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- Klinische proef NCT00134004
Fludarabine, Cyclophosphamide, and Total-Body Irradiation in Treating Patients Who Are Undergoing a Donor Bone Marrow Transplant for Hematologic Cancer
A Phase II Trial of Non-Myeloablative Conditioning and Transplantation of Partially HLA-Mismatched Bone Marrow for Patients With Hematologic Malignancies
RATIONALE: Giving low doses of chemotherapy, such as fludarabine and cyclophosphamide, and radiation therapy before a donor bone marrow transplant helps stop the growth of cancer cells. Giving chemotherapy or radiation therapy before or after transplant also stops the patient's immune system from rejecting the donor's bone marrow stem cells. The donated stem cells may replace the patient's immune system cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving tacrolimus and mycophenolate mofetil after the transplant may stop this from happening.
PURPOSE: This phase II trial is studying how well giving fludarabine and cyclophosphamide together with total-body irradiation works in treating patients who are undergoing a donor bone marrow transplant for hematologic cancer.
Studie Overzicht
Toestand
Conditie
Gedetailleerde beschrijving
OBJECTIVES:
- Determine transplant-related mortality, risk of relapse, and progression-free survival of patients with standard- or high-risk hematologic malignancies undergoing nonmyeloablative conditioning comprising fludarabine, cyclophosphamide, and total-body irradiation followed by HLA-haploidentical allogeneic bone marrow transplantation.
- Determine donor hematopoietic chimerism in patients' peripheral blood at 30, 60, and 180 days after transplantation.
- Determine hematologic and nonhematologic toxic effects of this regimen in these patients.
- Determine, when feasible, surface expression of HLA molecules and death receptors, sensitivity to cytotoxic lymphocytes, and expression of anti-apoptotic genes (e.g., Bcl-2, Bcl-xL, X-IAP, and c-FLIP) in cancer cells from patients who relapse after treatment with this regimen.
OUTLINE: This is a multicenter study. Patients are stratified according to risk of relapse (standard [defined as ≤ 30% risk] vs high [defined as ≥ 70% risk]).
- Nonmyeloablative conditioning regimen: Patients receive fludarabine IV over 30 minutes on days -6 to -2 and cyclophosphamide IV over 1-2 hours on days -6 and -5. Patients undergo total body irradiation on day -1.
- Allogeneic bone marrow transplantation: Patients undergo donor bone marrow infusion on day 0.
- Post-transplantation therapy: Patients receive cyclophosphamide IV over 1-2 hours on days 3 and 4.
- Graft-vs-host disease prophylaxis: Beginning on day 5, patients receive oral mycophenolate mofetil 3 times daily until day 35 and tacrolimus IV (then changing to orally) twice daily until day 180.
Treatment continues in the absence of disease progression.
After completion of study transplantation, patients are followed on days 30, 60, 100, and 180; at 1 year; and then annually for 4 additional years.
PROJECTED ACCRUAL: A total of 75-100 patients will be accrued for this study within 3-4 years.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 2
Contacten en locaties
Studie Locaties
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Georgia
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Atlanta, Georgia, Verenigde Staten, 30342
- Blood and Marrow Transplant Program at Northside Hospital
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Maryland
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Baltimore, Maryland, Verenigde Staten, 21231-2410
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Pennsylvania
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Philadelphia, Pennsylvania, Verenigde Staten, 19102-1192
- Hahnemann University Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
DISEASE CHARACTERISTICS:
Diagnosis of 1 of the following hematologic malignancies:
Acute leukemia
- In second or subsequent complete remission (CR), as defined by absence of abnormal blast population by flow cytometry
In first CR with any of the following poor-risk cytogenetic features:
- Alteration of chromosome 5 or 7
- Multiple abnormalities
- Philadelphia chromosome positive
Chronic phase chronic myelogenous leukemia (CML)
- In first chronic phase and refractory to interferon alfa or imatinib mesylate
- In second or subsequent chronic phase
Chronic lymphocytic leukemia, meeting 1 of the following criteria:
- Received prior chemotherapy with a nucleoside analog and had remission lasting < 6 months
Received 1 prior therapy and has any of the following high-risk features:
- Cytogenetic abnormalities of 17p, 11q
- Mutations of the Zap70 gene
- Somatically unmutated immunoglobulin heavy chain variable region genes
Hodgkin's lymphoma
Ineligible for autologous stem cell transplantation (SCT) due to any of the following exclusion factors:
- LVEF < 45%
- FEV_1 or FVC < 50% of predicted (75% of predicted in patients with prior thoracic or mantle radiotherapy)
- Total bilirubin > 2.0 mg/dL (unless documented Gilbert's disease)
- Creatinine > 2.0 mg/dL
Non-Hodgkin's lymphoma (NHL)
- Low-grade NHL allowed provided patient had a remission duration of < 1 year after administration of any established, multi-agent chemotherapy regimen (e.g., CVP, CHOP, or rituximab in combination with CHOP)
- Intermediate- or high-grade NHL allowed provided patient is ineligible for autologous SCT according to the criteria listed above
- Multiple myeloma
- Myelodysplastic syndromes
- Paroxysmal nocturnal hemoglobinuria
Chronic myeloproliferative disorders other than CML, including any of the following:
- Chronic myelomonocytic leukemia
- Agnogenic myeloid metaplasia (or myeloid metaplasia with myelofibrosis), with hemoglobin < 10 g/dL OR WBC < 4,000/mm^3 or > 30,000/mm^3
Polycythemia vera or essential thrombocythemia in "spent" phase, with a history of 2 of the following:
- Marrow fibrosis
- Splenomegaly
- Cytopenia (i.e., absolute neutrophil count < 1,500/mm^3, platelet count < 100,000/mm^3, hemoglobin < 10 g/dL)
- Polycythemia vera or essential thrombocythemia with transformation to myelodysplastic syndromes or acute myeloid leukemia (requires treatment to achieve < 20% blasts in marrow)
- No smoldering myeloma
- Patients with acute myeloid leukemia or myelodysplastic syndromes must have had comprehensive cytogenetic evaluation of bone marrow specimen during active disease
- Ineligible for or refused bone marrow transplantation from an HLA-matched sibling or unrelated donor
- Ineligible for or refused autologous SCT
Must have an HLA mismatched (i.e., 3/6, 4/6, or 5/6) related (first-degree relative)* donor available
- Donor ≥ 18 years of age NOTE: *Patients with an inherited recombinant HLA haplotype may receive marrow from the parent in whose gamete the recombination occurred
NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.
PATIENT CHARACTERISTICS:
Age
- 6 months to 74 years
Performance status
- ECOG 0-1
Life expectancy
- Not specified
Hematopoietic
- See Disease Characteristics
Hepatic
- See Disease Characteristics
- Bilirubin < 3.1 mg/dL
Renal
- See Disease Characteristics
Cardiovascular
- See Disease Characteristics
- LVEF ≥ 35%
Pulmonary
- See Disease Characteristics
- FEV_1 or FVC ≥ 40% of predicted in patients without prior thoracic or mantle radiotherapy (60% of predicted in patients with prior thoracic or mantle radiotherapy)
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- HIV negative
- Geographically accessible
- No debilitating medical or psychiatric illness that would preclude giving informed consent or receiving optimal treatment or follow-up
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- No prior transfusions from donor
Chemotherapy
- See Disease Characteristics
Endocrine therapy
- Not specified
Radiotherapy
- See Disease Characteristics
Surgery
- Not specified
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: Mini-haplo Transplant
Non-myeloablative haploidentical bone marrow transplant with a fludarabine, cyclophosphamide (Cy), TBI (total body irradiation) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Transplant-related Mortality
Tijdsspanne: Cumulative incidence for the entire study, up to 11 years
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Percentage of participants who die for any reason other than recurrence of disease.
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Cumulative incidence for the entire study, up to 11 years
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Relapse Rate
Tijdsspanne: Cumulative incidence for the entire study, up to 11 years
|
Percentage of participants who experience disease relapse.
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Cumulative incidence for the entire study, up to 11 years
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Progression-free Survival
Tijdsspanne: 2 years
|
Percentage of participants who do not experience disease relapse, disease progression, or death.
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2 years
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Graft Failure Rate
Tijdsspanne: Cumulative incidence for the entire study, up to 11 years
|
Percentage of participants who experienced failure to engraft (also called graft failure or graft rejection).
Failure to engraft is defined as <5% donor chimerism and absence of relapse or any other reason for that chimerism value.
All participants who met this criterion were included in this outcome measure.
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Cumulative incidence for the entire study, up to 11 years
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Hematologic and Non-hematologic Toxicities as Measured by NCI Common Toxicity Criteria for Adverse Events, v 3.0 Weekly Until 1 Year After Transplantation
Tijdsspanne: 1 year
|
Percentage of study participants who experienced a serious adverse event (SAE) within 1 year of bone marrow transplant.
Complete data is provided in the Adverse Event tables.
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1 year
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Medewerkers en onderzoekers
Medewerkers
Onderzoekers
- Studie stoel: Ephraim J. Fuchs, MD, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
- stadium III volwassen diffuus grootcellig lymfoom
- stadium III volwassen immunoblastisch grootcellig lymfoom
- stadium III volwassen Burkitt-lymfoom
- stadium IV graad 3 folliculair lymfoom
- stadium IV volwassen diffuus grootcellig lymfoom
- stadium IV volwassen immunoblastisch grootcellig lymfoom
- stadium IV volwassen Burkitt-lymfoom
- recidiverend graad 3 folliculair lymfoom
- recidiverend diffuus grootcellig lymfoom bij volwassenen
- recidiverend volwassen immunoblastisch grootcellig lymfoom
- recidiverend volwassen Burkitt-lymfoom
- terugkerend klein niet-gesplitst cellymfoom in de kindertijd
- recidiverend grootcellig lymfoom bij kinderen
- chronische myelomonocytaire leukemie
- de novo myelodysplastische syndromen
- eerder behandelde myelodysplastische syndromen
- secundaire myelodysplastische syndromen
- volwassen acute myeloïde leukemie met 11q23 (MLL) afwijkingen
- volwassen acute myeloïde leukemie met inv(16)(p13;q22)
- volwassen acute myeloïde leukemie met t(15;17)(q22;q12)
- volwassen acute myeloïde leukemie met t(16;16)(p13;q22)
- volwassen acute myeloïde leukemie met t(8;21)(q22;q22)
- acute lymfatische leukemie bij kinderen in remissie
- acute myeloïde leukemie bij kinderen in remissie
- chronische fase chronische myeloïde leukemie
- chronische myeloïde leukemie bij kinderen
- myelodysplastische syndromen bij kinderen
- volwassen acute myeloïde leukemie in remissie
- recidiverend volwassen Hodgkin-lymfoom
- recidiverend/refractair Hodgkin-lymfoom bij kinderen
- recidiverend diffuus kleincellig lymfoom bij volwassenen
- recidiverend diffuus gemengd cellymfoom bij volwassenen
- recidiverende chronische myeloïde leukemie
- stadium III graad 1 folliculair lymfoom
- stadium III graad 2 folliculair lymfoom
- stadium III graad 3 folliculair lymfoom
- stadium III diffuus kleincellig lymfoom bij volwassenen
- stadium III volwassen diffuus gemengd cellymfoom
- stadium IV graad 1 folliculair lymfoom
- stadium IV graad 2 folliculair lymfoom
- stadium IV volwassen diffuus klein-gesplitst cellymfoom
- stadium IV volwassen diffuus gemengd cellymfoom
- stadium III mantelcellymfoom
- stadium IV mantelcellymfoom
- stadium II multipel myeloom
- stadium III multipel myeloom
- recidiverend graad 1 folliculair lymfoom
- recidiverend graad 2 folliculair lymfoom
- niet-aangrenzend stadium II graad 1 folliculair lymfoom
- niet-aangrenzend stadium II graad 2 folliculair lymfoom
- niet-aaneengesloten stadium II diffuus kleincellig lymfoom bij volwassenen
- niet-aangrenzend stadium II klein lymfocytisch lymfoom
- niet-aaneengesloten stadium II marginale zone lymfoom
- recidiverend marginale zone-lymfoom
- terugkerend klein lymfocytisch lymfoom
- stadium III klein lymfocytisch lymfoom
- stadium III marginale zone lymfoom
- stadium IV klein lymfocytisch lymfoom
- stadium IV marginale zone lymfoom
- extranodale marginale zone B-cellymfoom van mucosa-geassocieerd lymfoïde weefsel
- nodale marginale zone B-cellymfoom
- milt marginale zone lymfoom
- stadium I multipel myeloom
- recidiverend volwassen lymfoblastisch lymfoom
- terugkerend mantelcellymfoom
- refractaire chronische lymfatische leukemie
- stadium III volwassen Hodgkin-lymfoom
- stadium IV volwassen Hodgkin-lymfoom
- stadium III volwassen lymfoblastisch lymfoom
- stadium IV volwassen lymfoblastisch lymfoom
- refractair multipel myeloom
- polycytemie Vera
- essentiële trombocytose
- niet-aaneengesloten stadium II mantelcellymfoom
- niet-aaneengesloten stadium II volwassen diffuus grootcellig lymfoom
- niet-aangrenzend stadium II volwassen diffuus gemengd cellymfoom
- niet-aaneengesloten stadium II volwassen lymfoblastisch lymfoom
- niet-aangrenzend stadium II graad 3 folliculair lymfoom
- volwassen acute lymfatische leukemie in remissie
- niet-aaneengesloten stadium II volwassen Burkitt-lymfoom
- niet-aaneengesloten stadium II volwassen immunoblastisch grootcellig lymfoom
- terugkerend lymfoblastisch lymfoom bij kinderen
- chronische idiopathische myelofibrose
Aanvullende relevante MeSH-voorwaarden
- Pathologische processen
- Hart-en vaatziekten
- Vaatziekten
- Ziekten van het immuunsysteem
- Neoplasmata per histologisch type
- Neoplasmata
- Lymfoproliferatieve aandoeningen
- Lymfatische ziekten
- Immunoproliferatieve aandoeningen
- Ziekte
- Beenmergziekten
- Hematologische ziekten
- Hemorragische aandoeningen
- Hemostatische aandoeningen
- Paraproteïnemieën
- Bloed eiwit stoornissen
- Voorstadia van kanker
- Lymfoom
- Syndroom
- Myelodysplastische syndromen
- Multipel myeloom
- Neoplasmata, plasmacel
- Leukemie
- Preleukemie
- Plasmacytoom
- Myeloproliferatieve aandoeningen
- Fysiologische effecten van medicijnen
- Moleculaire mechanismen van farmacologische werking
- Anti-infectieuze middelen
- Enzymremmers
- Antireumatische middelen
- Antimetabolieten, antineoplastische
- Antimetabolieten
- Antineoplastische middelen
- Immunosuppressieve middelen
- Immunologische factoren
- Antineoplastische middelen, alkylering
- Alkyleringsmiddelen
- Myeloablatieve agonisten
- Antibacteriële middelen
- Antibiotica, antineoplastiek
- Antituberculeuze middelen
- Antibiotica, antituberculair
- Calcineurineremmers
- Cyclofosfamide
- Fludarabine
- Fludarabine-fosfaat
- Tacrolimus
- Mycofenolzuur
Andere studie-ID-nummers
- J0457 CDR0000440990
- P30CA006973 (Subsidie/contract van de Amerikaanse NIH)
- P01CA015396 (Subsidie/contract van de Amerikaanse NIH)
- JHOC-J0457 (Andere identificatie: Johns Hopkins SKCCC)
- JHOC-04072704
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