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A Phase II Study of Parathyroid Hormone Following Sequential Unrelated Cord Blood Transplant


Phase 2
18 Years
65 Years
Not Enrolling
Both
CML, Myelodysplasia, Aplastic Anemia, Myelofibrosis, Lymphoma, Hodgkin's Disease., CLL, AML, ALL

Thank you

Trial Information

A Phase II Study of Parathyroid Hormone Following Sequential Unrelated Cord Blood Transplant


Myeloablative chemotherapy or chemoradiotherapy and allogeneic stem cell transplantation is
an accepted curative therapy for many cancers, leukemias, and genetic disorders. Given the
size of most American families, only 30% of patients will have a matched sibling donor and
although national and international registries exist for volunteer donors approximately 50%
of patients are unable to find a suitably matched unrelated donor in time to proceed to
transplant. It is particularly difficult for African Americans and other minorities to find
matched unrelated donors Umbilical cord blood has been shown to contain sufficient cells to
provide durable engraftment and estimated 70,000 cord blood units are available worldwide,
and can be shipped for immediate use

Despite advances in cord blood transplantation using cord blood units with higher cell doses
and the use of two cord blood transplants, delayed engraftment(particularly platelet
engraftment) and poor immune reconstitution remain major causes of morbidity and mortality
following cord blood transplantation.

In this study, we extend our experience with sequential cord blood transplantation. Patients
who are likely to benefit from an ablative conditioning regime will receive either a well
known myeloablative regimen of fludarabine, cyclophosphamide and total body irradiation or a
reduced intensity regimen of fludarabine/melphalan/thymoglobulin. Following conditioning
patients will receive dual sequential unrelated umbilical cord blood transplants. Tacrolimus
will be combined with MMF for the GVHD prophylaxis regimen. Parathyroid hormone is added to
this regimen in an attempt to improve engraftment.

Inclusion Criteria


Inclusion Criteria - myeloablative arm:

1. Disease criteria:

1. CML accelerated phase or second stable phase. Patients in first chronic phase
are eligible if they have resistance to imatinib.

2. Myelodysplasia.

3. Aplastic Anemia, not responding to immunosuppressive therapy.

4. Myelofibrosis, either primary or secondary to polycythemia vera.

5. Relapsed lymphoma or Hodgkin's disease.

6. Stage III/IV CLL, relapsed after or refractory to at least one fludarabine
containing regimen.

7. AML or ALL in CR 2 or greater or CR 1 with high risk features. Complete
remission or CRp as defined by WHO criteria are acceptable.50

2. Age 18-50 years.

3. No prior autologous stem cell transplant.

4. ECOG Performance status of <2.

5. The patient and the cord blood units must be a 4/6 allele level HLA A, B, DRB1 match
or greater with each other and the patient.

6. Total combined nucleated cell dose from the 2 cord blood units > 3.7 x 107NC/kg
(pre-freeze dose). Each single cord blood unit cell dose must be > 1.5 x 107NC/kg.

7. Lack of 6/6 or 5/6 matched related donor or lack of 10/10 matched unrelated donor, or
a donor is not available in time frame to perform a potentially curative stem cell
transplant.

8. DLCO >50% predicted (corrected for hemoglobin).

9. LVEF > 50%

10. Calcium <10.5 mg/dl, phosphate > 1.6 mg/dl.

11. Non-pregnant and non-nursing.

Inclusion criteria - reduced intensity arm

1. Disease-specific criteria

1. Non-Hodgkin's lymphoma, or Hodgkin's lymphoma: in Complete Remission >2 (second
complete remission, third complete remission, etc) or in partial remission.

2. Multiple myeloma: relapsed.

3. Chronic lymphocytic leukemia, Rai stage III or IV, or lymphocyte doubling time
of 6 months, or stage I-II, having progressed after > 2 chemotherapy regimens,
in partial remission.

4. Acute myelogenous or lymphoblastic leukemia in second or subsequent remission or
in first remission with adverse cytogenetics or antecedent hematologic disorder.
Complete remission or CRp as defined by WHO criteria are acceptable.

5. Chronic myelogenous leukemia in accelerated or second stable phase, or imatinib
resistant and not eligible for an ablative transplant.

6. Myelodysplasia, previously treated or not eligible for ablative Version
9/27/2007 Page 12 of 44 transplant.

2. Age 18-65 years.

3. ECOG performance status of 0, 1, or 2.

4. The patient and the cord blood units must be a 4/6 allele level HLA A, B, DRB1 match
or greater with each other and the patient.

5. Total combined nucleated cell dose from the 2 cord blood units > 3.7 x 107NC/kg
(pre-freeze dose). Each single cord blood unit cell dose must be > 1.5 x 107NC/kg.

6. Lack of 6/6 or 5/6 HLA-matched related, 10/10 matched unrelated donor, or unrelated
donor not available within the time frame necessary to perform a potentially curative
stem cell transplant.

7. DLCO >50% predicted corrected for hemoglobin.

8. LVEF > 45%.

9. Calcium <10.5 mg/dl, phosphate > 1.6 mg/dl.

10. Not pregnant or nursing

Exclusion Criteria:

Exclusion criteria for eligibility for both regimens include:

1. Cardiac disease: symptomatic congestive heart failure, active angina pectoris, or
uncontrolled hypertension.

2. Pulmonary disease: severe chronic obstructive lung disease, or symptomatic
restrictive lung disease, or corrected DLCO of < 50% predicted.

3. Renal disease: serum creatinine > 2.0 mg/dl.

4. Hepatic disease: serum bilirubin > 2.0 mg/dl (except in the case of Gilbert's
syndrome or hemolytic anemia in which the bilirubin can be elevated greater than
2.0mg/dl), SGOT or SGPT > 3 x upper limit normal.

5. Neurologic disease: symptomatic leukoencephalopathy, active CNS malignancy or other
neuropsychiatric abnormalities believed to preclude transplantation (previous CNS
malignancy, presently in CR is not exclusion).

6. HIV seropositive.

7. Uncontrolled infection.

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

To evaluate the time to neutrophil engraftment (defined as ANC >500/μL) among patients receiving parathyroid hormone following sequential unrelated cord blood transplantation.

Outcome Time Frame:

Variable

Safety Issue:

No

Principal Investigator

Karen Ballen, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Massachusetts General Hospital

Authority:

United States: Institutional Review Board

Study ID:

05-380

NCT ID:

NCT00579722

Start Date:

September 2006

Completion Date:

July 2010

Related Keywords:

  • CML
  • Myelodysplasia
  • Aplastic Anemia
  • Myelofibrosis
  • Lymphoma
  • Hodgkin's Disease.
  • CLL
  • AML
  • ALL
  • Cord blood transplant
  • Primary Myelofibrosis
  • Anemia
  • Anemia, Aplastic
  • Hodgkin Disease
  • Lymphoma
  • Myelodysplastic Syndromes
  • Preleukemia

Name

Location

Baylor College of Medicine Houston, Texas  77030
MD Anderson Cancer Center Houston, Texas  77030-4096
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Beth Israel Deaconess Medical Center Boston, Massachusetts  02215
Massachusetts General Hospital Boston, Massachusetts  02114-2617
University of Florida Gainesville, Florida  32610-0277
Dana Farber Cancer Institute Boston, Massachusetts  02115