- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02793544
HLA-Mismatched Unrelated Donor Bone Marrow Transplantation With Post-Transplantation Cyclophosphamide
A Multi-Center, Phase II Trial of HLA-Mismatched Unrelated Donor Bone Marrow Transplantation With Post-Transplantation Cyclophosphamide for Patients With Hematologic Malignancies
Study Overview
Status
Conditions
Intervention / Treatment
- Drug: Fludarabine
- Drug: Cyclophosphamide 14.5 mg/kg/day IV on Days -6, -5
- Radiation: Total Body Irradiation (TBI) 200cGy on Day -1
- Procedure: Infusion of non-T-cell depleted bone marrow on Day 0
- Drug: Post-HCT Cyclophosphamide 50mg/kg IV on Day+3, +4
- Drug: Sirolimus
- Drug: Mycophenolate mofetil
- Drug: G-CSF
- Drug: Pre-HCT Mesna on Days -6 and -5
- Drug: Post-HCT Mesna
- Drug: Busulfan
- Drug: Cyclophosphamide 50mg/kg/day IV on Days -2,-1
- Drug: Pre-HCT Mesna on Days -2 and -1
- Drug: Cyclophosphamide 50mg/kg/day IV on Days -5,-4
- Radiation: Total Body Irradiation (TBI) 200cGy twice a day on Days -3, -2, -1
- Drug: Pre-HCT Mesna on Days -5 and -4
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Florida
-
Gainesville, Florida, United States, 32610
- Shands HealthCare & University of Florida
-
Miami, Florida, United States, 33136
- University of Miami
-
Tampa, Florida, United States, 33612
- H. Lee Moffitt Cancer Center and Research Institute
-
-
Maryland
-
Baltimore, Maryland, United States, 21201
- University of Maryland Greenebaum Cancer Center
-
Baltimore, Maryland, United States, 21287
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
-
-
Michigan
-
Detroit, Michigan, United States, 48201
- Karmanos Cancer Institute
-
-
New York
-
New York, New York, United States, 10065
- Memorial Sloan Kettering Cancer Center - Adults
-
-
North Carolina
-
Chapel Hill, North Carolina, United States, 27599
- University of North Carolina Hospitals
-
-
Ohio
-
Columbus, Ohio, United States, 43210
- Ohio State Medical Center, James Cancer Center
-
-
Virginia
-
Richmond, Virginia, United States, 23298
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program
-
-
Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Froedtert Memorial Lutheran Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 15 years and < 71 years at the time of signing the informed consent form
- Partially HLA-mismatched unrelated donor: HLA typing will be performed at high resolution (allele level) for the HLA-A, -B, -C, and -DRB1 loci; a minimum match of 4/8 at HLA-A, -B, -C, and -DRB1 is required
- Product planned for infusion is bone marrow
Disease and disease status:
- Acute Leukemias or T lymphoblastic lymphoma in 1st or subsequent complete remission (CR): Acute lymphoblastic leukemia (ALL)/T lymphoblastic lymphoma; acute myelogenous leukemia (AML); acute biphenotypic leukemia (ABL); acute undifferentiated leukemia (AUL)
- Myelodysplastic Syndrome (MDS), fulfilling the following criteria: Subjects with de novo MDS who have or have previously had Intermediate-2 or High risk disease as determined by the International Prognostic Scoring System (IPSS). Current Intermediate-2 or High risk disease is not a requirement; Subjects must have < 20% bone marrow blasts, assessed within 60 days of informed consent; Subjects may have received prior therapy for the treatment of MDS prior to enrollment
- Chronic Lymphocytic Leukemia (CLL) in CR if RIC is to be used; in CR or partial response (PR) if FIC is to be used
- Chronic myeloid leukemia (CML) in 1st or subsequent chronic phase characterized by <10% blasts in the blood or bone marrow.
- Chemotherapy-sensitive lymphoma in status other than 1st CR
- Performance status: Karnofsky or Lansky score ≥ 60% (Appendix A)
Adequate organ function defined as:
- Cardiac: left ventricular ejection fraction (LVEF) at rest ≥ 35% (RIC cohort) or LVEF at rest ≥ 40% (FIC cohort), or left ventricular shortening fraction (LVFS) ≥ 25%
- Pulmonary: diffusing capacity of the lungs for carbon monoxide (DLCO), forced expiratory volume (FEV1), forced vital capacity (FVC) ≥ 50% predicted by pulmonary function tests (PFTs)
- Hepatic: total bilirubin ≤ 2.5 mg/dL, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) < 5 x upper limit of (ULN) (unless disease related)
- Renal: serum creatinine (SCr) within normal range for age (see table 2.3). If SCr is outside normal range for age, creatinine clearance (CrCl) > 40 mL/min/1.73m2 must be obtained (measured by 24-hour (hr) urine specimen or nuclear glomerular filtration rate (GFR), or calculated GFR (by Cockcroft-Gault formula for those aged ≥ 18 years; by Original Schwartz estimate for those < 18 years))
- Subjects ≥ 18 years of age must have the ability to give informed consent according to applicable regulatory and local institutional requirements. Legal guardian permission must be obtained for subjects < 18 years of age. Pediatric subjects will be included in age appropriate discussion in order to obtain assent.
Subjects with documentation of confirmed HIV-1 infection (i.e. HIV-positive), and a hematologic malignancy who meets all other eligibility requirements must:
- Receive only RIC regimen (i.e. Regimen A)
- Be willing to comply with effective antiretroviral therapy (ARV)
- Have achieved a sustained virologic response for 12 weeks after cessation of hepatitis C antiviral treatment (in HIV-positive subjects with hepatitis C)
Exclusion Criteria:
- HLA-matched related or 8/8 allele matched (HLA-A, -B, -C, -DRB1) unrelated donor available. This exclusion does not apply to HIV-positive subjects who have a CCR5delta32 homozygous donor.
- Autologous HCT < 3 months prior to the time of signing the informed consent form
- Females who are breast-feeding or pregnant
HIV-positive subjects:
- Acquired immunodeficiency syndrome (AIDS) related syndromes or symptoms that may pose an excessive risk for transplantation-related morbidity as determined by the Treatment Review Committee (see Appendix D).
- Untreatable HIV infection due to multidrug ARV resistance. Subjects with a detectable or standard viral load > 750 copies/mL should be evaluated with an HIV drug resistance test (HIV-1 genotype). The results should be included as part of the ARV review (described in Appendix D).
- May not be currently prescribed ritonavir, cobacistat and/or zidovudine
- Current uncontrolled bacterial, viral or fungal infection (currently taking medication with evidence of progression of clinical symptoms or radiologic findings)
- Prior allogeneic HCT
- History of primary idiopathic myelofibrosis
- MDS subjects may not receive RIC and must be < 50 years of age at the time of signing the informed consent form
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NON_RANDOMIZED
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Regimen A (RIC: Flu/Cy/TBI)
Although a schedule is proposed above, the regimen can be given according to institutional standards as long as the prescribed doses are the same as in the recommended regimen above. |
Other Names:
Other Names:
For subjects ≥ 18 years old:
For subjects < 18 years old:
Other Names:
MMF begins on Day+5, at least 24 hours after completion of PTCy. MMF dose is 15 mg/kg PO TID (adjusted IBW (Appendix K)) with total daily dose not to exceed 3 grams (i.e. maximum 1 g PO TID). An equivalent IV dose (1:1 conversion) may instead be given. MMF prophylaxis is discontinued after the last dose on Day+35, or may be continued if there is GVHD.
Other Names:
Granulocyte-colony stimulating factor (G-CSF): filgrastim or a biosimilar begins on Day+5 at a dose of 5 mcg/kg/day (actual body weight) IV or subcutaneously (SC) (rounding to the nearest vial dose is allowed), until the absolute neutrophil count (ANC) is ≥ 1,000/mm3 over the course of 3 consecutive days. Additional G-CSF may be administered as warranted.
Other Names:
Use of Mesna and dosing will be done according to institutional standards. A recommended approach is as follows: Mesna IV dose of ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy. Mesna is dosed according to adjusted IBW (Appendix K), unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual weight. Mesna is required. Mesna IV dose must be ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy on Day+3 and Day+4. Mesna is dosed according to IBW, unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual body weight. |
ACTIVE_COMPARATOR: Regimen B 2a (FIC: Bu/Cy)
Although a schedule is proposed above, the regimen can be given according to institutional standards as long as the prescribed doses are the same as in the recommended regimen above. |
For subjects ≥ 18 years old:
For subjects < 18 years old:
Other Names:
MMF begins on Day+5, at least 24 hours after completion of PTCy. MMF dose is 15 mg/kg PO TID (adjusted IBW (Appendix K)) with total daily dose not to exceed 3 grams (i.e. maximum 1 g PO TID). An equivalent IV dose (1:1 conversion) may instead be given. MMF prophylaxis is discontinued after the last dose on Day+35, or may be continued if there is GVHD.
Other Names:
Granulocyte-colony stimulating factor (G-CSF): filgrastim or a biosimilar begins on Day+5 at a dose of 5 mcg/kg/day (actual body weight) IV or subcutaneously (SC) (rounding to the nearest vial dose is allowed), until the absolute neutrophil count (ANC) is ≥ 1,000/mm3 over the course of 3 consecutive days. Additional G-CSF may be administered as warranted.
Other Names:
Mesna is required. Mesna IV dose must be ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy on Day+3 and Day+4. Mesna is dosed according to IBW, unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual body weight.
Other Names:
Other Names:
Use of Mesna and dosing will be done according to institutional standards. A recommended approach is as follows: Mesna IV dose of ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy. Mesna is dosed according to adjusted IBW (Appendix K), unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual weight. |
ACTIVE_COMPARATOR: Regimen B 2b (FIC: Bu/Flu)
Although a schedule is proposed above, the regimen can be given according to institutional standards as long as the prescribed doses are the same as in the recommended regimen above. |
Other Names:
For subjects ≥ 18 years old:
For subjects < 18 years old:
Other Names:
MMF begins on Day+5, at least 24 hours after completion of PTCy. MMF dose is 15 mg/kg PO TID (adjusted IBW (Appendix K)) with total daily dose not to exceed 3 grams (i.e. maximum 1 g PO TID). An equivalent IV dose (1:1 conversion) may instead be given. MMF prophylaxis is discontinued after the last dose on Day+35, or may be continued if there is GVHD.
Other Names:
Granulocyte-colony stimulating factor (G-CSF): filgrastim or a biosimilar begins on Day+5 at a dose of 5 mcg/kg/day (actual body weight) IV or subcutaneously (SC) (rounding to the nearest vial dose is allowed), until the absolute neutrophil count (ANC) is ≥ 1,000/mm3 over the course of 3 consecutive days. Additional G-CSF may be administered as warranted.
Other Names:
Mesna is required. Mesna IV dose must be ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy on Day+3 and Day+4. Mesna is dosed according to IBW, unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual body weight.
Other Names:
|
ACTIVE_COMPARATOR: Regimen C (FIC: Cy/TBI)
Although a schedule is proposed above, the regimen can be given according to institutional standards as long as the prescribed doses are the same as in the recommended regimen above. |
For subjects ≥ 18 years old:
For subjects < 18 years old:
Other Names:
MMF begins on Day+5, at least 24 hours after completion of PTCy. MMF dose is 15 mg/kg PO TID (adjusted IBW (Appendix K)) with total daily dose not to exceed 3 grams (i.e. maximum 1 g PO TID). An equivalent IV dose (1:1 conversion) may instead be given. MMF prophylaxis is discontinued after the last dose on Day+35, or may be continued if there is GVHD.
Other Names:
Granulocyte-colony stimulating factor (G-CSF): filgrastim or a biosimilar begins on Day+5 at a dose of 5 mcg/kg/day (actual body weight) IV or subcutaneously (SC) (rounding to the nearest vial dose is allowed), until the absolute neutrophil count (ANC) is ≥ 1,000/mm3 over the course of 3 consecutive days. Additional G-CSF may be administered as warranted.
Other Names:
Mesna is required. Mesna IV dose must be ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy on Day+3 and Day+4. Mesna is dosed according to IBW, unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual body weight.
Other Names:
Use of Mesna and dosing will be done according to institutional standards. A recommended approach is as follows: Mesna IV dose of ≥ 80% of the total daily dose of Cy and given in divided doses 30 minutes before and at 3, 6, and 8-9 hours after completion of Cy. Mesna is dosed according to adjusted IBW (Appendix K), unless the subject weighs less than IBW, in which case Mesna will be dosed according to actual weight. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Overall Survival
Time Frame: 1 year post transplant
|
1 year post transplant
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression-free survival
Time Frame: 180 days and 365 days post-transplant
|
180 days and 365 days post-transplant
|
|
Transplant-related mortality
Time Frame: 100 days, 180 days, and 365 days post-transplant
|
100 days, 180 days, and 365 days post-transplant
|
|
Cumulative incidence of neutrophil recovery
Time Frame: 1 year post transplant
|
1 year post transplant
|
|
Cumulative incidence of platelet recovery
Time Frame: 1 year post transplant
|
1 year post transplant
|
|
Cumulative incidence of primary graft failure
Time Frame: 56 days post-transplant
|
56 days post-transplant
|
|
Donor Chimerism
Time Frame: 28 days, 56 days, 100 days, 180 days, and 365 days post-transplant
|
Peripheral blood chimerism (% of donor chimerism) in whole blood (unsorted)
|
28 days, 56 days, 100 days, 180 days, and 365 days post-transplant
|
Peripheral blood chimerism
Time Frame: 56 days post-transplant
|
The percentage of subjects with peripheral blood (unsorted) chimerism>95%
|
56 days post-transplant
|
Cumulative incidence of acute GVHD
Time Frame: 100 days post-transplant
|
100 days post-transplant
|
|
Cumulative incidence of chronic GVHD
Time Frame: 180 days and 365 days post-transplant
|
180 days and 365 days post-transplant
|
|
Cumulative incidences of viral reactivations and infections
Time Frame: 100 days, 180 days and 365 days post-transplant
|
100 days, 180 days and 365 days post-transplant
|
|
Cumulative incidence of relapse/progression
Time Frame: 180 days and 365 days post-transplant
|
180 days and 365 days post-transplant
|
|
Cumulative incidences of thrombotic microangiopathy (TMA) and hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS)
Time Frame: 1 year post transplant
|
1 year post transplant
|
|
Proportion of subjects proceeding to transplant
Time Frame: 1 year post transplant
|
1 year post transplant
|
|
Donor Selection Characteristics
Time Frame: 1 year post transplant
|
number of mismatches at HLA-A, -B, -C, -DRB1, -DQB1, -DPB1, donor age, donor-recipient CMV serostatus match, donor weight, donor-recipient sex match and donor-recipient ABO group match
|
1 year post transplant
|
Time from search to donor identification
Time Frame: 1 year post transplant
|
1 year post transplant
|
|
Subgroup analysis of HIV-positive subjects
Time Frame: 1 year post transplant
|
If CCR5delta32 homozygous donors are successfully found and used for one or more HIV-positive subjects, a descriptive analysis of baseline characteristics and outcomes for those HIV-positive subjects will be conducted, including the viral load detected over time obtained from collected samples.
|
1 year post transplant
|
Donor clonal hematopoiesis
Time Frame: 100 days and 365 days post-transplant
|
The proportion of subjects developing donor clonal hematopoiesis
|
100 days and 365 days post-transplant
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Javier Bolaños Meade, MD, Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins
- Study Chair: Bronwen E. Shaw, MD, PhD, CIBMTR/Medical College of Wisconsin
Publications and 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 (ESTIMATE)
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
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Bone Marrow Diseases
- Hematologic Diseases
- Precancerous Conditions
- Leukemia, Lymphoid
- Leukemia, B-Cell
- Lymphoma
- Myelodysplastic Syndromes
- Leukemia
- Leukemia, Myeloid
- Leukemia, Myeloid, Acute
- Preleukemia
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
- Leukemia, Lymphocytic, Chronic, B-Cell
- Leukemia, Biphenotypic, Acute
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Protective Agents
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antifungal Agents
- Antitubercular Agents
- Antibiotics, Antitubercular
- Cyclophosphamide
- Fludarabine
- Mycophenolic Acid
- Sirolimus
- Busulfan
- Mesna
Other Study ID Numbers
- 15-MMUD
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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