Fludarabine, Cyclophosphamide, and Total-Body Irradiation Followed by Cyclosporine and Mycophenolate Mofetil in Treating Patients Who Are Undergoing a Donor Umbilical Cord Blood Transplant for Hematologic Cancer

September 28, 2016 updated by: University of Rochester

Non-Myeloablative Conditioning and Unrelated Umbilical Cord Blood Transplantation for Children and Adults With Serious Oncohematologic Diseases

RATIONALE: Giving low doses of chemotherapy, such as fludarabine and cyclophosphamide, and radiation therapy before a donor umbilical cord blood stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after transplant may stop this from happening.

PURPOSE: This clinical trial is studying how well giving fludarabine and cyclophosphamide together with total-body irradiation followed by cyclosporine and mycophenolate mofetil works in treating patients who are undergoing a donor umbilical cord blood transplant for hematologic cancer.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

OBJECTIVES:

  • Determine the frequency, extent, and rate of donor (myeloid and lymphoid) engraftment in patients with serious hematologic malignancies treated with nonmyeloablative conditioning regimen comprising fludarabine, cyclophosphamide, and low-dose total-body irradiation followed by unrelated allogeneic umbilical cord blood transplantation and post-transplant immunosuppression comprising cyclosporine and mycophenolate mofetil.
  • Correlate clinical and umbilical cord blood-related factors with engraftment in patients treated with this regimen.
  • Determine transplant-related complications, in terms of toxicity, myelosuppression, infections, and acute and chronic graft-versus-host disease, in patients treated with this regimen.
  • Determine disease-free and overall survival of patients treated with this regimen.
  • Determine treatment-related mortality of patients treated with this regimen.

OUTLINE: This is a uncontrolled, pilot study.

  • Nonmyeloablative conditioning regimen: Patients receive fludarabine IV over 30 minutes daily on days -6 to -2 and cyclophosphamide IV over 2 hours on day -6 and undergo low-dose total-body irradiation (TBI) on day 0.
  • Unrelated allogeneic umbilical cord blood transplantation (UCBT): After completion of TBI, patients undergo 1 or 2 unrelated allogeneic UCBTs on day 0.
  • Post-transplant immunosuppression: Patients receive oral or IV cyclosporine daily beginning on day -3 and continuing until day 180 and oral or IV mycophenolate mofetil twice daily on days 0-30.

Patients are followed periodically for 1 year after transplantation.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Study Type

Interventional

Enrollment (Actual)

16

Phase

  • Not Applicable

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
    • New York
      • Rochester, New York, United States, 14642
        • James P. Wilmot Cancer Center at University of Rochester Medical 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 75 years (Child, Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following hematologic malignancies:

    • Acute myeloid leukemia (AML) with or without history of myelodysplastic syndromes, meeting 1 of the following criteria:

      • In first complete remission (CR-1) with unfavorable cytogenetics and/or achieved CR-1 after ≥ 1 course of induction therapy
      • Secondary or treatment-related AML
      • In second or further complete remission
      • Relapsed with ≤ 20% blasts in the bone marrow AND no circulating blasts

    • Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria:

      • In CR-1 with unfavorable cytogenetics or elevated WBC at presentation OR failed to achieve CR-1 after ≥ 4 weeks of induction therapy
      • In second or further complete remission
      • Relapsed with ≤ 20% blasts in the bone marrow AND no circulating blasts
    • Other acute leukemic variants allowed at the discretion of the principal investigator

    • Chronic myelogenous leukemia (CML), meeting 1 of the following criteria:

      • In first chronic phase AND refractory to or unable to tolerate imatinib mesylate
      • In second or further chronic phase
      • In first or second accelerated phase

    • Myelodysplastic syndromes with intermediate 2- or high-risk International Prognosis Scoring System (IPSS) score, including any of the following:

      • Refractory anemia
      • Refractory anemia with excess blasts
      • Chronic myelomonocytic leukemia

    • Myeloproliferative disorders with poor prognosis, including any of the following:

      • Myelofibrosis with myeloid metaplasia

        • No ≥ grade 3 myelofibrosis
      • Atypical CML
      • Juvenile myelomonocytic leukemia
    • Other clonal hemopathies with an accepted poor prognosis
    • Multiple myeloma with chromosome 13 abnormalities and/or progression after prior autologous bone marrow transplantation (BMT)

    • Chronic lymphocytic leukemia, meeting 1 of the following criteria:

      • Primary refractory OR relapsed and refractory disease (less than partial remission)
      • Relapsed twice on or after prior chemotherapy

    • Lymphoma, meeting both of the following criteria:

      • Hodgkin's or non-Hodgkin's lymphoma in > CR-1 OR failed primary induction
      • Chemosensitive disease, defined as > 50% reduction in mass size after the most recent chemotherapy

  • Must meet ≥ 1 of the following criteria:

    • Over 45 years of age
    • Has undergone prior autologous or allogeneic BMT
    • Charlson^ comorbidity score ≥ 2
  • Must have a high degree of tumor control (salvage therapy allowed)
  • At high risk for treatment-related mortality with a myeloablative conditioning regimen

  • No massive splenomegaly

    • Patients may become eligible after splenectomy or radiotherapy to the spleen
  • No 5/6 or 6/6 HLA-matched related donor available
  • No well-matched (i.e., ≥ 9/10 HLA match by high-resolution typing) unrelated donor available

PATIENT CHARACTERISTICS:

Performance status

  • Not specified

Life expectancy

  • Not specified

Hematopoietic

  • See Disease Characteristics

Hepatic

  • Bilirubin ≤ 2 times upper limit of normal (ULN)
  • Transaminases ≤ 4 times ULN (unless due to underlying disease)

Renal

  • Creatinine clearance ≥ 50 mL/min

Cardiovascular

  • Ejection fraction ≥ 30%

Pulmonary

  • DCLO ≥ 35%

Other

  • Negative pregnancy test
  • No uncontrolled viral, bacterial, or fungal infection
  • HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics

Chemotherapy

  • See Disease Characteristics

Radiotherapy

  • See Disease Characteristics

Other

  • At least 3 months since prior immunosuppressive therapy
  • At least 10 days since prior salvage therapy for patients not in at least morphologic or radiologic complete remission

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)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Conditioning therapy followed by TBI
Fludarabine, Cyclophosphamide; Total-Body Irradiation Followed by Cyclosporine and Mycophenolate Mofetil
Drug: cyclophosphamide
Radiation: radiation therapy
Drug: fludarabine phosphate
Drug: cyclosporine
Biological: graft-versus-tumor induction therapy
Drug: mycophenolate mofetil
Procedure: umbilical cord blood transplantation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Number of Participants Who Survived 100 Days or Longer
Time Frame: 100 days
100 days

Secondary Outcome Measures

Outcome Measure
Time Frame
Number of Participants Who Developed Acute Graft Versus Host Disease
Time Frame: 3 months
3 months

Collaborators and Investigators

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

Sponsor

University of Rochester

Investigators

  • Principal Investigator: Gordon L. Phillips, MD, James P. Wilmot Cancer Center

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

December 1, 2003

Primary Completion (Actual)

March 1, 2013

Study Completion (Actual)

June 1, 2016

Study Registration Dates

First Submitted

November 18, 2005

First Submitted That Met QC Criteria

November 18, 2005

First Posted (Estimate)

November 21, 2005

Study Record Updates

Last Update Posted (Estimate)

November 3, 2016

Last Update Submitted That Met QC Criteria

September 28, 2016

Last Verified

September 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CDR0000448637
  • URCC-U19403
  • URCC-RSRB-10063

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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