- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT01050946
Hematopoietic Stem Cell Transplantation (HSCT) Using CD34 Selected Mismatched Related Donor and One Umbilical Cord Unit (Haplo/Cord)
Phase II Study: HSCT Using CD34 Selected Mismatched Related Donor and One Umbilical Cord Unit
This study is a means of providing transplantation to those patients who would be a stem cell transplant candidate who do not have an appropriate donor.
The use of CD34 selected haploidentical donor with an umbilical cord unit may help provide earlier engraftment without the need for long term immunosuppression.
This study tests a new method of bone marrow transplantation called combined haploidentical-cord blood transplantation. In this procedure, some of the blood forming cells (the stem cells) from a partially human leukocyte antigen (HLA) matched (haploidentical) related donor are collected from the blood, as well as cells from an umbilical cord are transplanted into the patient (the recipient) after administration of a "conditioning regimen". A conditioning regimen consists of chemotherapy and sometimes radiation to the entire body (total body irradiation, or TBI), which is meant to destroy the cancer cells and suppress the recipient's immune system to allow the transplanted cells to take (grow).
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
This method of stem cell transplantation is designed to overcome some of the limitations of other alternative donor transplant options. Use of unrelated umbilical cord unit (UCB) donors appears to allow a greater degree of HLA mismatch with acceptable rates of GVHD. However, when UCB transplant was studied in the adult population, investigators discovered several limitations. One major limitation with UCB was delayed engraftment, resulting in higher risk of infection in the early post transplant period. The limitations to cord blood transplant involve delayed engraftment resulting in early complications such as infections. The main limitation associated with haploidentical donors is the significant immunosuppression required to prevent/treat aGVHD. Use of this combined modality of transplantation appears to allow for rapid neutrophil engraftment from the haploidentical donor and coupled with long term hematopoiesis from the UCB donor, thus requiring less long term immunosuppression.
This study tests a new method of bone marrow transplantation called combined haploidentical-cord blood transplantation. In this procedure, some of the blood forming cells (the stem cells) from a partially HLA matched (haploidentical) related donor are collected from the blood, as well as cells from an umbilical cord are transplanted into the patient (the recipient) after administration of a "conditioning regimen". A conditioning regimen consists of chemotherapy and sometimes radiation to the entire body (total body irradiation, or TBI),
One of two 'conditioning regimens' which will be determined by the physician.
FLUDARABINE, MELPHALAN, ATG
Fludarabine 30mg/m2(Days-7,-6,-5,-4,-3)-,Melphalan 70mg/m2(Day -3,-2), ATG 1.5mg/m2(Day-7,-5,-3,-1)
- FLUDARABINE, BUSULFAN, 400 CGY TBI, ATG Fludarabine 50mg/m2(Day -6,-5,-4,-3,-2),Busulfan 3.2mg/kg(Day -5,-4,-3,-2) 400cGY Total Body Irradiation(TBI)Day-1,ATG 1.5mg/kg(Day-7,-5,-3,-1)
Day 0 -Haploidentical donor and one umbilical cord blood unit infusion
Filgrastim will be administered daily from day +1 until blood counts have completely recovered. Tacrolimus and another immunosuppressant, Cellcept, starting before transplant also to reduce the risks of graft versus host disease and to promote the growth of the graft. Tacrolimus will be given daily from two days before the transplant until at least three months after transplantation. Cellcept, will be tapered after the cells engraft.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Fase 2
Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Patients between 18 and 65 years old
- Patient has a related family member(haploidentical) or unrelated which is 5 of 10 HLA identical match.
Standard Risk
- Acute myelogenous leukemia: CR1 with high risk cytogenetics or molecular abnormalities such as FLT-3 ITD, or CR2 with a first remission that must have lasted > 1 year.
- Acute Lymphocytic Leukemia: CR1, in order to be standard risk must NOT have Philadelphia Chromosome.
- Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): Must be refractory to fludarabine or fail to have a complete or partial response after therapy with a regimen containing fludarabine (or another nucleoside analog, e.g. 2-CDA, pentostatin) or experience disease relapse within 12 months after completing therapy with a regimen containing fludarabine (or another nucleoside analog).
- Chronic myelogenous leukemia: resistant to or intolerant of TKI, in CP1 or CP2, or with a mutation that suggests resistance to TKI.
- Myelodysplastic Syndrome: RA, RARS, must be IPSS ≥ INT-2, Blasts <5%.
High Risk Patients:
- Acute myelogenous leukemia: Patients with CR2 are considered high risk if they have high risk cytogenetics, or molecular abnormalities or CR1 lasted for less than 1 year. Any evidence of active disease or no blasts in an acellular marrow.
- Acute Lymphocytic Leukemia: CR1- with Ph+ disease, CR2/+ with any cytogenetics. Any evidence of active disease.
- Chronic myelogenous leukemia- CP2/+, AP1/+, resistant or intolerant to TKI.
- Hodgkin's or Non Hodgkin's lymphoma- Disease recurrence following an autologous transplant, or high risk disease not thought to benefit from autologous transplant.
- Chronic lymphocytic leukemia- that is resistant to fludarabine, and never has been in remission or with stable disease/progressive disease
- Multiple myeloma: Must have had prior treatment. Patients in CR2 or greater can be considered, must have already failed autologous transplant Previous autologous transplant,must have been greater than 6 months prior to undergoing this transplant.
- Myelodysplastic syndrome: RAEB
- Other Myeloproliferative disorders including myelofibrosis, spent phase p Vera,Essential thrombocytosis,CMML.
Exclusion Criteria:
- Patients <18 years old Disease related criteria
- APML, presence of t(15,17) in first CR
- Patients with good risk AML, for example t(8;21), or inv 16, or normal cytogenetics with FLT-3-ITD negative, NPM-1 positive disease in 1st CR
- MDS IPSS < INT-2 Miscellaneous Criteria
- Recipients who have a matched related sibling or unrelated donor
- If recipient has evidence of anti-HLA antibodies directed against cord or haplo-donor as determined byflowPRA.
Underlying health criteria:
- Zubrod performance status > 2 (see Appendix E)
- Life expectancy is limited to less than 8 weeks by concomitant illness
- Patients with severely decreased LVEF (EF < 40%)
- Impaired pulmonary function tests (PFT's) (FVC, FEV1, DLCO < 45% predicted)
- Estimated Creatinine Clearance <50 ml/min
- Serum bilirubin> 2.0 mg/dl or SGPT >3 x upper limit of normal
- Evidence of chronic active hepatitis or cirrhosis
- HIV-positive
- Patient is pregnant
- Patient or guardian not able to provide informed consent
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
---|---|
Altro: Haploidentical/cord transplant
Haploidentical/cord transplant with the precondition regimen at discretion of treating physician.
|
Myeloablative preparative regimen of chemotherapy and radiation followed by mismatch related(haploidentical)donor and one unit umbilical cord blood transplantation. Conditioning Regimens Choice of regimen at the discretion of the treating physician
Day 0 -Haploidentical donor and one umbilical cord blood unit infusion
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Lasso di tempo |
---|---|
The Primary Objective is to Estimate the Overall Survival, Separately in the Two Risk Strata.
Lasso di tempo: 3 years
|
3 years
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Time to Relapse: To Assess the Incidence of Acute Leukemia or Lymphoma Relapse From Day of Transplant
Lasso di tempo: 2 years
|
NOT analyzed since there was only patient and no relapse was observed till patient passed away
|
2 years
|
Time to Neutrophil Engraftment: To Assess the Incidence of Neutrophil Engraftment From Day of Transplant
Lasso di tempo: 100 days
|
time to neutrophil recovery after transplant
|
100 days
|
Time to Platelet Engraftment: To Assess the Incidence of Platelet Engraftment From Day of Transplant,
Lasso di tempo: 100 days
|
100 days
|
|
Time to Acute GVHD: We Will Assess the Incidence and Severity of Grades II-IV and Grades III-IV Acute GVHD From Day of Transplant.
Lasso di tempo: 100 days
|
100 days
|
|
Transplant Related Mortality (TRM): TRM is Death Occurring in Patients in Continuous Complete Remission.
Lasso di tempo: 1 year
|
1 year
|
|
Disease-free Survival:Death or Relapse Will be Considered Events for This Endpoint.
Lasso di tempo: 3 years
|
3 years
|
Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Jeanne Palmer, M.D., Medical College of Wisconsin
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Stima)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
- Antiriciclaggio
- NHL
- TUTTO
- Linfoma non Hodgkin
- LMC
- HL
- Leucemia, linfocitica, acuta
- Leucemia, mieloide, cronica
- Leucemia, mielocitica, acuta
- Haploidentical donor
- Unrelated Umbilical Cord Blood Transplant(UCB)
- CD34+ Selected mismatched related donor
- hematopoietic stem cell transplantation(HSCT)
- Lymphoma, Hodgkins
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, cellule B
- Linfoma
- Leucemia
- Leucemia, mieloide
- Leucemia, mieloide, acuta
- Malattia di Hodgkin
- Linfoma non Hodgkin
- Leucemia-linfoma linfoblastico a cellule precursori
- Leucemia, linfocitica, cronica, cellule B
- Leucemia, linfoide
- Leucemia, Mielogena, Cronica, BCR-ABL Positivo
Altri numeri di identificazione dello studio
- MCW 11491
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
Prove cliniche su Linfoma non Hodgkin
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National Cancer Institute (NCI)CompletatoLinfoma di Hodgkin dell'adulto ricorrente | Linfoma di Hodgkin adulto stadio III | Linfoma di Hodgkin adulto stadio IV | Linfoma di Hodgkin infantile ricorrente/refrattario | Linfoma di Hodgkin infantile in stadio III | Linfoma di Hodgkin infantile in stadio IV | Linfoma di Hodgkin adulto stadio I | Linfoma di Hodgkin infantile in stadio... e altre condizioniStati Uniti
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Tomsk National Research Medical Center of the Russian...Uppsala UniversityCompletatoLinfoma di Hodgkin, adulto | Linfoma non Hodgkin, adultoFederazione Russa
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University of WashingtonReclutamentoLinfoma di Hodgkin ricorrente | Linfoma di Hodgkin refrattario | Linfoma non Hodgkin ricorrente | Linfoma non Hodgkin refrattarioStati Uniti
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Fred Hutchinson Cancer CenterNational Cancer Institute (NCI)CompletatoLinfoma di Hodgkin ricorrente | Linfoma di Hodgkin refrattario | Linfoma Mantellare Ricorrente | Linfoma non Hodgkin a cellule B refrattario | Linfoma non Hodgkin a cellule T refrattario | Linfoma non Hodgkin ricorrente a cellule B | Linfoma non Hodgkin ricorrente a cellule T | Linfoma mantellare refrattarioStati Uniti
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Tessa TherapeuticsBristol-Myers SquibbAttivo, non reclutanteLinfoma di Hodgkin classico | Malattia di Hodgkin ricorrente | Malattia di Hodgkin refrattariaStati Uniti
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Academic and Community Cancer Research UnitedNational Cancer Institute (NCI)Attivo, non reclutanteLinfoma di Hodgkin in stadio III di Ann Arbor | Linfoma di Hodgkin in stadio IIIA di Ann Arbor | Linfoma di Hodgkin in stadio IIIB di Ann Arbor | Linfoma di Hodgkin stadio IV di Ann Arbor | Linfoma di Hodgkin allo stadio IVA di Ann Arbor | Linfoma di Hodgkin allo stadio IVB di Ann Arbor | Linfoma... e altre condizioniStati Uniti
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Academic and Community Cancer Research UnitedNational Cancer Institute (NCI)Attivo, non reclutanteLinfoma di Hodgkin classico | Linfoma di Hodgkin stadio IB di Ann Arbor | Linfoma di Hodgkin in stadio II di Ann Arbor | Linfoma di Hodgkin stadio IIA di Ann Arbor | Linfoma di Hodgkin in stadio IIB di Ann Arbor | Linfoma di Hodgkin stadio I di Ann Arbor | Linfoma di Hodgkin stadio IA di Ann ArborStati Uniti
-
Northwestern UniversitySeagen Inc.; Robert H. Lurie Cancer CenterSconosciutoLinfoma di Hodgkin adulto stadio III | Linfoma di Hodgkin adulto stadio IV | Linfoma di Hodgkin adulto stadio II | Linfoma di Hodgkin a deplezione di linfociti adulti | Linfoma di Hodgkin a predominanza dei linfociti adulti | Linfoma di Hodgkin a cellula mista dell'adulto | Sclerosi nodulare adulta...Stati Uniti
Prove cliniche su Haploidentical/cord transplant
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Biotronik, Inc.Biotronik Australia Pty Ltd.; BIOTRONIK NeuroReclutamentoDolore lombare cronico | Dolore cronico alle gambeAustralia
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Cairo UniversitySconosciuto
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