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Immunoablative Mini Transplant (Hematopoietic Peripheral Blood Stem Cell Transplant [HPBSC])

Primary Purpose

Tumors, Malignant Melanoma, Hematological Malignancies

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Immunoablative Hematopoietic PBSC Transplant
Busulfan pharmacokinetics
Central Nervous System (CNS) prophylaxis radiation
Sponsored by
Ann & Robert H Lurie Children's Hospital of Chicago
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tumors focused on measuring Patients with recurrent solid tumors, Patients with malignant melanoma, Patients with hematological malignancies, Acute lymphoblastic leukemia (ALL), Acute myelogenous leukemia (AML)

Eligibility Criteria

undefined - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients with recurrent solid tumors Patients with malignant melanoma Patients with hematological malignancies. Chronic myelogenous leukemia in chronic or accelerated phase, to include chronic myelomonocytic leukemia (juvenile chronic myelogenous leukemia (JCML) or CMML). Acute lymphoblastic leukemia (ALL) First remission high-risk ALL (Ph+ with initial high white blood cell (WBC)t (4-11) in infants less than 1 year and CALLA negative) Second or subsequent remission ALL or isolated extramedullary disease on or off therapy. Acute non-lymphocytic leukemia (ANLL) Patients with ANLL in first remission who have a matched sibling donor. ANLL in second remission, or patients who only achieve an initial partial remission < 15% blasts, or early relapse. Myelodysplastic syndromes (MDS): refractory anemia (RA), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T) and CMML/JCML. Selected immunodeficiencies: Wiskott-Aldrich syndrome. Severe combined immunodeficiency variants that require ablation. Hyper-Immunoglobulin M (IgM) syndrome. Other immune deficiencies after approval from the medical director. Bone marrow failure syndromes (single or multiple hematopoietic lines) Venous access: A double lumen central vascular access device or its equivalent will be required for all patients entered on the protocol. Informed consent: The donor and the patient and/or the patient's legally authorized guardian must acknowledge in writing that consent to become a study subject has been obtained in accordance with the institutional policy approved by the United States (U.S.) Department of Health and Human Services. Patient organ function requirements: Adequate renal function: serum creatinine < 2 x normal, or creatinine clearance calculated by Schwartz formula, of glomerular filtration rate (GFR) > 40 ml/min/1.73m2, or an equivalent GFR as determined by the institutional normal range. Adequate liver function: total bilirubin </= 2 x normal; and Aspartate aminotransferase (AST) or Alanine aminotransferase (ALT) </= 4 x normal. Adequate cardiac function: shortening fraction of > 24% by echocardiogram, or ejection fraction of > 30% by radionuclide angiogram. Adequate pulmonary function: Diffusion Lung Capacity Carbon Monoxide (DLCO), Forced Expiratory Volume in 1 second (FEV1) / Forced Vital Capacity (FVC) > 30% by pulmonary function test. For children who are uncooperative for pulmonary function tests and have no evidence of dyspnea at rest or exercise intolerance, pulse oximetry > 94% on room air is considered acceptable. Performance status: Lansky Score >/= 60% for children </= 16 years of age; or Karnofsky > 60% status for those > 16 years of age. Exclusion Criteria: Patients who are pregnant Inability to find a suitable donor for the patient Patient is HIV-positive Patient has active Hepatitis B Disease progression or relapse prior to HPC infusion

Sites / Locations

  • Lurie Children's Hospital

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Reduced Intensity Conditioning Regimen

Arm Description

Outcomes

Primary Outcome Measures

Evaluate the morbidity and mortality of matched related and unrelated hematopoietic progenitor cell (HPC) transplantation at Children's Memorial Hospital using high dose CD34+ HPCs after a reduced intensity conditioning regimen.
Determine the toxicity of a reduced intensity conditioning regimen consisting of Fludarabine and Busulfan.

Secondary Outcome Measures

Validate the pharmacokinetics of once-a-day dosing of intravenous Busulfan given as a 3-hour infusion, using a limited number of samples.
Assess chimeric engraftment utilizing this regimen in malignant and non-malignant disorders.
Assess the relapse rate of patients transplanted with this reduced intensity regimen.
Determine the incidence of acute and chronic Graft vs. Host Disease (GVHD) using prophylaxis with Cyclosporine A and mycophenolate mofetil following this reduced intensity regimen.

Full Information

First Posted
September 10, 2005
Last Updated
August 28, 2019
Sponsor
Ann & Robert H Lurie Children's Hospital of Chicago
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1. Study Identification

Unique Protocol Identification Number
NCT00179764
Brief Title
Immunoablative Mini Transplant (Hematopoietic Peripheral Blood Stem Cell Transplant [HPBSC])
Official Title
Immunoablative Protocol for Allogeneic Related and Unrelated Hematopoietic Peripheral Blood Stem Cell Transplant (HPBSC)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
March 10, 2000 (Actual)
Primary Completion Date
January 24, 2014 (Actual)
Study Completion Date
January 24, 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ann & Robert H Lurie Children's Hospital of Chicago

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this research study is to evaluate the effectiveness of transplantation of high doses of peripheral blood stem cells (stem cells are special cells found in the blood and bone marrow that produce new blood cells) after treatment with non-myeloablative chemotherapy (not toxic to the bone marrow). In addition, this study will assess the side effects of the transplant.
Detailed Description
The standard treatment in many disorders of the bone marrow is high dose chemotherapy and whole-body radiation treatment followed by the stem cell transplant. This type of transplant not only suppresses or kills off the immune system, but is very toxic to the bone marrow. This study uses a chemotherapy regimen that will suppress the patient's immune system; however, it is non-myeloablative (not toxic to the bone marrow). It does not use whole-body radiation treatment. This approach can minimize the short- and long-term effects of transplantation. Other studies have shown that using chemotherapy followed by bone marrow transplantation without whole-body radiation can produce similar results as treatment with whole-body radiation. Patients will be given chemotherapy with Fludarabine and Busulfan prior to the stem cell transplant. This treatment not only destroys diseased cells, but it also kills normal bone marrow cells. Following this experimental treatment, the patient will be given the stem cells through a central venous catheter (tube inserted in a vein). When the healthy stem cells are given to the patient, they will replace the destroyed bone marrow cells and produce new blood cells. The Allogeneic (not one's own) stem cells used in this experimental transplant will be obtained from a related matched donor or from an unrelated matched donor located through the National Marrow Donor Program.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tumors, Malignant Melanoma, Hematological Malignancies, Myelogenous Leukemia, Chronic, Leukemia, Lymphoblastic, Acute
Keywords
Patients with recurrent solid tumors, Patients with malignant melanoma, Patients with hematological malignancies, Acute lymphoblastic leukemia (ALL), Acute myelogenous leukemia (AML)

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
68 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Reduced Intensity Conditioning Regimen
Arm Type
Other
Intervention Type
Procedure
Intervention Name(s)
Immunoablative Hematopoietic PBSC Transplant
Intervention Description
Immunoablative conditioning chemotherapy regimen, followed by transplantation of peripheral blood stem cells on Day 0 of the conditioning regimen.
Intervention Type
Procedure
Intervention Name(s)
Busulfan pharmacokinetics
Intervention Description
Pharmacokinetics of once-a-day dosing of intravenous busulfan as a 3-hour infusion
Intervention Type
Radiation
Intervention Name(s)
Central Nervous System (CNS) prophylaxis radiation
Intervention Description
Patients diagnosed with ALL over 1 year of age and without prior CNS disease will receive CNS prophylaxis radiation to the whole brain prior to transplant. Patients diagnosed with ALL with prior CNS disease over the age of 1 year will be treated with prophylaxis radiation to the whole brain and spine prior to transplant.
Primary Outcome Measure Information:
Title
Evaluate the morbidity and mortality of matched related and unrelated hematopoietic progenitor cell (HPC) transplantation at Children's Memorial Hospital using high dose CD34+ HPCs after a reduced intensity conditioning regimen.
Time Frame
To study end
Title
Determine the toxicity of a reduced intensity conditioning regimen consisting of Fludarabine and Busulfan.
Time Frame
To study end
Secondary Outcome Measure Information:
Title
Validate the pharmacokinetics of once-a-day dosing of intravenous Busulfan given as a 3-hour infusion, using a limited number of samples.
Time Frame
To study end
Title
Assess chimeric engraftment utilizing this regimen in malignant and non-malignant disorders.
Time Frame
To study end
Title
Assess the relapse rate of patients transplanted with this reduced intensity regimen.
Time Frame
To study end
Title
Determine the incidence of acute and chronic Graft vs. Host Disease (GVHD) using prophylaxis with Cyclosporine A and mycophenolate mofetil following this reduced intensity regimen.
Time Frame
To study end

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with recurrent solid tumors Patients with malignant melanoma Patients with hematological malignancies. Chronic myelogenous leukemia in chronic or accelerated phase, to include chronic myelomonocytic leukemia (juvenile chronic myelogenous leukemia (JCML) or CMML). Acute lymphoblastic leukemia (ALL) First remission high-risk ALL (Ph+ with initial high white blood cell (WBC)t (4-11) in infants less than 1 year and CALLA negative) Second or subsequent remission ALL or isolated extramedullary disease on or off therapy. Acute non-lymphocytic leukemia (ANLL) Patients with ANLL in first remission who have a matched sibling donor. ANLL in second remission, or patients who only achieve an initial partial remission < 15% blasts, or early relapse. Myelodysplastic syndromes (MDS): refractory anemia (RA), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T) and CMML/JCML. Selected immunodeficiencies: Wiskott-Aldrich syndrome. Severe combined immunodeficiency variants that require ablation. Hyper-Immunoglobulin M (IgM) syndrome. Other immune deficiencies after approval from the medical director. Bone marrow failure syndromes (single or multiple hematopoietic lines) Venous access: A double lumen central vascular access device or its equivalent will be required for all patients entered on the protocol. Informed consent: The donor and the patient and/or the patient's legally authorized guardian must acknowledge in writing that consent to become a study subject has been obtained in accordance with the institutional policy approved by the United States (U.S.) Department of Health and Human Services. Patient organ function requirements: Adequate renal function: serum creatinine < 2 x normal, or creatinine clearance calculated by Schwartz formula, of glomerular filtration rate (GFR) > 40 ml/min/1.73m2, or an equivalent GFR as determined by the institutional normal range. Adequate liver function: total bilirubin </= 2 x normal; and Aspartate aminotransferase (AST) or Alanine aminotransferase (ALT) </= 4 x normal. Adequate cardiac function: shortening fraction of > 24% by echocardiogram, or ejection fraction of > 30% by radionuclide angiogram. Adequate pulmonary function: Diffusion Lung Capacity Carbon Monoxide (DLCO), Forced Expiratory Volume in 1 second (FEV1) / Forced Vital Capacity (FVC) > 30% by pulmonary function test. For children who are uncooperative for pulmonary function tests and have no evidence of dyspnea at rest or exercise intolerance, pulse oximetry > 94% on room air is considered acceptable. Performance status: Lansky Score >/= 60% for children </= 16 years of age; or Karnofsky > 60% status for those > 16 years of age. Exclusion Criteria: Patients who are pregnant Inability to find a suitable donor for the patient Patient is HIV-positive Patient has active Hepatitis B Disease progression or relapse prior to HPC infusion
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Morris Kletzel, M.D.
Organizational Affiliation
Ann & Robert H Lurie Children's Hospital of Chicago
Official's Role
Principal Investigator
Facility Information:
Facility Name
Lurie Children's Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States

12. IPD Sharing Statement

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Immunoablative Mini Transplant (Hematopoietic Peripheral Blood Stem Cell Transplant [HPBSC])

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