- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03399773
Infusion of Expanded Cord Blood Cells in Addition to Single Cord Blood Transplant in Treating Patients With Acute Leukemia, Chronic Myeloid Leukemia, or Myelodysplastic Syndromes
Pilot Study: Infusion of Off-the-Shelf Ex Vivo Expanded Cryopreserved Progenitor Cells (Dilanubicel) in the Setting of Single Cord Blood Transplantation for Patients With Hematologic Malignancies
Study Overview
Status
Conditions
Intervention / Treatment
- Other: Laboratory Biomarker Analysis
- Procedure: Computed Tomography
- Procedure: Biospecimen Collection
- Drug: Cyclophosphamide
- Drug: Fludarabine
- Radiation: Total-Body Irradiation
- Procedure: Multigated Acquisition Scan
- Drug: Thiotepa
- Biological: Dilanubicel
- Procedure: Umbilical Cord Blood Transplantation
- Procedure: Electrocardiography
- Procedure: Bone Marrow Biopsy
- Procedure: Bone Marrow Aspirate
Detailed Description
OUTLINE:
Patients receive either regimen A or regimen B.
REGIMEN A: Patients (10 through 45 years old) receive fludarabine intravenously (IV) over 30 minutes on days -8 to -6 and cyclophosphamide IV on days -7 and -6. Patients undergo total body irradiation (TBI) twice daily (BID) on days -4 to -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.
REGIMEN B: Patients (10 through 65 years old) receive fludarabine IV over 30-60 minutes on days -6 to -3 and IV over 30 minutes on day -2, cyclophosphamide IV on day -6, and thiotepa IV over 2-4 hours on days -5 and -4. Patients undergo TBI once daily (QD) on days -2 and -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.
All patients undergo bone marrow aspirate and biopsy as clinically indicated during screening and on study. Patients undergo multigated acquisition scan (MUGA) or echocardiography (ECHO), and computed tomography (CT) during screening. Patients also undergo blood sample collection on study.
After completion of study treatment, patients are followed up at 180 days, 1 year, and 2 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Filippo Milano
- Phone Number: 206.667.5925
- Email: fmilano@fredhutch.org
Study Locations
-
-
Washington
-
Seattle, Washington, United States, 98109
- Recruiting
- Fred Hutch/University of Washington Cancer Consortium
-
Contact:
- Filippo Milano
- Phone Number: 206-667-5925
- Email: fmilano@fredhutch.org
-
Principal Investigator:
- Filippo Milano
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients 10 to 65 years old with a hematologic malignancy in need of hematopoietic cell transplant who are > 30 kg and without a suitable related donor
- Patient must have hematologic malignancy that meets institutional eligibility requirements for cord blood transplant
Malignancies included are:
- Acute leukemia, including acute myeloid leukemia (AML), biphenotypic acute leukemia or mixed-lineage leukemia, acute lymphoblastic leukemia (ALL); all patients must be in complete response (CR) as defined by < 5% blasts by morphology/flow cytometry in a representative bone marrow sample with adequate cellularity to assess remission status
- Myelodysplasia (MDS) International Prognostic Scoring System (IPSS) intermediate (Int)-2 or high risk (i.e., RAEB, RAEBt) or refractory anemia with severe pancytopenia or high risk cytogenetics; blasts must be < 10% in a representative bone marrow aspirate
- Chronic myeloid leukemia excluding refractory blast crisis; to be eligible in first chronic phase (CP1) patient must have failed or be intolerant to tyrosine kinase inhibitor therapy
- High dose TBI regimen: 10 to =< 45 years
- Intermediate intensity regimen: 10 to =< 65 years
- Patients 10 to =< 45 years:Lansky (< 16 years old) or Karnofsky (>= 16 years old) >= 70 or Eastern Cooperative Oncology Group (ECOG) 0-1
- Patients > 45 to =< 65 years: Karnofsky >= 70 or ECOG 0-1 and non-age adjusted comorbidity index =< 5
- Adults: Calculated creatinine clearance must be > 60 mL and serum creatinine =< 2 mg/dL
- Children (< 18 years old): Calculated creatinine clearance must be > 60 mL/min
- Total serum bilirubin must be < 3 mg/dL unless the elevation is thought to be due to Gilbert's disease or hemolysis
- Transaminases must be < 3 x the upper limit of normal per reference values of treating institution
- Carbon monoxide diffusing capability (DLCO) corrected >= 60% normal (may not be on supplemental oxygen)
- For pediatric patients unable to perform pulmonary function tests, O2 saturation > 92% on room air
- Left ventricular ejection fraction >= 50% OR
- Shortening fraction > 26%
- Ability of participant or legally authorized representative to understand and the willingness to sign a written informed consent form
- DONOR: Minimum requirement: The cord blood (CB) unit must be matched at a minimum at 4/6 HLA-A, B antigens and DRB1 allele with the recipient; therefore, 0-2 mismatches at the A or B or DRB1 loci based on intermediate resolution at HLA-A, B and high resolution allele level typing at HLA- DRB1 are allowed
- DONOR: Institutional guidelines for HLA-match may be followed as long as the minimum criteria for HLA-matching as above are met
- DONOR: The CB unit selected for transplant must have a MINIMUM of 2.5 x 10^7 TNC/kg
- DONOR: The minimum recommended CD34/kg cell dose is 1.7 x 10^5 CD34/kg
DONOR: A backup unit must be identified and reserved prior to the start of the treatment plan for possible infusion in the unlikely event of poor post-thaw viability of the primary CB unit. A suitable back up unit will be considered, as follows:
- Must be matched at a minimum at 4/6 HLA-A, B, DRBl loci with the recipient. Therefore 0-2 mismatches at the A or B or DRBl loci based on intermediate resolution A, B antigen and DRBl allele typing for determination of HLA-match is allowed (Fred Hutch Protocol 2010).
- Must contain a MINIMUM of 1.5 x 10^7 TNC/kg to ensure the same requirement we use for a standard double CBT per CB selection guideline (Fred Hutch Protocol 2010).
Exclusion Criteria:
- Uncontrolled viral or bacterial infection at the time of study enrollment
- Active or recent (prior 6 month) invasive fungal infection unless cleared by infectious disease (ID) consult
- History of human immunodeficiency virus (HIV) infection
- Pregnant or breastfeeding
- Prior allogeneic transplant
- Central nervous system (CNS) leukemic involvement not clearing with intrathecal chemotherapy; diagnostic lumbar puncture is to be performed
- < 30 kg
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 (chemotherapy, TBI, NLA101)
Patients receive either regimen A or regimen B. REGIMEN A: Patients (10 through 45 years old) receive fludarabine IV over 30 minutes on days -8 to -6 and cyclophosphamide IV on days -7 and -6. Patients undergo TBI BID on days -4 to -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0. REGIMEN B: Patients (10 through 65 years old) receive fludarabine IV over 30-60 minutes on days -6 to -3 and IV over 30 minutes on day -2, cyclophosphamide IV on day -6, and thiotepa IV over 2-4 hours on days -5 and -4. Patients undergo TBI QD on days -2 and -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0. All patients undergo bone marrow aspirate and biopsy as clinically indicated during screening and on study. Patients undergo MUGA or ECHO, and CT during screening. Patients also undergo blood sample collection on study. |
Correlative studies
Undergo CT
Other Names:
Undergo blood sample collection
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Undergo TBI
Other Names:
Undergo MUGA
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Undergo ECHO
Other Names:
Undergo bone marrow aspirate and biopsy
Undergo bone marrow aspirate and biopsy
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of graft failure
Time Frame: Up to day 45 post-transplant
|
Primary graft failure/rejection as defined by no neutrophil recovery (regardless of donor chimerism) or autologous recovery (neutrophil recovery but < 10% donor chimerism in blood and bone marrow [BM]).
|
Up to day 45 post-transplant
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence and severity of acute graft versus host disease (GVHD)
Time Frame: At day 100 post-transplant
|
Assessed using the Acute GVHD Grading Scale (reference: Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading.
Bone Marrow Transplant 1995; 15: 825-8).
|
At day 100 post-transplant
|
Incidence and severity of chronic graft versus host disease (GVHD)
Time Frame: Up to approximately 2 years post-transplant
|
Assessed using the Chronic GVHD Grading Scale (reference: Filipovich AH, Weisdorf D, Pavletic S, et al.
National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease.
I. Diagnosis and Staging Working Group report.
Blood Marrow Transplant 2005; 11: 945-56).
|
Up to approximately 2 years post-transplant
|
Time to neutrophil engraftment
Time Frame: Up to day 45 post-transplant
|
The day of neutrophil recovery will be the 1st day of 2 consecutive days of absolute neutrophil count at or above 500 after the 1st post-cord blood transplant nadir.
|
Up to day 45 post-transplant
|
Time to platelet engraftment
Time Frame: Up to day 100 post-transplant
|
Measured by the number of participants with a platelet count > 20,000/ul without subsequent transfusions for 7 days
|
Up to day 100 post-transplant
|
Incidence of non-relapse mortality
Time Frame: At day 100 post-transplant
|
At day 100 post-transplant
|
|
Incidence of non-relapse mortality
Time Frame: At 1 year post-transplant
|
At 1 year post-transplant
|
|
Incidence of adverse events
Time Frame: Up to day 100 post-transplant
|
Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 5.0.
|
Up to day 100 post-transplant
|
Incidence and severity of chronic graft versus host disease (GVHD)
Time Frame: 1 year post-transplant
|
Assessed using the Chronic GVHD Grading Scale (reference: Filipovich AH, Weisdorf D, Pavletic S, et al.
National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease.
I. Diagnosis and Staging Working Group report.
Blood Marrow Transplant 2005; 11: 945-56).
|
1 year post-transplant
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Filippo Milano, Fred Hutch/University of Washington Cancer Consortium
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- Disease Attributes
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Myeloproliferative Disorders
- Anemia
- Precancerous Conditions
- Leukemia, Lymphoid
- Anemia, Refractory
- Chronic Disease
- Syndrome
- Myelodysplastic Syndromes
- Leukemia
- Leukemia, Myeloid
- Preleukemia
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive
- Anemia, Refractory, with Excess of Blasts
- Leukemia, Biphenotypic, Acute
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Cyclophosphamide
- Fludarabine
- Thiotepa
Other Study ID Numbers
- 9910 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)
- P30CA015704 (U.S. NIH Grant/Contract)
- P50HL110787 (U.S. NIH Grant/Contract)
- NCI-2017-02205 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- RG9218003 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)
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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