- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02122081
Organ-Sparing Marrow-Targeted Irradiation Before Stem Cell Transplant in Treating Patients With High-Risk Hematologic Malignancies
A Feasibility Study of Organ-Sparing Marrow-Targeted Irradiation (OSMI) to Condition Patients With High-Risk Hematologic Malignancies Prior to Allogeneic Hematopoietic Stem Cell Transplantation
Study Overview
Status
Conditions
- Recurrent Adult Acute Myeloid Leukemia
- Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities
- Adult Acute Myeloid Leukemia With Del(5q)
- Adult Acute Myeloid Leukemia With Inv(16)(p13;q22)
- Adult Acute Myeloid Leukemia With t(16;16)(p13;q22)
- Adult Acute Myeloid Leukemia With t(8;21)(q22;q22)
- Untreated Adult Acute Myeloid Leukemia
- Adult Acute Myeloid Leukemia in Remission
- Adult Acute Lymphoblastic Leukemia in Remission
- Previously Treated Myelodysplastic Syndromes
- Recurrent Adult Acute Lymphoblastic Leukemia
- Secondary Myelodysplastic Syndromes
- Adult Acute Myeloid Leukemia With t(15;17)(q22;q12)
- Untreated Adult Acute Lymphoblastic Leukemia
- de Novo Myelodysplastic Syndromes
Intervention / Treatment
- Other: laboratory biomarker analysis
- Biological: anti-thymocyte globulin
- Drug: methotrexate
- Drug: tacrolimus
- Radiation: radiation therapy
- Drug: cyclophosphamide
- Procedure: allogeneic bone marrow transplantation
- Procedure: allogeneic hematopoietic stem cell transplantation
- Procedure: peripheral blood stem cell transplantation
Detailed Description
PRIMARY OBJECTIVES:
I. To assess feasibility and tolerability of OSMI based hematopoietic stem cell transplant (HSCT) as defined by transplant-related mortality (TRM) at day 30 as well as rate of grade II/III organ toxicity (defined by Bearman Regimen-Related Toxicities Scale) attributable to conditioning occurring within 30 days.
SECONDARY OBJECTIVES:
I. Day 100 transplant-related mortality (TRM). II. Donor chimerism assessment at day 100 (to assess failure of engraftment rate).
III. Incidence of acute graft-versus-host disease (aGVHD) by day 100. IV. Incidence of chronic GVHD at one year. V. Cumulative incidence of grade II organ toxicity through day 100. VI. Rate and kinetics of hematopoietic recovery. VII. Incidence of graft failure (primary and secondary). VIII. Rate of infectious complications. IX. Cumulative incidence of relapse, overall survival, and progression-free survival at 1 year.
OUTLINE:
CONDITIONING REGIMEN: Patients undergo organ-sparing marrow irradiation twice daily (BID) on days -6 to -4 and receive cyclophosphamide intravenously (IV) over 1-2 hours every 24 hours on days -3 to -2. Patients with an unrelated donor also receive anti-thymocyte globulin every 24 hours on days -4 to -2.
GVHD PROPHYLAXIS: Patients receive tacrolimus IV or orally (PO) beginning on day -1 and continuing for at least 6 months and methotrexate IV on days 1, 3, 6, and 11.
TRANSPLANT: Patients undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0.
After completion of study treatment, patients are followed up weekly for 12 weeks, at day 100, and then at 6 and 12 months.
Study Type
Enrollment (Actual)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
Ohio
-
Columbus, Ohio, United States, 43210
- Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Patients with a diagnosis of acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS) with fewer than 10% myeloblasts or lymphoblasts in the bone marrow and no blasts in the peripheral blood on morphologic analysis performed within 30 days of start of the conditioning regimen; if remission bone marrow is available beyond 30 days a new bone marrow evaluation is required to assess remission status
- The diagnosis of AML, ALL, or MDS will be based on World Health Organization (WHO) criteria
- Pre-transplant bone marrow sample must be evaluable for assessment of remission status (i.e. aspirate smear containing particles and/or evaluable bone marrow core biopsy)
- Patients with leukemia infiltration in the central nervous system (CNS) are eligible if cerebrospinal fluid (CSF) cytospin is negative for myeloblasts or lymphoblasts at time of enrollment
- If the patient has an intra-abdominal chloroma on presentation, and has a partial response or complete response to treatment (size reduction of chloroma and marrow blast < 10%), the patient is eligible; however the chloroma must be included as part of the treatment target
For patients receiving treatment of their AML, MDS or ALL prior to transplantation:
- Interval between the start of a cycle of conventional cytotoxic chemotherapy and the start of conditioning regimen must be at least 30 days
- Interval between completing treatment with a hypomethylating agent or other non-cytotoxic chemotherapy and the start of conditioning regimen must be at least 10 days
- Hematopoietic Cell Transplantation-Specific Comorbidity Index score (HCT-CI) =< 4 for patients in Cohort 1 and > 4 for Cohort 2
- Patient must be able to lie still in full body cast for 45 minutes
- Must have a suitable donor defined as a sibling matched at 5/6 or 6/6 antigens (human leukocyte antigen [HLA]-A, B, and DRB1) or an unrelated volunteer matched at 7/8 or 8/8 HLA alleles (HLA-A, B, C, and DRB1)
- Signed informed consent
DONOR: "High resolution" typing at HLA-A, B, C and DRB1 alleles
- Single antigen mismatch for siblings and single allele mismatch for volunteer unrelated donors is acceptable
- Donors must be >= 17 years of age
Exclusion Criteria:
- Circulating peripheral blood myeloblasts or lymphoblasts on morphologic analysis from time of last treatment to time of enrollment
- Prior allograft or prior autograft
- Active CNS disease as identified by positive CSF cytospin at time of enrollment
- Karnofsky performance score < 70
- Symptomatic uncontrolled coronary artery disease or ejection fraction < 40%
- Total bilirubin >= 2 x the upper limit of normal
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >= 3 x the upper limit of normal
- Diffusion capacity of the lung for carbon monoxide (DLCO) < 40%
- Forced expiratory volume in one second (FEV1) < 50% (corrected for hemoglobin)
- Receiving supplementary continuous oxygen
- Creatinine clearance < 50 mL/min/1.73m^2
- Patients with active uncontrolled bacterial, viral or fungal infections (undergoing appropriate treatment and with progression of clinical symptoms)
- Patients seropositive for the human immunodeficiency virus (HIV)
- Females who are pregnant or breastfeeding
- Fertile men and women unwilling to use contraceptive techniques during and for 12 months following treatment
- Patients who had prior radiation to more than 20% bone marrow containing areas or to any areas exceeding 2000 cGy
DONOR:
- Donors will be excluded if they are an identical twin of the recipient
- Females who are pregnant (positive serum beta human chorionic gonadotropin beta [β HCG]) or uninterruptible breastfeeding
- HIV seropositive
- Donors receiving experimental therapy or investigational agents unless approved by the protocol chair
Study Plan
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: Treatment (OSMI, allogeneic transplant)
CONDITIONING REGIMEN: Patients undergo organ-sparing marrow irradiation BID on days -6 to -4 and receive cyclophosphamide IV over 1-2 hours every 24 hours on days -3 to -2. Patients with an unrelated donor also receive anti-thymocyte globulin every 24 hours on days -4 to -2. GVHD PROPHYLAXIS: Patients receive tacrolimus IV or PO beginning on day -1 and continuing for at least 6 months and methotrexate IV on days 1, 3, 6, and 11. TRANSPLANT: Patients undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0. |
Correlative studies
Other Names:
Given IV
Other Names:
Given IV or PO
Other Names:
Undergo organ-sparing marrow irradiation BID on days -6 to -4
Other Names:
Given IV over 1-2 hours every 24 hours on days -3 to -2.
Other Names:
Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0
Other Names:
Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant
Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
TRM, defined as death occurring in a patient from causes other than disease relapse
Time Frame: At day 30 post-transplant
|
Proportions will be derived for incidence of TRM divided by all evaluable patients along with corresponding 95% binomial confidence intervals.
|
At day 30 post-transplant
|
Rate of grade II/III organ toxicity, defined by the Bearman Regimen-Related Toxicities Scale
Time Frame: Up to 30 days
|
Toxicities will be tabulated by grade for each cohort, by type of toxicity, as well as the maximum grade overall.
Toxicity frequencies will be described for the day +30, day +100, and one year time intervals as well as cumulative over time.
Proportions will be derived for incidence of grade II/III organ toxicity divided by all evaluable patients along with corresponding 95% binomial confidence intervals.
|
Up to 30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
TRM
Time Frame: Day 100 post-transplant
|
Proportions will be derived for incidence of toxicity divided by all evaluable patients along with corresponding 95% binomial confidence intervals.
|
Day 100 post-transplant
|
Donor chimerism
Time Frame: Day 100
|
Donor chimerism is used to assess failure of engraftment rate.
|
Day 100
|
Incidence of aGVHD, graded according to Ohio State University Bone Marrow Transplant (OSU BMT) Program policy
Time Frame: Up to day 100
|
The first day of aGVHD onset at a certain grade will be used to calculate cumulative incidence curves for that GVHD grade.
|
Up to day 100
|
Incidence of chronic GVHD, scored according to the OSU BMT Program policy
Time Frame: At 1 year
|
The first day of chronic GVHD onset will be used to calculate cumulative incidence curves.
Rates and severity of chronic GHVD will be calculated.
|
At 1 year
|
Cumulative incidence of grade II organ toxicity
Time Frame: Up to day 100
|
Toxicity will be tabulated by grade for each cohort, by type of toxicity as well as the maximum grade overall.
|
Up to day 100
|
Incidence of hematopoietic recovery
Time Frame: Up to day 100
|
The rate and kinetics of hematopoietic recovery will be assessed.
The kinetics of post-transplant recovery of both neutrophil and platelet engraftment will be assessed.
|
Up to day 100
|
Incidence of graft failure
Time Frame: Up to 1 year post-transplant
|
Primary graft failure (defined by the lack of neutrophil engraftment by 28 days) and secondary graft failure (defined by initial neutrophil engraftment followed by subsequent decline in neutrophil counts < 500/uL unresponsive to growth factor therapy) will be assessed on days 30 and 100 and at 1 year post-transplant.
|
Up to 1 year post-transplant
|
Rate of infectious complications
Time Frame: Up to 12 months
|
The number of infections and the number of patients experiencing infections will be tabulated by type of infection, severity, and time period after transplant.
The cumulative incidence of severe, life-threatening, or fatal infections will be tabulated.
|
Up to 12 months
|
Incidence of relapse
Time Frame: Time from start of conditioning to relapse, assessed at 1 year
|
Time from start of conditioning to relapse, assessed at 1 year
|
|
Overall survival
Time Frame: Time from start of conditioning to death, loss to follow up, or end of study, whichever comes first, assessed at 1 year
|
Time from start of conditioning to death, loss to follow up, or end of study, whichever comes first, assessed at 1 year
|
|
Progression-free survival
Time Frame: Time from start of conditioning to relapse, progression, death, initiation of non-protocol therapy, loss to follow up or end of study, whichever comes first, assessed at 1 year
|
Patients are considered a failure of this endpoint if they die or suffer from disease relapse or progression.
|
Time from start of conditioning to relapse, progression, death, initiation of non-protocol therapy, loss to follow up or end of study, whichever comes first, assessed at 1 year
|
Immune reconstitution
Time Frame: Up to 12 months post transplant
|
Quantitative assessments of peripheral blood CD3, CD4, CD8, CD19, and CD56 positive lymphocytes will be done throw flow cytometric analysis at baseline, 100 days, and 12 months post transplantation.
|
Up to 12 months post transplant
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sumithira Vasu, MD, Ohio State University Comprehensive Cancer Center
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Neoplasms by Site
- Disease Attributes
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Precancerous Conditions
- Syndrome
- Myelodysplastic Syndromes
- Hematologic Neoplasms
- Leukemia
- Leukemia, Myeloid
- Leukemia, Myeloid, Acute
- Recurrence
- Preleukemia
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
- Leukemia, Lymphoid
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Dermatologic Agents
- Reproductive Control Agents
- Abortifacient Agents, Nonsteroidal
- Abortifacient Agents
- Folic Acid Antagonists
- Calcineurin Inhibitors
- Cyclophosphamide
- Immunoglobulins
- Methotrexate
- Tacrolimus
- Thymoglobulin
- Antilymphocyte Serum
Other Study ID Numbers
- OSU-13219
- NCI-2014-00763 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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