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Basiliximab #2: In-Vivo Activated T-Cell Depletion to Prevent Graft-Versus_Host Disease (GVHD) After Nonmyeloablative Allotransplantation for the Treatment of Blood Cancer

Primary Purpose

Acute Myelogenous Leukemia, Acute Lymphocytic Leukemia, Chronic Myelogenous Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Basiliximab
Sponsored by
Indiana University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myelogenous Leukemia focused on measuring Paroxysmal nocturnal hemoglobinuria, severe aplastic anemia, Mantle cell

Eligibility Criteria

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

Inclusion Criteria:

  • Acute myelogenous leukemia:

    • Second or subsequent remission; patient over 18 yrs of age.
    • Relapsed after autologous HC transplant, over 18 years of age.
    • First remission, Philadelphia chromosome + over age 18.
    • Secondary AML, in first or subsequent remissions.
  • Acute lymphocytic leukemia:

    • Philadelphia chromosome + over the age of 50, first or subsequent remission.
    • Relapse following Autologous HC transplantation, ages over 50.
    • Second or subsequent remission over the age of 50
  • Chronic myelogenous leukemia:

    • First or second chronic phase over the age of 18.
    • Accelerated phase over the age of 18.
    • Must have failed or been intolerant to a standard tyrosine kinase inhibitor.
  • Chronic lymphocytic leukemia:

    • Failed nucleoside-based therapy, ages >18.
  • Myelodysplasia:

    • All-risk categories, age greater than 18.
  • Non-Hodgkin's Lymphoma, less than 76 years of age

    • Relapsed diffuse aggressive NHL (intermediate and high grade) that fails to achieve CR or PR to conventional salvage chemotherapy.
    • Aggressive NHL includes diffuse large B cell lymphoma, diffuse mixed small and large cell lymphoma, follicular lymphoma for grade 3 (follicular large cell lymphoma), T or B cell lymphoblastic lymphoma, diffuse small noncleaved (Burkett's or Burkett-like ) lymphoma, mantle cell lymphoma, peripheral T cell lymphoma, anaplastic large cell lymphoma, and other diffuse aggressive lymphomas that are not otherwise classifiable
    • Aggressive NHL that has relapsed following autologous HCT. Patients that respond to additional treatment for post-transplant relapse are eligible.
    • Aggressive NHL that does not achieve CR or PR with primary chemotherapy (i.e., primary induction failure).
    • Low-grade lymphoma refractory to standard therapy, including the following:

      1. small cell lymphocytic lymphoma,
      2. follicular lymphoma of grades 1 and 2 (follicular small cleaved and follicular mixed small and large cell lymphoma)
      3. marginal cell lymphoma, splenic lymphoma),
      4. lymphoplasmacytic lymphoma and
      5. other lymphomas not otherwise classifiable.
  • Patients with low-grade lymphoma must have experienced progressive disease after receiving three or more of the following regimens:

    • alkylator-based therapy (cyclophosphamide/ vincristine/ prednisone) chlorambucil, monoclonal antibody based therapy (e.g., rituximab, Campath-1H, radiolabelled CD20+ antibodies);
    • nucleoside analog-based therapy (e.g., fludarabine, cladribine).)
  • Patients with marginal zone lymphoma or gastric MALT type associated with Helicobacter pylori infection must have progressed after receiving appropriate antibiotic therapy as well as three or more regimens as described above
  • Mantle cell, ages 18-75.
  • Hodgkin's Disease, ages 18-75.

    • Relapsed or refractory disease after autologous transplant.
  • Multiple Myeloma, ages 18-75

    • Recurrent disease after two medical therapies
    • Relapse following autologous transplant
  • Myelofibrosis, age greater than 18 years
  • Severe aplastic anemia (refractory to immunosuppressive therapy); age greater than 18 years

    • Patients with aplastic anemia must have marrow cellularity ≤ 10% plus 2 of the following:

      1. Absolute granulocyte count <500/mm3
      2. Corrected reticulocyte count <1%
      3. Untransfused platelet count <20,000/mm3 on at least 2 occasions
      4. Hemoglobin <9 g/dL (adults) or < 8 g/dL (children) on at least 2 occasions
  • Paroxysmal nocturnal hemoglobinuria; age greater than 18 years.

    • Renal function: creatinine greater than 2.5
  • Donor Requirement:

    • Must have a fully HLA-matched (10 of 10 Antigen matched) related or unrelated donor, eighteen years of age or older, who is capable of undergoing GCSF mobilization and apheresis

Exclusion Criteria:

  • Active CNS disease (the presence of leukemic blasts in the CSF)
  • Pregnancy or breast-feeding.
  • Inability to give informed consent.
  • AST, ALT, total bilirubin >3x upper limit of normal.
  • Creatinine > 2 or creatinine clearance < 50mL/hr. If patient has a creatinine of > 2 or creatinine clearance < 50mL/hr and it is due to the disease process then the patient will not be excluded based on this.
  • Fractional shortening by echocardiogram not within normal limits per institution or LVEF of < 40 %.
  • Pulmonary function: DLCO not within institutional normal limits or DLCO less than 45% of normal predicted, corrected for anemia
  • Prior allogeneic transplant.

Sites / Locations

  • Indiana University Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Basiliximab

Arm Description

Basiliximab will be given by IV on Day +7 post transplant for recipients of matched unrelated cells. Basiliximab will be given by IV on Day +9 post transplant for recipients of matched related cells.

Outcomes

Primary Outcome Measures

Grade 3-4 Acute GVHD Rate
The percent of patients where a patient experienced a Grade 3 or 4 acute GVHD

Secondary Outcome Measures

Time to Neutrophil Engraftment
Time to neutrophil engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of neutrophils is defined as the time from day 0 to the date of the first of three consecutive days after transplantation during which the absolute neutrophils count (ANC) is at least 0.5 x109/l. Patients who did not have neutrophil engraftment before death will be censored at the date of death. The median and 95% confidence intervals will be provided.
Time to Platelet Engraftment
Time to platelet engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of platelets is defined as the time from day 0 to the first of seven consecutive days after transplantation during which the platelet count is at least 20 x109/l without transfusion support. Patients who did not have platelet engraftment before death will be censored at the date of death. The median and 95% confidence intervals will be provided.

Full Information

First Posted
September 11, 2009
Last Updated
January 28, 2016
Sponsor
Indiana University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT00975975
Brief Title
Basiliximab #2: In-Vivo Activated T-Cell Depletion to Prevent Graft-Versus_Host Disease (GVHD) After Nonmyeloablative Allotransplantation for the Treatment of Blood Cancer
Official Title
Basiliximab #2: In-Vivo Activated T-Cell Depletion to Prevent GVHD After Nonmyeloablative Allotransplantation for the Treatment of Blood Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
January 2016
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
October 2012 (Actual)
Study Completion Date
November 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Indiana University School of Medicine

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to compare the effects (good and bad) of the medication basiliximab in combination with cyclosporine (investigational therapy) for the prevention of a complication of bone marrow transplantation known as graft-versus-host disease (GVHD). GVHD is a complication in which the cells of the transplanted bone marrow react against organs and tissues.
Detailed Description
This study is for patients with a blood condition or myelodysplasia (bone marrow disease) which has either not responded to treatment or is not treatable by conventional/routine medical treatments. Bone marrow transplantation is a medical treatment that involves giving high doses of chemotherapy followed by the transplantation of the blood-forming and immune cells from a relative or from a "matched" unrelated person through the National Marrow Donor Program, in an attempt to cure disease in the recipient (the person receiving the donated cells). Nonmyeloablative (bone-marrow preservation) bone marrow transplantation is a relatively new technique in which lower than usual doses of chemotherapy are given before transplantation, in hopes of reducing adverse side effects of the chemotherapy in transplant patients. Nonmyeloablative bone marrow transplantation has several advantages which doctors have determined are beneficial for this condition. This research is being done because the complication of graft-versus-host disease can be bad for a person and there is no completely safe and effective way to prevent this complication. We know that cyclosporine helps but would like to know if the addition of basiliximab, given with cyclosporine, will decrease the incidence and/or severity of graft-versus-host disease after a transplant known as nonmyeloablative or "mini" transplant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myelogenous Leukemia, Acute Lymphocytic Leukemia, Chronic Myelogenous Leukemia, Chronic Lymphocytic Leukemia, Myelodysplasia, Non-Hodgkin's Lymphoma, Hodgkin's Disease, Multiple Myeloma, Myelofibrosis, Anemia, Aplastic, Hemoglobinuria, Paroxysmal
Keywords
Paroxysmal nocturnal hemoglobinuria, severe aplastic anemia, Mantle cell

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Basiliximab
Arm Type
Experimental
Arm Description
Basiliximab will be given by IV on Day +7 post transplant for recipients of matched unrelated cells. Basiliximab will be given by IV on Day +9 post transplant for recipients of matched related cells.
Intervention Type
Drug
Intervention Name(s)
Basiliximab
Other Intervention Name(s)
Simulect
Intervention Description
Basiliximab given 1 time on Day +7 or Day +9.
Primary Outcome Measure Information:
Title
Grade 3-4 Acute GVHD Rate
Description
The percent of patients where a patient experienced a Grade 3 or 4 acute GVHD
Time Frame
Transplant (Day 0) up to 1 year
Secondary Outcome Measure Information:
Title
Time to Neutrophil Engraftment
Description
Time to neutrophil engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of neutrophils is defined as the time from day 0 to the date of the first of three consecutive days after transplantation during which the absolute neutrophils count (ANC) is at least 0.5 x109/l. Patients who did not have neutrophil engraftment before death will be censored at the date of death. The median and 95% confidence intervals will be provided.
Time Frame
Transplant (Day 0) up to 1 year
Title
Time to Platelet Engraftment
Description
Time to platelet engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of platelets is defined as the time from day 0 to the first of seven consecutive days after transplantation during which the platelet count is at least 20 x109/l without transfusion support. Patients who did not have platelet engraftment before death will be censored at the date of death. The median and 95% confidence intervals will be provided.
Time Frame
Transplant (Day 0) up to 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Acute myelogenous leukemia: Second or subsequent remission; patient over 18 yrs of age. Relapsed after autologous HC transplant, over 18 years of age. First remission, Philadelphia chromosome + over age 18. Secondary AML, in first or subsequent remissions. Acute lymphocytic leukemia: Philadelphia chromosome + over the age of 50, first or subsequent remission. Relapse following Autologous HC transplantation, ages over 50. Second or subsequent remission over the age of 50 Chronic myelogenous leukemia: First or second chronic phase over the age of 18. Accelerated phase over the age of 18. Must have failed or been intolerant to a standard tyrosine kinase inhibitor. Chronic lymphocytic leukemia: Failed nucleoside-based therapy, ages >18. Myelodysplasia: All-risk categories, age greater than 18. Non-Hodgkin's Lymphoma, less than 76 years of age Relapsed diffuse aggressive NHL (intermediate and high grade) that fails to achieve CR or PR to conventional salvage chemotherapy. Aggressive NHL includes diffuse large B cell lymphoma, diffuse mixed small and large cell lymphoma, follicular lymphoma for grade 3 (follicular large cell lymphoma), T or B cell lymphoblastic lymphoma, diffuse small noncleaved (Burkett's or Burkett-like ) lymphoma, mantle cell lymphoma, peripheral T cell lymphoma, anaplastic large cell lymphoma, and other diffuse aggressive lymphomas that are not otherwise classifiable Aggressive NHL that has relapsed following autologous HCT. Patients that respond to additional treatment for post-transplant relapse are eligible. Aggressive NHL that does not achieve CR or PR with primary chemotherapy (i.e., primary induction failure). Low-grade lymphoma refractory to standard therapy, including the following: small cell lymphocytic lymphoma, follicular lymphoma of grades 1 and 2 (follicular small cleaved and follicular mixed small and large cell lymphoma) marginal cell lymphoma, splenic lymphoma), lymphoplasmacytic lymphoma and other lymphomas not otherwise classifiable. Patients with low-grade lymphoma must have experienced progressive disease after receiving three or more of the following regimens: alkylator-based therapy (cyclophosphamide/ vincristine/ prednisone) chlorambucil, monoclonal antibody based therapy (e.g., rituximab, Campath-1H, radiolabelled CD20+ antibodies); nucleoside analog-based therapy (e.g., fludarabine, cladribine).) Patients with marginal zone lymphoma or gastric MALT type associated with Helicobacter pylori infection must have progressed after receiving appropriate antibiotic therapy as well as three or more regimens as described above Mantle cell, ages 18-75. Hodgkin's Disease, ages 18-75. Relapsed or refractory disease after autologous transplant. Multiple Myeloma, ages 18-75 Recurrent disease after two medical therapies Relapse following autologous transplant Myelofibrosis, age greater than 18 years Severe aplastic anemia (refractory to immunosuppressive therapy); age greater than 18 years Patients with aplastic anemia must have marrow cellularity ≤ 10% plus 2 of the following: Absolute granulocyte count <500/mm3 Corrected reticulocyte count <1% Untransfused platelet count <20,000/mm3 on at least 2 occasions Hemoglobin <9 g/dL (adults) or < 8 g/dL (children) on at least 2 occasions Paroxysmal nocturnal hemoglobinuria; age greater than 18 years. Renal function: creatinine greater than 2.5 Donor Requirement: Must have a fully HLA-matched (10 of 10 Antigen matched) related or unrelated donor, eighteen years of age or older, who is capable of undergoing GCSF mobilization and apheresis Exclusion Criteria: Active CNS disease (the presence of leukemic blasts in the CSF) Pregnancy or breast-feeding. Inability to give informed consent. AST, ALT, total bilirubin >3x upper limit of normal. Creatinine > 2 or creatinine clearance < 50mL/hr. If patient has a creatinine of > 2 or creatinine clearance < 50mL/hr and it is due to the disease process then the patient will not be excluded based on this. Fractional shortening by echocardiogram not within normal limits per institution or LVEF of < 40 %. Pulmonary function: DLCO not within institutional normal limits or DLCO less than 45% of normal predicted, corrected for anemia Prior allogeneic transplant.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Nelson, MD
Organizational Affiliation
Indiana University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Indiana University Cancer Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Basiliximab #2: In-Vivo Activated T-Cell Depletion to Prevent Graft-Versus_Host Disease (GVHD) After Nonmyeloablative Allotransplantation for the Treatment of Blood Cancer

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