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Stem Cell Transplant for Hematological Malignancy

Primary Purpose

Leukemia, Myeloid, Chronic, AML, Leukemia, Lymphocytic, Acute

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Stem Cell Transplant
Cyclophosphamide
Total Body Irradiation
Busulfan
Equine ATG (ATGAM)
CD4+/CD25+ cells
Sponsored by
Masonic Cancer Center, University of Minnesota
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia, Myeloid, Chronic focused on measuring stem cell transplant, chronic leukemia, acute leukemia, irradiation, chemotherapy

Eligibility Criteria

undefined - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Donor will be <75 years of age and in good health. Recipients will be < or = 55 years, will have normal organ function (excluding bone marrow) and will have a Karnofsky activity assessment > or = 90%. Recipients with related or unrelated donor matched at the HLA A, B, DRB1 loci, or mismatched related or unrelated (if < 35 years old) at a single HLA A, B, DRB1 locus. Recipients will be eligible in one of the following disease categories Chronic myelogenous leukemia in accelerated phase or in post blast crisis second or greater chronic phase; or in chronic phase but intolerant of or resistant to tyrosine kinase inhibitors. Acute myelocytic leukemia in first or greater remission, or first, second or third relapse. Acute lymphocytic leukemia in the 2nd or greater bone marrow remission. High risk children will be transplanted in first remission if they meet criteria Myelodysplastic syndrome. Myeloproliferative Diseases - (i.e. myelofibrosis, chronic myelomonocytic leukemia (CMML)) Juvenile myelomonocytic leukemia Chronic lymphocytic leukemia Advanced non-Hodgkin's (NHL). Advanced Hodgkin's disease beyond PR2 (> CR3, > PR3). Multiple Myeloma after initial therapy. Donors and recipients signed informed consent Exclusion Criteria donors and recipients should meet the following test criteria. required for donors: anti-HIV, Hepatitis B, surface antigen, anti-HCV, CMV, HSV, EBV serologies, pre-priming. CBC, platelet count each day of apheresis, day 0 (or 1 or 2 as needed) required for recipients: anti-HIV, Hepatitis B, surface antigen, anti-HCV, CMV, HSV, EBV serologies, pre-transplant.

Sites / Locations

  • Masonic Cancer Center, University of Minnesota

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

PBSC: No TBI

Marrow : No TBI

UCB : No TBI

UCB : No TBI/Bu/Cy/ATG

PBSC

Marrow

UCB

Co-Enroll From MT0403

Arm Description

Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Peripheral Blood Stem Cells (PBSC) as a source of transplant

Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Bone Marrow as a source of stem cell transplant

Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Umbilical Cord Blood (UCB) as a source of stem cell transplant

Patients who receives Umbilical Cord Blood (UCB) as a source of transplant and who have not had chemotherapy in the prior 3 months receives ATG in addition to cyclophosphamide, Busulfan preparative regimen

Patients receiving cyclophosphamide, Total Body Irradiation (TBI) and Peripheral blood stem cells as a source of transplant

Patients receiving cyclophosphamide, Total Body Irradiation (TBI) and Bone Marrow as a source of stem cell transplant

Patients receiving cyclophosphamide, Total Body Irradiation (TBI), and Umbilical Cord Blood (UCB) as a source of stem cell transplant

Patients receiving cyclophosphamide, Total Body Irradiation (TBI) , CD4+CD25+ and Peripheral Blood Stem Cells (PBSC) as a source of transplant. These patients are co-enrolled on the MT2004-03 trial (NCT00725062)

Outcomes

Primary Outcome Measures

Number of Participants Experiencing Disease-Free Survival at 2 Years Post Transplant
Disease-Free Survival is the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. It is sometimes used as a metric to study the health of a person with a disease to try to determine how well a new treatment is working.
Number of Participants Experiencing Disease-Free Survival at 5 Years Post Transplant
Disease-Free Survival is the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. It is sometimes used as a metric to study the health of a person with a disease to try to determine how well a new treatment is working.

Secondary Outcome Measures

Number of Participants With Neutrophil Engraftment
Neutrophil engraftment is defined as the first day of three consecutive days where the neutrophil count (absolute neutrophil count) is 500 cells/mm^3 (0.5 x 10^9/L) or greater.
Number of Participants With Acute Graft-versus-host Disease (GVHD)
Acute Graft-Versus-Host Disease (aGVHD) is a severe short-term complication created by infusion of donor cells into a foreign host. Determine the incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 post transplant. Patients will be staged weekly between days 0 and 100 after transplantation using standard criteria used for staging. Patients will be assigned an overall GVHD score based on extent of skin rash, volume of diarrhea and maximum bilirubin level.
Number of Participants With Chronic Graft-Versus-Host Disease
Chronic Graft-Versus-Host Disease is a severe long-term complication created by infusion of donor cells into a foreign host. Determine the incidence of chronic GVHD 1 year post transplant. Patients will be staged weekly between days 0 and 100 after transplantation using standard criteria. Patients will be assigned an overall GVHD score based on extent of skin rash, volume of diarrhea and maximum bilirubin level.
Number of Participants With Persistence or Relapse of Malignancy at 2 Years Post Transplant
Defined as the return of disease after its apparent recovery/cessation. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Number of Participants With Persistence or Relapse of Malignancy at 5 Years Post Transplant
Defined as the return of disease after its apparent recovery/cessation. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Number of Participants Who Were Alive at 2 Year Post Transplant
The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer.
Number of Participants Who Were Alive at 5 Year Post Transplant
The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer.
Number of Participants Experiencing Engraftment Failure
Graft failure is defined as not accepting donated cells. The donated cells do not make the new white blood cells, red blood cells and platelets.

Full Information

First Posted
September 12, 2005
Last Updated
December 31, 2020
Sponsor
Masonic Cancer Center, University of Minnesota
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1. Study Identification

Unique Protocol Identification Number
NCT00176930
Brief Title
Stem Cell Transplant for Hematological Malignancy
Official Title
Allogeneic Transplant for Hematological Malignancy
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Terminated
Why Stopped
replaced by another study ; Trial re-written as MT2015-29
Study Start Date
October 2001 (Actual)
Primary Completion Date
December 2019 (Actual)
Study Completion Date
December 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Masonic Cancer Center, University of Minnesota

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to develop a standard of care treatment using allogeneic stem cells for patients with cancers of the blood. The protocol was revised to reflect that this study is considered "treatment guidelines", rather than a research study.
Detailed Description
Preparative regimen using total body irradiation (TBI) and cyclophosphamide: on day -6 and -5: cyclophosphamide is given, on day -4, -3, -2, and -1: TBI is given, on day 0: stem cell or bone marrow is infused. Alternate preparative therapy for patients not able to receive TBI The chemotherapy (cyclophosphamide and busulfan) is given with the intent of destroying the bone marrow, eliminating any cancerous and preparing for the transplant of the donor's blood stem cells by suppressing the immune system. l. Ten days before the transplant (Day 10), subjects will be admitted to the bone marrow transplant unit and placed in isolation to reduce exposure to infections. Isolation will be continued until adequate numbers of cells are present in the blood to fight infection. 2. On day -9, -8, -7, -6 busulfan is given. 3. On day -5, -4, -3, -2 cyclophosphamide is given. 4. On day -1 no therapy is given (day of rest). 5. On day 0 the donor stem cells are given intravenously. Additional cells may be given on day +1 or 2 as needed. Transplant: Subjects will be admitted to the bone marrow transplant unit and put in isolation to reduce exposure to infectious agents. During this time, they will receive the preparative treatment outlined above. Once they have received the preparative regimen, stem cells will be obtained from the donor and given intravenously. The new stem cells will replace the bone marrow that was damaged by the treatment for the cancer. Isolation will be continued until adequate numbers of cells are present in the blood to fight infection. Subjects will then be transferred from the bone marrow transplant unit and discharged from the hospital when medically ready. Subjects will be expected to return for follow-up to the bone marrow transplant clinic at specific dates as determined by their physician.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myeloid, Chronic, AML, Leukemia, Lymphocytic, Acute, MDS, Leukemia, Lymphocytic, Chronic, JMML, Hodgkin's Disease, Non-hodgkin's Lymphoma, Multiple Myeloma
Keywords
stem cell transplant, chronic leukemia, acute leukemia, irradiation, chemotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
330 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PBSC: No TBI
Arm Type
Experimental
Arm Description
Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Peripheral Blood Stem Cells (PBSC) as a source of transplant
Arm Title
Marrow : No TBI
Arm Type
Experimental
Arm Description
Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Bone Marrow as a source of stem cell transplant
Arm Title
UCB : No TBI
Arm Type
Experimental
Arm Description
Patients who are not able to receive Total Body Irradiation (TBI) receives cyclophosphamide, Busulfan and Umbilical Cord Blood (UCB) as a source of stem cell transplant
Arm Title
UCB : No TBI/Bu/Cy/ATG
Arm Type
Experimental
Arm Description
Patients who receives Umbilical Cord Blood (UCB) as a source of transplant and who have not had chemotherapy in the prior 3 months receives ATG in addition to cyclophosphamide, Busulfan preparative regimen
Arm Title
PBSC
Arm Type
Experimental
Arm Description
Patients receiving cyclophosphamide, Total Body Irradiation (TBI) and Peripheral blood stem cells as a source of transplant
Arm Title
Marrow
Arm Type
Experimental
Arm Description
Patients receiving cyclophosphamide, Total Body Irradiation (TBI) and Bone Marrow as a source of stem cell transplant
Arm Title
UCB
Arm Type
Experimental
Arm Description
Patients receiving cyclophosphamide, Total Body Irradiation (TBI), and Umbilical Cord Blood (UCB) as a source of stem cell transplant
Arm Title
Co-Enroll From MT0403
Arm Type
Experimental
Arm Description
Patients receiving cyclophosphamide, Total Body Irradiation (TBI) , CD4+CD25+ and Peripheral Blood Stem Cells (PBSC) as a source of transplant. These patients are co-enrolled on the MT2004-03 trial (NCT00725062)
Intervention Type
Biological
Intervention Name(s)
Stem Cell Transplant
Other Intervention Name(s)
Bone Marrow Transplant.
Intervention Description
Certain cancers can be treated by giving patients stem cells that come from someone else. This is called a stem-cell transplant. As part of the transplant process, patients receive high doses of chemotherapy and/or radiation to treat their underlying disease, such as cancer. As one of its effects, this treatment also kills the healthy stem cells that are already in the marrow. The transplant provides new stem cells for the patient from a healthy donor; that replace the bone marrow and allow the blood counts to recover. (Allowable sources of stem cells = related or unrelated bone marrow or peripheral blood, for Busulfan/cyclophosphamide/ATG preparative chemo only, umbilical cord blood is also permitted.)
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
Cytoxan
Intervention Description
60 mg/kg intravenously (IV) Days -6 and -5 or 50 mg/kg/day IV Days -5 through -2.
Intervention Type
Radiation
Intervention Name(s)
Total Body Irradiation
Other Intervention Name(s)
Radiation therapy
Intervention Description
On Day -4, -3, -2, -1 total body irradiation is given twice daily.
Intervention Type
Drug
Intervention Name(s)
Busulfan
Other Intervention Name(s)
Busulfex, Myleran
Intervention Description
When not receiving total body irradiation, administered Days -9 through -6, 0.8 mg/kg/dose by intravenous dosing every 6 hours.
Intervention Type
Drug
Intervention Name(s)
Equine ATG (ATGAM)
Intervention Description
UCB recipients who have not had chemotherapy in the preceding 3 months will also receive Equine ATG (ATGAM) 15 mg/kg IV will be administered every 12 hours for 6 doses beginning on day -3 per institutional guidelines
Intervention Type
Biological
Intervention Name(s)
CD4+/CD25+ cells
Intervention Description
On days -2, patients will receive CD4+/CD25+ cells intravenously.
Primary Outcome Measure Information:
Title
Number of Participants Experiencing Disease-Free Survival at 2 Years Post Transplant
Description
Disease-Free Survival is the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. It is sometimes used as a metric to study the health of a person with a disease to try to determine how well a new treatment is working.
Time Frame
2 years
Title
Number of Participants Experiencing Disease-Free Survival at 5 Years Post Transplant
Description
Disease-Free Survival is the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. It is sometimes used as a metric to study the health of a person with a disease to try to determine how well a new treatment is working.
Time Frame
5 years
Secondary Outcome Measure Information:
Title
Number of Participants With Neutrophil Engraftment
Description
Neutrophil engraftment is defined as the first day of three consecutive days where the neutrophil count (absolute neutrophil count) is 500 cells/mm^3 (0.5 x 10^9/L) or greater.
Time Frame
Day 42
Title
Number of Participants With Acute Graft-versus-host Disease (GVHD)
Description
Acute Graft-Versus-Host Disease (aGVHD) is a severe short-term complication created by infusion of donor cells into a foreign host. Determine the incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 post transplant. Patients will be staged weekly between days 0 and 100 after transplantation using standard criteria used for staging. Patients will be assigned an overall GVHD score based on extent of skin rash, volume of diarrhea and maximum bilirubin level.
Time Frame
Day 100
Title
Number of Participants With Chronic Graft-Versus-Host Disease
Description
Chronic Graft-Versus-Host Disease is a severe long-term complication created by infusion of donor cells into a foreign host. Determine the incidence of chronic GVHD 1 year post transplant. Patients will be staged weekly between days 0 and 100 after transplantation using standard criteria. Patients will be assigned an overall GVHD score based on extent of skin rash, volume of diarrhea and maximum bilirubin level.
Time Frame
1 year
Title
Number of Participants With Persistence or Relapse of Malignancy at 2 Years Post Transplant
Description
Defined as the return of disease after its apparent recovery/cessation. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Time Frame
2 years
Title
Number of Participants With Persistence or Relapse of Malignancy at 5 Years Post Transplant
Description
Defined as the return of disease after its apparent recovery/cessation. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Time Frame
5 years
Title
Number of Participants Who Were Alive at 2 Year Post Transplant
Description
The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer.
Time Frame
2 years
Title
Number of Participants Who Were Alive at 5 Year Post Transplant
Description
The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer.
Time Frame
5 years
Title
Number of Participants Experiencing Engraftment Failure
Description
Graft failure is defined as not accepting donated cells. The donated cells do not make the new white blood cells, red blood cells and platelets.
Time Frame
Day 42

10. Eligibility

Sex
All
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Donor will be <75 years of age and in good health. Recipients will be < or = 55 years, will have normal organ function (excluding bone marrow) and will have a Karnofsky activity assessment > or = 90%. Recipients with related or unrelated donor matched at the HLA A, B, DRB1 loci, or mismatched related or unrelated (if < 35 years old) at a single HLA A, B, DRB1 locus. Recipients will be eligible in one of the following disease categories Chronic myelogenous leukemia in accelerated phase or in post blast crisis second or greater chronic phase; or in chronic phase but intolerant of or resistant to tyrosine kinase inhibitors. Acute myelocytic leukemia in first or greater remission, or first, second or third relapse. Acute lymphocytic leukemia in the 2nd or greater bone marrow remission. High risk children will be transplanted in first remission if they meet criteria Myelodysplastic syndrome. Myeloproliferative Diseases - (i.e. myelofibrosis, chronic myelomonocytic leukemia (CMML)) Juvenile myelomonocytic leukemia Chronic lymphocytic leukemia Advanced non-Hodgkin's (NHL). Advanced Hodgkin's disease beyond PR2 (> CR3, > PR3). Multiple Myeloma after initial therapy. Donors and recipients signed informed consent Exclusion Criteria donors and recipients should meet the following test criteria. required for donors: anti-HIV, Hepatitis B, surface antigen, anti-HCV, CMV, HSV, EBV serologies, pre-priming. CBC, platelet count each day of apheresis, day 0 (or 1 or 2 as needed) required for recipients: anti-HIV, Hepatitis B, surface antigen, anti-HCV, CMV, HSV, EBV serologies, pre-transplant.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Weisdorf, MD
Organizational Affiliation
Masonic Cancer Center, University of Minnesota
Official's Role
Principal Investigator
Facility Information:
Facility Name
Masonic Cancer Center, University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States

12. IPD Sharing Statement

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Stem Cell Transplant for Hematological Malignancy

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