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Allogeneic Hematopoietic Cell Transplantation From HLA-matched Donor After Flu-Mel-PTCy Versus Flu-Mel-ATG Reduced-intensity Conditioning (HLA)

Primary Purpose

Acute Myeloid Leukemia in Remission, Myelodysplastic Syndromes, Chronic Myeloid Leukemia in Remission

Status
Recruiting
Phase
Phase 2
Locations
Belgium
Study Type
Interventional
Intervention
Thymoglobulin
Melphalan
Fludarabine
Cyclophosphamid
Sponsored by
University of Liege
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia in Remission focused on measuring hematological malignancies, Graft versus host disease, GVHD, Progression free survival, Allogeneic hematopoeitic cell transplantation, HLA-matched donor, reduced intensity conditioning, Overall survival, ATG PK, Immunosuppressive regimen, Prophylaxis

Eligibility Criteria

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

Inclusion Criteria:

Patients V.1.1. Diseases

Hematological malignancies confirmed histologically:

  • AML in morphological CR or not in morphological CR but not rapidly progressing (i.e. no need to give treatments such as hydroxyurea to maintain WBC count < 10 000 x109/mL);
  • MDS;
  • CML in CP or AP;
  • MPD not in blast crisis,
  • MDS/MPD overlap,
  • ALL in CR;
  • Multiple myeloma;
  • CLL;
  • Non-Hodgkin's lymphoma (aggressive NHL should have chemosensitive disease);
  • Hodgkin's disease with chemosensitive disease or responding to checkpoint inhibitors.

    * Clinical situations

    • Theoretical indication for a standard allo-transplant, but not feasible because:

  • Age > 50 yrs;
  • Unacceptable end organ performance;
  • The physician's decision;
  • The patient's decision

    • Underlying 'lower risk' disease, for which Reduced Intensity Conditioning is preferred (eg CLL, MCL)

      * Other inclusion criteria

    • Male or female; fertile patients must use a reliable contraception method;
    • Age 18-75 yrs (children of any age are not allowed in the protocol);
    • Informed consent given by patient or his/her guardian if indicated.

Donors

  • Male or female;
  • Any age;
  • Human Leukocyte Antigen (HLA)-identical sibling donor or 10 of 10 (HLA-A, -B, -C, -DRB1, and -DQB1) HLA allele matched unrelated donor;
  • Weight > 15 Kg (because of leukapheresis);
  • Fulfills criteria for allogeneic Peripheral Blood Stem Cell (PBSC) donation according to standard procedures;
  • Informed consent given by donor or his/her guardian if indicated, as per donor center standard procedures.

Exclusion Criteria:

Patients

  • Any condition not fulfilling inclusion criteria;
  • Human Immunodeficiency Virus positive;
  • Non-hematological malignancy(ies) (except non-melanoma skin cancer) active < 3 years before Hematopoietic Cell Transplantation (HCT).
  • Life expectancy severely limited by disease other than malignancy;
  • Central Nervous System involvement with disease refractory to intrathecal chemotherapy.
  • Terminal organ failure, except for renal failure (dialysis acceptable)

    1. Cardiac: Symptomatic coronary artery disease; ejection fraction <40%; uncontrolled arrhythmia, uncontrolled hypertension;
    2. Pulmonary: Diffusing Capacity of the Lung for Carbon Monoxide (DLCO)< 40% and/or receiving supplementary continuous oxygen, Forced Expiratory Volume in 1 Second (FEV1)< 40%;
    3. Hepatic: Fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin >3 mg/dL, and symptomatic biliary disease;
  • Uncontrolled infection;
  • Karnofsky Performance Score <70%;
  • Patient is a fertile man or woman who is unwilling to use contraceptive techniques during and for 12 months following treatment;
  • Patient is a female who is pregnant or breastfeeding;
  • Any condition precluding the use of melphalan or Thymoglobulin;

Donors

  • Any condition not fulfilling inclusion criteria;
  • Unable to undergo leukapheresis because of poor vein access or other reasons.

Sites / Locations

  • ZNA StuivenbergRecruiting
  • AZ Sint Jan BruggeRecruiting
  • IJ BordetRecruiting
  • UZ BrusselRecruiting
  • UCL St LucRecruiting
  • UZ GentRecruiting
  • UZ LeuvenRecruiting
  • CHU de LiègeRecruiting
  • AZ Delta RoeselareRecruiting
  • CHU UCL Namur GodinneRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Fludarabine-Melphalan-Cyclophosphamide

Fludarabine-Melphalan-thymoglobulin

Arm Description

FM-PTCy conditioning will consist in IV fludarabine 30 mg/m2 on days -6, -5, -4, -3, and -2 (total dose 150 mg/m2), melphalan given at the dose of 100 mg/m2 on day -2, and cyclophosphamide 50 mg/kg on days +3 and +4.

FM-ATG conditioning will consist in IV fludarabine 30 mg/m2 on days -6, -5, -4, -3, and -2 (total dose 150 mg/m2), melphalan given at the dose of 100 mg/m2 on day -2, and ATG (Thymoglobulin®, Genzyme), at a dose of 2.5 mg/kg/d on days -2 and -1.

Outcomes

Primary Outcome Measures

Current GVHD-free, relapse-free survival (cGRFS)
To assess the current GVHD-free, relapse-free survival (cGRFS) for patients in the 2 arms

Secondary Outcome Measures

cGRFS according donor
To assess cGRFS for patients conditioned with FM-PTCy or FM-ATG separately in those transplanted with a related or an unrelated donor
Relapse/progression rate
To assess the relapse/progression rate for patients conditioned with FM-PTCy or FM-ATG
Rate aGVHD
To assess rate of grade II-IV and III-IV acute GVHD (Graft-versus-host disease) in patients conditioned with FM or FM-ATG.
Rate cGVHD
To assess rate of grade of moderate-severe chronic GVHD in patients conditioned with FM or FM-ATG.
Rate of Nonrelapse Mortality (NRM)
To assess rate of Nonrelapse Mortality in patients conditioned with FM-PTCy or FM-ATG.
Rate of Leukemia Free Survival (LFS)
To assess rate of Leukemia Free Survival in patients conditioned with FM-PTCy or FM-ATG.
Rate of Overall Survival (OS)
To assess rate of Overall Survival in patients conditioned with FM-PTCy or FM-ATG.
Proportion of patients alive
To assess the proportion of patients alive without active disease and without systemic immunosuppression

Full Information

First Posted
January 21, 2019
Last Updated
October 11, 2022
Sponsor
University of Liege
Collaborators
Belgian Hematological Society
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1. Study Identification

Unique Protocol Identification Number
NCT03852407
Brief Title
Allogeneic Hematopoietic Cell Transplantation From HLA-matched Donor After Flu-Mel-PTCy Versus Flu-Mel-ATG Reduced-intensity Conditioning
Acronym
HLA
Official Title
Allogeneic Hematopoietic Cell Transplantation From HLA-matched Donor After Flu-Mel-PTCy Versus Flu-Mel-ATG Reduced-intensity Conditioning: a Phase II Randomized Study From the Belgian Hematology Society (BHS)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 4, 2019 (Actual)
Primary Completion Date
November 1, 2033 (Anticipated)
Study Completion Date
November 1, 2038 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Liege
Collaborators
Belgian Hematological Society

4. Oversight

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

5. Study Description

Brief Summary
The present project aims at comparing two conditioning regimens (FM-PTCy vs FM-ATG). The hypothesis is that one or the two regimens will lead to a 2-year cGRFS rate improvement from 30% (the cGRFS rate with FM without ATG/PTCy) to 45% (Pick-a-winner phase 2 randomized study).
Detailed Description
This study is a multicenter, randomized, open-label, phase II study pick-a-winner study, comparing 2 conditioning regimens. A total of 114 eligible patients with HLA-matched donors will be randomized 1:1 between the FM-PTCy arm and the FM-ATG arm, with stratification for donor type (related or unrelated). The recruitment period is 3 years with a 5-year follow-up plus a 10-year additional long-term follow-up (for GVHD status, disease status, second malignancy and QOL). The whole study will be completed within 18 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia in Remission, Myelodysplastic Syndromes, Chronic Myeloid Leukemia in Remission, Myeloproliferative Syndrome, Myeloproliferative Disorder, Acute Lymphoid Leukemia in Remission, Multiple Myeloma, Chronic Lymphoid Leukemia, Non Hodgkin Lymphoma, Hodgkin Lymphoma
Keywords
hematological malignancies, Graft versus host disease, GVHD, Progression free survival, Allogeneic hematopoeitic cell transplantation, HLA-matched donor, reduced intensity conditioning, Overall survival, ATG PK, Immunosuppressive regimen, Prophylaxis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
114 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fludarabine-Melphalan-Cyclophosphamide
Arm Type
Experimental
Arm Description
FM-PTCy conditioning will consist in IV fludarabine 30 mg/m2 on days -6, -5, -4, -3, and -2 (total dose 150 mg/m2), melphalan given at the dose of 100 mg/m2 on day -2, and cyclophosphamide 50 mg/kg on days +3 and +4.
Arm Title
Fludarabine-Melphalan-thymoglobulin
Arm Type
Experimental
Arm Description
FM-ATG conditioning will consist in IV fludarabine 30 mg/m2 on days -6, -5, -4, -3, and -2 (total dose 150 mg/m2), melphalan given at the dose of 100 mg/m2 on day -2, and ATG (Thymoglobulin®, Genzyme), at a dose of 2.5 mg/kg/d on days -2 and -1.
Intervention Type
Drug
Intervention Name(s)
Thymoglobulin
Other Intervention Name(s)
ATG
Intervention Description
ATG: 2.5 mg /kg/day on day -2 and -1 (day 0 is allogenic transplantation)
Intervention Type
Drug
Intervention Name(s)
Melphalan
Other Intervention Name(s)
alkeran
Intervention Description
100mg/m² on day -2
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Intervention Description
30mg/m² on days -6, -5, -4, -3, and -2
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamid
Other Intervention Name(s)
PTCy
Intervention Description
50 mg/kg on days +3 and +4.
Primary Outcome Measure Information:
Title
Current GVHD-free, relapse-free survival (cGRFS)
Description
To assess the current GVHD-free, relapse-free survival (cGRFS) for patients in the 2 arms
Time Frame
15 years (the primary endpoint will be first assessed after 191 events have been reached)
Secondary Outcome Measure Information:
Title
cGRFS according donor
Description
To assess cGRFS for patients conditioned with FM-PTCy or FM-ATG separately in those transplanted with a related or an unrelated donor
Time Frame
15 years
Title
Relapse/progression rate
Description
To assess the relapse/progression rate for patients conditioned with FM-PTCy or FM-ATG
Time Frame
15 years
Title
Rate aGVHD
Description
To assess rate of grade II-IV and III-IV acute GVHD (Graft-versus-host disease) in patients conditioned with FM or FM-ATG.
Time Frame
6 months
Title
Rate cGVHD
Description
To assess rate of grade of moderate-severe chronic GVHD in patients conditioned with FM or FM-ATG.
Time Frame
24 months
Title
Rate of Nonrelapse Mortality (NRM)
Description
To assess rate of Nonrelapse Mortality in patients conditioned with FM-PTCy or FM-ATG.
Time Frame
15 years
Title
Rate of Leukemia Free Survival (LFS)
Description
To assess rate of Leukemia Free Survival in patients conditioned with FM-PTCy or FM-ATG.
Time Frame
15 years
Title
Rate of Overall Survival (OS)
Description
To assess rate of Overall Survival in patients conditioned with FM-PTCy or FM-ATG.
Time Frame
15 years
Title
Proportion of patients alive
Description
To assess the proportion of patients alive without active disease and without systemic immunosuppression
Time Frame
15 years
Other Pre-specified Outcome Measures:
Title
Hematopoietic engraftment
Description
To assess hematopoietic (whole blood and T cell chimerism) engraftment in the 2 arms.
Time Frame
2 years
Title
Quality of immunologic reconstitution
Description
To assess the quality of immunologic reconstitution in the 2 arms
Time Frame
5 years
Title
Timing of immunologic reconstitution
Description
To assess the timing (days) of immunologic reconstitution in the 2 arms
Time Frame
5 years
Title
Incidences of bacterial infections
Description
To assess the incidences of bacterial infections (number of episode, site, grade) in the 2 arms, in the whole group of patients
Time Frame
1 year
Title
Incidences of fungal infections
Description
To assess the incidences of fungal infections (number of episode, site, grade) in the 2 arms, in the whole group of patients
Time Frame
1 year
Title
Incidences of viral infections
Description
To assess the incidences of viral infections (number of episode, site, grade) in the 2 arms, in the whole group of patients
Time Frame
1 year
Title
Assess Thymoglobulin (ATG) Pharmacokinetic
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm
Time Frame
10 days
Title
Assess ATG Pharmacokinetic in association with cGRFS
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with cGRFS
Time Frame
15 years
Title
Assess ATG Pharmacokinetic in association with NRM
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with NRM
Time Frame
15 years
Title
Assess ATG Pharmacokinetic in association with OS
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with OS
Time Frame
15 years
Title
Assess ATG Pharmacokinetic in association with Relapse/progression
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with Relapse/progression
Time Frame
15 years
Title
Assess ATG Pharmacokinetic in association with Infections
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with Infections
Time Frame
1 years
Title
Assess ATG Pharmacokinetic in association with immunologic reconstitution
Description
To assess kinetics of functional ATG serum levels (mg/L) in the FM-ATG arm in association with immunologic reconstitution (CD4 and NAIVE T cells counts)
Time Frame
5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients V.1.1. Diseases Hematological malignancies confirmed histologically: AML in morphological CR or not in morphological CR but not rapidly progressing (i.e. no need to give treatments such as hydroxyurea to maintain WBC count < 10 000 x109/mL); MDS; CML in CP or AP; MPD not in blast crisis, MDS/MPD overlap, ALL in CR; Multiple myeloma; CLL; Non-Hodgkin's lymphoma (aggressive NHL should have chemosensitive disease); Hodgkin's disease with chemosensitive disease or responding to checkpoint inhibitors. * Clinical situations • Theoretical indication for a standard allo-transplant, but not feasible because: Age > 50 yrs; Unacceptable end organ performance; The physician's decision; The patient's decision Underlying 'lower risk' disease, for which Reduced Intensity Conditioning is preferred (eg CLL, MCL) * Other inclusion criteria Male or female; fertile patients must use a reliable contraception method; Age 18-75 yrs (children of any age are not allowed in the protocol); Informed consent given by patient or his/her guardian if indicated. Donors Male or female; Any age; Human Leukocyte Antigen (HLA)-identical sibling donor or 10 of 10 (HLA-A, -B, -C, -DRB1, and -DQB1) HLA allele matched unrelated donor; Weight > 15 Kg (because of leukapheresis); Fulfills criteria for allogeneic Peripheral Blood Stem Cell (PBSC) donation according to standard procedures; Informed consent given by donor or his/her guardian if indicated, as per donor center standard procedures. Exclusion Criteria: Patients Any condition not fulfilling inclusion criteria; Human Immunodeficiency Virus positive; Non-hematological malignancy(ies) (except non-melanoma skin cancer) active < 3 years before Hematopoietic Cell Transplantation (HCT). Life expectancy severely limited by disease other than malignancy; Central Nervous System involvement with disease refractory to intrathecal chemotherapy. Terminal organ failure, except for renal failure (dialysis acceptable) Cardiac: Symptomatic coronary artery disease; ejection fraction <40%; uncontrolled arrhythmia, uncontrolled hypertension; Pulmonary: Diffusing Capacity of the Lung for Carbon Monoxide (DLCO)< 40% and/or receiving supplementary continuous oxygen, Forced Expiratory Volume in 1 Second (FEV1)< 40%; Hepatic: Fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin >3 mg/dL, and symptomatic biliary disease; Uncontrolled infection; Karnofsky Performance Score <70%; Patient is a fertile man or woman who is unwilling to use contraceptive techniques during and for 12 months following treatment; Patient is a female who is pregnant or breastfeeding; Any condition precluding the use of melphalan or Thymoglobulin; Donors Any condition not fulfilling inclusion criteria; Unable to undergo leukapheresis because of poor vein access or other reasons.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Frédéric Baron, MD,Ph
Phone
+32 4 366 72 01
Ext
0032497121806
Email
F.Baron@uliege.be
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frédéric Baron, MD,Ph
Organizational Affiliation
Centre Hospitalier Universitaire de Liege
Official's Role
Principal Investigator
Facility Information:
Facility Name
ZNA Stuivenberg
City
Antwerp
ZIP/Postal Code
2060
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dimitri Breems, MD PhD
Email
dimitri.Breems@zna.be
Facility Name
AZ Sint Jan Brugge
City
Brugge
ZIP/Postal Code
8000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dominik Selleslag, MD, PhD
Email
dominik.selleslag@AZsintjan.be
Facility Name
IJ Bordet
City
Brussels
ZIP/Postal Code
1000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Philippe Lewalle, MD PhD
Email
philippe.lewalle@bordet.be
Facility Name
UZ Brussel
City
Brussels
ZIP/Postal Code
1090
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ann De Becker, MD PhD
Email
ann.debecker@uzbrussel.be
First Name & Middle Initial & Last Name & Degree
Rik Schots, MD PhD
Facility Name
UCL St Luc
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xavier Poiré, MD
Email
xavier.poire@uclouvain.be
Facility Name
UZ Gent
City
Gent
ZIP/Postal Code
9000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tessa Kerre, MD PhD
Email
t.Kerre@UGent.be
Facility Name
UZ Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Johan Maertens, MD PhD
Email
johan.maertens@uzleuven.be
First Name & Middle Initial & Last Name & Degree
Hélène Schoemans, MD PhD
Facility Name
CHU de Liège
City
Liège
ZIP/Postal Code
4000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frédéric Baron, MD, PhD
Phone
+3243667201
Ext
+3243667201
Email
F.Baron@uliege.be
First Name & Middle Initial & Last Name & Degree
Yves Beguin, MD, PhD
Phone
+3243667201
Ext
+3243667201
Email
yves.beguin@chuliege.be
First Name & Middle Initial & Last Name & Degree
Evelyne Willems, MD
First Name & Middle Initial & Last Name & Degree
Sophie Servais, MD
Facility Name
AZ Delta Roeselare
City
Roeselare
ZIP/Postal Code
8800
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dries Deeren, MD
Email
dries.deeren@AZdelta.be
Facility Name
CHU UCL Namur Godinne
City
Yvoir
ZIP/Postal Code
5530
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carlos Graux, MD PhD
Email
carlos.graux@uclouvain.be

12. IPD Sharing Statement

Learn more about this trial

Allogeneic Hematopoietic Cell Transplantation From HLA-matched Donor After Flu-Mel-PTCy Versus Flu-Mel-ATG Reduced-intensity Conditioning

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