Transplantation of Unrelated Donor Hematopoietic Stem Cells for the Treatment of Hematological Malignancies
OBJECTIVES:
Primary
- Determine the effectiveness of unrelated donor allogeneic hematopoietic stem cells for
transplantation after conditioning for the treatment of patients with high-risk
hematologic malignancies.
- Compare survival, disease-free survival (DFS), response rate, and toxicity rates in
these patients with historical controls.
- Compare the rate and severity of acute and chronic GVHD after allogeneic hematopoietic
stem cell transplantation in patients with hematopoietic malignancies with historical
controls transplanted with stem cells from related sibling donors
- Assess engraftment, long-term hematopoietic recovery, relapse rate, and disease-free
survival when allogeneic hematopoietic stem cells are used as a source of stem cells
for transplantation in patients with high-risk hematological malignancies.
- Assess engraftment, long-term hematopoietic recovery, and overall survival when
allogeneic hematopoietic stem cells are used as a source of stem cells for
transplantation in patients who have graft failure or graft rejection.
- Compare engraftment, long-term hematopoietic recovery, rate of GVHD, rate of relapse,
toxicity rates, overall disease-free survival and overall survival when donor leukocyte
infusions (DLI) are given for patients who have disease recurrence, progression, or low
donor chimerisms after unrelated stem cell transplantation or before DLI with
historical controls of other donor leukocyte infusions.
Secondary
- Determine the quality of life of patients undergoing hematopoietic stem cell
transplantation or donor leukocyte infusions from unrelated HLA genotypically-identical
donors.
OUTLINE: Patients are assigned to 1 of 8 treatment groups.
- Group 1*: Patients undergo total body irradiation (TBI) twice a day on days -7 to -4.
Patients then receive cyclophosphamide IV over 1 hour on days -3 and -2. On day 0
patients undergo stem cell transplantation (SCT). Beginning on day 7, patients receive
filgrastim (G-CSF) IV once daily until blood counts recover.
- Group 2 (patients who have previously experienced dose-limiting radiotherapy): Patients
receive oral busulfan 4 times daily on days -7 to -4 and cyclophosphamide IV over 1
hour on days -3 and -2. On day 0 patients undergo SCT. Beginning on day 7, patients
receive G-CSF IV once daily until blood counts recover.
- Group 3 (pediatric patients only): Patients receive busulfan IV 4 times daily on days
-9 to -6 and cyclophosphamide IV over 1 hour and fludarabine IV over 30 minutes on days
-5 to -2. On day 0 patients undergo SCT. Beginning on day 7, patients may receive G-CSF
IV once daily until blood counts recover.
- Group 4 (second SCT for patients who have experienced graft rejection or failure)*:
Patients receive low-dose fludarabine IV over 30 minutes on days -4 to -2. Patients
then undergo low-dose TBI once followed by SCT on day 0. Beginning on day 7, patients
may receive G-CSF IV once daily until blood counts recover.
- Group 5 (patients who developed grade 3 cystitis after prior
cyclophosphamide-containing therapy): Patients receive carmustine IV over 2 hours on
day -6, etoposide IV over 2 hours and cytarabine IV over 30 minutes on days -5 to -2,
and melphalan IV over 30 minutes on day -1 (BEAM). On day 0, patients undergo SCT.
Beginning on day 7, patients receive G-CSF IV once daily until blood counts recover.
- Group 6 (cord blood transplantation): Patients receive anti-thymocyte globulin IV once
daily and methylprednisolone IV twice daily on days -3 to -1. On day 0, patients
undergo an umbilical cord blood SCT.
- Group 7 (patients with relapsing or progressive disease after prior transplants or low
donor chimerisms)*: Patients must not have existing graft-versus-host disease (GVHD).
Patients receive donor lymphocyte infusions with conditioning chemotherapy and/or
radiotherapy at the discretion of the investigator.
- Group 8 (pediatric patients only)*: Patients undergo TBI twice a day on days -7 to -5.
Patients also receive etoposide IV over 24 hours on day -4 and cyclophosphamide IV over
1 hour on days -3 and -2. On day 0, patients undergo SCT. Beginning on day 7, patients
may receive G-CSF IV once daily until blood counts recover.
NOTE: *Patients who have received > 3000 cGy to the central nervous system or > 2000 cGy to
the lung or liver may not receive any regimen containing total body irradiation (TBI)
All patients receive GVHD prophylaxis comprising methotrexate IV on days 1, 3, 6, and 11;
cyclosporine and/or tacrolimus on days -2 to 100; and/or methylprednisolone IV on days 7 to
100.
Patients with an unrelated donor who experience a relapse prior to transplantation, may
proceed directly to transplantation. However, if immediate transplantation from the
unrelated donor is not possible, the patient must be re-induced into a complete
hematological remission. Patients who experience graft failure or graft rejection after
allogeneic transplantation are eligible for a second stem cell infusion from the original
donor.
Quality of life is assessed at baseline and at 7 days, 3 months, and 1 year after
transplantation.
After completion of study treatment, patients are followed periodically for survival.
PROJECTED ACCRUAL: A total of 43 patients will be accrued for this study.
Interventional
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of Participants With Disease Free Survival (DFS).
Determine the effectiveness of unrelated donor allogeneic hematopoietic stem cells for transplantation after conditioning for the treatment of high-risk hematopoietic malignancies. Disease-free survival: The length of time after treatment ends that a patient survives without any signs or symptoms of that cancer or any other type of cancer.
Duration of the study; Up to 2 years
No
Richard Maziarz, MD
Study Chair
OHSU Knight Cancer Institute
United States: Institutional Review Board
CDR0000452794
NCT00281879
February 2006
March 2008
Name | Location |
---|---|
OHSU Knight Cancer Institute | Portland, Oregon 97239 |