TBF Conditioning Regimen for Haploidentical Stem Cell Transplantation in Elderly AML Patients in First Complete Remission (TBF-AML)
A Single-Center, Prospective, Single-Arm Clinical Study Evaluating the Efficacy and Safety of Thiotepa, Busulfan, and Fludarabine (TBF) Conditioning Regimen in Haploidentical Peripheral Blood Stem Cell Transplantation for Elderly Acute Myeloid Leukemia Patients in First Complete Remission
Acute myeloid leukemia (AML) is a serious blood cancer that mainly affects older adults. For patients who achieve their first complete remission (CR1), allogeneic hematopoietic stem cell transplantation (HSCT) may provide a chance for long-term survival. However, relapse after transplantation remains a major challenge.
This study aims to evaluate the effectiveness and safety of a conditioning regimen that combines thiotepa, busulfan, and fludarabine (TBF) before haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) in elderly patients with AML in first complete remission.
Eligible patients will receive the TBF conditioning regimen followed by stem cell transplantation from a partially matched donor. Participants will be followed to assess relapse-free survival, overall survival, transplant-related complications, and infections.
The results of this study may help improve treatment strategies and outcomes for elderly AML patients undergoing transplantation.
Tutkimuksen yleiskatsaus
Tila
Yksityiskohtainen kuvaus
Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy with increasing incidence in older populations. Despite achieving first complete remission (CR1) after induction chemotherapy, elderly patients remain at high risk of relapse and have poor long-term outcomes.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered a potentially curative treatment for AML. With the development of reduced-intensity conditioning regimens and haploidentical transplantation strategies, more elderly patients are now eligible for transplantation. However, relapse after transplantation remains a major limitation.
The conditioning regimen plays a critical role in determining transplant outcomes. The combination of thiotepa, busulfan, and fludarabine (TBF) has been proposed to enhance anti-leukemic activity while maintaining acceptable toxicity. Previous retrospective and registry-based studies suggest that TBF conditioning may reduce relapse risk compared with conventional regimens, but prospective data in elderly AML patients, especially in Asian populations, remain limited.
This study is a single-center, prospective, single-arm clinical trial designed to evaluate the efficacy and safety of the TBF conditioning regimen in elderly AML patients in first complete remission undergoing haploidentical peripheral blood stem cell transplantation (haplo-PBSCT).
Eligible patients aged 55-75 years with AML in CR1 or CRi will receive a conditioning regimen consisting of thiotepa (day -7), busulfan (days -4 and -3), and fludarabine (days -6 to -2), followed by infusion of donor stem cells on day 0.
The primary endpoint is 1-year relapse-free survival (RFS), defined as the time from transplantation to relapse or death from any cause. Secondary endpoints include overall survival, incidence of acute and chronic graft-versus-host disease (GVHD), non-relapse mortality, hematopoietic engraftment, donor chimerism, and infection rates.
Participants will be followed regularly after transplantation with clinical assessments, laboratory tests, and bone marrow evaluations according to protocol-defined schedules.
The findings from this study are expected to provide prospective evidence for the use of TBF conditioning in elderly AML patients and support optimization of transplantation strategies in this population.
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Xianmin Song, MD
- Puhelinnumero: +86-13501672508
- Sähköposti: shongxm@sjtu.edu.cn
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Age 55 to 75 years
- Diagnosed with acute myeloid leukemia (AML) based on morphology, immunophenotyping, cytogenetics, or molecular testing
- First complete remission (CR1) or complete remission with incomplete hematologic recovery (CRi)
- Eligible for haploidentical hematopoietic stem cell transplantation
- Availability of a suitable haploidentical donor
- ECOG performance status 0-2
Adequate organ function:
- Left ventricular ejection fraction ≥50%
- Oxygen saturation >92% on room air
- Serum creatinine ≤1.5 × upper limit of normal (ULN)
- Total bilirubin ≤1.5 × ULN
- AST and ALT ≤2.0 × ULN
- DLCO ≥40% and FEV1 ≥50%
- Ability to understand and sign informed consent
Exclusion Criteria:
- Secondary AML (including AML evolving from myelodysplastic syndrome or therapy-related AML)
- Active, uncontrolled infection
- Severe uncontrolled systemic disease (e.g., unstable cardiovascular disease, recent stroke, or severe organ dysfunction)
- HIV infection
- Active hepatitis B or C requiring antiviral treatment
- Pregnant or breastfeeding women
- Known hypersensitivity to study drugs
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei käytössä
- Inventiomalli: Yksittäinen ryhmätehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
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Kokeellinen: Arms Back to Arms and Interventions * Required * § Required if Study Start Date is on or after Janu
Participants will receive a conditioning regimen consisting of thiotepa, busulfan, and fludarabine (TBF) followed by haploidentical peripheral blood stem cell transplantation.
Thiotepa is administered on day -7, busulfan on days -4 and -3, and fludarabine on days -6 to -2.
Donor stem cells are infused on day 0. Standard graft-versus-host disease prophylaxis and supportive care will be provided according to institutional guidelines.
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Thiotepa is administered intravenously at a dose of 5 mg/kg on day -7 as part of the TBF conditioning regimen prior to haploidentical peripheral blood stem cell transplantation.
Busulfan is administered intravenously at a dose of 3.2 mg/kg on days -4 and -3 as part of the TBF conditioning regimen.
Fludarabine is administered intravenously at a dose of 30 mg/m² daily from day -6 to day -2 as part of the conditioning regimen.
Haploidentical peripheral blood stem cell transplantation is performed on day 0 following conditioning.
Donor stem cells are infused, and standard graft-versus-host disease prophylaxis and supportive care are provided according to institutional protocols.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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1-year Relapse-Free Survival (RFS)
Aikaikkuna: 12 months after transplantation
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Relapse-free survival (RFS) is defined as the time from transplantation to the first occurrence of disease relapse or death from any cause.
Patients who are alive without relapse at the last follow-up will be censored.
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12 months after transplantation
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Overall Survival (OS)
Aikaikkuna: 12 months after transplantation
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Overall survival is defined as the time from transplantation to death from any cause.
Patients alive at last follow-up will be censored.
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12 months after transplantation
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Incidence of Acute Graft-Versus-Host Disease (aGVHD)
Aikaikkuna: Up to 180 days after transplantation
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The cumulative incidence of grade I-IV and grade III-IV acute graft-versus-host disease within 180 days after transplantation, assessed according to standard criteria.
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Up to 180 days after transplantation
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Incidence of Chronic Graft-Versus-Host Disease (cGVHD)
Aikaikkuna: 12 months after transplantation
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The cumulative incidence of all-grade and moderate-to-severe chronic graft-versus-host disease, assessed according to NIH consensus criteria.
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12 months after transplantation
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Non-Relapse Mortality (NRM)
Aikaikkuna: 12 months after transplantation
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Non-relapse mortality is defined as death without evidence of disease relapse.
Relapse is treated as a competing event.
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12 months after transplantation
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Yhteistyökumppanit ja tutkijat
Tutkijat
- Päätutkija: Xianmin Song, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
- Neoplasmat
- Neoplasmat histologisen tyypin mukaan
- Hematologiset sairaudet
- Leukemia, myeloidi
- Leukemia
- Hemic- ja imusuutteet
- Leukemia, myelooinen, akuutti
- Rikkiyhdisteet
- Orgaaniset kemikaalit
- Heterosykliset yhdisteet, 1-rengas
- Heterosykliset yhdisteet
- Hiilivedyt, asyklinen
- Hiilivety
- Alkanit
- Alkoholit
- Butyleeniglykolit
- Glykolit
- Mesylaatit
- Alkanesulfonaatit
- Alkaanilaishapot
- Sulfonihappot
- Rikkihappot
- Fosforamidit
- Organofosforiyhdisteet
- Trietyleeniposforamidi
- Atsiridiinit
- Atsiriinit
- Busulfaani
- Tiotepa
- fludarabiini
Muut tutkimustunnusnumerot
- SHSYXY-202510-TBF-AML
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