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Combination Chemotherapy Followed By Umbilical Cord Blood Transplantation in Treating Patients With Hematologic Cancer or Severe Aplastic Anemia

Primary Purpose

Chronic Myeloproliferative Disorders, Leukemia, Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
anti-thymocyte globulin
filgrastim
cyclophosphamide
fludarabine phosphate
umbilical cord blood transplantation
methylprednisolone
Sponsored by
Case Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Myeloproliferative Disorders focused on measuring refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, adult acute myeloid leukemia in remission, childhood acute myeloid leukemia in remission, recurrent adult acute myeloid leukemia, recurrent childhood acute myeloid leukemia, adult erythroleukemia (M6a), childhood acute erythroleukemia (M6), adult acute minimally differentiated myeloid leukemia (M0), childhood acute minimally differentiated myeloid leukemia (M0), adult acute megakaryoblastic leukemia (M7), childhood acute megakaryocytic leukemia (M7), adult acute lymphoblastic leukemia in remission, childhood acute lymphoblastic leukemia in remission, recurrent adult acute lymphoblastic leukemia, recurrent childhood acute lymphoblastic leukemia, accelerated phase chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, previously treated myelodysplastic syndromes, refractory chronic lymphocytic leukemia, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, recurrent/refractory childhood Hodgkin lymphoma, polycythemia vera, primary myelofibrosis, essential thrombocythemia, refractory multiple myeloma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult Burkitt lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent mantle cell lymphoma, recurrent childhood large cell lymphoma, recurrent childhood lymphoblastic lymphoma, recurrent childhood small noncleaved cell lymphoma, childhood diffuse large cell lymphoma, childhood immunoblastic large cell lymphoma, Burkitt lymphoma, anaplastic large cell lymphoma, recurrent adult Hodgkin lymphoma, childhood chronic myelogenous leukemia, chronic eosinophilic leukemia, chronic neutrophilic leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, atypical chronic myeloid leukemia, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma, 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), childhood myelodysplastic syndromes

Eligibility Criteria

undefined - 120 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: One of the following histologically confirmed diagnoses: Acquired severe aplastic anemia Meets at least 2 of the following criteria: Granulocyte count less than 500/mm^3 Platelet count less than 20,000/mm^3 Absolute reticulocyte count less than 20,000/mm^3 (after correction for hematocrit) Unresponsive to OR recurrent disease after prior treatment with anti-thymocyte globulin and/or cyclosporine Acute myeloid leukemia (AML), meeting 1 of the following criteria: Failed induction therapy In first complete remission (CR) with any of the following high-risk features: Stem cell or biphenotype classification (M0) Erythroleukemia (M6) Acute megakaryocytic leukemia (M7) Cytogenetic markers indicative of poor prognosis t(15;17) translocation and failed first-line induction therapy OR there is molecular evidence of persistent disease t(8;21) and inv(16) translocations and failed first-line induction therapy In early relapse* In second or subsequent remission Recurrent disease after prior autologous stem cell transplantation (SCT) NOTE: *No refractory relapse Acute lymphoblastic leukemia, meeting 1 of the following criteria: In early relapse* In second or subsequent remission In first CR with the following high-risk features: t(4;11) or t(9;22) translocation Hyperleukocytosis (initial WBC greater than 30,000/mm^3) Failed to achieve CR by day 28 of standard induction therapy Recurrent disease after prior autologous SCT NOTE: *No refractory relapse Chronic myelogenous leukemia Chronic or accelerated phase that has failed medical management Blastic phase allowed after reinduction chemotherapy induces chronic phase Myelodysplastic syndromes meeting 1 of the following criteria: Refractory to medical management Presence of cytogenetic abnormalities predictive of transformation to acute leukemia, including the following: = 5q- = 7q- Monosomy 7 and trisomy 8 Evidence of evolution to AML (e.g., refractory anemia with excess blasts [RAEB], or RAEB in transformation) Chronic lymphocytic leukemia Refractory to treatment including fludarabine-based therapy Recurrent disease after prior autologous SCT Multiple myeloma Recurrent disease after prior autologous SCT Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Hodgkin's lymphoma Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Non-Hodgkin's lymphoma (NHL) Recurrent disease after prior autologous SCT Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Mantle zone NHL allowed after induction therapy Myeloproliferative disorders Refractory to medical management Allografting required unless grade 3 or greater myelofibrosis by bone marrow biopsy No HLA-matched sibling donor available Ineligible for a myeloablative conditioning regimen due to advanced age (over 55), extensive prior therapy, and/or other comorbidities If under age 55, must meet at least 1 of the following criteria: Received extensive prior therapy Organ toxicity or infection precluding eligibility for allogeneic transplantation with full ablation conditioning Availability of 2-5 umbilical cord blood units that are at least a 4/6 HLA match No active CNS disease No primary or grade 3 or 4 myelofibrosis PATIENT CHARACTERISTICS: Age Any age Performance status Karnofsky 70-100% (for patients 16 years of age and older) Lansky 50-100% (for patients under 16 years of age) Life expectancy At least 3 months Hematopoietic See Disease Characteristics Hepatic ALT/AST less than 4 times normal Bilirubin less than 2.0 mg/dL (unless due to hepatic infiltration by primary malignancy) Renal Creatinine clearance greater than 40 mL/min Cardiovascular Shortening fraction or ejection fraction greater than 40% of normal value for age by echocardiogram or radionuclide scan Pulmonary FVC and FEV_1 greater than 60% of predicted DLCO greater than 60% of predicted (adult patients) Clearance by pulmonologist required if patient cannot perform pulmonary function tests Other Not pregnant or nursing No uncontrolled active infection (viral, bacterial, or fungal) HIV negative PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 3 months since prior autologous stem cell transplantation Chemotherapy See Disease Characteristics At least 4 weeks since prior chemotherapy Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other Recovered from prior therapy No other concurrent investigational agents that would preclude study participation or increase risk to patient Investigational diagnostic procedures allowed

Sites / Locations

  • Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

non-myeloablative conditioning regimen

Arm Description

Outcomes

Primary Outcome Measures

Event-free survival by disease assessment

Secondary Outcome Measures

Umbilical cord blood donor engraftment by chimerism and complete blood count (CBC)

Full Information

First Posted
February 5, 2003
Last Updated
July 23, 2020
Sponsor
Case Comprehensive Cancer Center
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1. Study Identification

Unique Protocol Identification Number
NCT00054236
Brief Title
Combination Chemotherapy Followed By Umbilical Cord Blood Transplantation in Treating Patients With Hematologic Cancer or Severe Aplastic Anemia
Official Title
Pilot Study Of Multiple Umbilical Cord Blood Unit Transplantation Following Non-Myeloablative Conditioning In Patients With Hematologic Disorders Or Severe Aplastic Anemia
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
May 2002 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
March 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Case Comprehensive Cancer Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Umbilical cord blood transplantation may be able to replace cells destroyed by chemotherapy. PURPOSE: Phase I trial to study the effectiveness of combination chemotherapy followed by umbilical cord blood transplantation in treating patients who have hematologic cancer or severe aplastic anemia.
Detailed Description
OBJECTIVES: Determine the incidence and severity of acute toxicity in patients with hematologic malignancies or severe aplastic anemia treated with a non-myeloablative conditioning regimen followed by umbilical cord blood transplantation. Determine the incidence and severity of acute and chronic graft-versus-host-disease in patients treated with this regimen. Determine the incidence of relapse, disease-free survival, and overall survival of patients treated with this regimen. Determine the survival rate at 100 days post-transplantation in patients treated with this regimen. Determine the incidence of regimen-related complications (infection, hepatic veno-occlusive disease, and interstitial pneumonitis) in patients treated with this regimen. Determine the incidence of primary and secondary graft failure in patients treated with this regimen. Determine the rates and kinetics of donor-derived lymphoid, myeloid, neutrophil, RBC, and platelet engraftment in patients treated with this regimen. OUTLINE: Patients receive a non-myeloablative conditioning regimen comprising fludarabine IV over 30 minutes on days -8 to -4, cyclophosphamide IV over 2 hours on days -3 to -2, and anti-thymocyte globulin (ATG) IV over at least 4 hours on days -2 to -1. Patients unable to tolerate ATG may receive methylprednisolone IV over 1 hour on days -3 to -1. Patients undergo multiple unit umbilical cord blood transplantation on days 0-1. Patients receive filgrastim (G-CSF) subcutaneously beginning on day 7 and continuing until blood counts recover. Patients are followed monthly for 6 months; at 9, 12, 14, 16, 18, and 24 months; and then annually thereafter. PROJECTED ACCRUAL: A total of 24 patients will be accrued for this study within 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Myeloproliferative Disorders, Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases
Keywords
refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, adult acute myeloid leukemia in remission, childhood acute myeloid leukemia in remission, recurrent adult acute myeloid leukemia, recurrent childhood acute myeloid leukemia, adult erythroleukemia (M6a), childhood acute erythroleukemia (M6), adult acute minimally differentiated myeloid leukemia (M0), childhood acute minimally differentiated myeloid leukemia (M0), adult acute megakaryoblastic leukemia (M7), childhood acute megakaryocytic leukemia (M7), adult acute lymphoblastic leukemia in remission, childhood acute lymphoblastic leukemia in remission, recurrent adult acute lymphoblastic leukemia, recurrent childhood acute lymphoblastic leukemia, accelerated phase chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, previously treated myelodysplastic syndromes, refractory chronic lymphocytic leukemia, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, recurrent/refractory childhood Hodgkin lymphoma, polycythemia vera, primary myelofibrosis, essential thrombocythemia, refractory multiple myeloma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult Burkitt lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent mantle cell lymphoma, recurrent childhood large cell lymphoma, recurrent childhood lymphoblastic lymphoma, recurrent childhood small noncleaved cell lymphoma, childhood diffuse large cell lymphoma, childhood immunoblastic large cell lymphoma, Burkitt lymphoma, anaplastic large cell lymphoma, recurrent adult Hodgkin lymphoma, childhood chronic myelogenous leukemia, chronic eosinophilic leukemia, chronic neutrophilic leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, atypical chronic myeloid leukemia, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma, 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), childhood myelodysplastic syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
55 (Actual)

8. Arms, Groups, and Interventions

Arm Title
non-myeloablative conditioning regimen
Arm Type
Experimental
Intervention Type
Biological
Intervention Name(s)
anti-thymocyte globulin
Intervention Description
anti-thymocyte globulin (ATG) IV over at least 4 hours on days -2 to -1
Intervention Type
Biological
Intervention Name(s)
filgrastim
Intervention Description
Patients receive filgrastim (G-CSF) subcutaneously beginning on day 7 and continuing until blood counts recover.
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Intervention Description
cyclophosphamide IV over 2 hours on days -3 to -2
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Intervention Description
fludarabine IV over 30 minutes on days -8 to -4
Intervention Type
Procedure
Intervention Name(s)
umbilical cord blood transplantation
Intervention Description
Patients undergo multiple unit umbilical cord blood transplantation on days 0-1.
Intervention Type
Drug
Intervention Name(s)
methylprednisolone
Intervention Description
Patients unable to tolerate ATG may receive methylprednisolone IV over 1 hour on days -3 to -1.
Primary Outcome Measure Information:
Title
Event-free survival by disease assessment
Time Frame
at 28 and 100 days and then at 6, 9, 12, 18, and 24 months
Secondary Outcome Measure Information:
Title
Umbilical cord blood donor engraftment by chimerism and complete blood count (CBC)
Time Frame
monthly for 6 months and then at 9, 12, 18, and 24 months

10. Eligibility

Sex
All
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: One of the following histologically confirmed diagnoses: Acquired severe aplastic anemia Meets at least 2 of the following criteria: Granulocyte count less than 500/mm^3 Platelet count less than 20,000/mm^3 Absolute reticulocyte count less than 20,000/mm^3 (after correction for hematocrit) Unresponsive to OR recurrent disease after prior treatment with anti-thymocyte globulin and/or cyclosporine Acute myeloid leukemia (AML), meeting 1 of the following criteria: Failed induction therapy In first complete remission (CR) with any of the following high-risk features: Stem cell or biphenotype classification (M0) Erythroleukemia (M6) Acute megakaryocytic leukemia (M7) Cytogenetic markers indicative of poor prognosis t(15;17) translocation and failed first-line induction therapy OR there is molecular evidence of persistent disease t(8;21) and inv(16) translocations and failed first-line induction therapy In early relapse* In second or subsequent remission Recurrent disease after prior autologous stem cell transplantation (SCT) NOTE: *No refractory relapse Acute lymphoblastic leukemia, meeting 1 of the following criteria: In early relapse* In second or subsequent remission In first CR with the following high-risk features: t(4;11) or t(9;22) translocation Hyperleukocytosis (initial WBC greater than 30,000/mm^3) Failed to achieve CR by day 28 of standard induction therapy Recurrent disease after prior autologous SCT NOTE: *No refractory relapse Chronic myelogenous leukemia Chronic or accelerated phase that has failed medical management Blastic phase allowed after reinduction chemotherapy induces chronic phase Myelodysplastic syndromes meeting 1 of the following criteria: Refractory to medical management Presence of cytogenetic abnormalities predictive of transformation to acute leukemia, including the following: = 5q- = 7q- Monosomy 7 and trisomy 8 Evidence of evolution to AML (e.g., refractory anemia with excess blasts [RAEB], or RAEB in transformation) Chronic lymphocytic leukemia Refractory to treatment including fludarabine-based therapy Recurrent disease after prior autologous SCT Multiple myeloma Recurrent disease after prior autologous SCT Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Hodgkin's lymphoma Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Non-Hodgkin's lymphoma (NHL) Recurrent disease after prior autologous SCT Beyond first CR or failed induction therapy Disease is sensitive to pretransplantation cytoreduction Mantle zone NHL allowed after induction therapy Myeloproliferative disorders Refractory to medical management Allografting required unless grade 3 or greater myelofibrosis by bone marrow biopsy No HLA-matched sibling donor available Ineligible for a myeloablative conditioning regimen due to advanced age (over 55), extensive prior therapy, and/or other comorbidities If under age 55, must meet at least 1 of the following criteria: Received extensive prior therapy Organ toxicity or infection precluding eligibility for allogeneic transplantation with full ablation conditioning Availability of 2-5 umbilical cord blood units that are at least a 4/6 HLA match No active CNS disease No primary or grade 3 or 4 myelofibrosis PATIENT CHARACTERISTICS: Age Any age Performance status Karnofsky 70-100% (for patients 16 years of age and older) Lansky 50-100% (for patients under 16 years of age) Life expectancy At least 3 months Hematopoietic See Disease Characteristics Hepatic ALT/AST less than 4 times normal Bilirubin less than 2.0 mg/dL (unless due to hepatic infiltration by primary malignancy) Renal Creatinine clearance greater than 40 mL/min Cardiovascular Shortening fraction or ejection fraction greater than 40% of normal value for age by echocardiogram or radionuclide scan Pulmonary FVC and FEV_1 greater than 60% of predicted DLCO greater than 60% of predicted (adult patients) Clearance by pulmonologist required if patient cannot perform pulmonary function tests Other Not pregnant or nursing No uncontrolled active infection (viral, bacterial, or fungal) HIV negative PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 3 months since prior autologous stem cell transplantation Chemotherapy See Disease Characteristics At least 4 weeks since prior chemotherapy Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other Recovered from prior therapy No other concurrent investigational agents that would preclude study participation or increase risk to patient Investigational diagnostic procedures allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brenda Cooper, MD
Organizational Affiliation
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106-5065
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Combination Chemotherapy Followed By Umbilical Cord Blood Transplantation in Treating Patients With Hematologic Cancer or Severe Aplastic Anemia

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