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Purine-Analog-Containing Non-Myeloablative Allogeneic Stem Cell Transplantation for Treatment of Hematologic Malignancies and Severe Aplastic Anemia


Phase 2
N/A
70 Years
Not Enrolling
Both
Chronic Myeloproliferative Disorders, Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases, Precancerous/Nonmalignant Condition, Small Intestine Cancer

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Trial Information

Purine-Analog-Containing Non-Myeloablative Allogeneic Stem Cell Transplantation for Treatment of Hematologic Malignancies and Severe Aplastic Anemia


OBJECTIVES:

- Determine the rates of durable full donor hematologic engraftment in patients with
high-risk hematologic malignancies or severe aplastic anemia treated with
non-myeloablative conditioning using fludarabine, cyclophosphamide, and anti-thymocyte
globulin followed by allogeneic peripheral blood stem cell transplantation.

- Determine the acute and delayed toxic effects of this non-myeloablative conditioning
regimen in this patient population.

- Determine the event-free and overall survival of patients treated with this regimen.

- Determine the incidence and severity of acute and chronic graft-versus-host disease in
patients treated with this regimen.

- Determine the rate and quality of immune reconstitution in patients treated with this
regimen.

- Determine the rate of disease relapse and incidence of post-transplantation
lymphoproliferative disease in these patients.

OUTLINE: Patients are stratified according to disease category (malignant vs non-malignant)
and graft source (unrelated vs HLA-matched sibling).

Beginning at least 4 weeks after conventional-dose chemotherapy, patients receive
non-myeloablative conditioning comprising fludarabine IV over 30 minutes on days -8 to -4,
cyclophosphamide IV over 2 hours on days -3 to -2, and anti-thymocyte globulin IV over at
least 4 hours on days -2 and -1. Patients undergo filgrastim (G-CSF)-mobilized allogeneic
peripheral blood stem cell transplantation on day 0.

Patients are followed weekly for 3 months, every 2 weeks for 3 months, monthly for 6 months,
and then every 2 months thereafter.

PROJECTED ACCRUAL: A minimum of 30 patients will be accrued for this study within 4 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically proven high-risk hematologic malignancy

- Acute non-lymphocytic leukemia (ANLL) after induction failure, or in first
complete remission (CR) with high-risk features, including any of the following:

- Stem cell or biphenotypic classification (AML-M0)

- Erythroleukemia (AML-M6)

- Acute megakaryocytic leukemia (AML-M7)

- Cytogenetic markers indicative of poor prognosis

- Failure to achieve CR after standard induction therapy

- Acute lymphocytic leukemia (ALL) or ANLL in relapse or second or subsequent
remission

- Chronic myelogenous leukemia (CML) in chronic or accelerated phase

- Patients with CML in blast crisis are eligible after reinduction
chemotherapy places them in chronic phase

- High-risk ALL in first CR with high risk defined by presence of t(4;11), t(9;22)
translocation, hyperleukocytosis (initial WBC greater than 30,000/mm^3), or
failure to achieve CR by day 28 after standard induction

- No T-cell ALL or t(8;14) positive B-cell ALL in first remission with
hyperleukocytosis

- Myelodysplastic syndrome by peripheral blood smear and bone marrow examination

- Refractory to medical management OR

- Cytogenetic abnormalities predictive of transformation into acute leukemia
including 5q-, 7q-, monosomy 7, and trisomy 8 OR

- Evidence of evolution to AML (e.g., refractory anemia with excess blasts
(RAEB) or RAEB in transformation)

- Multiple myeloma, non-Hodgkin's lymphoma (NHL), ANLL, or ALL with recurrent
disease after autologous stem cell transplantation (SCT)

- At least 3 months since prior autologous SCT

- Hodgkin's lymphoma, NHL, or multiple myeloma beyond first CR or primary
induction failures whose disease has demonstrated sensitivity to
pre-transplantation cytoreduction (defined as greater than 50% reduction in
tumor burden)

- Mantle zone NHL allowed after induction therapy

- Myeloproliferative disorder that is non-responsive to medical management and
requires allografting, unless evidence of grade 3 or worse myelofibrosis on
marrow biopsy OR

- Histologically proven acquired severe aplastic anemia (SAA) that is recurrent or
unresponsive after anti-thymocyte globulin and/or cyclosporine

- SAA defined by at least 2 of the following conditions:

- Granulocyte count less than 500/mm^3

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

- Absolute reticulocyte count less than 20,000/mm^3 after correction for
hematocrit

- Ineligible for full ablative conditioning due to any of the following conditions:

- Prior extensive therapy (more than 2 salvage chemotherapy regimens and/or
autologous transplantation)

- Over age 55 OR

- Under age 55 with comorbid disease (e.g., suboptimal cardiac, pulmonary, or
renal function and/or prior life-threatening infection)

- HLA-A, B, and DR phenotypically identical sibling donor OR

- HLA-A, B, and DR identical genetically matched unrelated donor

- No ANLL in first CR (less than 5% blasts in marrow) with translocations t(8;21) and
inv(16) unless failed first-line induction therapy OR

- No ANLL in first CR (less than 5% blasts in marrow) with translocations t(15;17)
abnormality unless failed first-line induction therapy OR molecular evidence of
persistent disease

- No active CNS disease

PATIENT CHARACTERISTICS:

Age:

- 0 to 70

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:

- See Disease Characteristics

- Creatinine clearance at least 50 mL/min

Cardiovascular:

- See Disease Characteristics

- Shortening fraction or ejection fraction at least 40% of normal for age by
echocardiogram or radionuclide scan

- No clinically significant comorbid illnesses (e.g., myocardial infarction or
cerebrovascular accident)

Pulmonary:

- See Disease Characteristics

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

- DLCO at least 60% of predicted for adults

Other:

- No severe neurosensory symptoms (i.e., peripheral neuropathy)

- HIV negative

- Active infection allowed if controlled by appropriate drug therapy

- Not pregnant or nursing

- Negative pregnancy test

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- See Disease Characteristics

Chemotherapy:

- See Disease Characteristics

Endocrine therapy:

- Not specified

Radiotherapy:

- Not specified

Surgery:

- Not specified

Other:

- Recovered from prior therapy

- No concurrent investigational agents unless approved by protocol investigators

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Evaluation of Donor Engraftment

Outcome Description:

Peripheral blood from the donor and patient is obtained for chimerism studies. The primary analysis will consist of estimating the graft failure proportions for each of the separate patient groups and calculating confidence intervals for these proportions. This analysis will be done conditional on patients surviving at least 28 days.

Outcome Time Frame:

at 28 days

Safety Issue:

No

Principal Investigator

Tamila Kindwall-Keller, DO

Investigator Role:

Principal Investigator

Investigator Affiliation:

Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center

Authority:

United States: Federal Government

Study ID:

CWRU3Y00

NCT ID:

NCT00006379

Start Date:

June 2000

Completion Date:

October 2011

Related Keywords:

  • Chronic Myeloproliferative Disorders
  • Leukemia
  • Lymphoma
  • Multiple Myeloma and Plasma Cell Neoplasm
  • Myelodysplastic Syndromes
  • Myelodysplastic/Myeloproliferative Diseases
  • Precancerous/Nonmalignant Condition
  • Small Intestine Cancer
  • monoclonal gammopathy of undetermined significance
  • recurrent childhood acute lymphoblastic leukemia
  • recurrent adult Hodgkin lymphoma
  • recurrent cutaneous T-cell non-Hodgkin lymphoma
  • isolated plasmacytoma of bone
  • extramedullary plasmacytoma
  • refractory multiple myeloma
  • Waldenstrom macroglobulinemia
  • recurrent childhood lymphoblastic lymphoma
  • recurrent childhood acute myeloid leukemia
  • recurrent adult acute myeloid leukemia
  • recurrent adult acute lymphoblastic leukemia
  • relapsing chronic myelogenous leukemia
  • small intestine lymphoma
  • chronic phase chronic myelogenous leukemia
  • accelerated phase chronic myelogenous leukemia
  • blastic phase chronic myelogenous leukemia
  • adult acute myeloid leukemia in remission
  • adult acute lymphoblastic leukemia in remission
  • childhood acute myeloid leukemia in remission
  • childhood acute lymphoblastic leukemia in remission
  • polycythemia vera
  • chronic idiopathic myelofibrosis
  • essential thrombocythemia
  • adult acute erythroid leukemia (M6)
  • adult acute megakaryoblastic leukemia (M7)
  • childhood acute erythroleukemia (M6)
  • childhood acute megakaryocytic leukemia (M7)
  • recurrent/refractory childhood Hodgkin lymphoma
  • refractory anemia with excess blasts
  • refractory anemia with excess blasts in transformation
  • chronic myelomonocytic leukemia
  • acute undifferentiated leukemia
  • recurrent grade 1 follicular lymphoma
  • recurrent grade 2 follicular lymphoma
  • recurrent grade 3 follicular lymphoma
  • recurrent adult diffuse small cleaved cell lymphoma
  • recurrent adult diffuse mixed cell lymphoma
  • recurrent adult diffuse large cell lymphoma
  • recurrent adult immunoblastic large cell lymphoma
  • recurrent adult lymphoblastic lymphoma
  • recurrent adult Burkitt lymphoma
  • recurrent adult T-cell leukemia/lymphoma
  • secondary acute myeloid leukemia
  • de novo myelodysplastic syndromes
  • previously treated myelodysplastic syndromes
  • secondary myelodysplastic syndromes
  • prolymphocytic leukemia
  • primary systemic amyloidosis
  • adult acute minimally differentiated myeloid leukemia (M0)
  • childhood acute minimally differentiated myeloid leukemia (M0)
  • recurrent childhood small noncleaved cell lymphoma
  • recurrent childhood large cell lymphoma
  • recurrent mantle cell lymphoma
  • angioimmunoblastic T-cell lymphoma
  • anaplastic large cell lymphoma
  • recurrent mycosis fungoides/Sezary syndrome
  • childhood chronic myelogenous leukemia
  • chronic eosinophilic leukemia
  • chronic neutrophilic leukemia
  • atypical chronic myeloid leukemia
  • myelodysplastic/myeloproliferative disease, unclassifiable
  • juvenile myelomonocytic leukemia
  • recurrent marginal zone lymphoma
  • recurrent small lymphocytic lymphoma
  • extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
  • nodal marginal zone B-cell lymphoma
  • splenic marginal zone lymphoma
  • adult acute myeloid leukemia with t(8;21)(q22;q22)
  • adult acute myeloid leukemia with t(16;16)(p13;q22)
  • adult acute myeloid leukemia with inv(16)(p13;q22)
  • adult acute myeloid leukemia with 11q23 (MLL) abnormalities
  • adult acute myeloid leukemia with t(15;17)(q22;q12)
  • childhood myelodysplastic syndromes
  • Neoplasms
  • Leukemia
  • Lymphoma
  • Multiple Myeloma
  • Neoplasms, Plasma Cell
  • Plasmacytoma
  • Myelodysplastic Syndromes
  • Preleukemia
  • Myeloproliferative Disorders
  • Precancerous Conditions
  • Duodenal Neoplasms
  • Ileal Neoplasms
  • Jejunal Neoplasms
  • Intestinal Neoplasms
  • Hematologic Neoplasms
  • Myelodysplastic-Myeloproliferative Diseases

Name

Location

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