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Haploidentical Stem Cell Transplant With Prophylactic Natural Killer DLI for Lymphoma, Multiple Myeloma, and CLL

Primary Purpose

Multiple Myeloma, CLL, Chronic Lymphocytic Leukemia

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Total Body Irradiation
Haploidentical Stem Cell Transplantation
CD56-Enriched Donor Lymphocyte Infusion
Bendamustine
Fludarabine
Rituximab
Sponsored by
Noah Merin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma focused on measuring Relapsed/Refractory Lymphoma, Multiple Myeloma, CLL, Bendamustine, Haploidentical Stem Cell Transplantation, GVHD, Allogeneic Stem Cell Transplantation, Natural Killer Cell, CliniMACS, Post-transplantation cyclophosphamide, Donor Lymphocyte Infusion, Minimal Residual Disease, Hodgkin Lymphoma

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

General Inclusion Criteria (For Treatment Groups)

  • Patient age 18 - 75 years
  • ECOG 0 - 2
  • HIV-positive patients are allowed if these criteria are met:

    1. No history of opportunistic infections
    2. CD4+ cell count greater or equal to 250 cells/mm3
    3. No history of non-malignancy AIDS-defining conditions other than historical low CD4+ cell counts
    4. Patient is on antiretroviral therapy with undetectable viral load. There must be minimal interactions of the antiviral therapy with the experimental treatment (antiretroviral such as ritonavir is potent CYP3A4 inhibitor and p-gp inducer may interact with tacrolimus resulted in increased serum concentration of tacrolimus).
  • Patients must have a related donor or who is at minimum HLA haploidentical. The donor and recipient must be identical at least one allele of each of the following genetic loci: HLA-A, HLA-B, HLA-Cw, HLA-DRB1, and HLA-DQB1. A minimum match of 5/10 is therefore required, and will be considered sufficient evidence that the donor and recipient share one HLA haplotype. An unrelated donor search is not required. (Patients with a readily-available, suitable, fully-matched sibling donor less than age 55 are not eligible for this trial, these patients should proceed to transplant using the matched related donor as standard-of-care).

Criteria for Donor Eligibility

  • Age greater than 12 years
  • Donors must meet the selection criteria as defined by the Foundation for the Accreditation of Hematopoietic Cell Therapy (FACT).
  • In the event that two or more eligible donors are identified, the following order of priority will be used to determine the preferred donor:

    • Medically and psychologically fit and willing to donate
    • For CMV seronegative recipients, a CMV seronegative donor
    • Red blood-cell compatibility

      • RBC cross-match compatible
      • Minor ABO incompatibility
      • Major ABO incompatibility
  • If more than one preferred donor is identified and there is no medical, HLA- or KIR ligand reason to prefer one of them, then the following guidelines are recommended:

If the patient is male, choose a male donor:

  • Choose the youngest preferred donor
  • If the patient and family express a strong preference for a particular donor, use that one.

Inclusion Criteria (Lymphoma)

  • Diagnosis of resistant or relapsed CLL, Non-Hodgkin Lymphoma, Hodgkin Lymphoma, T-cell lymphoma, NK or NK/T Lymphoma.
  • Meets one of the following criteria:

    • relapsed after auto-transplant, or
    • failed to mobilize autologous stem cells, or
    • for whom allogeneic stem cell transplant is deemed appropriate given disease risk factors that make cure with autologous transplant seem unlikely, such as history of chemotherapy refractoriness, high risk disease features/mutations/translocations (e.g., Double Hit / Double Expressor DLBCL), short remission after prior chemotherapy, or histologic transformation (see below).
  • For Patients with Aggressive Mantle Cell and Diffuse Large B Cell Lymphoma who have not had a prior autologous transplant:

    • Must have received at least 2 lines of prior therapy, and
    • Have been exposed to anthracycline, and
    • High and High-Intermediate aaIPI score (2 or 3 factors), and
    • Have relapsed within one year of primary therapy
  • For diagnosis of other aggressive lymphoma (e.g. NK/T Lymphoma, T Cell

Lymphoma, etc.):

  • Must have received at least 2 lines of prior therapy, and
  • Relapsed within 12 months of most recent therapy

    • For low-grade lymphomas / CLL:
    • Standard risk patients (absence of del(17p), absence of del(11q), no TP53 mutation and absence of complex karyotype) must have progressed on BCR inhibitor, or undergone histologic transformation, to be eligible.
    • Patients with high risk disease (del(17p) or TP53 mutations and/or complex phenotype) who relapse after frontline therapy, demonstrate refractory disease to second line therapy (not BCR inhibitors), but show an objective response to BCR inhibitors are eligible to be taken off BCR inhibitors in order to proceed to alloHSCT on trial. Patients with high risk disease who relapse after frontline therapy, demonstrate refractory disease to second line therapy including BCR inhibitors (not BCL-2 inhibitors), but show an objective response to BCL-2 inhibitors (venetoclax) are eligible to be taken off BCL-2 inhibitors in order to proceed to alloHSCT on trial.
    • For aggressive lymphomas, partial or complete remission (PR or CR) is required prior to alloHSCT.
    • Regarding CD20 expression: Patients with B cell malignancies that were CD20+ at any level at the time of relapse diagnosis (including partial / dim staining on IHC or partial / low level expression by flow cytometry) will receive rituximab as part of allogeneic transplant conditioning, if indicated. Patients with primary-refractory disease who were CD20+ at any level at the time of diagnosis will likewise receive rituximab, if indicated. Patients with histologies that were CD20- will not receive rituximab (T cell lymphoma, NK/T lymphoma, etc.). Fresh tissue / repeat biopsy is not required; the most recent biopsy will be reviewed to assess CD20 status.

Inclusion Criteria (Multiple Myeloma)

- Patient age 18 - 75 years with:

  • Early relapse (less than 24 months) after primary therapy that included an autologous HSCT, or
  • High risk multiple myeloma defined as t(4;14), del(17p), -13, t(14;16), amp (1q21), chromosome 8q24.1/c-MYC abnormality, or LDH > ULN at diagnosis, provided patients respond favorably to salvage therapy before enrollment for alloHSCT on trial and patient is age < 55, or
  • Patients failing to mobilize peripheral blood stem cells for autologous transplantation, or
  • Extramedullary disease at diagnosis or relapse, or
  • Plasma-cell leukemia with chemosensitive disease

Inclusion Criteria - Control Patients (specimen collection, only)

  • Age 18-75 years
  • Undergoing standard-of-care reduced-intensity peripheral blood allogeneic stem cell transplantation (any indication, donor source, conditioning regimen) using PTCy GVHD prophylaxis.
  • Willing to provide longitudinal blood samples per Control Specimen Collection Calendar for correlative studies (for comparison to specimens from patients treated on the trial).
  • Agrees to let study personnel collect excess bone marrow aspirate whenever a bone marrow biopsy is performed for clinical purposes, and use for research.

Exclusion Criteria

  • Patient has a readily-available, suitable, fully-matched sibling donor (MRD) less than age 55. 'Suitable' means no high-titre donor-specific antibodies present, and negative IDM testing with no contraindications.
  • Patient has a clinically-significant donor-specific antibody for the selected donor (DSA clearance is not allowed).
  • Poor cardiac function: left ventricular ejection fraction <45% as determined by MUGA or ECHO.
  • Symptomatic pulmonary disease. Poor pulmonary function: FEV1, FVC, and DLCO <50% predicted (corrected for hemoglobin) for patients who have not received thoracic or mantle irradiation. For patients who have received thoracic or mantle irradiation, FEV1 and FVC <70% predicted or DLCO < 50 of predicted.
  • Poor liver function: bilirubin >2 mg/dl (not due to hemolysis, Gilbert's or primary malignancy). ALT or AST > 5 x laboratory upper normal limits.
  • Poor renal function: Creatinine >2.0mg/dl or creatinine clearance (calculated creatinine clearance is permitted) < 60 mL/min based on Traditional Cockcroft-Gault formula
  • Women of childbearing potential who currently are pregnant (Β-HCG+) or who are not practicing adequate contraception.
  • Uncontrolled viral, bacterial, or fungal infections. Patients with symptoms consistent with RSV, influenza A, B, or parainfluenza at the time of enrollment will be assayed for the above viruses and if positive are not eligible for the trial until they are no longer symptomatic (patients may have continued assay positivity for a period of time post resolution of symptoms secondary to the nature of the assay).
  • Uncontrolled CNS involvement by malignancy (patients with prior history of CNS disease controlled with intrathecal chemotherapy or prior systemic therapy are allowed).
  • Patients who have any debilitating medical or psychiatric illness which would preclude their giving informed consent or their receiving optimal treatment and follow-up.

Exclusion Criteria - Control Patients (specimen collection, only)

  • Undergoing myeloablative alloHSCT.
  • Non-PTCy GVHD prophylaxis.
  • Non-PBSC transplant (bone marrow stem cell source).
  • Not willing to give longitudinal blood specimens for research use or not willing to allow access to medical records for non-clinical purposes.

Sites / Locations

  • Cedars Sinai Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Subjects

Controls

Arm Description

Pre-Transplantation Conditioning (Bendamustine, Fludarabine, and Rituximab + Total Body Irradiation) + Haploidentical Stem Cell Transplantation with CD56-enriched donor lymphocyte infusion

Patients undergoing standard-of-care reduced-intensity peripheral blood allogeneic stem cell transplantation (any indication, donor source, conditioning regimen) using PTCy GVHD prophylaxis.

Outcomes

Primary Outcome Measures

Rate of Survival at 30 days post -transplantation
Proportion of patients undergoing BFR-TBI conditioning + haploidentical alloHSCT alive at 30 days post-transplantation.

Secondary Outcome Measures

Rate of neutrophil engraftment at 30 days
Proportion of patients undergoing BFR-TBI conditioning + haploidentical alloHSCT with neutrophil engraftment at 30 days post-transplantation. -Neutrophil engraftment is defined as ANC recovery to >500/uL.
Rate of platelet recovery at 100 days post-transplantation
Proportion of patients with platelets > 20/uL with no platelet transfusions within the prior 7 days at day 100 post-transplantation.
Rate of severe chronic GVHD at 365 days post-transplantation
Proportion of patients with severe chronic GVHD at day 365 post-transplantation. -Severe chronic GVHD is defined by NIH Consensus Criteria for GVHD severity

Full Information

First Posted
May 2, 2018
Last Updated
July 14, 2023
Sponsor
Noah Merin
Collaborators
Miltenyi Biomedicine GmbH, Teva Branded Pharmaceutical Products R&D, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03524235
Brief Title
Haploidentical Stem Cell Transplant With Prophylactic Natural Killer DLI for Lymphoma, Multiple Myeloma, and CLL
Official Title
IIT2017-03-Merin-HaploBFR: Bendamustine, Fludarabine, And Rituximab Conditioning For Haploidentical Stem Cell Transplantation With CD56-Enriched Donor Cell Infusion For Relapsed/Refractory Lymphoma, Multiple Myeloma, and CLL
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 18, 2018 (Actual)
Primary Completion Date
November 7, 2021 (Actual)
Study Completion Date
November 2031 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Noah Merin
Collaborators
Miltenyi Biomedicine GmbH, Teva Branded Pharmaceutical Products R&D, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study seeks to examine the investigational use of the conditioning regimen (bendamustine, fludarabine, and rituximab) prior to haploidentical peripheral blood allogeneic stem cell transplantation with Post-Transplant Cyclophosphamide. The study will also test the investigational use of CD56-enriched Donor Lymphocyte Infusion to see if this treatment is safe, and whether or not it will help patients achieve better outcomes post-transplant, including reduced risk of Graft-Versus-Host Disease (GVHD), and preventing disease relapse.
Detailed Description
This is a single center Phase I trial of a new haploidentical stem cell transplant regimen intended to assess safety. Two groups of patients are planned: patients with lymphoma and patients with multiple myeloma. Each subject will receive a haploidentical stem cell transplantation using peripheral blood stem cells. Bendamustine-fludarabine-rituximab-TBI conditioning will be used, followed by stem cell infusion, with Post-Transplant Cyclophosphamide and tacrolimus for GVHD prophylaxis. Patients will receive a CD56-selected DLI on day +8. Evaluations will be taken at baseline and at each of the study visits. Screening data will be reviewed to determine subject eligibility. Subjects who meet all inclusion criteria and none of the exclusion criteria will be entered into the study. Total duration of subject participation will be one year. Total duration of the study is expected to be three years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma, CLL, Chronic Lymphocytic Leukemia, Lymphoma, Hodgkin Lymphoma
Keywords
Relapsed/Refractory Lymphoma, Multiple Myeloma, CLL, Bendamustine, Haploidentical Stem Cell Transplantation, GVHD, Allogeneic Stem Cell Transplantation, Natural Killer Cell, CliniMACS, Post-transplantation cyclophosphamide, Donor Lymphocyte Infusion, Minimal Residual Disease, Hodgkin Lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Subjects
Arm Type
Experimental
Arm Description
Pre-Transplantation Conditioning (Bendamustine, Fludarabine, and Rituximab + Total Body Irradiation) + Haploidentical Stem Cell Transplantation with CD56-enriched donor lymphocyte infusion
Arm Title
Controls
Arm Type
No Intervention
Arm Description
Patients undergoing standard-of-care reduced-intensity peripheral blood allogeneic stem cell transplantation (any indication, donor source, conditioning regimen) using PTCy GVHD prophylaxis.
Intervention Type
Radiation
Intervention Name(s)
Total Body Irradiation
Other Intervention Name(s)
TBI
Intervention Description
Pre-Transplantation Total Body Irradiation
Intervention Type
Procedure
Intervention Name(s)
Haploidentical Stem Cell Transplantation
Intervention Description
Haploidentical Stem Cell Transplantation
Intervention Type
Biological
Intervention Name(s)
CD56-Enriched Donor Lymphocyte Infusion
Intervention Description
CD56-Enriched Donor Lymphocyte Infusion
Intervention Type
Drug
Intervention Name(s)
Bendamustine
Other Intervention Name(s)
Bendeka; Treanda
Intervention Description
Pre-Transplantation Bendamustine
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
Fludara
Intervention Description
Pre-Transplantation Fludarabine
Intervention Type
Drug
Intervention Name(s)
Rituximab
Other Intervention Name(s)
Rituxan
Intervention Description
Pre-Transplantation Rituximab (Rituximab for lymphoma diagnosis only)
Primary Outcome Measure Information:
Title
Rate of Survival at 30 days post -transplantation
Description
Proportion of patients undergoing BFR-TBI conditioning + haploidentical alloHSCT alive at 30 days post-transplantation.
Time Frame
30 Days
Secondary Outcome Measure Information:
Title
Rate of neutrophil engraftment at 30 days
Description
Proportion of patients undergoing BFR-TBI conditioning + haploidentical alloHSCT with neutrophil engraftment at 30 days post-transplantation. -Neutrophil engraftment is defined as ANC recovery to >500/uL.
Time Frame
30 days
Title
Rate of platelet recovery at 100 days post-transplantation
Description
Proportion of patients with platelets > 20/uL with no platelet transfusions within the prior 7 days at day 100 post-transplantation.
Time Frame
100 days
Title
Rate of severe chronic GVHD at 365 days post-transplantation
Description
Proportion of patients with severe chronic GVHD at day 365 post-transplantation. -Severe chronic GVHD is defined by NIH Consensus Criteria for GVHD severity
Time Frame
365 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
General Inclusion Criteria (For Treatment Groups) Patient age 18 - 75 years ECOG 0 - 2 HIV-positive patients are allowed if these criteria are met: No history of opportunistic infections CD4+ cell count greater or equal to 250 cells/mm3 No history of non-malignancy AIDS-defining conditions other than historical low CD4+ cell counts Patient is on antiretroviral therapy with undetectable viral load. There must be minimal interactions of the antiviral therapy with the experimental treatment (antiretroviral such as ritonavir is potent CYP3A4 inhibitor and p-gp inducer may interact with tacrolimus resulted in increased serum concentration of tacrolimus). Patients must have a related donor or who is at minimum HLA haploidentical. The donor and recipient must be identical at least one allele of each of the following genetic loci: HLA-A, HLA-B, HLA-Cw, HLA-DRB1, and HLA-DQB1. A minimum match of 5/10 is therefore required, and will be considered sufficient evidence that the donor and recipient share one HLA haplotype. An unrelated donor search is not required. (Patients with a readily-available, suitable, fully-matched sibling donor less than age 55 are not eligible for this trial, these patients should proceed to transplant using the matched related donor as standard-of-care). Criteria for Donor Eligibility Age greater than 12 years Donors must meet the selection criteria as defined by the Foundation for the Accreditation of Hematopoietic Cell Therapy (FACT). In the event that two or more eligible donors are identified, the following order of priority will be used to determine the preferred donor: Medically and psychologically fit and willing to donate For CMV seronegative recipients, a CMV seronegative donor Red blood-cell compatibility RBC cross-match compatible Minor ABO incompatibility Major ABO incompatibility If more than one preferred donor is identified and there is no medical, HLA- or KIR ligand reason to prefer one of them, then the following guidelines are recommended: If the patient is male, choose a male donor: Choose the youngest preferred donor If the patient and family express a strong preference for a particular donor, use that one. Inclusion Criteria (Lymphoma) Diagnosis of resistant or relapsed CLL, Non-Hodgkin Lymphoma, Hodgkin Lymphoma, T-cell lymphoma, NK or NK/T Lymphoma. Meets one of the following criteria: relapsed after auto-transplant, or failed to mobilize autologous stem cells, or for whom allogeneic stem cell transplant is deemed appropriate given disease risk factors that make cure with autologous transplant seem unlikely, such as history of chemotherapy refractoriness, high risk disease features/mutations/translocations (e.g., Double Hit / Double Expressor DLBCL), short remission after prior chemotherapy, or histologic transformation (see below). For Patients with Aggressive Mantle Cell and Diffuse Large B Cell Lymphoma who have not had a prior autologous transplant: Must have received at least 2 lines of prior therapy, and Have been exposed to anthracycline, and High and High-Intermediate aaIPI score (2 or 3 factors), and Have relapsed within one year of primary therapy For diagnosis of other aggressive lymphoma (e.g. NK/T Lymphoma, T Cell Lymphoma, etc.): Must have received at least 2 lines of prior therapy, and Relapsed within 12 months of most recent therapy For low-grade lymphomas / CLL: Standard risk patients (absence of del(17p), absence of del(11q), no TP53 mutation and absence of complex karyotype) must have progressed on BCR inhibitor, or undergone histologic transformation, to be eligible. Patients with high risk disease (del(17p) or TP53 mutations and/or complex phenotype) who relapse after frontline therapy, demonstrate refractory disease to second line therapy (not BCR inhibitors), but show an objective response to BCR inhibitors are eligible to be taken off BCR inhibitors in order to proceed to alloHSCT on trial. Patients with high risk disease who relapse after frontline therapy, demonstrate refractory disease to second line therapy including BCR inhibitors (not BCL-2 inhibitors), but show an objective response to BCL-2 inhibitors (venetoclax) are eligible to be taken off BCL-2 inhibitors in order to proceed to alloHSCT on trial. For aggressive lymphomas, partial or complete remission (PR or CR) is required prior to alloHSCT. Regarding CD20 expression: Patients with B cell malignancies that were CD20+ at any level at the time of relapse diagnosis (including partial / dim staining on IHC or partial / low level expression by flow cytometry) will receive rituximab as part of allogeneic transplant conditioning, if indicated. Patients with primary-refractory disease who were CD20+ at any level at the time of diagnosis will likewise receive rituximab, if indicated. Patients with histologies that were CD20- will not receive rituximab (T cell lymphoma, NK/T lymphoma, etc.). Fresh tissue / repeat biopsy is not required; the most recent biopsy will be reviewed to assess CD20 status. Inclusion Criteria (Multiple Myeloma) - Patient age 18 - 75 years with: Early relapse (less than 24 months) after primary therapy that included an autologous HSCT, or High risk multiple myeloma defined as t(4;14), del(17p), -13, t(14;16), amp (1q21), chromosome 8q24.1/c-MYC abnormality, or LDH > ULN at diagnosis, provided patients respond favorably to salvage therapy before enrollment for alloHSCT on trial and patient is age < 55, or Patients failing to mobilize peripheral blood stem cells for autologous transplantation, or Extramedullary disease at diagnosis or relapse, or Plasma-cell leukemia with chemosensitive disease Inclusion Criteria - Control Patients (specimen collection, only) Age 18-75 years Undergoing standard-of-care reduced-intensity peripheral blood allogeneic stem cell transplantation (any indication, donor source, conditioning regimen) using PTCy GVHD prophylaxis. Willing to provide longitudinal blood samples per Control Specimen Collection Calendar for correlative studies (for comparison to specimens from patients treated on the trial). Agrees to let study personnel collect excess bone marrow aspirate whenever a bone marrow biopsy is performed for clinical purposes, and use for research. Exclusion Criteria Patient has a readily-available, suitable, fully-matched sibling donor (MRD) less than age 55. 'Suitable' means no high-titre donor-specific antibodies present, and negative IDM testing with no contraindications. Patient has a clinically-significant donor-specific antibody for the selected donor (DSA clearance is not allowed). Poor cardiac function: left ventricular ejection fraction <45% as determined by MUGA or ECHO. Symptomatic pulmonary disease. Poor pulmonary function: FEV1, FVC, and DLCO <50% predicted (corrected for hemoglobin) for patients who have not received thoracic or mantle irradiation. For patients who have received thoracic or mantle irradiation, FEV1 and FVC <70% predicted or DLCO < 50 of predicted. Poor liver function: bilirubin >2 mg/dl (not due to hemolysis, Gilbert's or primary malignancy). ALT or AST > 5 x laboratory upper normal limits. Poor renal function: Creatinine >2.0mg/dl or creatinine clearance (calculated creatinine clearance is permitted) < 60 mL/min based on Traditional Cockcroft-Gault formula Women of childbearing potential who currently are pregnant (Β-HCG+) or who are not practicing adequate contraception. Uncontrolled viral, bacterial, or fungal infections. Patients with symptoms consistent with RSV, influenza A, B, or parainfluenza at the time of enrollment will be assayed for the above viruses and if positive are not eligible for the trial until they are no longer symptomatic (patients may have continued assay positivity for a period of time post resolution of symptoms secondary to the nature of the assay). Uncontrolled CNS involvement by malignancy (patients with prior history of CNS disease controlled with intrathecal chemotherapy or prior systemic therapy are allowed). Patients who have any debilitating medical or psychiatric illness which would preclude their giving informed consent or their receiving optimal treatment and follow-up. Exclusion Criteria - Control Patients (specimen collection, only) Undergoing myeloablative alloHSCT. Non-PTCy GVHD prophylaxis. Non-PBSC transplant (bone marrow stem cell source). Not willing to give longitudinal blood specimens for research use or not willing to allow access to medical records for non-clinical purposes.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Noah Merin, MD, PhD
Organizational Affiliation
Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cedars Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States

12. IPD Sharing Statement

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Haploidentical Stem Cell Transplant With Prophylactic Natural Killer DLI for Lymphoma, Multiple Myeloma, and CLL

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