Donor Peripheral Stem Cell Transplant, Fludarabine, and Busulfan in Treating Patients With Hematologic Cancers
Reduced Intensity Stem Cell Transplantation (RIST) for Patients With Hematological Malignancies Conditioned With Fludarabine and Busulfan
Giving chemotherapy drugs, such as fludarabine and busulfan, before a donor peripheral stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune 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 cyclosporine and mycophenolate mofetil before and after the transplant may stop this from happening.
PURPOSE: This phase II trial is studying the side effects of giving donor peripheral stem cell transplant together with fludarabine and busulfan and to see how well it works in treating patients with hematologic cancers.
研究概览
地位
详细说明
OUTLINE:
- Conditioning regimen: Patients receive busulfan IV over 3 hours on days -6 and -5 and fludarabine phosphate IV over 30 minutes on days -6 to -2.
- Allogeneic peripheral blood stem cell transplant (PBSC): Patients undergo allogeneic PBSC on day 0.
- Immunosuppressive therapy/graft-versus-host disease (GVHD) prophylaxis: Patients achieve100% donor T-cell chimerism on day 30 without disease recurrence, and cyclosporine A (CSA) IV continuously over 24 hours or orally every 12 hours on days -1 to 60 followed by a taper until day 100 and oral mycophenolate mofetil (MMF) once every 12 hours on days 1-40, in the absence of ≥ grade 2 GVHD.
Patients with recurrent disease or < 100% donor T-cell chimerism (on day 30) undergo a 12-day CSA and MMF taper followed by escalating doses of previously collected donor leukocyte infusion every 4 weeks until 100% donor T-cell chimerism or disease regression, in the absence of ≥ grade 2 GVHD.
After completion of study treatment, patients are followed periodically.
研究类型
注册 (实际的)
阶段
- 阶段2
联系人和位置
学习地点
-
-
California
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Sacramento、California、美国、95817
- University of California Davis Cancer Center
-
-
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
DISEASE CHARACTERISTICS:
Diagnosed with any of the following:
Acute myeloid leukemia (AML), meeting 1 of the following criteria:
- Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
- In first complete remission (CR1) with poor-risk cytogenetics, antecedent hematological disease (i.e., myelodysplasia), or treatment-related leukemia
Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria:
- Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
- CR1 with Philadelphia chromosome or poor-risk cytogenetics
Chronic myelogenous leukemia (CML), meeting the following criteria:
First or second chronic phase
- Must be documented disease progression after imatinib mesylate therapy OR documented lack of cytogenetic response 6 months post-imatinib mesylate initiation OR imatinib mesylate intolerance
Chronic lymphocytic leukemia (CLL), meeting the following criteria:
Recurrent disease after fludarabine-based therapy
- Must have chemosensitive disease at the time of relapse, defined as greater than 50% reduction of WBC and lymphadenopathy
Recurrent Hodgkin lymphoma, recurrent non-Hodgkin lymphoma (NHL) (low-, intermediate-, or high-grade disease*), or transformed NHL, meeting 1 of the following criteria:
- Received prior autologous transplantation and cytoreductive therapy at the time of relapse to achieve complete remission (CR) or CR/unconfirmed (CRu) as defined by the International Workshop
- Relapsed disease that required more than 2 salvage regimens to achieve CR or CRu
Recurrent multiple myeloma, meeting the following criteria:
- Must have received prior autologous transplantation and demonstrate chemosensitivity at the time of relapse, defined as greater than 50% reduction of M-component or plasma-cell marrow infiltration
Myelodysplastic syndrome
Refractory anemia (RA)/RA with ringed sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD)/refractory cytopenia with multilineage dysplasia with ringed sideroblasts (RCMD-RS), or RA with excess blasts (RAEB) I, meeting the following criteria:
- Must be transfusion-dependent and have an IPSS score ≥ 1.5, based on WHO criteria
- No RAEB II or del(5q)
- No uncontrolled CNS metastases
- 5-6/6 HLA-matched sibling or 9-10/10 matched unrelated donor (both patient and donor) available
PATIENT CHARACTERISTICS:
- Karnofsky performance status ≥ 50%
- Serum creatinine ≤ 2 mg/dL
- Not pregnant
- Fertile patients must use effective contraception
50 years of age or older
Patients 18-50 years of age are eligible if meeting 1 of the following criteria:
- Have a preexisting medical condition
- Received prior therapy (i.e., autologous transplantation) and are considered to be too high risk for conventional myeloablative transplantation
- Must be willing to accept or comprehend irreversible sterility as a side effect of therapy
- No uncontrolled active infection
- No psychiatric illness or mental deficiency making compliance with treatment or informed consent impossible
- Cardiac ejection fraction ≥ 30%
- Corrected pulmonary-diffusing capacity ≥ 35%
- No serologic evidence of infection with HIV
- No decompensated liver disease with serum bilirubin > 2.0 mg/dL
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
其他:RIST for Heme malignancies
Busulfan 3.3 mg/kg over 3 hours on day -6 and day -5 Fludarabine 30 mg/m2 IV over 30 minutes on day -6 to day -2 followed by Transplant followed by Immunosuppressive/GVHD therapy
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Number of Patients With Day 100 Transplant-related Mortality
大体时间:24 months after day 100 transplant
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Patients were followed for death and whether or not that death was attributed to the day 100 transplant via physician assessment for 24 months after day 100 transplant.
|
24 months after day 100 transplant
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Number of Patients Without Progression After Day 100 Transplant
大体时间:24 months after day 100 transplant
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All patients will be followed for progression for 24 months after their day 100 transplant.
|
24 months after day 100 transplant
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Number of Patients Alive 24 Months Post Day 100 Transplant
大体时间:24 months post day 100 transplant
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Patients will be followed for survival for 24 months post day 100 transplant.
|
24 months post day 100 transplant
|
合作者和调查者
调查人员
- 学习椅:Carol M. Richman, MD、University of California, Davis
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
- III期成人弥漫性大细胞淋巴瘤
- III期成人免疫母细胞大细胞淋巴瘤
- III期成人伯基特淋巴瘤
- IV期3级滤泡性淋巴瘤
- IV期成人弥漫性大细胞淋巴瘤
- IV期成人免疫母细胞大细胞淋巴瘤
- IV期成人Burkitt淋巴瘤
- 复发性 3 级滤泡性淋巴瘤
- 复发性成人弥漫性大细胞淋巴瘤
- 复发性成人免疫母细胞大细胞淋巴瘤
- 复发性成人伯基特淋巴瘤
- 难治性贫血
- 难治性贫血伴环状铁粒幼细胞
- 顽固性贫血伴原始细胞过多
- 新生骨髓增生异常综合征
- 既往治疗过的骨髓增生异常综合征
- 继发性骨髓增生异常综合征
- 具有 11q23 (MLL) 异常的成人急性髓性白血病
- 伴有 inv(16)(p13;q22) 的成人急性髓性白血病
- 成人急性髓性白血病伴 t(15;17)(q22;q12)
- 成人急性髓性白血病伴 t(16;16)(p13;q22)
- 成人急性髓性白血病伴 t(8;21)(q22;q22)
- 继发性急性髓性白血病
- 慢性期慢性粒细胞白血病
- 复发性成人急性髓性白血病
- 缓解期成人急性髓性白血病
- 复发性成人霍奇金淋巴瘤
- 复发性成人弥漫性小裂细胞淋巴瘤
- 复发性成人弥漫性混合细胞淋巴瘤
- 复发性慢性粒细胞白血病
- III 期 1 级滤泡性淋巴瘤
- III期2级滤泡性淋巴瘤
- III期3级滤泡性淋巴瘤
- III期成人弥漫性小裂细胞淋巴瘤
- III期成人弥漫性混合细胞淋巴瘤
- IV 期 1 级滤泡性淋巴瘤
- IV 期 2 级滤泡性淋巴瘤
- IV期成人弥漫性小裂细胞淋巴瘤
- IV期成人弥漫性混合细胞淋巴瘤
- II期多发性骨髓瘤
- III期多发性骨髓瘤
- 复发性 1 级滤泡性淋巴瘤
- 复发性 2 级滤泡性淋巴瘤
- 复发性小淋巴细胞淋巴瘤
- III期小淋巴细胞淋巴瘤
- IV期小淋巴细胞淋巴瘤
- I期多发性骨髓瘤
- 复发性成人淋巴母细胞淋巴瘤
- 难治性慢性淋巴细胞白血病
- III期慢性淋巴细胞白血病
- IV期慢性淋巴细胞白血病
- III期成人霍奇金淋巴瘤
- IV期成人霍奇金淋巴瘤
- III期成人淋巴母细胞淋巴瘤
- IV期成人淋巴母细胞淋巴瘤
- 难治性多发性骨髓瘤
- 复发性成人急性淋巴细胞白血病
- 缓解期成人急性淋巴细胞白血病
- 难治性血细胞减少伴多系发育异常
其他相关的 MeSH 术语
- 病理过程
- 心血管疾病
- 血管疾病
- 免疫系统疾病
- 组织学类型的肿瘤
- 肿瘤
- 淋巴增生性疾病
- 淋巴系统疾病
- 免疫增生性疾病
- 疾病
- 骨髓疾病
- 血液病
- 出血性疾病
- 止血障碍
- 副蛋白血症
- 血液蛋白失调
- 癌前病变
- 淋巴瘤
- 综合症
- 骨髓增生异常综合征
- 多发性骨髓瘤
- 肿瘤,浆细胞
- 白血病
- 白血病前期
- 浆细胞瘤
- 药物的生理作用
- 药理作用的分子机制
- 抗感染药
- 酶抑制剂
- 抗风湿药
- 抗代谢药、抗肿瘤药
- 抗代谢物
- 抗肿瘤药
- 免疫抑制剂
- 免疫因素
- 抗肿瘤药,烷基化
- 烷化剂
- 清髓性激动剂
- 皮肤病药物
- 抗菌剂
- 抗生素、抗肿瘤药
- 抗真菌剂
- 抗结核药
- 抗生素,抗结核药
- 神经钙蛋白抑制剂
- 氟达拉滨
- 磷酸氟达拉滨
- 麦考酚酸
- 白消安
- 环孢菌素
- 环孢菌素
其他研究编号
- UCDCC#196
- 288263 (其他标识符:UC Davis)
- UCD-196 (其他标识符:UCDCC)
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