Single vs Double Umbilical Cord Blood Transplants in Children With High Risk Leukemia and Myelodysplasia (BMT CTN 0501)
Multi-center, Open Label, Randomized Trial Comparing Single Versus Double Umbilical Cord Blood (UCB) Transplantation in Pediatric Patients With High Risk Leukemia and Myelodysplasia (BMT CTN #0501)
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
BACKGROUND:
In nearly every large single center or registry analysis of outcomes after UCB transplantation, cell dose is identified as an important factor influencing the incidence and rate of hematopoietic recovery, risk of transplant-related mortality, and probability of survival. Pilot data suggest that infusion of two partially human leukocyte antigen (HLA)-matched UCB units, which always augments the graft cell dose, is safe and may improve neutrophil recovery and survival. To determine whether the infusion of two UCB units enhances survival, a multi-center, open-label, randomized trial is proposed. As adequate single UCB units can be identified for more than 80% of pediatric recipients (in contrast to less than 30% for adults), this study will be open only to pediatric patients. The population will be restricted to patients with high-risk hematologic malignancy, the most common indication of UCB transplantation in children.
DESIGN NARRATIVE:
Participants will include patients 1 to 21 years of age with a diagnosis of hematological malignancy and with two partially HLA-matched UCB units. Units must be HLA-matched at 3 of 6 HLA-A and B (intermediate resolution molecular typing) and DRB1 (high resolution molecular typing) with each other and 4 of 6 with the recipient. Two appropriately HLA-matched units must be available such that one unit delivers a pre-cryopreserved, nucleated cell dose of at least 2.5 x 10^7 per kilogram and the second unit delivers at least 1.5 x 10^7 per kilogram.
Patients will be randomized no more than 14 days prior to initiation of conditioning. UCB units will be shipped prior to initiation of conditioning.
The preparative regimen will consist of the following:
- Fludarabine: 25 mg/m2/day IV on Days -10, -9, and -8.
- Total Body Irradiation (TBI): 165 cGy twice daily on Days -7, -6, -5, and -4.
- Cyclophosphamide: 60 mg/kg/day x 2 on Days -3 and -2.
- Day 0 will be the day of the UCB transplant. The Graft-vs-Host-Disease (GVHD) prophylaxis regimen will be mycophenolate mofetil (MMF) 15 mg/kg IV BID on Day -3 to Day + 45 and cyclosporine A (CSA) to maintain level 200-400 ng/mL beginning on Day -3.
Patients will be followed for at least 24 months post-transplant.
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Fase 3
Contatti e Sedi
Luoghi di studio
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New South Wales
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Westmead, New South Wales, Australia, 2145
- Children's Hospital at Westmead
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British Columbia
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Vancouver, British Columbia, Canada, V5Z 4E3
- BC Cancer Agency
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Alabama
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Birmingham, Alabama, Stati Uniti, 35294
- University of Alabama
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Arizona
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Phoenix, Arizona, Stati Uniti, 85016
- Phoenix Children's Hospital
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California
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Duarte, California, Stati Uniti, 91010
- City of Hope National Medical Center
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Oakland, California, Stati Uniti, 94609
- Childrens Hospital at Oakland
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San Diego, California, Stati Uniti, 92123
- UCSD/Rady Childrens Hospital
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San Francisco, California, Stati Uniti, 94143
- University of California, San Francisco (Peds)
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Colorado
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Denver, Colorado, Stati Uniti, 80218
- The Children's Hospital of Denver
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District of Columbia
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Washington, District of Columbia, Stati Uniti, 20010
- Children's National Medical Center
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Florida
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Gainesville, Florida, Stati Uniti, 32610
- University of Florida College of Medicine (Shands)
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Jacksonville, Florida, Stati Uniti, 32207
- Nemours Childrens Clinic
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Miami, Florida, Stati Uniti, 33136
- University of Miami
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Saint Petersburg, Florida, Stati Uniti, 33710
- All Children's Hospital
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Georgia
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Atlanta, Georgia, Stati Uniti, 30322-1062
- Children's Healthcare of Atlanta
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Indiana
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Indianapolis, Indiana, Stati Uniti, 46202
- Indiana University Medical Center
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Kentucky
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Louisville, Kentucky, Stati Uniti, 40202
- University of Louisville/Kosiar Children's Hospital
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Louisiana
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New Orleans, Louisiana, Stati Uniti, 70118
- Children's of New Orleans
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Massachusetts
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Boston, Massachusetts, Stati Uniti, 02115
- DFCI/Children's Hospital of Boston
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Michigan
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Ann Arbor, Michigan, Stati Uniti, 48109
- University of Michigan Medical Center
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Detroit, Michigan, Stati Uniti, 48201
- Karmanos Cancer Institute/Children's Hospital of Michigan
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Minnesota
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Minneapolis, Minnesota, Stati Uniti, 55455
- University of Minnesota
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Mississippi
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Jackson, Mississippi, Stati Uniti, 39216
- University of Mississippi
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Missouri
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Kansas City, Missouri, Stati Uniti, 64108
- Children's Mercy Hospital and Clinics
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New York
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Valhalla, New York, Stati Uniti, 10595
- New York Medical College
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North Carolina
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Durham, North Carolina, Stati Uniti, 27705
- Duke University Medical Center
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Ohio
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Columbus, Ohio, Stati Uniti, 43205-2696
- Nationwide Children's Hospital
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Oregon
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Portland, Oregon, Stati Uniti, 97239
- Oregon Health Sciences University
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Pennsylvania
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Philadelphia, Pennsylvania, Stati Uniti, 19104
- Children's Hospital of Philadelphia
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South Carolina
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Charleston, South Carolina, Stati Uniti, 29425
- Medical University of South Carolina
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Tennessee
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Nashville, Tennessee, Stati Uniti, 37232-7610
- Vanderbilt University Medical Center
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Texas
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Dallas, Texas, Stati Uniti, 75235
- Children's Medical Center of Dallas
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Fort Worth, Texas, Stati Uniti, 76104
- Cook Childrens Medical Center
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San Antonio, Texas, Stati Uniti, 78229
- Texas Transplant Institute
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Utah
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Salt Lake City, Utah, Stati Uniti, 84132
- Utah BMT/University of Utah Medical School
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Virginia
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Richmond, Virginia, Stati Uniti, 23298
- Virgina Commonwealth University
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Washington
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Seattle, Washington, Stati Uniti, 98109
- Fred Hutchinson Cancer Research Center
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Wisconsin
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Milwaukee, Wisconsin, Stati Uniti, 53211
- Medical College of Wisconsin
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Two partially HLA-matched UCB units. Units must be HLA-matched minimally at 4 of 6 HLA-A and B (at intermediate resolution by molecular typing) and DRB1 (at high resolution by molecular typing) loci with the patient, and the units must be HLA-matched at 3 of 6 HLA- A, B, DRB1 loci with each other (using same resolution of molecular typing as indicated above). Two appropriately HLA-matched units must be available such that one unit delivers a pre-cryopreserved nucleated cell dose of at least 2.5 x 10^7 per kilogram and the second unit at least 1.5 x 10^7 per kilogram.
Acute myelogenous leukemia (AML) at the following stages:
High risk first complete remission (CR1), defined as the following:
- Having preceding myelodysplasia (MDS)
- High risk cytogenetics (high risk cytogenetics: del (5q) -5, -7, abn (3q), t (6;9) complex karyotype [at least 5 abnormalities],)the presence of a high FLT3 ITD-AR (> 0.4)
- Requiring more than 1 cycle of chemotherapy to obtain complete remission (CR);
- FAB M6
- Second or greater CR
- First relapse with less than 25% blasts in bone marrow
- Morphologic complete remission with incomplete blood count recovery
- Therapy-related AML for which prior malignancy has been in remission for at least 12 months
Acute lymphocytic leukemia (ALL) at the following stages:
High risk first remission, defined as one of the following conditions:
- Philadelphia chromosome-positive adult lymphoblastic leukemia (Ph+ ALL)
- Mixed lineage leukemia (MLL) rearrangement with slow early response (defined as having M2 [5-25% blasts] or M3 [more than 25% blasts on bone marrow examination on Day 14 of induction therapy])
- Hypodiploidy (less than 44 chromosomes or DNA index less than 0.81)
- End of induction M3 bone marrow
- End of induction M2 with M2-3 at Day 42
- Evidence of minimal residual disease (MRD). If a patient's only high risk criterion is MRD, approval by a protocol chair or protocol officer is required for enrollment. For COG centers, this will only be for MRD greater than 1 percent by flow MRD at the end of extended induction.
High risk second remission, defined as one of the following conditions:
- Philadelphia chromosome-positive adult lymphoblastic leukemia (Ph+ ALL)
- Bone marrow relapse less than 36 months from induction
- T-lineage relapse at any time
- Very early isolated central nervous system (CNS) relapse (6 months from diagnosis)
- Slow reinduction (M2-3 at Day 28) after relapse at any time
- Evidence of minimal residual disease (MRD). If a patient's only high risk criterion is MRD, approval by a protocol chair or protocol officer is required for enrollment. For COG centers, this will only be for MRD greater than 1 percent by flow MRD at the end of extended induction.
- Any third or subsequent CR
- NK cell lymphoblastic leukemia in any CR
- Biphenotypic or undifferentiated leukemia in any CR or if in first relapse must have less than 25% blasts in bone marrow (BM)
- Myelodysplastic syndrome (MDS) at any stage
- Chronic myelogenous leukemia (CML) in chronic or accelerated phase
- All patients with evidence of CNS leukemia must be treated and be in CNS CR to be eligible for study.
- Patients 16 years old or older must have a Karnofsky score of at least 70% and patients younger than 16 years old must have a Lansky score of at least 70%.
Patients with adequate physical function as measured by:
- Cardiac: Left ventricular ejection fraction greater than 40% or shortening fraction greater than 26%
- Hepatic: Bilirubin no more than 2.5 mg/dL; alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) no more than 5 times the upper limit of normal (ULN)
- Renal: Serum creatinine within normal range for age, or if serum creatinine is outside normal range for age, then renal function (creatinine clearance or GFR) greater than 70 mL/min/1.73 m^2
- Pulmonary: Diffusing capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in one second (FEV1), or forced vital capacity (FVC) greater than 50% of predicted value (corrected for hemoglobin); if unable to perform pulmonary function tests, then O2 saturation greater than 92% of room air
Exclusion Criteria:
- Pregnant (β-positive human chorionic gonadotropin [HCG]) or breastfeeding
- Evidence of HIV infection or HIV positive serology
- Current uncontrolled bacterial, viral, or fungal infection (currently taking medication and progression of clinical symptoms)
- Autologous transplant less than 12 months prior to enrollment
- Prior autologous transplant for the disease for which the UCB transplant will be performed
- Prior allogeneic hematopoietic stem cell transplant
- Active malignancy other than the one for which the UCB transplant is being performed within 12 months of enrollment
- Inability to receive TBI
- Requirement of supplemental oxygen
- HLA-matched related donor able to donate
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Sperimentale: Single Cord Blood Transplant
Unrelated donor, single umbilical cord blood unit transplant; conditioning regimen: Total Body Irradiation/cyclophosphamide/fludarabine; GVHD prophylaxis: Cyclosporine A/Mycophenolate Mofetil
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Unrelated donor, single umbilical cord blood unit; conditioning regimen: TBI/cyclophosphamide/fludarabine; GVHD prophylaxis: cyclosporine/MMF
The TBI will be delivered from either a linear accelerator or cobalt source at a dose rate of between 4 and 26 cGy/minute using energies of between 1 and 25 MV.
Altri nomi:
Cyclophosphamide 60 mg/kg/day will be administered as a 2 hour intravenous infusion with a high volume fluid flush on Days -3 and -2.
Altri nomi:
Fludarabine 25 mg/m2/day will be administered over 30-60 minutes intravenous infusion on Days -10 through -8.
Fludarabine will not be dose adjusted for body weight.
Altri nomi:
CSA will be administered beginning on Day -3 and doses will be adjusted to maintain a level of 200-400 ng/mL by TDX method (or 100-250 ng/mL by Tandem MS or equivalent level for other CSA testing methods).
CSA can be administered per institutional practice.
Altri nomi:
MMF will be given at a dose of 1 gram IV q 8 hours if > 50 kg or 15 mg/kg IV q 8 hours if < 50 kg beginning the morning of Day -3.
Altri nomi:
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Sperimentale: Double Cord Blood Transplant
Unrelated donor, double umbilical cord blood unit transplant; Conditioning regimen: Total Body Irradiation/cyclophosphamide/fludarabine; GVHD prophylaxis: Cyclosporine A/Mycophenolate Mofetil
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The TBI will be delivered from either a linear accelerator or cobalt source at a dose rate of between 4 and 26 cGy/minute using energies of between 1 and 25 MV.
Altri nomi:
Cyclophosphamide 60 mg/kg/day will be administered as a 2 hour intravenous infusion with a high volume fluid flush on Days -3 and -2.
Altri nomi:
Fludarabine 25 mg/m2/day will be administered over 30-60 minutes intravenous infusion on Days -10 through -8.
Fludarabine will not be dose adjusted for body weight.
Altri nomi:
CSA will be administered beginning on Day -3 and doses will be adjusted to maintain a level of 200-400 ng/mL by TDX method (or 100-250 ng/mL by Tandem MS or equivalent level for other CSA testing methods).
CSA can be administered per institutional practice.
Altri nomi:
MMF will be given at a dose of 1 gram IV q 8 hours if > 50 kg or 15 mg/kg IV q 8 hours if < 50 kg beginning the morning of Day -3.
Altri nomi:
Unrelated donor, double umbilical cord blood unit; Conditioning regimen: TBI/cyclophosphamide/fludarabine; GVHD prophylaxis: cyclosporine/MMF
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Percentage of Participants With Overall Survival
Lasso di tempo: 1 year post-randomization
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Overall survival is defined as survival of death from any cause.
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1 year post-randomization
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Percentage of Participants With Disease-free Survival
Lasso di tempo: 1 year post-randomization
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Disease-free survival is defined as survival without relapse of the primary disease.
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1 year post-randomization
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Percentage of Participants With Neutrophil and Platelet Engraftment
Lasso di tempo: Days 42 and 100
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Neutrophil engraftment is defined as achieving an absolute neutrophil count greater than 500x10^6/liter for three consecutive measurements on different days.
The first of the three days will be designated the day of neutrophil engraftment.
Platelet engraftment is defined as achieving platelet counts greater than 50,000/microliter for consecutive measurements over 7 days without requiring platelet transfusions.
The first of the 7 days will be designated the day of platelet engraftment.
Subjects must not have had platelet transfusions during the preceding 7 days.
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Days 42 and 100
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Time to Neutrophil and Platelet Engraftment
Lasso di tempo: 2 years post-transplant
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Platelet engraftment is defined as achieving platelet counts greater than 50,000/microliter for consecutive measurements over 7 days without requiring platelet transfusions.
The first of the 7 days will be designated the day of platelet engraftment.
Subjects must not have had platelet transfusions during the preceding 7 days.
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2 years post-transplant
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Percentage of Participants With Acute Graft-versus-host Disease (GVHD)
Lasso di tempo: Day 100 post-randomization
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Acute GVHD is graded according to the scoring system proposed by Przepiorka et al.1995: Skin stage: 0: No rash
Liver stage (based on bilirubin level)*: 0: <2 mg/dL
GI stage*: 0: No diarrhea or diarrhea <500 mL/day
GVHD grade: 0: All organ stages 0 or GVHD not listed as an etiology I: Skin stage 1-2 and liver and GI stage 0 II: Skin stage 3 or liver or GI stage 1 III: Liver stage 2-3 or GI stage 2-4 IV: Skin or liver stage 4 |
Day 100 post-randomization
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Percentage of Participants With Chronic GVHD
Lasso di tempo: 1 year post-randomization
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Incidences of chronic GVHD will be graded per Shulman et al. 1980.
This reference categorizes chronic GVHD as either limited or extensive.
For this outcome, participants developing either type are considered to have a chronic GVHD event.
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1 year post-randomization
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Number of Infections Per Participant
Lasso di tempo: 2 years post-randomization
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2 years post-randomization
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Percentage of Participants With Relapse
Lasso di tempo: 1 year post-randomization
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Relapse is defined by either morphological or cytogenetic evidence of AML, ALL, CML, or MDS consistent with pre-transplant features.
Testing for recurrent malignancy in the blood, marrow or other sites will be used to assess relapse after transplantation.
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1 year post-randomization
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Percentage of Participants With Treatment-related Mortality
Lasso di tempo: 1 year post-randomization
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Treatment related mortality is defined as death without relapse of the primary disease.
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1 year post-randomization
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Number of Participants With Engraftment Syndrome
Lasso di tempo: Day 100 post-transplant
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Day 100 post-transplant
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Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Pubblicazioni e link utili
Pubblicazioni generali
- Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE, Hackman R, Tsoi MS, Storb R, Thomas ED. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med. 1980 Aug;69(2):204-17. doi: 10.1016/0002-9343(80)90380-0.
- Wagner JE Jr, Eapen M, Carter S, Wang Y, Schultz KR, Wall DA, Bunin N, Delaney C, Haut P, Margolis D, Peres E, Verneris MR, Walters M, Horowitz MM, Kurtzberg J; Blood and Marrow Transplant Clinical Trials Network. One-unit versus two-unit cord-blood transplantation for hematologic cancers. N Engl J Med. 2014 Oct 30;371(18):1685-94. doi: 10.1056/NEJMoa1405584.
Collegamenti utili
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Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Effettivo)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie del sistema immunitario
- Neoplasie per tipo istologico
- Neoplasie
- Malattie linfoproliferative
- Malattie linfatiche
- Disturbi immunoproliferativi
- Malattie del midollo osseo
- Malattie ematologiche
- Malattie mieloproliferative
- Leucemia, linfoide
- Sindromi mielodisplastiche
- Leucemia
- Leucemia, mieloide
- Leucemia, mieloide, acuta
- Leucemia-linfoma linfoblastico a cellule precursori
- Leucemia, Mielogena, Cronica, BCR-ABL Positivo
- Effetti fisiologici delle droghe
- Meccanismi molecolari dell'azione farmacologica
- Agenti antinfettivi
- Inibitori enzimatici
- Agenti antireumatici
- Agenti antineoplastici
- Agenti immunosoppressivi
- Fattori immunologici
- Agenti Antineoplastici, Alchilanti
- Agenti Alchilanti
- Agonisti mieloablativi
- Agenti dermatologici
- Agenti antibatterici
- Antibiotici, Antineoplastici
- Agenti antimicotici
- Agenti antitubercolari
- Antibiotici, Antitubercolari
- Inibitori della calcineurina
- Ciclofosfamide
- Fludarabina
- Acido micofenolico
- Ciclosporina
- Ciclosporine
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- BMTCTN0501
- 5U24CA076518 (Sovvenzione/contratto NIH degli Stati Uniti)
- 2U01HL069294 (Sovvenzione/contratto NIH degli Stati Uniti)
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
Periodo di condivisione IPD
Criteri di accesso alla condivisione IPD
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