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Donor Peripheral Stem Cell Transplant, Fludarabine, and Busulfan in Treating Patients With Hematologic Cancers

Primary Purpose

Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
busulfan
cyclosporine
fludarabine phosphate
mycophenolate mofetil
allogeneic hematopoietic stem cell transplantation
peripheral blood stem cell transplantation
Sponsored by
University of California, Davis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent adult acute myeloid leukemia, adult acute lymphoblastic leukemia in remission, refractory anemia with excess blasts, refractory anemia with ringed sideroblasts, refractory anemia, refractory cytopenia with multilineage dysplasia, previously treated myelodysplastic syndromes, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia in remission, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), chronic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, refractory chronic lymphocytic leukemia, recurrent adult Hodgkin lymphoma, refractory multiple myeloma, recurrent adult acute lymphoblastic leukemia, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, stage III adult Hodgkin lymphoma, stage IV adult Hodgkin lymphoma, secondary acute myeloid leukemia, recurrent small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, stage IV grade 3 follicular lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, stage III adult diffuse large cell lymphoma, stage III adult diffuse mixed cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage IV adult diffuse large cell lymphoma, stage IV adult diffuse mixed cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, stage III adult immunoblastic large cell lymphoma, stage IV adult immunoblastic large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, stage III adult lymphoblastic lymphoma, stage IV adult lymphoblastic lymphoma, recurrent adult lymphoblastic lymphoma, stage III adult Burkitt lymphoma, stage IV adult Burkitt lymphoma, recurrent adult Burkitt lymphoma, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, de novo myelodysplastic syndromes, secondary myelodysplastic syndromes

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Diagnosed with any of the following:

    • Acute myeloid leukemia (AML), meeting 1 of the following criteria:

      • Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
      • In first complete remission (CR1) with poor-risk cytogenetics, antecedent hematological disease (i.e., myelodysplasia), or treatment-related leukemia
    • Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria:

      • Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
      • CR1 with Philadelphia chromosome or poor-risk cytogenetics
    • Chronic myelogenous leukemia (CML), meeting the following criteria:

      • First or second chronic phase

        • Must be documented disease progression after imatinib mesylate therapy OR documented lack of cytogenetic response 6 months post-imatinib mesylate initiation OR imatinib mesylate intolerance
    • Chronic lymphocytic leukemia (CLL), meeting the following criteria:

      • Recurrent disease after fludarabine-based therapy

        • Must have chemosensitive disease at the time of relapse, defined as greater than 50% reduction of WBC and lymphadenopathy
    • Recurrent Hodgkin lymphoma, recurrent non-Hodgkin lymphoma (NHL) (low-, intermediate-, or high-grade disease*), or transformed NHL, meeting 1 of the following criteria:

      • Received prior autologous transplantation and cytoreductive therapy at the time of relapse to achieve complete remission (CR) or CR/unconfirmed (CRu) as defined by the International Workshop
      • Relapsed disease that required more than 2 salvage regimens to achieve CR or CRu
    • Recurrent multiple myeloma, meeting the following criteria:

      • Must have received prior autologous transplantation and demonstrate chemosensitivity at the time of relapse, defined as greater than 50% reduction of M-component or plasma-cell marrow infiltration
    • Myelodysplastic syndrome

      • Refractory anemia (RA)/RA with ringed sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD)/refractory cytopenia with multilineage dysplasia with ringed sideroblasts (RCMD-RS), or RA with excess blasts (RAEB) I, meeting the following criteria:

        • Must be transfusion-dependent and have an IPSS score ≥ 1.5, based on WHO criteria
        • No RAEB II or del(5q)
  • No uncontrolled CNS metastases
  • 5-6/6 HLA-matched sibling or 9-10/10 matched unrelated donor (both patient and donor) available

PATIENT CHARACTERISTICS:

  • Karnofsky performance status ≥ 50%
  • Serum creatinine ≤ 2 mg/dL
  • Not pregnant
  • Fertile patients must use effective contraception
  • 50 years of age or older

    • Patients 18-50 years of age are eligible if meeting 1 of the following criteria:

      • Have a preexisting medical condition
      • Received prior therapy (i.e., autologous transplantation) and are considered to be too high risk for conventional myeloablative transplantation
  • Must be willing to accept or comprehend irreversible sterility as a side effect of therapy
  • No uncontrolled active infection
  • No psychiatric illness or mental deficiency making compliance with treatment or informed consent impossible
  • Cardiac ejection fraction ≥ 30%
  • Corrected pulmonary-diffusing capacity ≥ 35%
  • No serologic evidence of infection with HIV
  • No decompensated liver disease with serum bilirubin > 2.0 mg/dL

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics

Sites / Locations

  • University of California Davis Cancer Center

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

RIST for Heme malignancies

Arm Description

Busulfan 3.3 mg/kg over 3 hours on day -6 and day -5 Fludarabine 30 mg/m2 IV over 30 minutes on day -6 to day -2 followed by Transplant followed by Immunosuppressive/GVHD therapy

Outcomes

Primary Outcome Measures

Number of Patients With Day 100 Transplant-related Mortality
Patients were followed for death and whether or not that death was attributed to the day 100 transplant via physician assessment for 24 months after day 100 transplant.

Secondary Outcome Measures

Number of Patients Without Progression After Day 100 Transplant
All patients will be followed for progression for 24 months after their day 100 transplant.
Number of Patients Alive 24 Months Post Day 100 Transplant
Patients will be followed for survival for 24 months post day 100 transplant.

Full Information

First Posted
February 20, 2008
Last Updated
January 5, 2018
Sponsor
University of California, Davis
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1. Study Identification

Unique Protocol Identification Number
NCT00619645
Brief Title
Donor Peripheral Stem Cell Transplant, Fludarabine, and Busulfan in Treating Patients With Hematologic Cancers
Official Title
Reduced Intensity Stem Cell Transplantation (RIST) for Patients With Hematological Malignancies Conditioned With Fludarabine and Busulfan
Study Type
Interventional

2. Study Status

Record Verification Date
January 2018
Overall Recruitment Status
Completed
Study Start Date
June 2007 (undefined)
Primary Completion Date
October 2013 (Actual)
Study Completion Date
November 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, Davis

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Giving chemotherapy drugs, such as fludarabine and busulfan, before a donor peripheral 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 cells and help destroy any remaining cancer cells (graft-versus-tumor 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 before and after the transplant may stop this from happening. PURPOSE: This phase II trial is studying the side effects of giving donor peripheral stem cell transplant together with fludarabine and busulfan and to see how well it works in treating patients with hematologic cancers.
Detailed Description
OUTLINE: Conditioning regimen: Patients receive busulfan IV over 3 hours on days -6 and -5 and fludarabine phosphate IV over 30 minutes on days -6 to -2. Allogeneic peripheral blood stem cell transplant (PBSC): Patients undergo allogeneic PBSC on day 0. Immunosuppressive therapy/graft-versus-host disease (GVHD) prophylaxis: Patients achieve100% donor T-cell chimerism on day 30 without disease recurrence, and cyclosporine A (CSA) IV continuously over 24 hours or orally every 12 hours on days -1 to 60 followed by a taper until day 100 and oral mycophenolate mofetil (MMF) once every 12 hours on days 1-40, in the absence of ≥ grade 2 GVHD. Patients with recurrent disease or < 100% donor T-cell chimerism (on day 30) undergo a 12-day CSA and MMF taper followed by escalating doses of previously collected donor leukocyte infusion every 4 weeks until 100% donor T-cell chimerism or disease regression, in the absence of ≥ grade 2 GVHD. After completion of study treatment, patients are followed periodically.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes
Keywords
recurrent adult acute myeloid leukemia, adult acute lymphoblastic leukemia in remission, refractory anemia with excess blasts, refractory anemia with ringed sideroblasts, refractory anemia, refractory cytopenia with multilineage dysplasia, previously treated myelodysplastic syndromes, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia in remission, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), chronic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, refractory chronic lymphocytic leukemia, recurrent adult Hodgkin lymphoma, refractory multiple myeloma, recurrent adult acute lymphoblastic leukemia, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, stage III adult Hodgkin lymphoma, stage IV adult Hodgkin lymphoma, secondary acute myeloid leukemia, recurrent small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, stage IV grade 3 follicular lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, stage III adult diffuse large cell lymphoma, stage III adult diffuse mixed cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage IV adult diffuse large cell lymphoma, stage IV adult diffuse mixed cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, stage III adult immunoblastic large cell lymphoma, stage IV adult immunoblastic large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, stage III adult lymphoblastic lymphoma, stage IV adult lymphoblastic lymphoma, recurrent adult lymphoblastic lymphoma, stage III adult Burkitt lymphoma, stage IV adult Burkitt lymphoma, recurrent adult Burkitt lymphoma, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, de novo myelodysplastic syndromes, secondary myelodysplastic syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
8 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RIST for Heme malignancies
Arm Type
Other
Arm Description
Busulfan 3.3 mg/kg over 3 hours on day -6 and day -5 Fludarabine 30 mg/m2 IV over 30 minutes on day -6 to day -2 followed by Transplant followed by Immunosuppressive/GVHD therapy
Intervention Type
Drug
Intervention Name(s)
busulfan
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Intervention Type
Drug
Intervention Name(s)
mycophenolate mofetil
Intervention Type
Procedure
Intervention Name(s)
allogeneic hematopoietic stem cell transplantation
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation
Primary Outcome Measure Information:
Title
Number of Patients With Day 100 Transplant-related Mortality
Description
Patients were followed for death and whether or not that death was attributed to the day 100 transplant via physician assessment for 24 months after day 100 transplant.
Time Frame
24 months after day 100 transplant
Secondary Outcome Measure Information:
Title
Number of Patients Without Progression After Day 100 Transplant
Description
All patients will be followed for progression for 24 months after their day 100 transplant.
Time Frame
24 months after day 100 transplant
Title
Number of Patients Alive 24 Months Post Day 100 Transplant
Description
Patients will be followed for survival for 24 months post day 100 transplant.
Time Frame
24 months post day 100 transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosed with any of the following: Acute myeloid leukemia (AML), meeting 1 of the following criteria: Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required) In first complete remission (CR1) with poor-risk cytogenetics, antecedent hematological disease (i.e., myelodysplasia), or treatment-related leukemia Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria: Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required) CR1 with Philadelphia chromosome or poor-risk cytogenetics Chronic myelogenous leukemia (CML), meeting the following criteria: First or second chronic phase Must be documented disease progression after imatinib mesylate therapy OR documented lack of cytogenetic response 6 months post-imatinib mesylate initiation OR imatinib mesylate intolerance Chronic lymphocytic leukemia (CLL), meeting the following criteria: Recurrent disease after fludarabine-based therapy Must have chemosensitive disease at the time of relapse, defined as greater than 50% reduction of WBC and lymphadenopathy Recurrent Hodgkin lymphoma, recurrent non-Hodgkin lymphoma (NHL) (low-, intermediate-, or high-grade disease*), or transformed NHL, meeting 1 of the following criteria: Received prior autologous transplantation and cytoreductive therapy at the time of relapse to achieve complete remission (CR) or CR/unconfirmed (CRu) as defined by the International Workshop Relapsed disease that required more than 2 salvage regimens to achieve CR or CRu Recurrent multiple myeloma, meeting the following criteria: Must have received prior autologous transplantation and demonstrate chemosensitivity at the time of relapse, defined as greater than 50% reduction of M-component or plasma-cell marrow infiltration Myelodysplastic syndrome Refractory anemia (RA)/RA with ringed sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD)/refractory cytopenia with multilineage dysplasia with ringed sideroblasts (RCMD-RS), or RA with excess blasts (RAEB) I, meeting the following criteria: Must be transfusion-dependent and have an IPSS score ≥ 1.5, based on WHO criteria No RAEB II or del(5q) No uncontrolled CNS metastases 5-6/6 HLA-matched sibling or 9-10/10 matched unrelated donor (both patient and donor) available PATIENT CHARACTERISTICS: Karnofsky performance status ≥ 50% Serum creatinine ≤ 2 mg/dL Not pregnant Fertile patients must use effective contraception 50 years of age or older Patients 18-50 years of age are eligible if meeting 1 of the following criteria: Have a preexisting medical condition Received prior therapy (i.e., autologous transplantation) and are considered to be too high risk for conventional myeloablative transplantation Must be willing to accept or comprehend irreversible sterility as a side effect of therapy No uncontrolled active infection No psychiatric illness or mental deficiency making compliance with treatment or informed consent impossible Cardiac ejection fraction ≥ 30% Corrected pulmonary-diffusing capacity ≥ 35% No serologic evidence of infection with HIV No decompensated liver disease with serum bilirubin > 2.0 mg/dL PRIOR CONCURRENT THERAPY: See Disease Characteristics
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carol M. Richman, MD
Organizational Affiliation
University of California, Davis
Official's Role
Study Chair
Facility Information:
Facility Name
University of California Davis Cancer Center
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Donor Peripheral Stem Cell Transplant, Fludarabine, and Busulfan in Treating Patients With Hematologic Cancers

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