| Conditions: |
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Chronic Myeloproliferative Disorders - Leukemia - Lymphoma - Multiple Myeloma and Plasma Cell Neoplasm - Myelodysplastic Syndromes |
| Purpose: |
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RATIONALE: Giving chemotherapy, such as fludarabine, busulfan, and melphalan, before a donor
peripheral stem cell transplant or bone marrow transplant helps stop the growth of cancer or
abnormal cells. It also helps stop the patient's immune system from rejecting the donor's
stem cells. When the healthy stem cells from a donor are infused into the patient they may
help the patient's bone marrow make stem cells, red blood cells, white blood cells, and
platelets. Sometimes the transplanted cells from a donor can make an immune response against
the body's normal cells. Giving tacrolimus, methotrexate, mycophenolate mofetil, and
antithymocyte globulin before and after transplant may stop this from happening. Once the
donated stem cells begin working, the patient's immune system may see the remaining cancer
or abnormal cells as not belonging in the patient's body and destroy them
(graft-versus-tumor effect). Giving an infusion of the donor's white blood cells (donor
lymphocyte infusion) may boost this effect.
PURPOSE: This phase II trial is studying how well donor stem cell transplant works in
treating patients with hematologic cancer or other diseases.
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| Study Summary: |
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OBJECTIVES:
Primary
- Determine the feasibility (i.e., risk of treatment-related mortality during the first 6
months after transplantation) of administering reduced-intensity allogeneic
hematopoietic stem cell transplantation to patients with hematologic cancer or other
diseases.
Secondary
- Determine the response rate (partial and complete response), 6- and 12-month
probabilities of response, and time to progression in patients treated with this
regimen.
- Determine the risk of acute and chronic graft-versus-host disease in patients treated
with this regimen.
- Determine other toxicities of this regimen in these patients.
- Determine the overall survival and disease-free survival of patients treated with this
regimen.
- Determine the impact of iron status on overall and disease-free survival.
- Determine the influence of quality of life (at time of transplantation) on overall
survival.
OUTLINE:
- Preparative regimen: Patients receive fludarabine phosphate IV over 30 minutes on days
-7 to -3. Patients also receive busulfan IV over 2 hours every 6 hours on days -4 and
-3 or melphalan IV over 2 hours on day -3.
- Graft-versus-host disease (GVHD) prophylaxis: Patients with matched related donors
receive oral tacrolimus twice daily on days -1 to 90 followed by a taper until day 180.
Patients also receive methotrexate IV on days 1, 3, and 6. Patients with matched
unrelated and 9/10 matched related donors receive oral tacrolimus twice daily on days
-1 to 180 followed by a taper; methotrexate IV on days 1, 3, 6, and 11; and oral
mycophenolate mofetil twice daily on days -2 to 60 followed by a taper. All patients
also receive antithymocyte globulin IV over 4 to 6 hours once a day on days -4 to -1.
- Allogeneic stem cell transplantation: Patients undergo allogeneic peripheral blood stem
cell transplantation or bone marrow transplantation on day 0. Patients receive
filgrastim (G-CSF) beginning on day 7 and continuing until blood counts recover.
- Lymphocyte infusion: Patients with progressive or stable disease while off
immunosuppression and no active GVHD may receive up to 3 donor lymphocyte infusions
from the original donor at 8-week intervals beginning on day 180 or 210 .
Quality of life is assessed at baseline.
After completion of study therapy, patients are followed every 3 months for 2 years and then
every 6 months for up to 3 years.
PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study.
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| Criteria: |
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Inclusion Criteria:
- Histologically confirmed hematological disease, including any of the following:
- Chronic lymphocytic leukemia
- Absolute lymphocytosis > 5,000/µL
- Morphologically mature lymphocytes with < 55% prolymphocytes
- Lymphocyte phenotype with expression of CD19 and CD5
- Absence of CD23 expression allowed provided disease is morphologically
distinguished from mantle cell lymphoma
- Prolymphocytic leukemia
- Absolute lymphocytosis > 5,000/µL
- Morphologically mature lymphocytes with > 55% prolymphocytes
- Non-Hodgkin's or Hodgkin's lymphoma
- Any WHO classification histologic subtype
- Diagnosis by core biopsy allowed provided there is adequate tissue for
diagnosis and immunophenotyping
- Diagnosis by bone marrow biopsy not acceptable for follicular lymphomas
- Multiple myeloma
- Has received ≥ 1 prior treatment regimen
- Has a partial response or greater by the Blade Criteria
- Patients who achieved complete remission are eligible
- Acute myeloid leukemia
- Documented control (i.e., < 10% bone marrow blasts and no circulating
blasts)
- Myelodysplastic syndromes
- Documented disease as defined by WHO or French-American-British Cooperative
group criteria
- Chronic myelogenous leukemia
- Patients with atypical chronic myelogenous leukemia (i.e., absent Philadelphia
chromosome) are eligible
- Polycythemia vera
- Documented disease as defined by WHO criteria (i.e., A1 + A2, and any other
category A, OR A1 + A2, and any 2 category B):
- A1: Total red blood cell mass > 25% above mean normal predicted value
OR hemoglobin > 18.5 g/dL in males, 16.5 g/dL in females (hematocrit ≥
60% in males or ≥ 56% in females)
- A2: No cause of secondary erythrocytosis (absence of familial
erythrocytosis, no elevation of epoetin alfa [EPO] due to hypoxia,
high oxygen affinity hemoglobin, truncated EPO receptor, or
inappropriate ectopic EPO production)
- A3: Splenomegaly
- A4: Clonal genetic abnormality other than the Philadelphia chromosome
- A5: Endogenous erythroid colony formation in vitro
- B: Platelet count > 400,000/mm³, WBC > 12,000/mm³, bone marrow biopsy
with prominent erythroid and megakaryocytic proliferation, and low
serum EPO
- Chronic idiopathic myelofibrosis
- Documented disease as defined by WHO criteria
- Must have a HLA-identical donor, a matched unrelated donor, or a HLA 9/10
related donor meeting the following criteria:
- HLA-identical sibling (6/6)
- Serologic typing for class I (A, B)
- Molecular typing for class II (DRB1)
- 9/10 matched related donor
- High-resolution molecular typing at HLA-A, B, C, DRB1, and DQB1
- Only a single mismatch at one class I or II allele allowed
- 10/10 matched unrelated donor
- Molecular identity at HLA-A, B, C, DRB1, and DQB1 by high-resolution
typing
- Syngeneic donors are not eligible
- Creatinine clearance ≥ 40 mL/min
- Bilirubin ≤ 3 times upper limit of normal (ULN)
- AST ≤ 3 times ULN
- DLCO ≥ 40% with no symptomatic pulmonary disease
- LVEF ≥ 30% by cardiac MRI or echocardiogram with no symptomatic cardiac disease
- Fertile patients willing to use effective contraception
Exclusion Criteria:
- Uncontrolled diabetes mellitus
- Active serious infection
- Known hypersensitivity to E. coli-derived products
- Known HIV positivity
- History of another malignancy*, meeting the following criteria:
- Non-skin malignancy or melanoma within the past 5 years
- Concomitant malignancy that has not been curatively treated
- NOTE: *However, cancer survivors who have undergone potentially curative therapy
for a prior malignancy at least 5 years before enrollment and are deemed at low
risk of < 30% for recurrence by their treating physicians is considered
- Pregnant or nursing
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| NCT ID: |
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NCT00453206 |
| Primary Contact: |
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Study Chair
David Hurd, MD
Wake Forest University Baptist Medical Center
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| Backup Contact: |
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N/A |
| Location Contact: |
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Winston-Salem, North Carolina 27157
United States
Clinical Trials Office - Wake Forest University Comprehensive
Phone: 336-713-6771
Site Status: Recruiting |