- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00436761
Busulfan, Melphalan, and Antithymocyte Globulin Followed By Umbilical Cord Blood Transplant in Treating Young Patients With Refractory or Relapsed Malignant Solid Tumors
A Phase I Study to Examine the Toxicity of Killer IG-Like Receptor (KIR) Mismatched Umbilical Cord Blood for Pediatric Patients With Malignant Solid Tumors
RATIONALE: Giving chemotherapy before a donor umbilical cord blood stem cell transplant helps stop the growth of tumor cells. It also helps stop the patient's immune system from rejecting the donor's stem cells when they do not exactly match the patient's blood. The donated stem cells may replace the patient's immune cells and help destroy any remaining tumor 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 methylprednisolone after the transplant may stop this from happening.
PURPOSE: This phase I trial is studying the side effects of busulfan, melphalan, and antithymocyte globulin followed by umbilical cord blood transplant in treating young patients with refractory or relapsed malignant solid tumors.
Study Overview
Status
Intervention / Treatment
- Other: laboratory biomarker analysis
- Drug: methylprednisolone
- Biological: anti-thymocyte globulin
- Procedure: allogeneic hematopoietic stem cell transplantation
- Drug: busulfan
- Drug: melphalan
- Drug: cyclosporine
- Other: flow cytometry
- Biological: sargramostim
- Biological: graft-versus-tumor induction therapy
- Other: immunologic technique
- Procedure: umbilical cord blood transplantation
Detailed Description
OBJECTIVES:
- Examine the impact of the use of killer cell immunoglobulin-like receptor (KIR)-mismatched umbilical cord blood as a source of hematopoietic stem cells, after busulfan, melphalan, and anti-thymocyte globulin in pediatric patients with relapsed or refractory solid tumors.
- Determine the toxicity of this regimen, in terms of incidence of grade 3-4 acute graft-versus-host disease, donor/host chimerism, and cellular immunity against tumor cell lines, in these patients.
OUTLINE:
- Transplantation: Patients receive busulfan orally or IV every 6 hours on days -8 to -5, anti-thymocyte globulin IV over 6 hours on days -4 to -1, and melphalan IV over 15-20 minutes on days -4 to -2. Patients undergo allogeneic umbilical cord blood stem cell infusion on day 0. Patients receive sargramostim (GM-CSF) subcutaneously beginning on day 7 and continuing until blood counts recover.
- Graft-vs-host disease prophylaxis: Patients receive cyclosporine IV over 1 hour or orally twice daily on days -1 to 180 and methylprednisolone IV or orally once or twice daily on days 5 - 49.
Blood samples are collected periodically for immunophenotyping and flow cytometric analysis (including interferon gamma and other TH1 and TH2 cytokines).
After completion of study treatment, patients are followed periodically.
PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.
Study Type
Enrollment (Anticipated)
Phase
- Phase 1
Contacts and Locations
Study Locations
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Pennsylvania
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Hershey, Pennsylvania, United States, 17033-0850
- Penn State Cancer Institute at Milton S. Hershey Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
- Diagnosis of malignant solid tumor
Relapsed or refractory disease
- No isolated local recurrence of disease (in the site of the primary tumor) > 1 year after completing therapy
- No brain tumors or brain metastases
Unrelated cord blood donor available
May be HLA 6/6 matched (HLA-A, -B, -DR) OR mismatched for 1, 2, or 3 of these HLA loci, but must be mismatched for HLA-C group as indicated by their following killer cell immunoglobulin-like receptor (KIR) group specificity:
KIR2DL1
- Cw 2
- Cw 0307
- Cw 4, 5, 6
- Cw 0707, 0709
- Cw 1204, 1205
- All other Cw 15 alleles
- Cw 1602
- Cw 17
- Cw 18
KIR2DL2
- Cw 1
- All other Cw 3 alleles
- All other Cw 7 alleles
- Cw 8
- Cw 1202, 1203, 1206
- Cw 1301
- Cw 1402, 1403
- Cw 1507
- Cw 1601, 1604
- Cord blood specimen must have ≥ 1 x 10^7 nucleated cells/kg patient ideal body weight
PATIENT CHARACTERISTICS:
- ECOG performance status (PS) 0-2 OR Lansky PS 70-100%
- Cardiac ejection fraction ≥ 50%
- Creatinine clearance ≥ 50%
- Bilirubin ≤ 3.0 mg/dL
- DLCO ≥ 70% OR O_2 saturation ≥ 95% on room air
PRIOR CONCURRENT THERAPY:
- Prior autologous stem cell transplantation allowed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Masking: None (Open Label)
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
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Safety
|
Incidence of graft-versus-host disease
|
Secondary Outcome Measures
Outcome Measure |
---|
Donor/host chimerism status
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Immune function post-transplant
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Kenneth G. Lucas, MD, Milton S. Hershey Medical Center
Study record dates
Study Major Dates
Study Start
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
Additional Relevant MeSH Terms
- Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Autonomic Agents
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Neuroprotective Agents
- Protective Agents
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Dermatologic Agents
- Antifungal Agents
- Calcineurin Inhibitors
- Methylprednisolone
- Melphalan
- Busulfan
- Sargramostim
- Antilymphocyte Serum
- Cyclosporine
- Cyclosporins
Other Study ID Numbers
- CDR0000529361
- PSCI-18589
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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