Treosulfan and Fludarabine in Treating Younger Patients Who Are Undergoing a Donor Stem Cell Transplant for Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, or Myelodysplastic Syndrome

This study has been completed.
Sponsor:
Collaborators:
medac GmbH
Information provided by (Responsible Party):
OHSU Knight Cancer Institute
ClinicalTrials.gov Identifier:
NCT00253513
First received: November 11, 2005
Last updated: May 24, 2012
Last verified: February 2011
  Purpose

RATIONALE: Drugs used in chemotherapy, such as treosulfan and fludarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving treosulfan and fludarabine together with a donor bone marrow transplant or a peripheral stem cell transplant may be an effective treatment for acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome.

PURPOSE: This phase II trial is studying giving treosulfan together with fludarabine to see how well it works in treating patients who are undergoing a donor stem cell transplant for acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Drug: fludarabine
Drug: treosulfan
Procedure: allogeneic blood or bone marrow transplantation
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Study of a Reduced-Intensity Conditioning Regimen With Treosulfan and Fludarabine for Allogeneic Hematopoietic Cell Transplantation for Patients With Acute Leukemia

Resource links provided by NLM:


Further study details as provided by OHSU Knight Cancer Institute:

Primary Outcome Measures:
  • Number of Patients Experiencing Regimen-related Toxicity Events in Study Population [ Time Frame: 34 days and 2 years ] [ Designated as safety issue: Yes ]
    Proportion of patients experiencing regimen-related toxicity to major organ systems from day minus 6 to day 28. Major organ systems: cardiac, bladder/renal, pulmonary, hepatic, neurologic and gastrointestinal

  • Number of Patients Experiencing Graft Failure [ Time Frame: 42 days ] [ Designated as safety issue: Yes ]
    Graft versus Host Disease (GVHD) is a frequent complication of allogeneic bone marrow transplant in which the engrafted donor cells attacks the patient's organs and tissue. Acute GVHD (aGVHD) usually occurs during the first three months following an allogeneic BMT. Chronic GVHD (cGVHD) usually develops after the third month post-transplant. Patients may experience one, both or neither.

  • Incidence (Percent of Participants) With Nonrelapse Mortality (NRM) by Day 200 (Secondary Phase Only) [ Time Frame: 200 days ] [ Designated as safety issue: Yes ]
    NRM (Non relapse mortality) - death not attributed to the primary cancer.


Secondary Outcome Measures:
  • Number of Subjects Who Are Without Disease at One Year as Indicator of Disease Free Survival. [ Time Frame: One year ] [ Designated as safety issue: No ]

Enrollment: 60
Study Start Date: June 2005
Study Completion Date: October 2009
Primary Completion Date: October 2009 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: fludarabine
    30 mg/m2, IV for 5 days
    Drug: treosulfan
    12 or 14 g/m2, IV for 5 days
    Procedure: allogeneic blood or bone marrow transplantation
    bone marrow or peripheral blood stem cells
Detailed Description:

OBJECTIVES:

Primary Phase

  • Determine the best dose of treosulfan when administered with fludarabine as a reduced-intensity conditioning regimen followed by allogeneic hematopoietic stem cell transplantation, in terms of incidence of severe to fatal toxicity to major organ systems and incidence of graft failure, in patients with acute myeloid leukemia, lymphoblastic leukemia, or myelodysplastic syndrome.

Secondary Phase

  • Determine the safety of this regimen, in terms of incidence of grade II-IV acute and chronic graft-versus-host disease, in these patients.
  • Determine, preliminarily, the efficacy of this regimen, in terms of incidence of relapse, overall and disease-free survival, donor chimerism on days 28 and 100, and incidence of 200-day and 1-year nonrelapse mortality, in these patients.
  • Determine the pharmacokinetic and pharmacodynamic profile of treosulfan in patients treated with this regimen.

OUTLINE: This is a multicenter, dose-finding study of treosulfan.

  • Reduced-intensity conditioning: Patients receive treosulfan IV over 2 hours on days -6 to -4 and fludarabine IV over 30 minutes on days -6 to -2.

Cohorts of 5-10 patients receive escalating/de-escalating doses of treosulfan until the best dose is determined among the 3 pre-selected doses. The best dose is defined as the dose preceding that at which 4 of 10 patients experience dose-limiting toxicity.

  • Allogeneic hematopoietic cell transplantation (AHCT): Patients undergo allogeneic bone marrow or peripheral blood stem cell transplantation on day 0.

All male patients with acute lymphoblastic leukemia OR male patients with acute myeloid leukemia who have prior or current testicular involvement receive external-beam radiotherapy to the testicles before AHCT.

After completion of study treatment, patents are followed periodically.

PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   up to 60 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of acute myeloid leukemia, lymphoblastic leukemia, or myelodysplastic syndrome

    • Any phase allowed, including any of the following:

      • Disease in remission
      • Relapsed or primary refractory disease
  • No CNS leukemic involvement not clearing with prior intrathecal chemotherapy and/or cranial radiotherapy
  • Planning to undergo unmanipulated allogeneic bone marrow or peripheral blood stem cell transplantation

    • Filgrastim (G-CSF) mobilization of bone marrow or stem cells allowed
  • Donor available, meeting 1 of the following criteria:

    • HLA-identical related donor
    • HLA-A, -B, -C, -DRB1, and -DQB1 matched unrelated donor by high-resolution DNA typing

      • A single allele mismatch allowed

PATIENT CHARACTERISTICS:

Performance status

  • Karnofsky 70-100% OR
  • Lansky 70-100%

Life expectancy

  • Not specified

Hematopoietic

  • Not specified

Hepatic

  • Bilirubin ≤ 2 times upper limit of normal (ULN)
  • AST ≤ 2 times ULN
  • No evidence of synthetic dysfunction
  • No severe cirrhosis
  • No active infectious hepatitis

Renal

  • Creatinine clearance ≥ 50%
  • Creatinine ≤ 2 times ULN
  • Dialysis independent

Cardiovascular

  • No cardiac insufficiency requiring treatment
  • No symptomatic coronary artery disease
  • Ejection fraction ≥ 35% (for patients with history of cardiac disease or anthracycline exposure)

Pulmonary

  • PO_2 ≥ 70 mm Hg AND DLCO ≥ 70% of predicted OR
  • PO_2 ≥ 80 mm Hg AND DLCO ≥ 60% of predicted
  • Not requiring supplementary continuous oxygen

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No other disease that would severely limit life expectancy
  • No HIV positivity
  • No active infection requiring deferral of conditioning
  • No known hypersensitivity to the study drugs

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics
  • No prior allogeneic bone marrow or stem cell transplantation
  • No concurrent umbilical cord blood or autologous transplantation

Chemotherapy

  • See Disease Characteristics

Radiotherapy

  • See Disease Characteristics

Other

  • More than 4 weeks since prior experimental drugs
  • Concurrent enrollment on another protocol for graft-versus-host disease prophylaxis allowed
  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: NCT00253513

Locations
United States, Oregon
OHSU Knight Cancer Institute
Portland, Oregon, United States, 97239-3098
United States, Washington
Fred Hutchinson Cancer Research Center
Seattle, Washington, United States, 98109
Seattle Cancer Care Alliance
Seattle, Washington, United States, 98109-1023
Sponsors and Collaborators
OHSU Knight Cancer Institute
medac GmbH
Investigators
Principal Investigator: Eneida Nemecek, MD OHSU Knight Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: OHSU Knight Cancer Institute
ClinicalTrials.gov Identifier: NCT00253513     History of Changes
Other Study ID Numbers: CDR0000445306, FHCRC-1931.00, MEDAC-FHCRC-1931.00, OHSU-HEM-05107-LM, 1765
Study First Received: November 11, 2005
Results First Received: November 16, 2010
Last Updated: May 24, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by OHSU Knight Cancer Institute:
adult acute lymphoblastic leukemia in remission
adult acute myeloid leukemia in remission
childhood acute lymphoblastic leukemia in remission
recurrent adult acute lymphoblastic leukemia
recurrent adult acute myeloid leukemia
recurrent childhood acute lymphoblastic leukemia
recurrent childhood acute myeloid leukemia
secondary acute myeloid leukemia
myelodysplastic syndromes
childhood myelodysplastic syndromes

Additional relevant MeSH terms:
Leukemia
Leukemia, Lymphoid
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Preleukemia
Syndrome
Bone Marrow Diseases
Disease
Hematologic Diseases
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Pathologic Processes
Precancerous Conditions
Fludarabine
Fludarabine phosphate
Treosulfan
Alkylating Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on October 29, 2014