Peripheral Stem Cell Transplant in Treating Patients With High-Risk Leukemia

This study has been terminated.
(Trial was withdrawn for drug availability issues.)
Sponsor:
Information provided by:
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT00066417
First received: August 6, 2003
Last updated: April 30, 2013
Last verified: November 2006
  Purpose

RATIONALE: Giving chemotherapy and total-body irradiation before a donor peripheral stem cell transplant helps stop the growth of cancer and abnormal cells and helps stop the patient's immune system from rejecting the donor's stem cells. When the stem cells from a related donor, that do not exactly match the patient's blood, are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.

PURPOSE: This phase II trial is studying how well peripheral stem cell transplant works in treating patients with high-risk leukemia.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Myelodysplastic/Myeloproliferative Diseases
Drug: cyclophosphamide
Drug: cyclosporine
Drug: fludarabine phosphate
Drug: methylprednisolone
Drug: therapeutic allogeneic lymphocytes
Drug: thiotepa
Procedure: allogeneic bone marrow transplantation
Procedure: biological therapy
Procedure: bone marrow ablation with stem cell support
Procedure: bone marrow transplantation
Procedure: chemotherapy
Procedure: leukocyte therapy
Procedure: non-specific immune-modulator therapy
Procedure: peripheral blood lymphocyte therapy
Procedure: peripheral blood stem cell transplantation
Procedure: radiation therapy
Phase 2

Study Type: Interventional
Study Design: Masking: Open Label
Primary Purpose: Treatment
Official Title: Pilot Study Of T-Cell-Depleted Peripheral Blood Stem Cell Transplantation From Partially Matched Related Donors For Patients With High-Risk Leukemia

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Incidence of graft failure 100 days post-transplant
  • Incidence of acute and chronic graft-vs-host disease100 days post-transplant
  • Transplant-related mortality 100 days post-transplant
  • Disease-free survival 100 days post-transplant
  • Overall survival 100 days post-transplant

Estimated Enrollment: 51
Study Completion Date: January 2007
Detailed Description:

OBJECTIVES:

  • Determine the safety of a preparative regimen comprising total body irradiation, cyclophosphamide, thiotepa, and fludarabine, but without anti-thymocyte globulin, in patients with high-risk leukemia treated with peripheral blood stem cell transplantation from partially matched related donors.
  • Determine the incidence of graft failure, acute graft-versus-host disease (GVHD), and treatment-related mortality in patients treated with this regimen.
  • Determine rates of chronic GVHD and relapse in patients treated with this regimen.
  • Determine disease-free and overall survival in patients treated with this regimen.

OUTLINE: This is a pilot study.

Patients receive a preparative regimen comprising total lymphoid irradiation once daily on days -13 to -11; cyclophosphamide IV over 1 hour on days -8 and -7; thiotepa IV over 4 hours every 12 hours on day -6; fludarabine IV over 30 minutes on days -5 to -1; and total body irradiation once on day -1. Patients also receive cyclosporine IV over 12 hours on days -8 to -1 and methylprednisolone IV twice daily on days -3 and -2. Patients receive CD34-enriched T-cell-depleted allogeneic stem cell infusion on day 0.

Patients with disease progression or uncontrolled infection but without grade II or greater graft-versus-host disease may receive up to 3 donor lymphocyte infusions at least 4 weeks apart until disease regression.

Patients are followed at least weekly until day 100 and then at 6, 12, 18, 24, 36, and 48 months.

PROJECTED ACCRUAL: A total of 20-51 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   10 Years to 50 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following:

    • High-risk myelodysplastic syndromes (MDS), meeting 1 of the following criteria:

      • Transformation to acute leukemia defined by at least 15% blasts
      • Secondary to prior treatment with chemotherapy and/or radiotherapy
      • Presence of complex cytogenetics (at least 3 karyotypic abnormalities)
      • Monosomy or deletion of chromosome 7
    • Acute myeloid leukemia (AML), meeting 1 of the following criteria :

      • High-risk AML in first remission and meeting 1 of the following criteria:

        • At least 3 karyotypic abnormalities
        • Monosomy or deletion of chromosome 5 or 7 = 11q23 chromosomal abnormality
        • Prior diagnosis of MDS
        • Received prior radiotherapy or chemotherapy
      • In second or subsequent remission
      • Primary induction failure or partial remission
      • Untested or sensitive relapse
    • Chronic myelogenous leukemia, meeting 1 of the following criteria:

      • Blast crisis
      • Accelerated phase disease that has failed prior treatment with imatinib mesylate, defined as a failure to achieve hematologic response after 3 months of standard dose (600 mg/day) therapy or disease progression on therapy
    • Myeloproliferative disease

      • The following diagnoses are eligible:

        • Agnogenic myeloid metaplasia
        • Essential thrombocythemia
        • Polycythemia vera
      • Must have evidence of transformation to acute leukemia
    • Acute lymphocytic leukemia (ALL), meeting 1 of the following criteria:

      • High-risk ALL in first remission defined by 1 of the following:

        • t(9;22) or 11q23 chromosomal abnormality
        • Complete response at least 4 weeks after induction therapy OR requiring at least 2 induction regimens
      • Second or subsequent remission
  • No relapsed leukemia refractory to appropriate salvage therapy
  • Availability of an HLA-mismatched family donor

    • Donor age 75 or under
  • No better donor alternative (i.e., HLA-matched related or unrelated stem cell donor) is available

PATIENT CHARACTERISTICS:

Age

  • 10 to 50

Performance status

  • ECOG 0-1

Life expectancy

  • More than 3 months

Hematopoietic

  • See Disease Characteristics

Hepatic

  • Bilirubin no greater than 4 mg/dL
  • Transaminases no greater than 3 times upper limit of normal

Renal

  • Creatinine no greater than 2.0 mg/dL OR
  • Creatinine clearance at least 60 mL/min

Cardiovascular

  • LVEF at least 40%

Pulmonary

  • DLCO at least 65% of predicted

Other

  • Not pregnant
  • Negative pregnancy test
  • HIV negative
  • No other prior malignancy except basal cell or squamous cell skin cancer or a remote history of cancer now considered cured
  • No major organ dysfunction that would preclude transplantation
  • No major anticipated illness or organ failure that would preclude transplantation
  • No severe psychiatric illness or mental deficiency that would preclude giving informed consent or complying with study
  • No uncontrolled infection

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • Not specified

Chemotherapy

  • See Disease Characteristics

Endocrine therapy

  • Not specified

Radiotherapy

  • See Disease Characteristics

Surgery

  • Not specified
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00066417

Locations
United States, Maryland
NIH - Warren Grant Magnuson Clinical Center
Bethesda, Maryland, United States, 20892-1182
Sponsors and Collaborators
Investigators
Study Chair: Bipin N. Savani, MD National Heart, Lung, and Blood Institute (NHLBI)
  More Information

No publications provided

ClinicalTrials.gov Identifier: NCT00066417     History of Changes
Obsolete Identifiers: NCT00062725
Other Study ID Numbers: CDR0000315900, NHLBI-03-H-0209
Study First Received: August 6, 2003
Last Updated: April 30, 2013
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
essential thrombocythemia
polycythemia vera
blastic phase chronic myelogenous leukemia
secondary myelodysplastic syndromes
previously treated myelodysplastic syndromes
adult acute myeloid leukemia in remission
childhood acute myeloid leukemia in remission
de novo myelodysplastic syndromes
secondary acute myeloid leukemia
accelerated phase chronic myelogenous leukemia
childhood chronic myelogenous leukemia
adult acute lymphoblastic leukemia in remission
childhood acute lymphoblastic leukemia in remission
recurrent adult acute myeloid leukemia
relapsing chronic myelogenous leukemia
recurrent childhood acute myeloid leukemia
chronic idiopathic myelofibrosis
atypical chronic myeloid leukemia
myelodysplastic/myeloproliferative disease, unclassifiable
adult acute myeloid leukemia with t(8;21)(q22;q22)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with t(15;17)(q22;q12)

Additional relevant MeSH terms:
Leukemia
Myeloproliferative Disorders
Myelodysplastic-Myeloproliferative Diseases
Neoplasms by Histologic Type
Neoplasms
Bone Marrow Diseases
Hematologic Diseases
Immunologic Factors
Cyclophosphamide
Cyclosporins
Cyclosporine
Thiotepa
Fludarabine phosphate
Fludarabine
Methylprednisolone Hemisuccinate
Prednisolone
Vidarabine
Methylprednisolone acetate
Prednisolone acetate
Methylprednisolone
Prednisolone hemisuccinate
Prednisolone phosphate
Physiological Effects of Drugs
Pharmacologic Actions
Immunosuppressive Agents
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 28, 2014