RIC With Thiotepa Combined With Bu/Flu/Ara-C in Allo-HSCT for Relapsed or Refractory PTCL.

Reduced Intensity Conditioning With Thiotepa Combined With Busulfan, Fludarabine and Cytarabine in Allogeneic Hematopoietic Stem Cell Transplantation in the Treatment of Relapsed or Refractory Peripheral T-cell Lymphoma.

This study is a single-center, single-arm, prospective phase II clinical trial that evaluates the efficacy and safety of an reduced-intensity conditioning (RIC) regimen with thiotepa combined with busulfan, fludarabine, and cytarabine for allogeneic hematopoietic stem cell transplantation in the treatment of relapse and refratory peripheral T-cells lymphoma. The conditioning regimen includes thiotepa at a dose of 5mg/kg/d at d -7 (1 day), fludarabine at 30mg/m2/d from d -6 to d -2 (5 days), cytarabine at 1g/m2/d from d -6 to d -2 (5 days), and busulfan at 3.2mg/kg/d from d -4 to d -3 (2 days). Conditioning begins on day -7, and donor hematopoietic stem cell infusion is performed on day 0. All patients will undergo bone marrow examination on day 14 and day 28 post-transplant, followed by bone marrow examinations every 30 days within the first year after transplantation, and every 60 days within the second year after transplantation. FDG-PET/CT imaging will be adopted every 6 months after transplantation. If disease relapse is suspected during the follow-up period, bone marrow and relapse site examinations will be conducted at any time. The primary study endpoints are the 1-year and 2-year progression-free survival (PFS) rates post-transplant. Secondary study endpoints include the incidence of acute graft-versus-host disease (GVHD) within 180 days post-transplant, cumulative relapse rates at 1 year and 2 years post-transplant, 1-year and 2-year overall survival (OS), graft-versus-host disease-free, relapse-free survival (GRFS), non-relapse mortality (NRM), cumulative incidence of chronic GVHD, and the incidence of Cytomegalovirus （CMV）and Epstein-Barr virus（EBV）reactivation within 1 year.

Study Overview

• Status: Recruiting
• Conditions: Peripheral T Cell Lymphoma
• Intervention / Treatment: Drug: Thiotepa

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: xianmin Song, MD; Phone Number: +86 1350167250; Email: shongxm@139.com

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200080
      • Recruiting
      • Shanghai General Hospital
      • Principal Investigator: Xianmin Song, MD
      • Contact: Xianmin Song, MD; Phone Number: 3175 +86 21 63240090; Email: shongxm@139.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and less than 70 years, regardless of gender
• Peripheral T-cell lymphoma (PTCL) was diagnosed according to the 2016 WHO criteria and met any of the following criteria: Relapse: Except ALK+ anaplastic large cell lymphoma （ALCL), CR was achieved by standard chemotherapy but disease progressed，and relapse after hematopoietic stem cell transplantation;Refractory: Except ALK+ anaplastic large cell lymphoma （ALCL), the tumor shrank < 50% or progressive disease after 4 courses of standard chemotherapy, or not achieve CR after 6 courses of standard chemotherapy;Not suitable for or refusing autologous hematopoietic stem cell transplantation.
• Patients must have a suitable hematopoietic stem cell donor:Related donors must have at least 5/10 matches for HLA-A, -B, -C, -DQB1, and - DRB1;Unrelated donors must have at least 8/10 matches for HLA-A, -B, -C, -DQB1, and -DRB1
• Hematopoietic cell transplantation comorbidity index (HCT-CI) score ≤ 2
• ECOG (Eastern Cooperative Oncology Group) performance status: 0-2
• Adequate liver, kidney, and cardiopulmonary function, meeting the following requirements:Serum creatinine ≤ 1.5x ULN (the upper limit of normal);Cardiac function: Ejection fraction ≥ 50%;Baseline oxygen saturation > 92%;Total bilirubin ≤ 2.0 x ULN; ALT and AST ≤ 2.0 x ULN，AKP ≤ 2.0 x ULN;Pulmonary function: DLCO (corrected for hemoglobin) ≥ 40% and FEV1 (Forced Expiratory Volume in 1 second) ≥ 50%
• Patients must have the ability to understand and be willing to participate in this study and sign an informed consent form

Exclusion Criteria:

• PTCL patients did not meet the criteria of relapse / refractory.
• Refuse to adopt allegeneic hematopoietic stem cell transplantation.
• History of malignancies other than lymphoid tumors within the 5 years prior to screening, except for adequately treated in situ cervical cancer, basal cell carcinoma, squamous cell carcinoma of the skin, and curatively treated localized prostate cancer or ductal carcinoma in situ
• ECOG ≥ 3.
• HCT-CI score ≥ 3.
• Any unstable systemic diseases, including but not limited to unstable angina, recent cerebrovascular accidents or transient ischemic attacks within the 3 months prior to screening, myocardial infarction within the 3 months prior to screening, congestive heart failure (New York Heart Association [NYHA] class ≥ III), severe arrhythmias requiring drug treatment after pacemaker implantation, significant liver, kidney, or metabolic diseases, and pulmonary arterial hypertension.
• Active, uncontrolled infections, including those associated with hemodynamic instability, new or worsening infection symptoms or signs, new infectious lesions on imaging, or persistent unexplained fever without signs or symptoms of infection.
• HIV-infected individuals.
• Active hepatitis B (HBV) or active hepatitis C (HCV) requiring antiviral therapy.
• History of autoimmune diseases
• Pregnant or breastfeeding women.
• Fertile males and females unwilling to use contraception during the treatment period and for 12 months after treatment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: intervention arm; Participants will receive allogenetic hematopoietic stem cell transplantation (allo-HSCT) with the reduced intensity conditioning regimen including thiotepa(5mg / kg / d-7d ( 1d )), fludarabine (30mg / m2 / d, -6d--2d ( 5d )), Ara-C (1g / m2 / d, -6d--2d ( 5d )), and busulfan(3.2mg / kg / d, -4d-3d ( 2d )).	Drug: Thiotepa; The reduced intensity conditioning regimen is composed by thiotepa (5mg / kg / d-7d (1d)), fludarabine (30mg / m2 / d, -6d--2d (5d)), Ara-C (1g / m2 / d, -6d--2d (5d)), and busulfan (3.2mg / kg / d, -4d-3d (2d)).; Other Names: Cytarabine; busulfan; fludarabine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
1y and 2y-progression-free survival (PFS)	1-year and 2-year progression-free survival (PFS) rates post-transplant	up to 1 years for the 1y-PFS and up to 2 years for the 2y-PFS

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CMV and EBV reactivation	the incidence of CMV and EBV reactivation within 1 year	up to 1 year
acute graft-versus-host disease (aGVHD)	acute graft-versus-host disease (aGVHD) within 180 days post-transplant	up to 180 days
1y and 2y-cumulative relapse rates (CIR)	cumulative relapse rates (CIR) at 1 year and 2 years post-transplant	up to 1 years for the 1y-CIR and up to 2 years for the 2y-CIR
1y and 2y-overall survival (OS)	overall survival (OS) at 1 year and 2 years post-transplant	up to 1 years for the 1y-OS and up to 2 years for the 2y-OS
graft-versus-host disease-free, relapse-free survival (GRFS)	graft-versus-host disease-free, relapse-free survival (GRFS) at 2 years post-transplant	up to 2 years
non-relapse mortality (NRM)	non-relapse mortality (NRM) at 2 years post-transplant	up to 2 years
cumulative incidence of chronic GVHD	cumulative incidence of chronic GVHD at 2 years post-transplant	up to 2 years

Collaborators and Investigators

• Sponsor: Xianmin Song, MD
• Investigators: Principal Investigator: Xianmin Song, MD, Shanghai General HospitalShanghai General Hospital, Shanghai Jiao Tong University School of Medicine

Publications and helpful links

General Publications

• Vose J, Armitage J, Weisenburger D; International T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol. 2008 Sep 1;26(25):4124-30. doi: 10.1200/JCO.2008.16.4558. Epub 2008 Jul 14.
• Cao C, Feng J, Gu H, Tang H, Xu L, Dong H, Dong B, Shu M, Bai Q, Liang R, Zhang T, Yang L, Wang Z, Chen X, Gao G. Distribution of lymphoid neoplasms in Northwest China: Analysis of 3244 cases according to WHO classification in a single institution. Ann Diagn Pathol. 2018 Jun;34:60-65. doi: 10.1016/j.anndiagpath.2017.05.005. Epub 2017 May 12.
• Yang QP, Zhang WY, Yu JB, Zhao S, Xu H, Wang WY, Bi CF, Zuo Z, Wang XQ, Huang J, Dai L, Liu WP. Subtype distribution of lymphomas in Southwest China: analysis of 6,382 cases using WHO classification in a single institution. Diagn Pathol. 2011 Aug 22;6:77. doi: 10.1186/1746-1596-6-77.
• Liu X, Yang M, Wu M, Zheng W, Xie Y, Zhu J, Song Y, Liu W. A retrospective study of the CHOP, CHOPE, and CHOPE/G regimens as the first-line treatment of peripheral T-cell lymphomas. Cancer Chemother Pharmacol. 2019 Mar;83(3):443-449. doi: 10.1007/s00280-018-3744-z. Epub 2018 Dec 3.
• Janikova A, Chloupkova R, Campr V, Klener P, Hamouzova J, Belada D, Prochazka V, Pytlik R, Pirnos J, Duras J, Mocikova H, Bortlicek Z, Kopalova N, Mayer J, Trneny M. First-line therapy for T cell lymphomas: a retrospective population-based analysis of 906 T cell lymphoma patients. Ann Hematol. 2019 Aug;98(8):1961-1972. doi: 10.1007/s00277-019-03694-y. Epub 2019 May 8.
• Couto SCF, Kowes A, Aurabi CS, Oliveira TGM, Klinger P, Rocha V. Autologous, allogeneic hematopoietic cell transplantation and CAR-T/NK therapy: what is their real importance in PTCL? Front Oncol. 2023 Aug 30;13:1195759. doi: 10.3389/fonc.2023.1195759. eCollection 2023.
• Rodriguez J, Caballero MD, Gutierrez A, Marin J, Lahuerta JJ, Sureda A, Carreras E, Leon A, Arranz R, Fernandez de Sevilla A, Zuazu J, Garcia-Larana J, Rifon J, Varela R, Gandarillas M, SanMiguel J, Conde E. High-dose chemotherapy and autologous stem cell transplantation in peripheral T-cell lymphoma: the GEL-TAMO experience. Ann Oncol. 2003 Dec;14(12):1768-75. doi: 10.1093/annonc/mdg459.
• Bellei M, Foss FM, Shustov AR, Horwitz SM, Marcheselli L, Kim WS, Cabrera ME, Dlouhy I, Nagler A, Advani RH, Pesce EA, Ko YH, Martinez V, Montoto S, Chiattone C, Moskowitz A, Spina M, Biasoli I, Manni M, Federico M; International T-cell Project Network. The outcome of peripheral T-cell lymphoma patients failing first-line therapy: a report from the prospective, International T-Cell Project. Haematologica. 2018 Jul;103(7):1191-1197. doi: 10.3324/haematol.2017.186577. Epub 2018 Mar 29.
• Garcia-Sancho AM, Bellei M, Lopez-Parra M, Gritti G, Cortes M, Novelli S, Panizo C, Petrucci L, Gutierrez A, Dlouhy I, Bastos-Oreiro M, Sancho JM, Ramirez MJ, Moraleda JM, Carrillo E, Jimenez-Ubieto AI, Jarque I, Orsucci L, Garcia-Torres E, Montalban C, Dodero A, Arranz R, De Las Heras N, Pascual MJ, Lopez-Jimenez J, Spina M, Re A, De Villambrosia SG, Bobillo S, Federico M, Caballero D. Autologous stem-cell transplantation as consolidation of first-line chemotherapy in patients with peripheral T-cell lymphoma: a multicenter GELTAMO/FIL study. Haematologica. 2022 Nov 1;107(11):2675-2684. doi: 10.3324/haematol.2021.279426.
• Civallero M, Schroers-Martin JG, Horwitz S, Manni M, Stepanishyna Y, Cabrera ME, Vose J, Spina M, Hitz F, Nagler A, Montoto S, Chiattone C, Skrypets T, Perez Saenz MA, Priolo G, Luminari S, Lymboussaki A, Pavlovsky A, Marino D, Liberati M, Trotman J, Mannina D, Federico M, Advani R. Long-term outcome of peripheral T-cell lymphomas: Ten-year follow-up of the International Prospective T-cell Project. Br J Haematol. 2024 Mar 26. doi: 10.1111/bjh.19433. Online ahead of print.
• Fossard G, Broussais F, Coelho I, Bailly S, Nicolas-Virelizier E, Toussaint E, Lancesseur C, Le Bras F, Willems E, Tchernonog E, Chalopin T, Delarue R, Gressin R, Chauchet A, Gyan E, Cartron G, Bonnet C, Haioun C, Damaj G, Gaulard P, Fornecker L, Ghesquieres H, Tournilhac O, da Silva MG, Bouabdallah R, Salles G, Bachy E. Role of up-front autologous stem-cell transplantation in peripheral T-cell lymphoma for patients in response after induction: an analysis of patients from LYSA centers. Ann Oncol. 2018 Mar 1;29(3):715-723. doi: 10.1093/annonc/mdx787. Erratum In: Ann Oncol. 2021 Jul;32(7):945. doi: 10.1016/j.annonc.2021.04.021.
• Ahn SY, Jung SY, Jung SH, Ahn JS, Lee JJ, Kim HJ, Kang SR, Han YH, Kwak JY, Yhim HY, Yang DH. Prognostic significance of FDG-PET/CT in determining upfront autologous stem cell transplantation for the treatment of peripheral T cell lymphomas. Ann Hematol. 2020 Jan;99(1):83-91. doi: 10.1007/s00277-019-03867-9. Epub 2019 Dec 6.
• Schmitz N, Truemper L, Bouabdallah K, Ziepert M, Leclerc M, Cartron G, Jaccard A, Reimer P, Wagner E, Wilhelm M, Sanhes L, Lamy T, de Leval L, Rosenwald A, Roussel M, Kroschinsky F, Lindemann W, Dreger P, Viardot A, Milpied N, Gisselbrecht C, Wulf G, Gyan E, Gaulard P, Bay JO, Glass B, Poeschel V, Damaj G, Sibon D, Delmer A, Bilger K, Banos A, Haenel M, Dreyling M, Metzner B, Keller U, Braulke F, Friedrichs B, Nickelsen M, Altmann B, Tournilhac O. A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL. Blood. 2021 May 13;137(19):2646-2656. doi: 10.1182/blood.2020008825.
• Loirat M, Chevallier P, Leux C, Moreau A, Bossard C, Guillaume T, Gastinne T, Delaunay J, Blin N, Mahe B, Dubruille V, Augeul-Meunier K, Peterlin P, Maisonneuve H, Moreau P, Juge-Morineau N, Jardel H, Mohty M, Moreau P, Le Gouill S. Upfront allogeneic stem-cell transplantation for patients with nonlocalized untreated peripheral T-cell lymphoma: an intention-to-treat analysis from a single center. Ann Oncol. 2015 Feb;26(2):386-92. doi: 10.1093/annonc/mdu515. Epub 2014 Nov 12.
• Rohlfing S, Dietrich S, Witzens-Harig M, Hegenbart U, Schonland S, Luft T, Ho AD, Dreger P. The impact of stem cell transplantation on the natural course of peripheral T-cell lymphoma: a real-world experience. Ann Hematol. 2018 Jul;97(7):1241-1250. doi: 10.1007/s00277-018-3288-7. Epub 2018 Mar 16.

Study record dates

Study Major Dates

• Study Start (Actual): July 15, 2024
• Primary Completion (Estimated): July 15, 2026
• Study Completion (Estimated): July 15, 2026

Study Registration Dates

• First Submitted: June 11, 2024
• First Submitted That Met QC Criteria: June 16, 2024
• First Posted (Actual): June 21, 2024

Study Record Updates

• Last Update Posted (Actual): August 1, 2024
• Last Update Submitted That Met QC Criteria: July 31, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: thiotepa; peripheral T cell lymphoma; reduced intensity conditioning regimen
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Lymphoma; Lymphoma, T-Cell; Lymphoma, T-Cell, Peripheral; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Antineoplastic Agents, Alkylating; Alkylating Agents; Myeloablative Agonists; Fludarabine; Cytarabine; Thiotepa; Busulfan
• Other Study ID Numbers: SHSYXY-202402-THI-FAB

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
• product manufactured in and exported from the U.S.: No