search
Back to results

Fludarabine and Radiation Therapy in Treating Patients Who Are Undergoing Donor Stem Cell Transplant for Chronic Phase or Accelerated Phase Chronic Myelogenous Leukemia

Primary Purpose

Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
recombinant interferon alfa
therapeutic allogeneic lymphocytes
cyclosporine
fludarabine phosphate
imatinib mesylate
mycophenolate mofetil
peripheral blood stem cell transplantation
radiation therapy
Sponsored by
Fred Hutchinson Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring accelerated phase chronic myelogenous leukemia, childhood chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, Philadelphia chromosome positive chronic myelogenous leukemia, relapsing chronic myelogenous leukemia

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia, meeting 1 of the following criteria: Chronic phase Ph+ by cytogenetics or fluorescent in situ hybridization (FISH) assay Accelerated phase, meeting any of the following criteria: More than 10% but < 30% myeloblasts and promyelocytes in marrow or peripheral blood Any additional clonal cytogenetic abnormalities Increasing splenomegaly Extramedullary tumor WBC, platelet count, or hematocrit perturbations not controlled by therapy with hydroxyurea, interferon, or imatinib mesylate Persistent unexplained fever or bone pain Less than 5% blasts in the marrow at time of transplantation Not eligible for OR refused conventional myeloablative allogeneic stem cell transplantation Failed OR suboptimal response to prior imatinib mesylate, as defined by 1 of the following: Absence of complete hematologic response after > 3 months of treatment with imatinib mesylate Absence of cytogenetic response, as defined by 1 of the following: Absence of any cytogenetic response (< 95% Ph+ or BCR/ABL+ cells by cytogenetic or FISH analysis, respectively) after 6 months of treatment with imatinib mesylate Absence of major cytogenetic response (< 35% Ph+ or BCR/ABL+ cells by cytogenetic or FISH analysis, respectively) after 1 year of treatment with imatinib mesylate Absence of complete cytogenetic response (no Ph+ cells by cytogenetic analysis OR BCR/ABL+ cells within normal limits by FISH analysis) after 18 months of treatment with imatinib mesylate Hematologic evidence of disease progression Cytogenetic evidence of disease progression Increase in Ph+ cells or BCR/ABL+ cells by > 20% with at least 1 month between sequential testing Molecular evidence of disease progression More than 10-fold increase in BCR/ABL mRNA levels by quantitative polymerase chain reaction (Q-PCR) with at least 1 month between 2 sequential tests Experienced adverse events during treatment with imatinib mesylate that precluded further administration of the drug No CNS disease refractory to intrathecal chemotherapy HLA identical related donor available Phenotypically matched at HLA-A, -B, -C, DRQ1, and DBQ1 No presence of circulating leukemic blasts by standard pathology PATIENT CHARACTERISTICS: Age Any age Performance status Karnofsky 70-100% OR Lansky 70-100% Life expectancy Not specified Hematopoietic See Disease Characteristics Hepatic No fulminant liver failure No cirrhosis of the liver with evidence of portal hypertension or bridging fibrosis No alcoholic hepatitis No esophageal varices No history of bleeding esophageal varices No hepatic encephalopathy No uncorrectable hepatic synthetic dysfunction evidenced by prolongation of PT No ascites related to portal hypertension No bacterial or fungal liver abscess No biliary obstruction No chronic viral hepatitis AND bilirubin > 3 mg/dL No symptomatic biliary disease Renal Renal failure allowed Cardiovascular No symptomatic coronary artery disease Ejection fraction ≥ 35% No other cardiac failure requiring therapy No poorly controlled hypertension (blood pressure ≥ 150/90 mm Hg) on standard medication Pulmonary DLCO ≥ 30% Total lung capacity ≥ 30% FEV_1 ≥ 30% No requirement for continuous supplementary oxygen No fungal pneumonia with radiological progression after treatment with amphotericin or mold-active azoles for > 1 month Other Not pregnant or nursing Fertile patients must use effective barrier contraception during and for 12 months after completion of study treatment HIV negative No other disease that severely limits life expectancy No other active malignancy except localized nonmelanoma skin cancer No nonhematologic malignancy within the past 5 years that is currently in complete remission and has a > 20% risk of disease recurrence except for nonmelanoma skin cancer No systemic uncontrolled infection No active bacterial or fungal infection unresponsive to medical therapy PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics Chemotherapy See Disease Characteristics Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other At least 48 hours since prior imatinib mesylate

Sites / Locations

  • City of Hope Comprehensive Cancer Center
  • Seattle Cancer Care Alliance
  • Fred Hutchinson Cancer Research Center

Outcomes

Primary Outcome Measures

Progression-free survival

Secondary Outcome Measures

Rate of complete molecular response
Late nonrelapse mortality
Incidence and severity of graft-vs-host disease (GVHD)
Incidence of serious infections
Myelosuppression
Overall survival and disease-free survival

Full Information

First Posted
May 3, 2005
Last Updated
November 15, 2011
Sponsor
Fred Hutchinson Cancer Center
Collaborators
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT00110058
Brief Title
Fludarabine and Radiation Therapy in Treating Patients Who Are Undergoing Donor Stem Cell Transplant for Chronic Phase or Accelerated Phase Chronic Myelogenous Leukemia
Official Title
A Multi-Center Phase II Study of Nonmyeloablative Conditioning With TBI and Fludarabine for HLA-Matched Related Hematopoietic Cell Transplantation for Treatment of Chronic Myeloid Leukemia in Chronic and Accelerated Phase
Study Type
Interventional

2. Study Status

Record Verification Date
November 2011
Overall Recruitment Status
Completed
Study Start Date
February 2005 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
July 2006 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Fred Hutchinson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Giving low doses of chemotherapy, such as fludarabine, and radiation therapy before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Giving an infusion of the donor's T cells (donor lymphocyte infusion) or interferon alfa after the transplant may help increase this effect. Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after the transplant may stop this from happening. PURPOSE: This phase II trial is studying how well giving fludarabine together with radiation therapy works in treating patients who are undergoing donor stem cell transplant for chronic phase or accelerated phase chronic myelogenous leukemia.
Detailed Description
OBJECTIVES: Primary Determine the disease-free survival rate in patients with chronic or accelerated phase chronic myelogenous leukemia that failed or inadequately responded to prior imatinib mesylate treated with nonmyeloablative conditioning comprising fludarabine and low-dose total-body irradiation followed by allogeneic peripheral blood stem cell transplantation. Secondary Determine the complete cytogenetic and molecular response rates in patients treated with this regimen. Determine overall survival of patients treated with this regimen. Determine non-relapse mortality in patients treated with this regimen. Determine the incidence of serious infection, graft-versus-host disease, and myelosuppression in patients treated with this regimen. OUTLINE: This is a multicenter study. Conditioning treatment: Patients receive fludarabine IV on days -4 to -2. Patients undergo low-dose total-body irradiation (TBI) on day 0. Allogeneic peripheral blood stem cell transplantation: After TBI, patients undergo allogeneic peripheral blood stem cell transplantation on day 0. Immunosuppression: Patients receive oral cyclosporine twice daily on days -3 to 56 followed by a taper to day 180 in the absence of graft-versus-host disease (GVHD). Patients also receive oral mycophenolate mofetil twice daily on days 0-27. Post-transplant treatment: Patients experiencing disease persistence or progression AND low donor chimerism discontinue immunosuppression. Patients with disease persistence or progression after discontinuing immunosuppression receive oral imatinib mesylate once daily. Patients who have disease improvement after day 28 of imatinib mesylate treatment AND who have no evidence of disease after day 84 of imatinib mesylate treatment continue imatinib mesylate in the absence of disease progression or unacceptable toxicity. Patients who fail to improve after day 28 of imatinib mesylate treatment OR who have residual disease after day 84 of imatinib mesylate treatment receive donor lymphocytes IV over 15-30 minutes once every 1-4 months for up to 4 infusions. Patients ineligible to receive donor lymphocytes (e.g., patients with evidence of GVHD) receive interferon alfa subcutaneously 3 times a week for up to 12 months in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed at 6, 9, 12, 18, and 24 months, and then annually for 5 years. PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia
Keywords
accelerated phase chronic myelogenous leukemia, childhood chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, Philadelphia chromosome positive chronic myelogenous leukemia, relapsing chronic myelogenous leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Masking
None (Open Label)
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
recombinant interferon alfa
Intervention Type
Biological
Intervention Name(s)
therapeutic allogeneic lymphocytes
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Intervention Type
Drug
Intervention Name(s)
imatinib mesylate
Intervention Type
Drug
Intervention Name(s)
mycophenolate mofetil
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Primary Outcome Measure Information:
Title
Progression-free survival
Secondary Outcome Measure Information:
Title
Rate of complete molecular response
Title
Late nonrelapse mortality
Title
Incidence and severity of graft-vs-host disease (GVHD)
Title
Incidence of serious infections
Title
Myelosuppression
Title
Overall survival and disease-free survival

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia, meeting 1 of the following criteria: Chronic phase Ph+ by cytogenetics or fluorescent in situ hybridization (FISH) assay Accelerated phase, meeting any of the following criteria: More than 10% but < 30% myeloblasts and promyelocytes in marrow or peripheral blood Any additional clonal cytogenetic abnormalities Increasing splenomegaly Extramedullary tumor WBC, platelet count, or hematocrit perturbations not controlled by therapy with hydroxyurea, interferon, or imatinib mesylate Persistent unexplained fever or bone pain Less than 5% blasts in the marrow at time of transplantation Not eligible for OR refused conventional myeloablative allogeneic stem cell transplantation Failed OR suboptimal response to prior imatinib mesylate, as defined by 1 of the following: Absence of complete hematologic response after > 3 months of treatment with imatinib mesylate Absence of cytogenetic response, as defined by 1 of the following: Absence of any cytogenetic response (< 95% Ph+ or BCR/ABL+ cells by cytogenetic or FISH analysis, respectively) after 6 months of treatment with imatinib mesylate Absence of major cytogenetic response (< 35% Ph+ or BCR/ABL+ cells by cytogenetic or FISH analysis, respectively) after 1 year of treatment with imatinib mesylate Absence of complete cytogenetic response (no Ph+ cells by cytogenetic analysis OR BCR/ABL+ cells within normal limits by FISH analysis) after 18 months of treatment with imatinib mesylate Hematologic evidence of disease progression Cytogenetic evidence of disease progression Increase in Ph+ cells or BCR/ABL+ cells by > 20% with at least 1 month between sequential testing Molecular evidence of disease progression More than 10-fold increase in BCR/ABL mRNA levels by quantitative polymerase chain reaction (Q-PCR) with at least 1 month between 2 sequential tests Experienced adverse events during treatment with imatinib mesylate that precluded further administration of the drug No CNS disease refractory to intrathecal chemotherapy HLA identical related donor available Phenotypically matched at HLA-A, -B, -C, DRQ1, and DBQ1 No presence of circulating leukemic blasts by standard pathology PATIENT CHARACTERISTICS: Age Any age Performance status Karnofsky 70-100% OR Lansky 70-100% Life expectancy Not specified Hematopoietic See Disease Characteristics Hepatic No fulminant liver failure No cirrhosis of the liver with evidence of portal hypertension or bridging fibrosis No alcoholic hepatitis No esophageal varices No history of bleeding esophageal varices No hepatic encephalopathy No uncorrectable hepatic synthetic dysfunction evidenced by prolongation of PT No ascites related to portal hypertension No bacterial or fungal liver abscess No biliary obstruction No chronic viral hepatitis AND bilirubin > 3 mg/dL No symptomatic biliary disease Renal Renal failure allowed Cardiovascular No symptomatic coronary artery disease Ejection fraction ≥ 35% No other cardiac failure requiring therapy No poorly controlled hypertension (blood pressure ≥ 150/90 mm Hg) on standard medication Pulmonary DLCO ≥ 30% Total lung capacity ≥ 30% FEV_1 ≥ 30% No requirement for continuous supplementary oxygen No fungal pneumonia with radiological progression after treatment with amphotericin or mold-active azoles for > 1 month Other Not pregnant or nursing Fertile patients must use effective barrier contraception during and for 12 months after completion of study treatment HIV negative No other disease that severely limits life expectancy No other active malignancy except localized nonmelanoma skin cancer No nonhematologic malignancy within the past 5 years that is currently in complete remission and has a > 20% risk of disease recurrence except for nonmelanoma skin cancer No systemic uncontrolled infection No active bacterial or fungal infection unresponsive to medical therapy PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics Chemotherapy See Disease Characteristics Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other At least 48 hours since prior imatinib mesylate
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brenda Sandmaier, MD
Organizational Affiliation
Fred Hutchinson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope Comprehensive Cancer Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010-3000
Country
United States
Facility Name
Seattle Cancer Care Alliance
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109-1023
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109-1024
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32499241
Citation
Cooper JP, Storer BE, Granot N, Gyurkocza B, Sorror ML, Chauncey TR, Shizuru J, Franke GN, Maris MB, Boyer M, Bruno B, Sahebi F, Langston AA, Hari P, Agura ED, Lykke Petersen S, Maziarz RT, Bethge W, Asch J, Gutman JA, Olesen G, Yeager AM, Hubel K, Hogan WJ, Maloney DG, Mielcarek M, Martin PJ, Flowers MED, Georges GE, Woolfrey AE, Deeg JH, Scott BL, McDonald GB, Storb R, Sandmaier BM. Allogeneic hematopoietic cell transplantation with non-myeloablative conditioning for patients with hematologic malignancies: Improved outcomes over two decades. Haematologica. 2021 Jun 1;106(6):1599-1607. doi: 10.3324/haematol.2020.248187.
Results Reference
derived

Learn more about this trial

Fludarabine and Radiation Therapy in Treating Patients Who Are Undergoing Donor Stem Cell Transplant for Chronic Phase or Accelerated Phase Chronic Myelogenous Leukemia

We'll reach out to this number within 24 hrs