Allogenic Stem Cell Transplantation in Patients With High Risk CD33+ AML/MDS/JMML (High Risk)
Primary Purpose
Acute Myeloid Leukemia, Juvenile Myelomonocytic Leukemia, Myelodysplastic Syndrome
Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Gemtuzumab Ozogamicin
Busulfan
Cyclophosphamide
Thymoglobulin
Tacrolimus
Mycophenolate Mofetil
Methotrexate
Sponsored by
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring AML, JMML, MDS, Allogenic Atem Cell Transplant, Gemtuzumab Ozogamicin
Eligibility Criteria
Eligibility
Inclusion Criteria:
Disease Status
- AML Induction Failure
- AML in 1st, 2nd, or 3rd Relapse (>10% bone marrow blasts)
- AML greater than or equal to 3rd CR
- MDS with >6% bone marrow blasts at diagnosis
- Secondary MDS with less than or equal to 5% bone marrow myeloblasts at diagnosis
- JMML with >6% bone marrow myeloblasts at diagnosis
Disease Immunophenotype Patients (AML only) receiving gemtuzumab ozogamicin must express minimum of >10% or =10% CD33 positivity. Patients with <10% CD33 positivity will not receive gemtuzumab ozogamicin.
Organ Function
Patients must have adequate organ function as defined below:
- Adequate renal function defined as:
- Serum creatinine <1.5 x normal, or
- Creatinine clearance or radioisotope GFR 40 ml/min/m2 or >60 ml/min/1.73 m2 or an equivalent GFR as determined by the institutional normal range
- Adequate liver function defined as:
- Total bilirubin 1.5 x normal, or SGOT (AST) or SGPT (ALT) <2.0 x normal or =2.0 x normal
- Adequate cardiac function defined as:
- Shortening fraction of >27% by echocardiogram, or
- Ejection fraction of >47% by radionuclide angiogram or echocardiogram
- Adequate pulmonary function defined as:
- DLCO >55% or =55% by PFT
- For children who are uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry >94% on room air
Exclusion Criteria:
- Patients with active CNS AML/JMML/MDS disease at time of conditioning therapy
- Female patients who are pregnant (positive HCG)
- Karnofsky <50% or Lansky <50% if 10 years or less
- Age >65 years
- Has received gemtuzumab in the previous 30 days or has not recovered from prior gemtuzumab therapy.
Sites / Locations
- Morgan Stanley Children's Hospital of NYP
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
study 515
Arm Description
Outcomes
Primary Outcome Measures
Maximal tolerated dose or tolerable dose of Gemtuzumab Ozogamicin (anti-CD33 immunotoxin) therapy combined with Busulfan/ Cyclophosphamide in the conditioning regimen prior to AlloSCT in patients with high risk CD33+ AML/JMML/MDS
Secondary Outcome Measures
Changes, if applicable, of minimal residual disease (cytogenetics, FISH, RT-PCR) in patients with high risk CD33+ AML/JMML/MDS after AlloSCT.
Progression Free Survival (PFS), overall survival (OS), and disease free survival (DFS), (if applicable), following GO, Bu/CY and AlloSCT in patients with high risk CD33+ AML/JMML/MDS.
Quality of life before and after GO, Bu/CY conditioning and AlloSCT in patients with high risk CD33+ AML/JMML/MDS
Full Information
NCT ID
NCT00669890
First Posted
April 29, 2008
Last Updated
April 20, 2015
Sponsor
New York Medical College
1. Study Identification
Unique Protocol Identification Number
NCT00669890
Brief Title
Allogenic Stem Cell Transplantation in Patients With High Risk CD33+ AML/MDS/JMML
Acronym
High Risk
Official Title
Gemtuzumab Ozogamicin in Combination With Busulfan and Cyclophosphamid and Allogenic Stem Cell Transplantation in Patients With High Risk CD33+ Acute Myelogenous Leukemia/Myelodysplastic Syndrome/Juvenile Myelomonocytic Leukemia
Study Type
Interventional
2. Study Status
Record Verification Date
April 2015
Overall Recruitment Status
Terminated
Why Stopped
PI left institution
Study Start Date
May 2004 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
December 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
New York Medical College
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The addition of gemtuzumab ozogamicin (GO) in combination with Busulfan/Cyclophosphamide followed by AlloSCT in patients with high risk CD33+ AML/JMML/MDS will be safe and well tolerated.
This study will attempt to determine the maximum tolerated dose of the immune therapy (gemtuzumab) when given in combination with the myeloablative (high dose) drugs used in this study for allogeneic stem cell transplant. (Part A)
Detailed Description
Gemtuzumab Ozogamicin (CMA-676) is a chemotherapeutic agent consisting of recombinant humanized anti-CD33 antibody conjugated with calicheamicin, a highly potent cytotoxic antitumor antibiotic. The antibody portion of Gemtuzumab binds specifically to the CD33 antigen, a sialic acid-dependent adhesion protein expressed on the surface of leukemia blasts, normal and leukemic myeloid colony-forming cells, including leukemic clonogenic precursors, but excluding pluripotent hematopoietic stem cells and nonhematopoietic cells. This results in formation of the complex that is internalized, upon which calicheamicin derivative is released with in the lysosomes of the myeloid cell. The free calicheamicin derivative then binds to the DNA, resulting in DNA double strand breaks and consequential cell death.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Juvenile Myelomonocytic Leukemia, Myelodysplastic Syndrome
Keywords
AML, JMML, MDS, Allogenic Atem Cell Transplant, Gemtuzumab Ozogamicin
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)
8. Arms, Groups, and Interventions
Arm Title
study 515
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Gemtuzumab Ozogamicin
Other Intervention Name(s)
Gemtuzumab
Intervention Description
Dose Escalation
Intervention Type
Drug
Intervention Name(s)
Busulfan
Other Intervention Name(s)
Busulfex
Intervention Description
Conditioning Regimen
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
Endoxan, Cytoxan
Intervention Description
Conditioning Regimen
Intervention Type
Drug
Intervention Name(s)
Thymoglobulin
Other Intervention Name(s)
ATG
Intervention Description
(Unrelated Donors only)
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Other Intervention Name(s)
FK506
Intervention Description
GVHD Prophylaxis
Intervention Type
Drug
Intervention Name(s)
Mycophenolate Mofetil
Other Intervention Name(s)
MMF
Intervention Description
GVHD Prophylaxis
Intervention Type
Drug
Intervention Name(s)
Methotrexate
Other Intervention Name(s)
MTX
Intervention Description
GVHD Prophylaxis
Primary Outcome Measure Information:
Title
Maximal tolerated dose or tolerable dose of Gemtuzumab Ozogamicin (anti-CD33 immunotoxin) therapy combined with Busulfan/ Cyclophosphamide in the conditioning regimen prior to AlloSCT in patients with high risk CD33+ AML/JMML/MDS
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Changes, if applicable, of minimal residual disease (cytogenetics, FISH, RT-PCR) in patients with high risk CD33+ AML/JMML/MDS after AlloSCT.
Time Frame
1 year
Title
Progression Free Survival (PFS), overall survival (OS), and disease free survival (DFS), (if applicable), following GO, Bu/CY and AlloSCT in patients with high risk CD33+ AML/JMML/MDS.
Time Frame
1 year
Title
Quality of life before and after GO, Bu/CY conditioning and AlloSCT in patients with high risk CD33+ AML/JMML/MDS
Time Frame
1 year
10. Eligibility
Sex
All
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Eligibility
Inclusion Criteria:
Disease Status
AML Induction Failure
AML in 1st, 2nd, or 3rd Relapse (>10% bone marrow blasts)
AML greater than or equal to 3rd CR
MDS with >6% bone marrow blasts at diagnosis
Secondary MDS with less than or equal to 5% bone marrow myeloblasts at diagnosis
JMML with >6% bone marrow myeloblasts at diagnosis
Disease Immunophenotype Patients (AML only) receiving gemtuzumab ozogamicin must express minimum of >10% or =10% CD33 positivity. Patients with <10% CD33 positivity will not receive gemtuzumab ozogamicin.
Organ Function
Patients must have adequate organ function as defined below:
Adequate renal function defined as:
Serum creatinine <1.5 x normal, or
Creatinine clearance or radioisotope GFR 40 ml/min/m2 or >60 ml/min/1.73 m2 or an equivalent GFR as determined by the institutional normal range
Adequate liver function defined as:
Total bilirubin 1.5 x normal, or SGOT (AST) or SGPT (ALT) <2.0 x normal or =2.0 x normal
Adequate cardiac function defined as:
Shortening fraction of >27% by echocardiogram, or
Ejection fraction of >47% by radionuclide angiogram or echocardiogram
Adequate pulmonary function defined as:
DLCO >55% or =55% by PFT
For children who are uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry >94% on room air
Exclusion Criteria:
Patients with active CNS AML/JMML/MDS disease at time of conditioning therapy
Female patients who are pregnant (positive HCG)
Karnofsky <50% or Lansky <50% if 10 years or less
Age >65 years
Has received gemtuzumab in the previous 30 days or has not recovered from prior gemtuzumab therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mitchell S Cairo, MD
Organizational Affiliation
Columbia University
Official's Role
Study Chair
Facility Information:
Facility Name
Morgan Stanley Children's Hospital of NYP
City
New York City
State/Province
New York
ZIP/Postal Code
10032
Country
United States
12. IPD Sharing Statement
Links:
URL
http://www.childrensnyp.org
Description
(Click on "Morgan Stanley Children's Hospital" and then "Clinical Services" and then "Blood & Marrow Transplantation")
Learn more about this trial
Allogenic Stem Cell Transplantation in Patients With High Risk CD33+ AML/MDS/JMML
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