- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05170828
Cryopreserved MMUD BM With PTCy for Hematologic Malignancies
October 30, 2023 updated by: Ossium Health, Inc.
PRESERVE: A Multi-Center Trial Using Banked, Cryopreserved HLA-Mismatched Unrelated Donor Bone Marrow and Post-Transplantation Cyclophosphamide in Allogeneic Transplantation for Patients With Hematologic Malignancies
Multicenter single arm study to assess the safety and efficacy of allogeneic transplantation using cryopreserved bone marrow from deceased MMUD and PTCy, sirolimus and MMF for GVHD prophylaxis.
Study Overview
Status
Withdrawn
Conditions
Study Type
Interventional
Phase
- Phase 1
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
Description
Inclusion Criteria:
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the duration of the study
- Male or female, aged ≥ 18 and < 71 years (Note: HIV-negative subjects with MDS must be aged <50 at the time of signing the informed consent form)
- Diagnosed with
- Acute leukemias or T-lymphoblastic lymphoma (T-LBL) in 1st or subsequent CR
- Acute lymphocytic leukemia (ALL) or T-LBL as defined by the following:
- < 5% blasts in the bone marrow
- Normal maturation of all cellular components in the bone marrow
- No currently active extramedullary disease (EMD) (e.g., central nervous system (CNS), soft tissue disease)
- ANC ≥ 1,000/mm3
- Acute myeloid leukemia (AML) defined by the following:
- < 5% blasts in the bone marrow
- No blasts with Auer rods
- Normal maturation of all cellular components in the bone marrow
- No currently active EMD (e.g., CNS, soft tissue disease)
- ANC ≥ 1,000/mm3
- Acute biphenotypic leukemia (ABL)/Acute undifferentiated leukemia (AUL) defined by the following:
- < 5% blasts in the bone marrow
- Normal maturation of all cellular components in the bone marrow
- No currently active EMD (e.g., CNS, soft tissue disease)
- ANC ≥ 1,000/mm3
- Myleodysplastic Syndromes (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 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
- Performance status: Karnofsky ≥ 60%
- Adequate organ function defined as:
- Cardiac: LVEF at rest ≥ 35% (RIC cohort) or LVEF at rest ≥ 40% (FIC cohort), or LVFS ≥ 25%
- Pulmonary: DLCO, FEV1, FVC ≥ 50% predicted by pulmonary function tests (PFTs). DLCO value may be corrected or uncorrected for hemoglobin
- Hepatic: total bilirubin ≤ 2.5 mg/dL, and ALT, AST, and ALP < 5 x ULN (unless ALT, AST, and/or ALP are disease related)
- Renal: SCr within normal range for age (see table 5.1B). If SCr is outside normal range for age, 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)
- Subjects must have the ability to give informed consent according to applicable regulatory and local institutional requirements
- Availability of deceased HLA MMUD cryopreserved product through Ossium cryobank
- HLA MMUD defined as 4-7/8 HLA-allele matching at MHC class (A, B, or C) or MHC class II (DRB1)
- Additional MHC class II HLA (DP and DQ) typing will be collected, but not incorporated in donor selection
Exclusion Criteria:
- Pediatric patients (17 years or younger)
- Suitable HLA-matched related or 8/8 allele matched (HLA-A, -B, -C, -DRB1) unrelated donor excluding Ossium product
- Autologous HCT < 3 months prior to the time of signing the informed consent form
- Pregnancy or lactation
- Treatment with an investigational drug or other interventional GVHD clinical trials
- Current uncontrolled bacterial, viral or fungal infection (currently taking medication with evidence of progression of clinical symptoms or radiologic findings)
- Prior allogeneic HCT
- Primary myelofibrosis or myelofibrosis secondary to essential thrombocythemia or polycythemia vera
- Subjects with MDS may not receive RIC and must be < 50 years of age at the time of signing the informed consent form
- Any condition(s) or diagnosis, both physical or psychological, or physical exam finding that in the investigator's opinion precludes participation
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: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Regmin A (RIC)
Pre-transplant conditioning treatment with Fludarabine, Cyclophosphamide, and Total Body Irradiation (TBI)
|
pre-transplant conditioning treatment
Other Names:
pre-transplant conditioning treatment
Other Names:
pre-transplant conditioning treatment
Other Names:
given with cyclophosphamide
Other Names:
post-transplant treatment for GVHD
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
Transplant with investigational bone marrow product
Other Names:
|
Other: Regimen B (FIC)
Pre-transplant conditioning treatment with Busulfan and Cyclophosphamide OR Fludarabine
|
pre-transplant conditioning treatment
Other Names:
pre-transplant conditioning treatment
Other Names:
pre-transplant conditioning treatment
Other Names:
given with cyclophosphamide
Other Names:
post-transplant treatment for GVHD
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
Transplant with investigational bone marrow product
Other Names:
|
Other: Regimen C (FIC)
Pre-transplant conditioning treatment with Cyclophosphamide and Total Body Irradiation (TBI)
|
pre-transplant conditioning treatment
Other Names:
pre-transplant conditioning treatment
Other Names:
given with cyclophosphamide
Other Names:
post-transplant treatment for GVHD
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
post-transplant treatment for GVHD
Other Names:
Transplant with investigational bone marrow product
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Neutrophil engraftment
Time Frame: Day 35 Post HCT
|
Run-in safety phase primary endpoint; Neutrophil engraftment is defined as neutrophil recovery by Day 35.
Neutrophil recovery is defined as donor-derived absolute neutrophil count (ANC) ≥ 500/mm3 for three consecutive days with evidence of donor chimerism in bone marrow or peripheral blood.
Full donor chimerism is >95%, and mixed donor chimerism is defined as 5-95%.
|
Day 35 Post HCT
|
Cumulative incidence and kinetics of neutrophil and platelet recovery
Time Frame: Day 35 Post HCT
|
Main phase primary endpoint; Neutrophil recovery is defined as achieving an absolute neutrophil count (ANC) greater than or equal to 500/mm3 for three consecutive measurements on three different days.
The first of the three days will be designated the day of neutrophil recovery.
The competing event is death without neutrophil recovery.
For subjects who never drop ANC below 500/mm3, the date of neutrophil recovery will be Day 1 post-transplant.
Platelet recovery is defined by two different metrics: the first day of a sustained platelet count greater than or equal to 20,000/mm3 or greater than or equal to 50,000/mm3 with no platelet transfusions in the preceding seven days.
The first day of sustained platelet count above these thresholds will be designated the day of platelet engraftment.
For subjects who never drop their platelet count below 20,000/mm3, the date of platelet recovery will be Day 1 post HCT.
|
Day 35 Post HCT
|
Overall survival (OS)
Time Frame: 1-year Post HCT
|
Main phase primary endpoint; The primary endpoint for the study is OS at 1-year post-HCT.
The event is death from any cause.
The time to this event is the time from HCT to death, loss to follow-up, or end of study (whichever comes first).
Subjects who are lost to follow-up prior to 1-year will be censored at the time of the last observation, and the OS probability will be estimated using the Kaplan-Meier method.
|
1-year Post HCT
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cumulative incidences of aGVHD and cGVHD
Time Frame: 1-year Post HCT
|
aGVHD is defined as any skin, gastrointestinal or liver abnormalities fulfilling the criteria of grades II-IV or grades III-IV.
cGVHD is defined per National Institutes of Health (NIH) Consensus Criteria and includes organ involvement and severity, and overall global composite score (mild/moderate/severe).
|
1-year Post HCT
|
Transplant-related mortality (TRM)
Time Frame: Day 100 and 1-year Post HCT
|
TRM is defined as death without evidence of disease progression or recurrence.
TRM will be evaluated at Day 100, 180, and 1-year (Day 365).
|
Day 100 and 1-year Post HCT
|
NK, B- and T-cell immune reconstitution
Time Frame: Days 35, 100, 180, and 1-year Post HCT
|
Quantitative assessments of peripheral blood CD3, CD4, CD8, CD19 positive lymphocytes will be done through flow cytometric analysis at Days 35, 100, 180, and 365 post-HCT.
Qualitative assessments will be tabulated according to time from transplant.
|
Days 35, 100, 180, and 1-year Post HCT
|
Progression free survival (PFS)
Time Frame: 1-year Post HCT
|
Progression free survival will be estimated at 1-year (Day 365) post-transplant.
An event for this time to event outcome is defined as disease relapse or progression, or death by any cause.
|
1-year Post HCT
|
Event free survival (EFS)
Time Frame: 1-year Post HCT
|
EFS will be estimated at 12 months post-HCT.
An event for this time to event outcome includes graft failure (PGF by Day 35 or secondary graft failure), relapse or progression of underlying disease, death, grade III-IV acute GVHD, or NIH-severe chronic GVHD.
|
1-year Post HCT
|
GVHD relapse free survival (GRFS)
Time Frame: 1-year Post HCT
|
GRFS will be estimated at 1-year (Day 365) post-transplant.
An event for this time to event outcome is defined as relapse or progression of underling disease, graft failure, grade III-IV acute GVHD, chronic GVHD requiring systemic immune suppression, or death by any cause.
|
1-year Post HCT
|
Cumulative incidence of cytokine release syndrome (CRS)
Time Frame: Day 14 Post HCT
|
Overall incidence of CRS of any grade and grade 3 or 4 CRS post-transplant will be reported on all patients.
CRS will be defined and graded using the American Society for Transplantation and Cellular Therapy (ASTCT) consensus grading criteria.
|
Day 14 Post HCT
|
Donor chimerism
Time Frame: Days 35, 56, 100, 180, and 1-year Post HCT
|
Peripheral blood chimerism (% of donor chimerism) in whole blood (unsorted) will be described on Day 35, 56, 100, 180, and 1-year (Day 365).
Donor cell engraftment will be assessed with donor/recipient chimerism studies at Day 100.
Chimerism may be assessed in CD3 blood cell fraction.
For the purpose of this protocol, mixed chimerism is defined as the presence of donor cells, as a proportion of total cells to be less than 95% but at least 5% in the bone marrow or peripheral blood.
Full donor chimerism is defined as greater than or equal to 95% of donor cells.
Mixed and full chimerism will be evidence of donor cell engraftment.
Donor cells of less than 5% by Day 35 will be considered as graft rejection.
The proportion of patients with each level of chimerism described above will be described as part of this outcome.
For sorted blood cell fractions, CD3+ donor cell chimerism will be used to define the donor/recipient chimerism status.
|
Days 35, 56, 100, 180, and 1-year Post HCT
|
Cumulative incidences of viral reactivations and infections
Time Frame: Days 100, 180, and 1-year Post HCT
|
The incidence of Cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus, Adenovirus (ADV), and Human herpesvirus (HHV-6) viral activations and infections at Days 100, 180 and 1-year (Day 365).
|
Days 100, 180, and 1-year Post HCT
|
Cumulative incidence of primary disease relapse/progression
Time Frame: 1-year Post HCT
|
Testing for recurrent malignancy in the blood, bone marrow or other sites will be used to assess relapse and progression post-HCT.
For the purpose of this study, relapse is defined by either morphological, cytogenetic/molecular or radiological evidence of disease consistent with pre-HCT features, in line with institutional standards.
The event for this endpoint is the time interval from HCT to relapse/recurrence of disease or to last follow-up through 1-year (Day 365) post-HCT.
Death in remission is considered a competing risk.
|
1-year Post HCT
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Length of stay in hospital
Time Frame: Day 100 Post HCT
|
Cumulative days alive and out of the hospital in the first 100 days and in the first year post-transplant.
|
Day 100 Post HCT
|
Incidence of clinically-significant infections
Time Frame: 1-year Post HCT
|
A clinically significant infection is defined as an infection that requires therapeutic intervention.
|
1-year Post HCT
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Study Chair: Jeffery Auletta, MD, Center for International Blood and Marrow Transplant Research
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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 (Estimated)
September 1, 2022
Primary Completion (Estimated)
March 1, 2024
Study Completion (Estimated)
November 1, 2024
Study Registration Dates
First Submitted
November 12, 2021
First Submitted That Met QC Criteria
December 8, 2021
First Posted (Actual)
December 28, 2021
Study Record Updates
Last Update Posted (Actual)
November 1, 2023
Last Update Submitted That Met QC Criteria
October 30, 2023
Last Verified
October 1, 2023
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
- Neoplasms by Site
- Bone Marrow Diseases
- Hematologic Diseases
- Leukemia, Lymphoid
- Myelodysplastic Syndromes
- Hematologic Neoplasms
- Leukemia
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
- 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
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antifungal Agents
- Antitubercular Agents
- Antibiotics, Antitubercular
- Cyclophosphamide
- Fludarabine
- Mycophenolic Acid
- Sirolimus
- Busulfan
Other Study ID Numbers
- PRESERVE
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
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
Yes
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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