T-Cell-Depleted Allogeneic Stem Cell Transplantation After Immunoablative Induction Chemotherapy and Reduced-Intensity Transplantation Conditioning in Treating Patients With Hematologic Malignancies
T-Cell Depleted, Reduced-Intensity Allogeneic Stem Cell Transplantation From Haploidentical Related Donors For Hematologic Malignancies
RATIONALE: Donor peripheral stem cell transplantation may be able to replace bone marrow and immune cells that were destroyed by chemotherapy. Sometimes the transplanted cells from a donor are rejected by the body's normal cells. Eliminating the T cells from the donor cells before transplanting them and giving cyclosporine may prevent this from happening.
PURPOSE: This phase I trial is studying the side effects of T-cell-depleted allogeneic stem cell transplantation after immunoablative induction chemotherapy and reduced-intensity transplantation conditioning (chemotherapy) in treating patients with hematologic malignancies.
調査の概要
状態
詳細な説明
OBJECTIVES:
Primary
- Determine engraftment in patients with hematologic malignancies treated with T-cell-depleted allogeneic stem cell transplantation after immunoablative induction chemotherapy and reduced-intensity transplantation conditioning.
Secondary
- Determine the incidence of acute graft-versus-host disease (GVHD), and nonrelapse mortality (within 100 days after transplantation) in these patients.
- Correlate levels of host immunosuppression before transplantation conditioning, as evaluated by peripheral blood CD4 counts, with graft rejection/failure within 100 days after transplantation and the level of donor hematopoietic chimerism 28 days after transplantation in these patients.
- Correlate donor-versus-recipient natural killer cell alloreactivity with graft rejection/failure, acute GVHD, and relapse of malignant disease in patients treated with this regimen.
- Determine the development of allospecific cytotoxic T-lymphocytes after transplantation in patients with myeloid or lymphoid leukemia.
- Correlate serum interleukin-7 and interleukin-15 levels with in vivo changes in host lymphocyte subpopulations in these patients during sequential immunoablative chemotherapy, before allogeneic stem cell transplantation, and during immune reconstitution after transplantation.
OUTLINE: This is a pilot study.
Induction chemotherapy: Patients receive 1 of 2 induction chemotherapy regimens according to diagnosis. Patients with partial response or better after prior therapy (i.e., already adequately immune depleted) proceed directly to the transplantation preparative regimen.
- Regimen A (Hodgkin's lymphoma, non-Hodgkin's lymphoma [except lymphoblastic lymphoma], chronic lymphocytic leukemia, prolymphocytic leukemia, or multiple myeloma): Patients receive rituximab IV (if they have CD20+ B-cell malignancies) on day 1; fludarabine IV over 30 minutes on days 1-4; etoposide, doxorubicin, and vincristine IV continuously on days 1-4; cyclophosphamide IV over 30 minutes on day 5; oral prednisone on days 1-5; and filgrastim (G-CSF) subcutaneously (SC) beginning on day 6 and continuing until blood counts recover.
- Regimen B (lymphoblastic lymphoma, acute myeloid leukemia, acute lymphoblastic leukemia, refractory anemia with excess blasts, myeloproliferative disorders, chronic myelomonocytic leukemia, or chronic myelogenous leukemia): Patients receive G-CSF SC beginning 24 hours before initiating induction chemotherapy and continuing until blood counts recover. Patients also receive fludarabine IV over 30 minutes and cytarabine IV over 4 hours on days 1-5.
For both regimens, treatment repeats every 21 days for 1-2 courses. Patients who achieve remission or who have responsive or stable disease after induction chemotherapy then proceed to transplantation preparative regimen chemotherapy.
- Transplantation preparative regimen chemotherapy: Patients receive fludarabine IV over 30 minutes and cyclophosphamide IV over 2 hours on days -6 to -3.
- Graft-versus-host disease (GVHD) prophylaxis: Patients receive cyclosporine IV over 2 hours twice daily beginning on day -1 and continuing IV or orally until day 100. Patients with no acute GVHD at day 100 taper cyclosporine over 12 weeks.
- Allogeneic stem cell transplantation (SCT): Patients undergo T-cell-depleted allogeneic peripheral blood SCT on day 0. Patients receive G-CSF SC beginning on day 0 and continuing until blood counts recover.
- Donor lymphocyte infusion (DLI): Patients with persistent or progressive malignant disease after transplantation or mixed chimerism that does not improve after tapering or discontinuing immunosuppression therapy may receive DLI. DLI may be administered alone or in combination with chemotherapy. DLI repeats every 4 weeks until adequate donor chimerism is achieved or until GVHD develops.
Patients are followed at 28 and 100 days and then at 6, 9, 12, 18, and 24 months.
PROJECTED ACCRUAL: A total of 6-20 patients will be accrued for this study within 2 years.
研究の種類
入学 (予想される)
段階
- フェーズ 1
連絡先と場所
研究場所
-
-
Maryland
-
Bethesda、Maryland、アメリカ、20892-1182
- Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
DISEASE CHARACTERISTICS:
Diagnosis of 1 of the following hematologic malignancies:
Acute myeloid leukemia (AML), meeting 1 of the following criteria:
In first complete remission (CR1), meeting 1 of the following criteria:
Adverse cytogenetics with minimal residual disease detectable by flow cytometry, cytogenetic analysis, fluorescence in situ hybridization (FISH), or polymerase chain reaction (PCR), defined as 1 of the following:
- Complex karyotype [≥ 3 abnormalities]
- inv(3) or t(3;3)
- t(6;9)
- t(6;11)
- Monosomy 7
- Trisomy 8, alone or with an abnormality other than t(8;21), t(9;11), inv(16), or t(16;16)
- t(11;19) (q23;p13.1)
- Failed to achieve CR after primary induction chemotherapy
- Secondary AML
- In second or subsequent remission (CR2 or greater)
Acute lymphoblastic leukemia, meeting 1 of the following criteria:
In CR1, meeting 1 of the following criteria:
Adverse cytogenetics with minimal residual disease detectable by flow cytometry, cytogenetic analysis, FISH, or PCR, defined as the following:
- Translocations involving 11q23, t(9;22), or bcr-abl rearrangement
- Failed to achieve CR after primary induction chemotherapy
- In CR2, if CR1 was < 12 months
- In CR3 or greater
Myelodysplastic syndromes (MDS)
- INT-2 or high-risk by International Prognostic Scoring System
- No MDS with Fanconi anemia
Chronic myelogenous leukemia (CML), meeting 1 of the following criteria:
- Accelerated phase with treatment failure after imatinib mesylate
- Blast phase
Myeloproliferative disorders, meeting 1 of the following criteria:
Agnogenic myeloid metaplasia with adverse-risk features, meeting at least 2 of the following criteria:
- Hemoglobin < 10 g/dL or > 10g/dL if transfusion-dependent
- WBC < 4,000/mm^3 OR > 30,000/mm^3 OR requires cytoreductive therapy to maintain WBC < 30,000/mm^3
- Abnormal cytogenetics, including +8, 12p-
- Polycythemia vera or essential thrombocythemia in transformation to secondary AML
Myelodysplastic/myeloproliferative disease
- Chronic myelomonocytic leukemia
Hodgkin's lymphoma or non-Hodgkin's lymphoma
- Refractory lymphoma with progressive disease during combination chemotherapy
- Relapse after OR ineligible for autologous stem cell transplantation (SCT)
Chronic lymphocytic leukemia
- Treatment failure* after fludarabine, chlorambucil, and at least 1 other salvage regimen
Prolymphocytic leukemia (PLL), meeting 1 of the following criteria:
T-PLL
- Treatment failure* after alemtuzumab and at least 1 other regimen
B-PLL
- Treatment failure* after fludarabine and at least 1 other salvage regimen
Multiple myeloma, meeting 1 of the following criteria:
- Relapse after autologous SCT
- Plasma cell leukemia
Adverse cytogenetics, defined as 1 of the following:
- del(13q) = 11q translocation NOTE: *Treatment failure is defined as relapse within 6 months OR failure to achieve remission
Less than 10% blasts in bone marrow and no circulating blasts in peripheral blood for the following diagnoses:
- Primary or secondary leukemia
- Refractory anemia with excess blasts
- CML
- Other eligible diagnosis in transformation to acute leukemia
- Expected survival of approximately 1 year or less with conventional therapy
No active CNS involvement by malignancy*
- Prior CNS involvement with no current evidence of CNS malignancy allowed NOTE: *Active CNS malignancy is defined by lymphoma: tumor mass on CT scan or leptomeningeal disease OR leukemia: blasts present on cerebrospinal fluid cytospin
Availability of a donor who is a sibling, parent, or offspring who shares 1 full haplotype (HLA-A, -B, or -DR)
- Recipient and donor must have at least a 2-antigen disparity in either the host-versus-graft or graft-versus-host direction
- Parent or offspring donor who is mismatched for a single HLA antigen (i.e., 5/6 HLA) is allowed
- No sibling donor who is 6/6 HLA-matched OR mismatched for a single HLA antigen (i.e., 5/6 HLA)
- No unrelated donor identified in a prior or current National Marrow Donor Program registry search
PATIENT CHARACTERISTICS:
Age
- 18 to 55
Performance status
- ECOG 0-2 OR
- Karnofsky 60-100%
Life expectancy
- At least 3 months
Hematopoietic
- See Disease Characteristics
- Absolute neutrophil count ≥ 1,000/mm^3*
- Platelet count ≥ 20,0000/mm^3* (without transfusion) NOTE: *Lower values may be accepted at the discretion of the principal investigator or study chairperson if due to bone marrow involvement by malignancy
Hepatic
- ALT and AST ≤ 2.5 times upper limit of normal (ULN)*
- Bilirubin ≤ 2.5 times ULN*
- Unconjugated hyperbilirubinemia consistent with Gilbert's syndrome allowed
No chronic active hepatitis B infection
- Hepatitis B core antibody positive allowed provided patient is surface antigen negative and has no evidence of active infection
No hepatitis C viral infection
- Seronegative for anti-hepatitis C antibody and detectable hepatitis C viral RNA by reverse transcriptase-polymerase chain reaction assay NOTE: *Higher levels may be accepted at the discretion of the principle investigator or study chairperson if such elevations are due to liver involvement by malignancy
Renal
- Creatinine ≤ 1.5 mg/dL OR
- Creatinine clearance ≥ 50 mL/min
Cardiovascular
- LVEF ≥ 45%
Pulmonary
- DLCO ≥ 50% of expected value (corrected for blood hemoglobin level and alveolar volume)
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 1 year after study participation
- HIV negative
- No active infection not responding to antimicrobial therapy
- No psychiatric disorder that would preclude study compliance or informed consent
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- At least 2 weeks since prior monoclonal antibody therapy
Chemotherapy
- See Disease Characteristics
- At least 2 weeks since prior systemic chemotherapy
Endocrine therapy
- Not specified
Radiotherapy
- Not specified
Surgery
- Not specified
Other
- Recovered from all prior therapy
- No administration of tyrosine kinase (TK) inhibitors, including imatinib mesylate and dasatinib, during the conditioning regimen; TK inhibitor administration may resume 28 days after transplantation
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
協力者と研究者
捜査官
- スタディチェア:Michael R. Bishop, MD、National Cancer Institute (NCI)
研究記録日
主要日程の研究
研究開始
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
- 原発性骨髄線維症
- 再発性グレード 3 濾胞性リンパ腫
- 再発性成人びまん性大細胞型リンパ腫
- 再発性成人免疫芽細胞性大細胞型リンパ腫
- 再発成人バーキットリンパ腫
- 過剰な芽球を伴う難治性貧血
- 慢性骨髄単球性白血病
- de novo 骨髄異形成症候群
- 以前に治療された骨髄異形成症候群
- 二次性骨髄異形成症候群
- 11q23 (MLL) 異常を伴う成人急性骨髄性白血病
- inv(16)(p13;q22)を伴う成人急性骨髄性白血病
- t(15;17)(q22;q12)を伴う成人急性骨髄性白血病
- t(16;16)(p13;q22)を伴う成人急性骨髄性白血病
- t(8;21)(q22;q22)を伴う成人急性骨髄性白血病
- 続発性急性骨髄性白血病
- 慢性期慢性骨髄性白血病
- 寛解期の成人急性骨髄性白血病
- 再発成人ホジキンリンパ腫
- 再発性成人びまん性小細胞分裂型リンパ腫
- 再発性成人びまん性混合細胞リンパ腫
- 慢性骨髄性白血病の再発
- II期の多発性骨髄腫
- III期の多発性骨髄腫
- 再発性グレード 1 濾胞性リンパ腫
- 再発性グレード 2 濾胞性リンパ腫
- 再発辺縁帯リンパ腫
- 再発小リンパ球性リンパ腫
- 節外性辺縁帯 粘膜関連リンパ組織の B 細胞性リンパ腫
- リンパ節辺縁帯B細胞リンパ腫
- 脾辺縁帯リンパ腫
- 再発性成人リンパ芽球性リンパ腫
- 再発性マントル細胞リンパ腫
- 難治性慢性リンパ性白血病
- 難治性多発性骨髄腫
- 真性赤血球増加症
- 本態性血小板血症
- 前リンパ球性白血病
- 加速期慢性骨髄性白血病
- 寛解期の成人急性リンパ芽球性白血病
- 骨髄異形成/骨髄増殖性腫瘍、分類不能
追加の関連 MeSH 用語
- 病理学的プロセス
- 心血管疾患
- 血管疾患
- 免疫系疾患
- 組織型別の新生物
- リンパ増殖性疾患
- リンパ疾患
- 免疫増殖性疾患
- 部位別新生物
- 疾患
- 骨髄疾患
- 血液疾患
- 出血性疾患
- 止血障害
- パラタンパク血症
- 血液タンパク質障害
- 前がん状態
- 新生物
- リンパ腫
- 症候群
- 骨髄異形成症候群
- 血液腫瘍
- 多発性骨髄腫
- 新生物、形質細胞
- 白血病
- 前白血病
- 形質細胞腫
- 骨髄増殖性疾患
- 骨髄異形成 - 骨髄増殖性疾患
- 薬の生理作用
- 薬理作用の分子機構
- 抗感染剤
- 抗ウイルス剤
- 酵素阻害剤
- 抗炎症剤
- 抗リウマチ剤
- 代謝拮抗薬、抗腫瘍薬
- 代謝拮抗剤
- 抗悪性腫瘍薬
- 免疫抑制剤
- 免疫学的要因
- チューブリンモジュレーター
- 抗有糸分裂剤
- 有糸分裂モジュレーター
- グルココルチコイド
- ホルモン
- ホルモン、ホルモン代替物、およびホルモン拮抗薬
- 抗腫瘍剤、ホルモン剤
- 抗悪性腫瘍薬、アルキル化
- アルキル化剤
- 骨髄破壊的アゴニスト
- 抗悪性腫瘍剤、ファイトジェニック
- トポイソメラーゼ II 阻害剤
- トポイソメラーゼ阻害剤
- 抗悪性腫瘍剤、免疫
- 皮膚科用薬
- 抗生物質、抗悪性腫瘍薬
- 抗真菌剤
- カルシニューリン阻害剤
- シクロホスファミド
- エトポシド
- リツキシマブ
- プレドニゾン
- ドキソルビシン
- リポソームドキソルビシン
- フルダラビン
- リン酸フルダラビン
- シタラビン
- ビンクリスチン
- シクロスポリン
- シクロスポリン
その他の研究ID番号
- 040116
- 04-C-0116
- CDR0000357432
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。