- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04622956
GVHD Prophylaxis With Methotrexate in Haploidentical HCT Using Posttransplant Cyclophosphamide
September 10, 2021 updated by: University of Sao Paulo General Hospital
GVHD Prophylaxis With Methotrexate and Cyclosporine in Haploidentical Stem Cell Transplantation Using Posttransplant Cyclophosphamide in Hematologic Malignancies: Phase I/II Trial
Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic strategy for many malignant and benign hematologic diseases.
Haploidentical HCT has been increasingly used in patients lacking a HLA-matched donor due to its prompt availability, possibly lower cost and results comparable with other donor types.
Graft-versus-host disease (GVHD) is the main cause of morbidity and mortality after HSCT, and prophylactic strategies are routinely used.
In the context of haploidentical HCT, posttransplant cyclophosphamide plus cyclosporine and mycophenolate mofetil (MMF) is the most common platform used in Brazil.
Data comparing MMF and methotrexate (MTX) as GVHD prophylaxes have proved controversial in other donor types, yet some large studies have showed that MTX is associated with lower risk of GVHD and improved long-term outcomes.
Moreover, it is known that MMF is a potent inhibitor of natural killer (NK) cells, possibly interfering with the graft-versus-leukemia effect in haploidentical HCT.
Given the possible advantages and the absence of consistent evidence regarding safety, efficacy and ideal dosage of MTX as GVHD prophylaxis in this setting, we propose a phase I / II study evaluating this drug in adult patients with hematologic malignancies undergoing haploidentical HCT with posttransplant cyclophosphamide.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
47
Phase
- Phase 2
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Giancarlo Fatobene, MD
- Phone Number: +551126617575
- Email: gian_fatobene@hotmail.com
Study Locations
-
-
-
Sao Paulo, Brazil, 05403-000
- Recruiting
- Hospital das Clínicas da Universidade de São Paulo
-
Contact:
- Giancarlo Fatobene, MD
- Phone Number: +551126617575
- Email: gian_fatobene@hotmail.com
-
Contact:
- Bruna Carvalho
- Phone Number: +551126617575
- Email: bruna.carvalho@hc.fm.usp.br
-
Principal Investigator:
- Giancarlo Fatobene, MD
-
Principal Investigator:
- Vanderson Rocha, MD, PhD
-
-
RJ
-
Rio De Janeiro, RJ, Brazil
- Recruiting
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA
-
Contact:
- Maria Claudia R Moreira, MD
- Email: mclaudiarm@gmail.com
-
-
São Paulo
-
Campinas, São Paulo, Brazil
- Recruiting
- Centro de Hematologia e Hemoterapia - HEMOCENTRO
-
Contact:
- Afonso Vigorito, MD, PhD
- Email: afonso@unicamp.br
-
Jaú, São Paulo, Brazil
- Recruiting
- Hospital Amaral Carvalho / Fundação Dr. Amaral Carvalho
-
Contact:
- Iago Colturato, MD
- Email: iago_colt@hotmail.com
-
-
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 to 70 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Diagnosis of acute myeloid leukemia and chronic myeloid leukemia in complete morphologic remission, myelodysplastic syndrome with less than 10% in bone marrow or peripheral blood, Ph-negative acute lymphoblastic leukemia in complete morphologic remission, chemosensitive Hodgkin lymphoma or non-Hodgkin lymphoma in at least partial remission
- Donor type: haploidentical related donor
- Graft source: bone marrow or peripheral blood
- Recipients of non-myeloblative or myeloablative intensity conditioning
- Left Ventricle Ejection fraction > 40%
- Estimated creatinine clearance > 40 mL/min
- Adjusted DLCO ≥ 40% and FEV1 ≥ 40%
- Total bilirubin < 2x ULN e ALT/AST < 2.5x ULN
Exclusion Criteria:
- Prior allogeneic transplant
- Ex-vivo graft manipulation (T-cell-depleted or CD34-selected grafts)
- Use of alemtuzumab or anti-thymocyte globulin
- KPS < 70%
- Patients with uncontrolled bacterial, viral or fungal infections (currently taking medication and with progression or no clinical improvement) at time of enrollment
- Pregnant or lactating women
- Patients seropositive for human immunodeficiency virus (HIV) or active hepatitis B or C infection by PCR
- Presence of fluid collection (ascites, pleural or pericardial effusion) that may interfere with methotrexate clearance or make methotrexate use contraindicated
- Patients with a serious medical or psychiatric illness likely to interfere with participation in this study
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: PREVENTION
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Experimental
GVHD prophylaxis will consist of high-dose PTCy (50 mg/kg i.v. on days +3 and +4) with mesna, cyclosporine (initiated on day +5) and methotrexate i.v (see doses on the right).
Cyclosporine will be dosed with a target trough of 200 to 250 ng/mL and discontinued without taper at D+60 (if bone marrow graft) or until D+90 (is peripheral blood graft), unless acute GVHD is present.
Filgrastim will be administered from day +5 until neutrophil recovery to ≥ 1,000/mcL for 3 days.
|
Phase 1:
Phase 2: dose determined in the phase 1 trial
Other Names:
|
NO_INTERVENTION: Control Group
GVHD prophylaxis will consist of high-dose PTCy (50 mg/kg i.v. on days +3 and +4) with mesna, cyclosporine (initiated on day +5) and mycophenolate mofetil (15 mg/kg/dose p.o. t.i.d.
initiated on day +5).
Cyclosporine will be dosed with a target trough of 200 to 250 ng/mL and discontinued without taper at D+60 (if bone marrow graft) or until D+90 (is peripheral blood graft), unless acute GVHD is present.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Methotrexate dose to be used in the phase 2 (Phase 1)
Time Frame: Day 30
|
The methotrexate dose to be used in the subsequent phase 2 will be equal to or lower than the maximum tolerated dose (MTD).
MTD will be considered exceeded if at least 2 out of 6 subjects on a certain dosing level develop dose-limiting toxicity (DLT).
DLT consists of gastrointestinal tract perforation, mediastinitis, airway obstruction requiring orotracheal intubation, severe gastrointestinal bleeding (without evidence of GVHD), graft failure, or hyperbilirubinemia or increase in alanine transaminase [ALT] / aspartate transaminase [AST] levels > 5x the upper limit of normal.
|
Day 30
|
GVHD-free, relapse-free survival (Phase 2)
Time Frame: Day 365
|
Relapse, grade 3-4 GVHD and 2014 NIH Chronic GVHD will be considered events, and non-relapse related mortality will be a competing event.
|
Day 365
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival
Time Frame: Day 365
|
Time to death
|
Day 365
|
Cumulative incidence of neutrophil and platelet engraftment
Time Frame: Day 30
|
Neutrophil engraftment will be the first of three consecutive daily absolute neutrophil counts > 500 / mcL after transplantation.
Disease relapse will be a competitive event.
Platelet engraftment will be considered as the first of seven daily consecutive platelet counts > 20,000 / mcL without transfusion support.
Disease relapse will be a competitive event.
|
Day 30
|
Cumulative incidence of graft failure
Time Frame: Day 30
|
Time to primary or secondary graft failure.
Primary graft failure will be defined as failure to reach neutrophils > 500 / mcL for three consecutive days or donor chimerism <5% in any hematopoietic compartment (lymphocyte chimerism or total bone marrow / peripheral blood chimerism) and requiring additional hematopoietic cells.
Secondary graft failure will be defined as the need for additional hematopoietic cells due to declining hematopoietic recovery in a patient with previous neutrophil engraftment.
|
Day 30
|
Cumulative incidence of grade II-IV acute GVHD
Time Frame: Day 100
|
Time to onset of grade II-IV acute GVHD according to the MAGIC criteria.
Death without previous acute GVHD will be a competing event.
|
Day 100
|
Cumulative incidence of grade III-IV acute GVHD
Time Frame: Day 100
|
Time to onset of grade III-IV acute GVHD according to the MAGIC criteria.
Death without previous acute GVHD will be a competing event.
|
Day 100
|
Cumulative incidence of non-relapse/progression related mortality
Time Frame: Day 365
|
Time to onset of disease relapse or progression (imaging, morphologic or molecular).
Non-relapse related mortality will be a competing event.
|
Day 365
|
Cumulative incidence of Chronic GVHD
Time Frame: Day 365
|
Time to onset of 2014 NIH Chronic GVHD.
Non-relapse related mortality will be a competing event.
|
Day 365
|
Change in 36-Item Short Form Health Survey (SF-36)
Time Frame: Baseline, Days 30, 90, 180, and 365
|
Change in mean subscale response of the SF-36 Survey version 2.0 (Physical functioning, Role limitations due to physical health, Role limitations due to emotional problems, Energy/fatigue, Emotional well-being, Social
|
Baseline, Days 30, 90, 180, and 365
|
Change in the Functional Assessment of Cancer Therapy (FACT)-Bone Marrow Transplantation (BMT) Survey
Time Frame: Baseline, Days 30, 90, 180, and 365
|
Change in mean subscale response of the FACT-BMT survey
|
Baseline, Days 30, 90, 180, and 365
|
Frequency of Grade 3-5 adverse events
Time Frame: Day 30
|
Adverse events will be classified according to the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE), Version 5.0
|
Day 30
|
Change in Natural Killer cell function [% activity]
Time Frame: Days 30, 90, and 180
|
Days 30, 90, and 180
|
|
Change in lymphocyte subsets [absolute number/mcL]
Time Frame: Days 30, 90, and 180
|
Days 30, 90, and 180
|
|
Cumulative incidence of CMV and EBV reactivation
Time Frame: Day 100
|
Day 100
|
|
Change in bone marrow or peripheral blood donor chimerism [%]
Time Frame: Days 30, 90, and 180
|
Days 30, 90, and 180
|
|
Change in mean free mycophenolic acid and mycophenolic acid glucuronide level [mcg/mL] on peripheral blood (controls only)
Time Frame: Days 12 and 19
|
Days 12 and 19
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Giancarlo Fatobene, MD, Hospital das Clínicas da Universidade de São Paulo
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 (ACTUAL)
October 7, 2020
Primary Completion (ANTICIPATED)
December 1, 2023
Study Completion (ANTICIPATED)
December 1, 2025
Study Registration Dates
First Submitted
October 29, 2020
First Submitted That Met QC Criteria
November 9, 2020
First Posted (ACTUAL)
November 10, 2020
Study Record Updates
Last Update Posted (ACTUAL)
September 14, 2021
Last Update Submitted That Met QC Criteria
September 10, 2021
Last Verified
September 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Immune System Diseases
- Neoplasms
- Neoplasms by Site
- Hematologic Diseases
- Hematologic Neoplasms
- Graft vs Host Disease
- 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
- Dermatologic Agents
- Reproductive Control Agents
- Abortifacient Agents, Nonsteroidal
- Abortifacient Agents
- Folic Acid Antagonists
- Methotrexate
Other Study ID Numbers
- 30802020.7.1001.0068
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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