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A Pilot Study of Unrelated Umbilical Cord Blood Transplantation in Patients With Severe Aplastic Anemia, Inborn Errors in Metabolism, or Inherited Hematologic Stem Cell Disorders


Phase 2
N/A
55 Years
Not Enrolling
Both
Leukemia, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases

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Trial Information

A Pilot Study of Unrelated Umbilical Cord Blood Transplantation in Patients With Severe Aplastic Anemia, Inborn Errors in Metabolism, or Inherited Hematologic Stem Cell Disorders


OBJECTIVES:

- Determine the rates of durable engraftment in patients with severe aplastic anemia,
myelodysplastic syndrome, inborn errors of metabolism, or inherited hematopoietic
disorders, refractory to medical management, who are undergoing high-dose
chemoradiotherapy followed by unrelated cord blood (UCB) transplantation.

- Evaluate the rate and quality of immunologic reconstitution in this patient population.

OUTLINE: Patients are stratified according to weight (under 45 kg vs over 45 kg).

Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen
beginning 6-9 days before the umbilical cord blood transplant (UCBT). The regimen varies
according to the underlying cause of the anemia, but could include busulfan,
cyclophosphamide or melphalan, anti-thymocyte globulin or methylprednisolone, and/or
radiation therapy. One day after the conditioning regimen is completed, patients receive the
UCBT.

Patients are followed weekly for 3 months, at 6 months, then every 6 months for 2.5 years,
then annually thereafter.

PROJECTED ACCRUAL: A total of 4-90 patients will be accrued for this study within 5 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed diagnosis of severe aplastic anemia based on bone marrow
cellularity of less than 20%

- Must meet at least two of the following criteria:

- Granulocyte count less than 500/mm^3

- Platelet count less than 20,000/mm^3

- Reticulocyte count less than 50,000/mm^3

- Following etiologies eligible:

- Fanconi's anemia

- Hypoplastic leukemia

- Monosomy 7

- Drug exposure (chloramphenicol, NSAIDS)

- Viral exposure (EBV, hepatitis, parvovirus, HIV)

- Nutritional deficiencies

- Thymoma

- Paroxysmal nocturnal hemoglobinuria

- Amegakaryocytic thrombocytopenia OR

- Histologically confirmed myelodysplastic syndrome (MDS) that is refractory to medical
management or with cytogenic abnormalities predictive of transformation into acute
leukemia, including 5q-, 7q-, monosomy 7, or trisomy 8

- The following etiologies only are eligible:

- Refractory anemia

- Refractory anemia with ringed sideroblasts

- De novo primary MDS

- Therapy-related secondary MDS OR

- Confirmed diagnosis of inherited hematopoietic disorder that is refractory to medical
management

- Following etiologies eligible:

- Severe combined immunodeficiency

- Familial erythrophagocytic lymphohistiocytosis

- Wiskott-Aldrich syndrome

- Kostmann's syndrome (infantile histiocytosis)

- Chronic granulomatous disease

- Leukocytic adhesion deficiency

- Chediak-Higashi syndrome

- Paroxysmal nocturnal hemoglobinuria

- Fanconi's anemia

- Dyskeratosis congenita

- Diamond-Blackfan anemia

- Amegakaryocytic thrombocytopenia

- Osteopetrosis

- Gaucher's disease

- Lesch-Nyhan syndrome

- Mucopolysaccharidoses

- Lipodoses

- Autologous or haploidentical related peripheral blood stem cells available as backup

- Serologically matched umbilical cord blood unit available in the New York Blood
Center's Placental Blood Project, or other acceptable umbilical cord blood registry

PATIENT CHARACTERISTICS:

Age:

- 55 and under

Performance status:

- Zubrod 0-1

- Karnofsky 80-100%

Life expectancy:

- At least 3 months

Hematopoietic:

- See Disease Characteristics

Hepatic:

- ALT/AST no greater than 4 times normal

- Bilirubin no greater than 2.0 mg/dL

Renal:

- Creatinine no greater than 2.0 mg/dL

- Creatinine clearance at least 50 mL/min

Cardiovascular:

- Normal cardiac function by echocardiogram or radionuclide scan

- Shortening fraction or ejection fraction at least 80% normal for age

- Non-Fanconi patients with acquired or congenital cardiomyopathy may receive melphalan
as a substitute for cyclophosphamide

Pulmonary:

- FVC and FEV_1 at least 60% of predicted for age

- DLCO at least 60% of predicted in adult patients

Other:

- No active concurrent malignancy

- No active infection

- Not pregnant or nursing

- HIV negative

- Must have an available serologic matched Umbilical Cord Blood Unit (UCBU) in the New
York Blood Center's Placental Blood Project, or other acceptable Umbilical Cord Blood
(UCB) registry

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No concurrent cytotoxic chemotherapy

Endocrine therapy:

- No concurrent immunosuppressive medications

Radiotherapy:

- No concurrent radiotherapy

Surgery:

- Not specified

Type of Study:

Interventional

Study Design:

Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Event-free survival by disease assessment

Outcome Time Frame:

at 100 days and at 6, 9, 12, 18, and 24 months

Safety Issue:

No

Principal Investigator

Mary J. Laughlin, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center

Authority:

United States: Federal Government

Study ID:

CWRU5Y97

NCT ID:

NCT00003336

Start Date:

January 1998

Completion Date:

February 2006

Related Keywords:

  • Leukemia
  • Myelodysplastic Syndromes
  • Myelodysplastic/Myeloproliferative Diseases
  • refractory anemia
  • refractory anemia with ringed sideroblasts
  • de novo myelodysplastic syndromes
  • previously treated myelodysplastic syndromes
  • secondary myelodysplastic syndromes
  • atypical chronic myeloid leukemia
  • myelodysplastic/myeloproliferative disease, unclassifiable
  • childhood myelodysplastic syndromes
  • Leukemia
  • Myelodysplastic Syndromes
  • Preleukemia
  • Myeloproliferative Disorders
  • Myelodysplastic-Myeloproliferative Diseases

Name

Location

Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065