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N99-02: Melphalan and Buthionine Sulfoximine Followed by Bone Marrow or Peripheral Stem Cell Transplantation in Treating Children With Resistant or Recurrent Neuroblastoma (BSO)
This study is currently recruiting participants.
Verified November 2010 by New Approaches to Neuroblastoma Therapy Consortium

First Received on June 2, 2000.   Last Updated on November 2, 2010   History of Changes
Sponsor: New Approaches to Neuroblastoma Therapy Consortium
Collaborator: National Cancer Institute (NCI)
Information provided by: New Approaches to Neuroblastoma Therapy Consortium
ClinicalTrials.gov Identifier: NCT00005835
  Purpose

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with bone marrow or peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.

PURPOSE: Phase I trial to study the effectiveness of melphalan and buthionine sulfoximine followed by bone marrow or peripheral stem cell transplantation in treating children who have resistant or recurrent neuroblastoma.


Condition Intervention Phase
Neuroblastoma
Drug: buthionine sulfoximine
Drug: melphalan
Procedure: Peripheral blood stem cell infusion
Other: Filgrastim
Phase I

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Modulation of Intensive Melphalan (L-PAM) by Buthionine Sulfoximine (BSO) Autologous Stem Cell Support for Resistant or Recurrent High-Risk Neuroblastoma (IND 69-112)

Resource links provided by NLM:


Further study details as provided by New Approaches to Neuroblastoma Therapy Consortium:

Primary Outcome Measures:
  • To determine the maximum tolerated dose(MTD) and the toxicities of Melphalan (L-PAM) escalated in the presence of Buthionine sulphoxamine (BSO) and followed by autologous stem cells rescue for pediatric patients with high-risk neuroblastoma. [ Time Frame: Within 4 weeks of completion of BSO/L-PAM therapy ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To determine the pharmacokinetics (PK) of BSO and L-PAM in pediatric patients. [ Time Frame: For BSO: just before start of therapy to 8 hours post end of 72 infusion. For L-PAM : just before start of 2nd dose to 4 hours post. ] [ Designated as safety issue: Yes ]
    Collection of blood samples for PK studies is optional and not required for study entry.

  • To determine the response rate of recurrent high risk neuroblastoma to BSO/LPAM within the confines of a phase I study. [ Time Frame: 84 days after completion of therapy with BSO/L-PAM and Stem cell re-infusion. ] [ Designated as safety issue: No ]
  • To determine the glutathione content of peripheral blood leucocytes in patients receiving BSO and L-PAM. [ Time Frame: For BSO: just before start of therapy to 8 hours post end of 72 infusion. For L-PAM : just before start of 2nd dose to 4 hours post. ] [ Designated as safety issue: No ]
    Collection of blood samples for biologic studies is optional and not required for study entry.

  • To determine the number of days to ANC =/> 500 for three days and platelets =/> 20,000 for three days (without transfusion) for this regimen. [ Time Frame: Maximum 56 days after completion of therapy with BSO/L-PAM and Stem cell re-infusion. ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: August 2001
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: buthionine sulfoximine
    Dose fixed at a bolus of 3 gm/M2 given over 30 minutes followed by a continuous infusion of 1 gm/M2/hour for 72 hours (total 72.5 hours).Total daily infusion dose (minus the initial bolus)will be 24 gm/m2/day.
    Other Name: BSO
    Drug: melphalan
    The dose level of melphalan will be assigned at study entry onto protocol. There will be 6 dose levels ranging from 20mg/m2/day x 2 days (dose level 1a) to 62.5 mg/m2/day x 2 days (dose level 6a). The starting dose level will be 1a, with a decrease to level 0a (15mg/m2/day x2 days) if there is unacceptable toxicity.
    Other Name: L-PAM
    Procedure: Peripheral blood stem cell infusion
    Stem cells will be infused intravenously on day 0 , 24 hours after BSO continuous infusion is completed.Infused within 1.5 hours of thawing via a central venous catheter over 15-30 minutes.
    Other Names:
    • PBSCT
    • Autologous Bone marrow Transplant
    • ABMT
    Other: Filgrastim
    5 microgram/kg/day , subcutaneous or intravenous, given daily beginning day 0. First dose to begin 4 hours after completion of stem cell infusion and then to continue till ANC >/= 1500 mm3 for three consecutive days.
    Other Name: G-CSF
Detailed Description:

OBJECTIVES:

  • Determine the maximum tolerated dose of melphalan when combined with buthionine sulfoximine and followed by autologous bone marrow or peripheral blood stem cell support in children with resistant or recurrent high-risk neuroblastoma.
  • Assess the toxic effects of this regimen in these patients.
  • Determine the pharmacokinetics of this regimen in these patients.
  • Determine the response rate of patients treated with this regimen.

OUTLINE: This is a multicenter, dose-escalation study of melphalan.

Patients receive buthionine sulfoximine IV as a bolus over 30 minutes followed by a 72-hour continuous infusion beginning on day -4; melphalan IV over 15 minutes on days -3 and -2; autologous peripheral blood stem cells or bone marrow IV over 15-30 minutes on day 0; and filgrastim (G-CSF) subcutaneously or IV once daily beginning on day 0 and continuing until blood counts recover.

Cohorts of 3-6 patients receive escalating doses of melphalan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Patients are followed at 84 days and then 2 months later if there is a complete and/or partial response. Patients who continue therapy on other protocols are followed before starting the new therapy. All patients are followed for life for any delayed toxic effects to protocol therapy and secondary malignancies.

PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study within 2-3 years.

  Eligibility

Ages Eligible for Study:   up to 30 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of high-risk neuroblastoma confirmed by histology and/or tumor cells in bone marrow with elevated urinary catecholamine metabolites
  • Meets 1 of the following response status criteria:

    • Current or previous progressive disease
    • Mixed or no response following completion of minimum of 4 courses of induction therapy
  • Meets 1 of the following criteria:

    • Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan
    • Metaiodobenzylguanidine (MIBG) scan with uptake at a minimum of one site
    • Bone marrow disease documented by standard morphology of bilateral bone marrow aspirate and biopsy specimens

      • Documentation by positive immunocytology is not sufficient
    • Biopsy of a lesion seen on bone scan that is non-avid for MIBG and that demonstrates viable neuroblastoma
  • Meets 1 of the following criteria for harvested autologous stem cells:

    • Availability of at least 1.5 x 10^6 CD34-positive unpurged autologous peripheral blood stem cells per kg of body weight*
    • Availability of at least 1.0 x 10^6 viable CD34-positive purged autologous peripheral blood stem cells per kg of body weight*

      • A backup source of stem cells is required if there are < 1.5 x 10^6 CD34-positive viable cells/kg available for infusion
    • Availability of at least 1 x 10^8 purged autologous mononuclear bone marrow cells per kg of body weight* NOTE: *Product to be infused must have 0 tumor cells by immunocytology
  • No history of intraparenchymal brain lesion
  • No concurrent intraparenchymal brain lesion or meningeal/parameningeal soft tissue mass extending directly into the cranial cavity by CT, MRI, or metaiodobenzylguanidine scan

PATIENT CHARACTERISTICS:

Age:

  • Over 9 months to 30 years

Performance status:

  • ECOG or Zubrod 0-1

Life expectancy:

  • At least 2 months

Hematopoietic:

  • Absolute neutrophil count at least 500/mm^3
  • Platelet count at least 20,000/mm^3 (transfusion allowed)
  • Hemoglobin at least 10 g/dL (transfusion allowed)

Hepatic:

  • Bilirubin normal
  • AST and ALT no greater than 2.5 times normal
  • No active hepatitis if HIV positive

Renal:

  • Glomerular filtration rate or creatinine clearance ≥ 100 mL/min
  • Creatinine ≤ 1.5 times normal

Cardiovascular:

  • Ejection fraction at least 55% by echocardiogram or MUGA scan OR
  • Fractional shortening at least 30% by echocardiogram

Pulmonary:

  • No dyspnea at rest or exercise intolerance
  • No active pneumonia if HIV positive

Neurologic:

  • No grade 1 or greater neurological function abnormality except grade 1 irritability, headache, dizziness, insomnia, or somnolence (if due to narcotic analgesics)
  • No history of seizures

Other:

  • No other active health problems if HIV positive
  • No concurrent neoplastic or nonneoplastic disease of any major organ system that would preclude study participation
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • See Disease Characteristics
  • At least 3 weeks since prior biologic therapy and recovered

Chemotherapy:

  • At least 3 weeks since prior chemotherapy (6 weeks for mitomycin or nitrosoureas) and recovered
  • No other concurrent anticancer chemotherapy

Endocrine therapy:

  • Not specified

Radiotherapy:

  • Recovered from prior radiotherapy
  • Prior diagnostic radiotherapy allowed
  • More than 6 months since prior radiotherapy to mantle and Y ports
  • More than 3 months since prior therapeutic metaiodobenzylguanidine (^131I-MIBG) and no more than 20 mCl/kg total dose received
  • At least 2 weeks since prior radiotherapy to all other sites
  • More than 6 months since prior radiotherapy to kidneys, liver, heart, skull, or face

    • No more than 25% of the liver can have received > 1800 cGy
    • No more than 20% of one of the kidneys can have received > 1200 cGy
    • No more than a 10 cc volume of the brain can have received > 1000 cGy
  • No prior total body irradiation
  • No prior total cranial or craniospinal radiotherapy
  • No concurrent radiotherapy

Surgery:

  • Not specified

Other:

  • Recovered from any prior therapy
  • At least 7 days since prior antibiotics, antifungals, or antivirals
  • No acetaminophen or cephalosporin antibiotics for at least 7 days before, during, and until at least 2 weeks after buthionine sulfoximine infusion
  • No prophylactic antimicrobials (i.e., nystatin or sulfamethoxazole/trimethoprim) for at least 7 days before, during, and until at least 7 days after buthionine sulfoximine infusion
  • No concurrent antiretroviral medications for HIV-positive patients
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00005835

Locations
United States, California
Childrens Hospital Los Angeles Recruiting
Los Angeles, California, United States, 90027-0700
Contact: Judith G. Villablanca, MD     323-361-5654     jvillablanca@chla.usc.edu    
Lucile Salter Packer Children's Hospital at Stanford University Medical Center Recruiting
Palo Alto, California, United States, 94304
Contact: Clare Twist, MD     650-723-5535     clare.twist@stanford.edu    
UCSF Helen Diller Family Comprehensive Cancer Center Recruiting
San Francisco, California, United States, 94143
Contact: Katherine K. Matthay, MD     415-476-3831     matthayK@peds.ucsf.edu    
United States, Illinois
University of Chicago Comer Children's Hospital Recruiting
Chicago, Illinois, United States, 60637
Contact: Susan L. Cohn, MD     773-702-2571     scohn@peds.bsd.uchicago.edu    
United States, Massachusetts
Childrens Hospital Boston, Dana-Farber Cancer Institute. Recruiting
Boston, Massachusetts, United States, 02115
Contact: Suzanne - Shusterman, MD     617-632-3725     suzanne_shusterman@dfci.harvard.edu    
United States, Michigan
C.S Mott Children's Hospital Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Gregory Yanik, MD     734-936-8785     gyanik@umich.edu    
United States, New York
Morgan Stanley Childrens Hospital of New York-Presbyterian, Herbert Irving Division of Child & Adolescent Oncology Recruiting
New York, New York, United States, 10032
Contact: Julia - Glade-Bender, MD     212-305-3379     Jg589@columbia.edu    
United States, Ohio
Cincinnati Children's Hospital Medical Center Recruiting
Cincinnati, Ohio, United States, 45229-3039
Contact: John P. Perentesis, MD     513-636-6090     john.perentesis@chmcc.org    
United States, Pennsylvania
Children's Hospital of Philadelphia Recruiting
Philadelphia, Pennsylvania, United States, 19104-4318
Contact: John M. Maris, MD     215-590-5242     maris@chop.edu    
United States, Texas
Cook Children's Medical Center - Fort Worth Recruiting
Fort Worth, Texas, United States, 76104
Contact: Clinical Trials Office - Cook's Children's Medical Center     682-885-2103        
Texas Childrens Hospital. Baylor College of Medicine Recruiting
Houston, Texas, United States, 77030
Contact: Susan - Blaney, MD     832-822-4586     Sblaney@txccc.org    
United States, Washington
Children's Hospital and Regional Medical Center - Seattle Recruiting
Seattle, Washington, United States, 98105
Contact: Julie R. Park, MD     206-987-1947     Julie.park@seattlechildrens.org    
Canada, Ontario
Hospital for Sick Children Recruiting
Toronto, Ontario, Canada, M5G 1X8
Contact: Sylvain Baruchel, MD     416-813-7795     sylvain.baruchel@sickkids.ca    
Sponsors and Collaborators
New Approaches to Neuroblastoma Therapy Consortium
Investigators
Study Chair: Judith G. Villablanca, MD Children's Hospital Los Angeles
  More Information

Additional Information:
No publications provided

Responsible Party: Judith G. Villablanca , M. D. Professor , Division of Pediatric Hematology/Oncology., Children's Hospital Los Angeles
ClinicalTrials.gov Identifier: NCT00005835     History of Changes
Other Study ID Numbers: CDR0000067849, P01CA081403, NANT-99-02
Study First Received: June 2, 2000
Last Updated: November 2, 2010
Health Authority: United States: Food and Drug Administration

Keywords provided by New Approaches to Neuroblastoma Therapy Consortium:
regional neuroblastoma
disseminated neuroblastoma
recurrent neuroblastoma
localized unresectable neuroblastoma

Additional relevant MeSH terms:
Neuroblastoma
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Melphalan
Buthionine Sulfoximine
Lenograstim
Myeloablative Agonists
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antimetabolites
Enzyme Inhibitors
Radiation-Protective Agents
Protective Agents
Radiation-Sensitizing Agents
Adjuvants, Immunologic

ClinicalTrials.gov processed this record on February 12, 2012