- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT00118352
Alemtuzumab, Fludarabine Phosphate, and Total-Body Irradiation Followed by Cyclosporine and Mycophenolate Mofetil in Treating Patients Who Are Undergoing Donor Stem Cell Transplant for Hematologic Cancer
Campath (Alemtuzumab) Dose Escalation, Low-Dose TBI and Fludarabine Followed by HLA Class II Mismatched Donor Stem Cell Transplantation for Patients With Hematologic Malignancies: A Multicenter Trial
연구 개요
상태
정황
- 만성골수단구성백혈병
- 재발성 성인 급성 골수성 백혈병
- 소아 골수단구성 백혈병
- 점막 관련 림프조직의 결절외 변연부 B세포 림프종
- 결절 변연부 B세포 림프종
- 재발성 성인 버킷 림프종
- 재발성 성인 미만성 대세포 림프종
- 재발성 성인 미만성 혼합 세포 림프종
- 재발성 성인 미만성 작은 절단 세포 림프종
- 재발성 성인 면역모세포성 대세포 림프종
- 재발성 성인 림프구성 림프종
- 재발성 등급 1 여포성 림프종
- 재발성 등급 2 여포성 림프종
- 재발성 등급 3 여포성 림프종
- 재발성 맨틀 세포 림프종
- 재발성 변연부 림프종
- 비장 변연부 림프종
- 발덴스트룀 마크로글로불린혈증
- 차도가 있는 성인 급성 골수성 백혈병
- 차도가 있는 소아 급성 골수성 백혈병
- 말초 T 세포 림프종
- 역형성 대세포 림프종
- 혈관면역모세포성 T세포 림프종
- 차도가 있는 성인 급성 림프구성 백혈병
- 성인 비강형 림프절외 NK/T 세포 림프종
- 차도가 있는 소아 급성 림프구성 백혈병
- 소아기 만성 골수성 백혈병
- 소아 골수이형성 증후군
- 만성기 만성 골수성 백혈병
- 피부 B세포 비호지킨 림프종
- 간비장 T 세포 림프종
- 안내 림프종
- 이전에 치료받은 골수이형성 증후군
- 재발성 성인 급성 림프구성 백혈병
- 재발성 성인 등급 III 림프종양 육아종증
- 재발성 성인 Hodgkin 림프종
- 재발성 성인 T세포 백혈병/림프종
- 재발성 소아기 급성 림프구성 백혈병
- 재발성 소아기 급성 골수성 백혈병
- 재발성 피부 T세포 비호지킨 림프종
- 재발성 균상 식육종/세자리 증후군
- 재발성 소림프구성 림프종
- 불응성 다발성 골수종
- 재발성 만성 골수성 백혈병
- 속발성 골수이형성 증후군
- 소장 림프종
- 고환 림프종
- 난치성 만성 림프 구성 백혈병
- 난치성 털 세포 백혈병
- 급성 미분화 백혈병
- 비정형 만성 골수성 백혈병, BCR-ABL1 음성
- 비만 세포 백혈병
- 골수이형성/골수증식성 신생물, 분류 불가
- 소아 미만성 대세포 림프종
- 소아 면역모세포성 대세포 림프종
- 소아비강형 림프절외 NK/T세포 림프종
- 재발성 소아 역형성 대세포 림프종
- 재발성 소아기 등급 III 림프종양 육아종증
- 재발성 소아 대세포 림프종
- 재발성 소아기 림프구성 림프종
- 재발성 소아기 소절단되지 않은 세포 림프종
- 재발성/불응성 소아 호지킨 림프종
- 소아 버킷 림프종
- 비피부 림프절외 림프종
상세 설명
PRIMARY OBJECTIVES:
I. To determine which dose of Campath (alemtuzumab) allows related and unrelated human leukocyte antigen (HLA) class-II mismatched hematopoietic cell transplantation (HCT) with an incidence of grade III-IV acute graft-versus-host disease (GVHD) less than 40%.
SECONDARY OBJECTIVES:
I. Incidence of graft rejection.
II. Number of days of steroids >= 1mg/kg required before day 100 in each patient.
III. Incidence of non-relapse mortality.
IV. Risk/incidence of infections.
V. Immune reconstitution.
VI. Risk for disease progression and relapse.
OUTLINE: This is a dose-escalation study of alemtuzumab.
NONMYELOABLATIVE CONDITIONING REGIMEN: Patients receive alemtuzumab intravenously (IV) over 6 hours once daily on days -6, -5, and -4 OR days -5 and -4 and fludarabine phosphate IV over 30 minutes on days -4, -3, and -2. Patients also undergo low-dose total-body irradiation (TBI) on day 0.
ALLOGENEIC PERIPHERAL BLOOD STEM CELL TRANSPLANTATION (PBSCT): After completion of TBI, patients undergo allogeneic PBSCT on day 0.
IMMUNOSUPPRESSION: Patients receive cyclosporine orally (PO) or IV every 12 hours on days -3 to 180 followed by a taper until day 365 in the absence of GVHD. Beginning 4-6 hours after completion of allogeneic PBSCT, patients receive mycophenolate mofetil PO every 8 hours on days 0 to 100 followed by a taper until day 156 in the absence of GVHD.
After completion of study treatment, patients are followed up periodically for 12 months, at 18 months, and then annually for 5 years.
연구 유형
등록 (실제)
단계
- 2 단계
연락처 및 위치
참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- The patient must be not eligible for conventional transplants and must have disease expected to be stable for at least 100 days without chemotherapy
Patients with hematologic malignancies treatable with HCT will be included:
- Aggressive non-Hodgkin lymphomas (NHLs) and other histologies such as diffuse large B-cell NHL: not eligible for autologous HCT, not eligible for conventional myeloablative HCT, or after failed autologous HCT;
- Low grade NHL: with < 6 month duration of complete response (CR) between courses of conventional therapy;
- Mantle cell NHL: may be treated in first CR;
- Chronic lymphocytic leukemia (CLL): must have failed 2 lines of conventional therapy and must be refractory to fludarabine; this includes patients who fail to have a complete or partial response after therapy with a regimen containing fludarabine (or another nucleoside analog] or experience disease relapse within 12 months after completing therapy with a regimen containing fludarabine [or another nucleoside analog);
- Hodgkin's disease (HD): must have received and failed frontline therapy and have failed or were not eligible for autologous transplant;
- Multiple myeloma (MM): must have received prior chemotherapy or failed autografting; following a planned autologous transplant [tandem] is allowed;
- Acute myeloid leukemia (AML): must have < 5% marrow blasts at the time of transplant;
- Acute lymphocytic leukemia (ALL): must have < 5% marrow blasts at the time of transplant;
- Chronic myelogenous leukemia (CML): patients will be accepted beyond first clinical progression (CP1) if they have received previous myelosuppressive chemotherapy or HCT, and have < 5% marrow blasts at time of transplant;
- Myelodysplastic syndrome/myeloproliferative disease (MDS/MPD): must have failed previous myelosuppressive chemotherapy or HCT, and have < 5% marrow blasts at time of transplant;
- Waldenstrom's macroglobulinemia: must have failed 2 courses of therapy
- Patient refuses to be treated on a conventional transplant protocol; for this inclusion criteria, transplants must be approved by both the participating institution's patient review committee, such as the Patient Care Conference (PCC) at the Fred Hutchinson Cancer Research Center (FHCRC), and the FHCRC principal investigator
Patient with related or unrelated donors for whom:
- There is a likelihood of disease progression while HLA typing and results of a preliminary search and the donor pool suggest that a 10/10 HLA-A, B, C, DRB1 and DQB1 matched unrelated donor will not be found;
- Patient and donor must be matched for at least one DRB1 allele and one DQB1 allele;
- Best available matches are HLA class I HLA-A, -B, -C allele matched donors allowing for any one or two DRB1 and/or DQB1 antigen/allele mismatch;
- There is no indication for an autologous transplantation as a treatment option
- DONOR: For HLA matching inclusion criteria, see patient inclusion criteria
- DONOR: Only peripheral blood stem cells (PBSC) will be permitted as a HSC source on this protocol
Exclusion Criteria:
- Positive crossmatch between donor and recipients
- Patient's life expectancy is severely limited by diseases other than malignancy
- Patient has central nervous system (CNS) involvement with disease refractory to intrathecal chemotherapy
- Presence of circulating leukemic blasts (in the peripheral blood) detected by standard pathology for patients with AML, ALL or CML
- Patient is a fertile man or woman unwilling to use contraceptives during and for up to 12 months post treatment
- Patient is a female who is pregnant or breastfeeding
- Patient is human immunodeficiency virus (HIV) positive
- Patients with active non-hematologic malignancies (except non-melanoma skin cancers)
- Patients with a history of non-hematologic malignancies (except non-melanoma skin cancers) currently in a complete remission, who are less than 5 years from the time of complete remission, and have a > 20% risk of disease recurrence
- Patient has a fungal infection with radiological progression after receipt of amphotericin B or active triazole for greater than 1 month
Patient has the following organ dysfunction:
- Symptomatic coronary artery disease or ejection fraction < 35% or other cardiac failure requiring therapy; ejection fraction is required if age > 50 years or if the patient has a history of anthracyclines or history of cardiac disease;
- Diffusion capacity of the lung for carbon monoxide (DLCO) < 35% total lung capacity (TLC) < 35%, forced expiratory volume of the lung in one second (FEV1) < 35% and/or receiving supplementary continuous oxygen; the FHCRC study principal investigator (PI) must approve enrollment of all patients with pulmonary nodules;
- Liver function abnormalities: patient with clinical or laboratory evidence of liver disease will be evaluated for the cause of liver disease, its clinical severity in terms of liver function, bridging fibrosis, and the degree of portal hypertension; the patient will be excluded if he/she is found to have fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin > 3mg/dL, or symptomatic biliary disease
- Patient has poorly controlled hypertension and on multiple antihypertensives
- Karnofsky performance score < 70 for adult patients
- Lansky play-performance score < 70 for pediatric patients
- Patient received cytotoxic agents for "cytoreduction" within three weeks (or the interval in which a cycle of standard chemotherapy would be administered in a non-transplant setting) prior to initiating the nonmyeloablative transplant conditioning; (exceptions are hydroxyurea and imatinib mesylate)
- DONOR: Marrow donors
- DONOR: Positive crossmatch between donor and recipient
- DONOR: Donor is HIV-positive and/or has a medical condition that would result in increased risk for filgrastim (G-CSF) mobilization and harvest of PBSC
- DONOR: Donor age < 12 years
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
---|---|
실험적: Treatment (chemotherapy, TBI, transplant)
NONMYELOABLATIVE CONDITIONING REGIMEN: Patients receive alemtuzumab IV over 6 hours once daily on days -6, -5, and -4 OR days -5 and -4 and fludarabine phosphate IV over 30 minutes on days -4, -3, and -2. Patients also undergo low-dose TBI on day 0. ALLOGENEIC PBSCT: After completion of TBI, patients undergo allogeneic PBSCT on day 0. IMMUNOSUPPRESSION: Patients receive cyclosporine PO or IV every 12 hours on days -3 to 180 followed by a taper until day 365 in the absence of GVHD. Beginning 4-6 hours after completion of allogeneic PBSCT, patients receive mycophenolate mofetil PO every 8 hours on days 0 to 100 followed by a taper until day 156 in the absence of GVHD. |
상관 연구
주어진 IV
다른 이름들:
PBSCT 받기
다른 이름들:
주어진 PO
다른 이름들:
주어진 IV
다른 이름들:
저용량 TBI를 받다
다른 이름들:
주어진 PO 또는 IV
다른 이름들:
동종 줄기세포 이식을 받다
Undergo GVHD prophylaxis/therapy
다른 이름들:
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
---|---|---|
Incidence of Grade III-IV Acute GVHD
기간: 100 days after transplant
|
Severity of Individual Organ Involvement Liver: Stage 2 - bilirubin (3-5.9mg/100ml) Stage 3 - bilirubin (6-14.9mg/100ml) Stage 4 - bilirubin > 15mg/100ml Gut: Diarrhea is graded stage 1 to stage 4 in severity. Nausea and vomiting and/or anorexia caused by GVHD is assigned as stage 1 in severity. The severity of gut involvement is assigned to the most severe involvement noted. Patients with visible bloody diarrhea are at least stage 2 gut and grade 3 overall Severity of GVHD Grade III - Stage 2 to 4 gastrointestinal involvement and/or Stage 2 to 4 liver involvement with or without a rash Grade IV - Pattern and severity of GVHD similar to grade 3 with extreme constitutional symptoms or death |
100 days after transplant
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
---|---|---|
Incidence of Graft Rejection
기간: 84 days after transplant
|
Percentage patients that experienced graft rejection.
|
84 days after transplant
|
Incidence of High-dose Corticosteroid Utilization.
기간: 100 days after transplant
|
Percentage patients requiring steroids greater than 1 mg/kg.
|
100 days after transplant
|
Incidence of Non-relapse Mortality
기간: 100 days after transplant
|
Percentage patient deaths due to non-relapse mortality
|
100 days after transplant
|
Incidence of Infection
기간: Up to 5 years post-transplant
|
Percentage patients that experienced infection(s).
|
Up to 5 years post-transplant
|
Immune Reconstitution
기간: Up to 1 year post-transplant
|
The outcome of immune reconstitution was not analyzed by the collaborating laboratory because only a small number of patients were only enrolled in Dose Level 1 (no alemtuzumab).
The Dose Level 1 patients were going to be the baseline for which to compare the other patients on Dose Level 2 (and 3) who would have received alemtuzumab.
The collaborating investigator determined that the study was not worthwhile performing based on this information.
|
Up to 1 year post-transplant
|
Disease Progression/Relapse
기간: Up to 5 years
|
CML New cytogenetic abnormality and/or development of accelerated phase or blast crisis. The criteria for accelerated phase will be defined as unexplained fever greater than 38.3°C, new clonal cytogenetic abnormalities in addition to a single Ph-positive chromosome, marrow blasts and promyelocytes >20%. AML, ALL >5% marrow blasts by morphologic or flow cytometric, or appearance of extramedullary disease. CLL ≥1 of: Physical exam/Imaging studies (nodes, liver, and/or spleen) ≥50% increase or new, circulating lymphocytes by morphology and/or flow cytometry ≥50% increase, and lymph node biopsy w/ Richter's transformation. NHL >25% increase in the sum of the products of the perpendicular diameters of marker lesions, or the appearance of new lesions. MM ≥100% increase of the serum myeloma protein from its lowest level, or reappearance of myeloma peaks that had disappeared w/ treatment; or definite increase in the size or number of plasmacytomas or lytic bone lesions. |
Up to 5 years
|
공동 작업자 및 조사자
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
- 병리학적 과정
- 심혈관 질환
- 혈관 질환
- 바이러스 질환
- 감염
- 면역계 질환
- 신생물, 결합 및 연조직
- 조직학적 유형에 따른 신생물
- 신생물
- 림프 증식 장애
- 림프계 질환
- 면역증식성 장애
- 부위별 신생물
- 질병 속성
- 질병
- 골수 질환
- 혈액 질환
- 출혈성 장애
- 지혈 장애
- 파라단백혈증
- 혈액 단백질 장애
- DNA 바이러스 감염
- 세균 감염 및 진균증
- 종양 바이러스 감염
- 신생물, 형질세포
- 전암 상태
- 엡스타인-바 바이러스 감염
- 헤르페스바이러스과 감염
- 백혈병, B세포
- 신생물, 결합 조직
- 눈 신생물
- 림프절 병증
- 비만세포증, 전신
- 비만세포증
- 림프종
- 림프종, 여포성
- 림프종, B세포
- 림프종, 대형 B세포, 미만성
- 증후군
- 골수이형성 증후군
- 다발성 골수종
- 백혈병
- 백혈병, 골수성
- 백혈병, 골수성, 급성
- 호지킨병
- 회귀
- 림프종, 비호지킨
- 전백혈병
- 백혈병, Myelomonocytic, 급성
- 백혈병, 골수단구구성, 만성
- 백혈병, Myelomonocytic, 청소년
- 진균증
- 버킷 림프종
- 림프종, 외투세포
- 림프종, B세포, 변연부
- 전구 세포 림프구성 백혈병-림프종
- 림프종, 대세포, 면역모세포성
- 형질모세포성 림프종
- 발덴스트롬 마크로글로불린혈증
- 백혈병, 림프구성, 만성, B세포
- 백혈병, 림프
- 림프종, T 세포
- 림프종, T 세포, 말초
- 백혈병, 골수성, 만성, BCR-ABL 양성
- 백혈병, 골수성, 만성기
- 림프종, T 세포, 피부
- 백혈병, T 세포
- 백혈병-림프종, 성인 T 세포
- 균상 식육종
- 시자리 증후군
- 림프종, 대세포, 역형성
- 림프종양 육아종증
- 림프종, 결절외 NK-T 세포
- 안내 림프종
- 면역모세포성 림프절병증
- 골수증식성 장애
- 골수이형성-골수증식성 질환
- 백혈병, 털이 많은 세포
- 백혈병, 골수성, 만성, 비정형, BCR-ABL 음성
- 백혈병, 비만 세포
- 약물의 생리적 효과
- 약리작용의 분자기전
- 항감염제
- 효소 억제제
- 항류마티스제
- 항대사물질, 항종양
- 항대사물질
- 항종양제
- 면역억제제
- 면역학적 요인
- 피부과 약제
- 항균제
- 항생제, 항종양제
- 항진균제
- 항결핵제
- 항생제, 항결핵
- 칼시뉴린 억제제
- 항체
- 면역글로불린
- 항체, 단클론
- 항종양제, 면역학적
- 플루다라빈
- 플루다라빈 포스페이트
- 미코페놀산
- 사이클로스포린
- 사이클로스포린
- 알렘투주맙
기타 연구 ID 번호
- 1959.00 (기타 식별자: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium)
- P30CA015704 (미국 NIH 보조금/계약)
- NCI-2009-01496 (레지스트리 식별자: CTRP (Clinical Trial Reporting Program))
- P01CA018029 (미국 NIH 보조금/계약)
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
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