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Transplantation of Ex-vivo Expanded Human Cord Blood Hematopoietic Stem Cells Expanded: Evaluation of Hematopoietic and Immunologic Reconstitution After a Reduced-intensity Conditioning Regimen


Phase 2
18 Years
65 Years
Open (Enrolling)
Both
Malignant Haematological Disease

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Trial Information

Transplantation of Ex-vivo Expanded Human Cord Blood Hematopoietic Stem Cells Expanded: Evaluation of Hematopoietic and Immunologic Reconstitution After a Reduced-intensity Conditioning Regimen


This is a multicenter prospective non randomized phase 2 clinical trial.

The primary objective is defined by getting a neutrophil count above 500/ml for 3
consecutive days at day 42 after transplantation, in association with complete or partial
chimerism on T cells (10 % to 90%).

The secondary objectives are:

- the feasibility of expansion,

- tolerance immediate injection of a graft amplified,

- the payback of a platelet count> 20 000/microlitre without transfusion,

- Incidence of graft loss or rejection within 6 months following transplantation,

- the incidence of acute and chronic GVHD,

- the mortality rate associated with transplantation,

- the incidence of relapse of hematologic malignancies,

- Overall survival,

- Disease-free survival at 1 year post transplant.


Inclusion Criteria:



- Age ≥ 18 and < 66 years

- Patient with acute myeloid leukemia (AML) high risk in 1st complete remission:

- CR1 obtained by 2 cycles of chemotherapy,

- unfavorable Cytogenetics

- FLT3 Duplication,

- Or acute myeloid leukemia (AML) in 2nd complete remission,

- Or acute lymphoblastic leukemia (ALL) High-risk 1st complete remission:

- Presence of the translocation t (9; 22),

- Or acute lymphoblastic leukemia (ALL) in 2nd complete remission,

- Or Chronic Myeloid Leukemia (LCM) beyond the 1st chronic phase

- Or Myelodysplasia or with IPSS score with 2 or more

- Or Hodgkin's disease in sensitive relapse or beyond the 2nd complete remission. or
following types of lymphoma :

- Diffuse large B lymphoma cells relapsed or refractory after two lines of treatment or
after a line with autologous hematopoietic stem cell, or

- Mantle cell lymphoma relapsed or refractory after two lines of treatment or after a
line with autologous hematopoietic stem cell

- Others aggressive lymphoma for which an indication of allograft is selected (Burkitt
lymphoma, lymphoblastic lymphoma, intravascular lymphoma, ...)

- Lymphoma (low-grade follicular lymphoma, marginal zone lymphoma) in histological
transformation.

- Low-grade lymphoma for which an indication of allograft is retained

- Unable to receive myeloablative conditioning because of age (> 45 years) and/or the
existence of co-morbidities precluding a myeloablative conditioning (status ECOG > /
= 2, DLCO <50%, fungal infection proven or probable in the previous 60 days) and / or
prior treatment with total body irradiation at doses above 2 Gy or busulfan doses> 8
mg/kg

- No contra-indication for a transplant in allogeneic non-myeloablative conditioning,

- No HLA-identical sibling,

- Absence of an unrelated donor on national or international registering with a 10/10
allelic matching or a 9/10 allelic matching with the only tolerated mismatches
being: HLA-C.

- No unit of placental blood available fulfilling the characteristics of compatibility
(HLA compatible at least 4/6 allele or generic) and richness

- Provision of at least 2 units of placental blood, whose compatibility is 4/6, 5/6 or
6/6 and whose richness is before thawing, > 2 x 107 and < 3 to 4 x 107 nucleated
cells per/kg.

- Patient affiliated to a social security scheme,

- Free and informed consent signed by the patient and the investigator.

Exclusion Criteria:

- Age <18 and ≥ 66 years

- Malignant myeloid or lymphoid acute or chronic disease without indication for an
allogeneic transplant according to the criteria of European Bone Marrow
Transplantation Group.

- Able to receive a myeloablative conditioning because of age (<45 years) and the
absence of co morbidities (status ECOG> / = 2, DLCO <50%, fungal infection proven or
probable in 60 preceding days) and the absence of prior treatment with total body
irradiation at doses above 2 Gy or busulfan doses> 8 mg / kg

- Contra indication for a non-myeloablative conditioning,

- HLA-identical sibling available

- Availability of an unrelated donor on a national or international register with 10/10
or 9/10 HLA matching (HLA-C Mismatch tolerated).

- At least one unit of cord blood available with the characteristics of compatibility
(HLA compatible at least 4/6 allelic or generic) and richness (before thawing> / = 3
to 4 x 107 nucleated cells/kg recipient, by degree of compatibility)

- Absence of at least 2 units of placental blood, whose compatibility is 4/6, 5/6 / or
6/6 and whose richness before thawing is > 2 x 107 and < 4 x 107 nucleated cells
per/kg of recipient.

- Women of childbearing age not using contraception, pregnant or lactating

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

The number of granulocytes, which will be evaluated daily after transplantation. And chimerism to be measured on the cells (total nucleated cells and lymphocytes) from peripheral blood on days 15, 42, 60, 100, 180, 360.

Outcome Time Frame:

Daily for Blood évaluation and on days 15-42-60-100-180-360 for chimérisme évaluation.

Safety Issue:

Yes

Principal Investigator

Noel MILPIED, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

University Hospital Bordeaux, France

Authority:

France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Study ID:

CHUBX 2008/12

NCT ID:

NCT01034449

Start Date:

February 2010

Completion Date:

February 2014

Related Keywords:

  • Malignant Haematological Disease
  • allo graft
  • cord blood
  • expansion
  • reduced-intensity conditioning
  • Hematologic Diseases

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