood myelodysplastic syndromes
- primary systemic amyloidosis
- recurrent adult acute myeloid leukemia
- atypical chronic myeloid leukemia
- myelodysplastic/myeloproliferative disease, unclassifiable
- adult acute myeloid leukemia in remission
- adult acute erythroid leukemia (M6)
- adult acute megakaryoblastic leukemia (M7)
- adult acute minimally differentiated myeloid leukemia (M0)
- recurrent adult Hodgkin lymphoma
- recurrent/refractory childhood Hodgkin lymphoma
- recurrent adult diffuse small cleaved cell lymphoma
- recurrent adult diffuse mixed cell lymphoma
- blastic phase chronic myelogenous leukemia
- relapsing chronic myelogenous leukemia
- Waldenstrom macroglobulinemia
- recurrent grade 1 follicular lymphoma
- recurrent grade 2 follicular lymphoma
- recurrent marginal zone lymphoma
- recurrent small lymphocytic lymphoma
- extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
- nodal marginal zone B-cell lymphoma
- splenic marginal zone lymphoma
- recurrent adult lymphoblastic lymphoma
- recurrent mantle cell lymphoma
- recurrent cutaneous T-cell non-Hodgkin lymphoma
- small intestine lymphoma
- recurrent adult T-cell leukemia/lymphoma
- angioimmunoblastic T-cell lymphoma
- anaplastic large cell lymphoma
- recurrent mycosis fungoides/Sezary syndrome
- refractory multiple myeloma
- recurrent adult acute lymphoblastic leukemia
- polycythemia vera
- essential thrombocythemia
- prolymphocytic leukemia
- monoclonal gammopathy of undetermined significance
- recurrent childhood acute lymphoblastic leukemia
- accelerated phase chronic myelogenous leukemia
- adult acute lymphoblastic leukemia in remission
- recurrent childhood acute myeloid leukemia
- chronic eosinophilic leukemia
- chronic neutrophilic leukemia
- recurrent childhood lymphoblastic lymphoma
- isolated plasmacytoma of bone
- extramedullary plasmacytoma
- chronic idiopathic myelofibrosis
- childhood acute erythroleukemia (M6)
- childhood acute megakaryocytic leukemia (M7)
- acute undifferentiated leukemia
- childhood acute minimally differentiated myeloid leukemia (M0)
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Neoplasms by Site
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Hemorrhagic Disorders
- Intestinal Diseases
- Hemostatic Disorders
- Paraproteinemias
- Blood Protein Disorders
- Lymphoma
- Syndrome
- Myelodysplastic Syndromes
- Hematologic Neoplasms
- Multiple Myeloma
- Neoplasms, Plasma Cell
- Leukemia
- Preleukemia
- Plasmacytoma
- Intestinal Neoplasms
- Myeloproliferative Disorders
- Myelodysplastic-Myeloproliferative Diseases
- Precancerous Conditions
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Cyclophosphamide
- Fludarabine
- Fludarabine phosphate
- Antilymphocyte Serum
Other Study ID Numbers
- CWRU3Y00
- P30CA043703 (U.S. NIH Grant/Contract)
- CWRU-3Y00 (Other Identifier: Case Comprehensive Cancer Center)
- 05-00-07 (Other Identifier: University Hospitals IRB)
- NCI-G00-1868
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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