Pilot Study of Reduced Intensity Haematopoietic Stem Cell Transplantation in Patients With Poor Risk Myelodysplastic Syndrome (MDS) and Acute Myeloid Leukaemia (AML) Utilising Conditioning With Fludarabine, Busulphan and Thymoglobulin (FB-ATG)

August 16, 2011 updated by: King's College Hospital NHS Trust

Pilot Study of Reduced Intensity Haematopoietic Stem Cell Transplantation in Patients With Poor Risk Myelodysplastic Syndrome and Acute Myeloid Leukaemia Utilising Conditioning With Fludarabine, Busulphan and Thymoglobulin

The purpose of this study is to determine the safety and feasibility of conditioning with fludarabine, busulphan and thymoglobuline in patients with myelodysplastic syndrome (MDS), myelodysplastic/myeloproliferative disorders (MDS/MPD) or acute myeloid leukaemia (AML) undergoing haematopoietic stem cell allograft with granulocyte colony-stimulating factor (G-CSF)-mobilised peripheral blood stem cells (PBSC) (or bone marrow) from HLA compatible sibling donors.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

20

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 Kingdom
      • London, United Kingdom, SE5 9RS
        • King's College Hospital NHS Foundation Trust

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

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

Patient Selection

  1. Availability of a HLA compatible sibling donor
  2. Age >18 years
  3. Myelodysplastic Syndromes with IPSS Intermediate-2 or High.
  4. Poor risk acute myeloid leukaemia, de novo or transformed from MDS
  5. Ineligibility for standard conditioning allograft due to age or co-existing morbidities

Donor selection

1. Related donors compatible for HLA-A, B, C, DRB1 and DQB1 by molecular typing.

Exclusion Criteria:

Patient selection

  1. Cardiac insufficiency requiring treatment or symptomatic coronary artery disease.
  2. Hepatic disease, with AST > 2 times normal.
  3. Severe hypoxaemia, pO2 < 70 mm Hg, with decreased DLCO < 70% of predicted; or mild hypoxemia, pO2 < 80 mm Hg with severely decreased DLCO < 60% of predicted.
  4. Impaired renal function (creatinine > 2 times upper limit of normal or creatinine clearance < 50% for age, gender, weight).
  5. Patients who have received previous treatment with Thymoglobuline
  6. HIV-positive patients.
  7. Female patients who are pregnant or breast feeding due to risks to foetus from conditioning regimen and potential risks to nursing infants.
  8. Life expectancy severely limited by diseases other than MDS or MPD.
  9. Serious concurrent untreated infection
  10. Patients with limited life expectancy for other reasons
  11. Serious psychiatric/ psychological disorders
  12. Absence of /inability to provide informed consent

Donor selection

  1. Age >75 years, unless independently assessed to be medically fit to donate
  2. Donors who for any reason are unable to tolerate the leukapheresis procedure and cannot undergo anaesthesia for marrow harvest.
  3. Donors who are HIV-positive, or hepatitis B or C PCR positive.
  4. Donors who are medically unsuitable to donate

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: FBATG
Haematopoietic stem cell transplantation utilising conditioning with Fludarabine, Busulphan and Thymoglobuline
Drug: Fludarabine
Fludarabine 30mg/m2 intravenously daily on days -9 to -5 inclusive of stem cell infusion.
Drug: Busulphan
Busulphan 0.8mg/kg intravenously 6 hourly on days -4 and -3 of stem cell infusion.
Drug: Thymoglobuline (Anti-thymocyte globulin [rabbit]) - Genzyme
Thymoglobuline will be given intravenously over a minimum of 6 hours for the first two doses and 4 hours for the subsequent doses. Acute side effects of ATG appear to be reduced if a very low dose is given for the first injection. Thymoglobuline 0.5mg/kg iv on day -4, 1.5mg/kg/day on day -3; and 2mg/kg/day iv on day -2 to -1 inclusive.
Procedure: Haematopoietic stem cell infusion
The source of stem cells will be PBSC wherever possible. Patients whose donors decline or are unable to donate PBSC will be transplanted with marrow cells.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Treatment related mortality to Day 100
Time Frame: Days 28, 56 and 100
Days 28, 56 and 100

Secondary Outcome Measures

Outcome Measure
Time Frame
Incidence of single or multi-organ acute toxicity
Time Frame: Days 28, 56 and 100
Days 28, 56 and 100
Incidence of graft failure/rejection
Time Frame: Days 28, 56 and 100
Days 28, 56 and 100
Incidence of acute graft-versus-host disease
Time Frame: Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Incidence of systemic infections
Time Frame: Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Days 28, 56, 100 and months 6, 9, 12, 18 and 24
EBV activation
Time Frame: Fortnightly for first 6 weeks after transplantation and then weekly for the first 6 months.
Fortnightly for first 6 weeks after transplantation and then weekly for the first 6 months.
Overall survival
Time Frame: Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Disease free survival/relapse risk
Time Frame: Days 28, 56, 100 and months 6, 9, 12, 18 and 24
Days 28, 56, 100 and months 6, 9, 12, 18 and 24

Collaborators and Investigators

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

Sponsor

King's College Hospital NHS Trust

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

June 1, 2007

Primary Completion (Actual)

June 1, 2011

Study Completion (Actual)

June 1, 2011

Study Registration Dates

First Submitted

June 5, 2009

First Submitted That Met QC Criteria

June 5, 2009

First Posted (Estimate)

June 8, 2009

Study Record Updates

Last Update Posted (Estimate)

August 17, 2011

Last Update Submitted That Met QC Criteria

August 16, 2011

Last Verified

June 1, 2011

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 06CC12
  • REC - 06/Q0703/208
  • EudraCT - 2006-004452-20

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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