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A Phase II Trial of Myeloablative Conditioning and Transplantation of Partially HLA-Mismatched Peripheral Blood Stem Cells for Patients With Hematologic Malignancies


Phase 2
18 Years
60 Years
Not Enrolling
Both
Leukemia, Lymphoma, Myelodysplastic Syndromes

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Trial Information

A Phase II Trial of Myeloablative Conditioning and Transplantation of Partially HLA-Mismatched Peripheral Blood Stem Cells for Patients With Hematologic Malignancies


OBJECTIVES:

Primary

- To estimate the incidence of graft rejection and severe graft-versus-host disease after
myeloablative HLA-mismatched peripheral blood stem cell transplantation (PBSCT) from
first-degree relatives in patients with high-risk hematologic malignancies.

Secondary

- To estimate overall survival, relapse, non-relapse mortality, and event-free survival
in these patients.

- To characterize additional hematologic and non-hematologic toxicities of myeloablative
haploidentical PBSCT.

- To characterize donor hematopoietic chimerism in peripheral blood stem cells after
PBSCT.

OUTLINE:

- Preparative regimen: Patients receive fludarabine phosphate IV over 30 minutes on days
-7 to -2, busulfan IV over 3 hours on days -7 to -4, and cyclophosphamide IV over 1-2
hours on days -3 and -2.

- Allogeneic peripheral blood stem cell transplantation (PBSCT): Patients undergo
infusion of unmanipulated peripheral blood stem cells on day 0.

- Post-transplant regimen: Patients receive high-dose cyclophosphamide IV over 1-2 hours
on days 3 and 4, tacrolimus IV over 24 hours or orally twice daily on days 5-180, and
oral mycophenolate mofetil 3 times daily on days 5-34 followed by a taper to day 90.
Treatment continues in the absence of disease progression or clinically significant
graft-vs-host disease.

After completion of PBSCT, patients are followed periodically for 1 year.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Diagnosis of one of the following high-risk hematologic malignancies:

- Chronic myelogenous leukemia meeting one of the following criteria:

- Disease in chronic phase and resistant to available tyrosine kinase
inhibitors

- Disease in accelerated phase

- Disease with blast crisis that has entered into a second chronic phase
after induction chemotherapy

- Acute myelogenous leukemia meeting the following criteria:

- Marrow blasts < 5% but persistence of minimal residual disease by flow
cytometry, cytogenetics, or FISH

- Must meet one of the following criteria:

- Disease in second or subsequent complete remission

- Primary induction chemotherapy failure with disease subsequently
entering complete remission

- Disease in first complete remission with poor-risk cytogenetics or
arising from preceding hematological disease

- Myelodysplastic syndrome meeting at least one of the following criteria:

- Treatment-related

- Monosomy 7 or complex cytogenetics

- International prognostic scoring system score ≥ 1.5

- Chronic myelomonocytic leukemia

- Acute lymphocytic leukemia or lymphoblastic lymphoma meeting the following
criteria:

- Marrow blasts < 5% but persistence of minimal residual disease by flow
cytometry, cytogenetics, or FISH

- Must meet one of the following criteria:

- Disease in second or subsequent complete remission

- Acute lymphocytic leukemia with poor-risk karyotype [e.g., t(9;22) or
bcr-abl fusion, t(4;11), or other MLL translocation] and in first
complete remission

- Chronic lymphocytic leukemia or prolymphocytic leukemia meeting both of the
following criteria:

- Previously treated disease that has either relapsed or failed to respond
adequately to conventional-dose therapy including purine analogs

- In the opinion of the transplant physician, unlikely to benefit from
reduced intensity transplantation due to the presence of one or more
high-risk features (i.e., bulky tumor masses, B symptoms, and/or inadequate
response to salvage chemotherapy)

- Hodgkin or non-Hodgkin lymphoma (including low-grade, mantle cell, and
intermediate-grade/diffuse disease) meeting the following criteria:

- Previously treated disease that has either relapsed or failed to respond
adequately to conventional-dose therapy or autologous transplantation

- In the opinion of the transplant physician, unlikely to benefit from
reduced intensity transplantation due to the presence of one or more
high-risk features (i.e., bulky tumor masses, B symptoms, and/or inadequate
response to salvage chemotherapy) NOTE: A new classification scheme for
adult non-Hodgkin lymphoma has been adopted by PDQ. The terminology of
"indolent" or "aggressive" lymphoma will replace the former terminology of
"low", "intermediate", or "high" grade lymphoma. However, this protocol
uses the former terminology.

- No available matched related or unrelated donor OR a matched related or unrelated
donor will not be available in the time frame necessary to perform a transplant

- Availability of a first-degree relative (parent, child, sibling) matched at 3/6-5/6
loci (HLA-A, -B, -DR)

- Donor must be willing to donate mobilized peripheral blood stem cells

- No positive HLA crossmatch in the host-vs-graft direction or high titer
donor-specific antibodies

PATIENT CHARACTERISTICS:

- Karnofsky performance status 70-100%

- Bilirubin < 2 mg/dL (unless due to hemolysis, Gilbert syndrome, or primary
malignancy)

- Creatinine < 2 mg/dL OR creatinine clearance ≥ 40 mL/min

- Not pregnant

- Fertile patients must use effective contraception

- LVEF ≥ 45%

- FEV_1 and forced vital capacity ≥ 50% predicted

- No HIV positivity

- No debilitating medical or psychiatric illness that would preclude giving informed
consent or receiving optimal treatment and follow-up

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No immunosuppressive agents ≤ 24 hours after completion of post-transplant
cyclophosphamide (including steroids as antiemetics)

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Incidence of Graft Rejection for Patients at Day 100

Outcome Description:

Number of patients who experienced graft rejection by Day 100

Outcome Time Frame:

Day 100

Safety Issue:

Yes

Principal Investigator

Scott R. Solomon, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Blood and Marrow Transplant Group of Georgia

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000617648

NCT ID:

NCT00782379

Start Date:

October 2008

Completion Date:

April 2012

Related Keywords:

  • Leukemia
  • Lymphoma
  • Myelodysplastic Syndromes
  • stage III adult diffuse large cell lymphoma
  • stage III adult diffuse mixed cell lymphoma
  • stage III adult diffuse small cleaved cell lymphoma
  • stage III adult Hodgkin lymphoma
  • stage III adult lymphoblastic lymphoma
  • stage III grade 1 follicular lymphoma
  • stage III grade 2 follicular lymphoma
  • stage III grade 3 follicular lymphoma
  • stage III mantle cell lymphoma
  • stage IV adult diffuse large cell lymphoma
  • stage IV adult diffuse mixed cell lymphoma
  • stage IV adult diffuse small cleaved cell lymphoma
  • stage IV adult Hodgkin lymphoma
  • stage IV adult lymphoblastic lymphoma
  • stage IV grade 1 follicular lymphoma
  • stage IV grade 2 follicular lymphoma
  • stage IV grade 3 follicular lymphoma
  • stage IV mantle cell lymphoma
  • recurrent adult diffuse large cell lymphoma
  • recurrent adult diffuse mixed cell lymphoma
  • recurrent adult diffuse small cleaved cell lymphoma
  • recurrent adult Hodgkin lymphoma
  • recurrent grade 1 follicular lymphoma
  • recurrent grade 2 follicular lymphoma
  • recurrent grade 3 follicular lymphoma
  • recurrent mantle cell lymphoma
  • noncontiguous stage II adult diffuse large cell lymphoma
  • noncontiguous stage II adult diffuse mixed cell lymphoma
  • noncontiguous stage II adult diffuse small cleaved cell lymphoma
  • noncontiguous stage II adult lymphoblastic lymphoma
  • noncontiguous stage II grade 1 follicular lymphoma
  • noncontiguous stage II grade 2 follicular lymphoma
  • noncontiguous stage II grade 3 follicular lymphoma
  • noncontiguous stage II mantle cell lymphoma
  • accelerated phase chronic myelogenous leukemia
  • adult acute lymphoblastic leukemia in remission
  • adult acute myeloid leukemia in remission
  • adult acute myeloid leukemia with 11q23 (MLL) abnormalities
  • adult acute myeloid leukemia with inv(16)(p13;q22)
  • adult acute myeloid leukemia with t(15;17)(q22;q12)
  • adult acute myeloid leukemia with t(16;16)(p13;q22)
  • adult acute myeloid leukemia with t(8;21)(q22;q22)
  • chronic myelomonocytic leukemia
  • chronic phase chronic myelogenous leukemia
  • recurrent adult acute myeloid leukemia
  • refractory chronic lymphocytic leukemia
  • relapsing chronic myelogenous leukemia
  • secondary acute myeloid leukemia
  • stage III chronic lymphocytic leukemia
  • stage IV chronic lymphocytic leukemia
  • de novo myelodysplastic syndromes
  • previously treated myelodysplastic syndromes
  • secondary myelodysplastic syndromes
  • prolymphocytic leukemia
  • Leukemia
  • Lymphoma
  • Lymphoma, Non-Hodgkin
  • Myelodysplastic Syndromes
  • Preleukemia

Name

Location

Blood and Marrow Transplant Group of Georgia Atlanta, Georgia  30342-1601