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CBM588 in Improving Clinical Outcomes in Patients Who Have Undergone Donor Hematopoietic Stem Cell Transplant

Primary Purpose

Hematopoietic and Lymphoid Cell Neoplasm

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Best Practice
Clostridium butyricum CBM 588 Probiotic Strain
Sponsored by
City of Hope Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Hematopoietic and Lymphoid Cell Neoplasm

Eligibility Criteria

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

Inclusion Criteria:

  • Documented informed consent of the participant and/or legally authorized representative.

    • Assent, when appropriate, will be obtained per institutional guidelines.
  • Willingness to be followed for the planned duration of the trial (2 years).
  • Karnofsky performance status must be >= 60%.
  • Any hematologic disorders receiving allogeneic hematopoietic stem cell transplant with reduced intensity conditioning.
  • Planned 8/8 or 7/8 (human leukocyte antigens [HLA]-A, B, C, DR) related or unrelated donor hematopoietic cell transplantation (HCT).
  • Clinical Laboratory and Organ Function Criteria: Consistent with City of Hope (COH) standard operating procedure (SOP) for "patient evaluation for selection for hematopoietic cell transplantation.
  • Patient is eligible to receive allogeneic hematopoietic cell transplantation with reduced intensity conditioning.
  • Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy.

    • Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only).

Exclusion Criteria:

  • Failure of research participant to understand the basic elements of the protocol and/or the risks/benefits of participating in this pilot study. A legal guardian may substitute for the research participant.
  • Refusing to use contraception up to 90 days post-HCT.
  • Pregnant and/or breast feeding if a female recipient.
  • Patients with history of chronic intestinal disease (e.g., Crohn's disease, ulcerative colitis).
  • In the opinion of the principal investigator (PI), the participant has a condition that will preclude them from complying with study treatment.
  • Research participants receiving any other investigational agents.
  • Known or documented history of hypersensitivity to all the listed antibiotics, used for severe infections related to CBM588:

    • Ampicillin.
    • Chloramphenicol.
    • Clindamycin.
    • Erythromycin.
    • Metronidazole.
    • Tetracycline.
    • Vancomycin.
  • Research participants with presence of other active malignancy within 2 years of study entry. Participants with history of prior malignancy treated with curative intent who achieved complete response (CR) more than 2 years before study entry are eligible. This exclusion rule does not apply to non-melanoma skin tumors and in-situ cervical cancer.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent (i.e., research participants whom are severe lactose intolerance or intolerance to milk products).
  • Research participants having any uncontrolled illness including ongoing or active infection. Research participants with known active hepatitis B or C infection; research participants who are human immunodeficiency virus (HIV) seropositive based on testing performed within 4 weeks of enrollment; research participants with any signs or symptoms of active infection, positive blood cultures, or radiological evidence of infections.
  • Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures.
  • Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).

Sites / Locations

  • City of Hope Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Arm I (CBM588)

Arm II (standard of care)

Arm Description

Patients receive standard peri-/post-transplant supportive care and CBM588 PO BID from day of admission to day 28 in the absence of disease progression or unacceptable toxicity.

Patients receive standard peri-/post-transplant supportive care.

Outcomes

Primary Outcome Measures

Incidence of adverse events
Will be scored according to the modified Bearman Scale and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5 scale. Observed toxicities will be summarized in terms of type (organ affected or laboratory determination), severity, time of onset, duration, probable association with the study treatment and reversibility or outcome.
Feasibility of CBM588
Will be evaluated by assessment of patients' ability to take half of the specified dose.

Secondary Outcome Measures

Incidence and severity of adverse events
Assessed by modified Bearman criteria and NCI CTCAE version 5 scale. Will be compared among CBM588 treated and untreated patients.
Overall survival
Will be estimated using the product-limit method of Kaplan and Meier.
Cumulative incidence (CI) of chronic graft versus host disease (cGVHD)
Will be estimated using the method described by Gooley et al (1999).
CI of acute graft versus host disease (aGVHD)
Will be estimated using the method described by Gooley et al (1999).
CI of relapse/progression of disease
Will be estimated using the method described by Gooley et al (1999).
Non-relapse mortality
Will be estimated using the method described by Gooley et al (1999).

Full Information

First Posted
September 10, 2018
Last Updated
February 19, 2023
Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03922035
Brief Title
CBM588 in Improving Clinical Outcomes in Patients Who Have Undergone Donor Hematopoietic Stem Cell Transplant
Official Title
A Randomized Open Label Pilot Study of Clostridium Butyricum MIYAIRI 588 (CBM588) in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
April 18, 2019 (Actual)
Primary Completion Date
December 24, 2023 (Anticipated)
Study Completion Date
December 24, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This pilot trial studies the side effects and how well CBM588 works in improving clinical outcomes in patients who have undergone donor hematopoietic stem cell transplant. Gut microbiota (formerly called gut flora) is the name given to the microbe (bacteria) population living in the intestine. Gut bacteria help the body to digest certain foods that the stomach and small intestine have not been able to digest. CBM588, may increase gut bacteria biodiversity, prevent recurrent symptoms of gastrointestinal toxicity (ranging from diarrhea to life-threatening inflammation of the colon).
Detailed Description
PRIMARY OBJECTIVES: I. In patients with hematologic malignancies who are undergoing standard reduced intensity conditioning regimen (RIC) prior to allogeneic stem cell transplantation, to evaluate the safety and feasibility of Clostridium butyricum CBM 588 probiotic strain (CBM588) treatment by assessing: Ia. Type, frequency, severity, attribution, time course and duration of adverse events, including diarrhea, bloodstream/intestinal infections. Ib. Patient compliance, the patients' ability to take CBM588 during the treatment period. SECONDARY OBJECTIVES: I. Compare the incidence and severity of adverse events (AE) among CBM588-treated and untreated patients, including diarrhea, bloodstream infections and intestinal infections. II. Estimate overall survival (OS), cumulative incidence (CI) of chronic graft versus host disease (GVHD), relapse/progression, and non-relapse mortality (NRM) at 100 days, 6 months, 1 year and 2 years. EXPLORATORY OBJECTIVES: I. Compare gut microbiome diversity among CBM588-treated/untreated patients. II. Obtain a preliminary estimate of the possible association between gut microbiome diversity and bloodstream infections. III. Characterize and compare graft versus host disease (GVHD) inflammatory biomarkers (presence, level) among CBM588-treated and untreated patients. IV. Obtain preliminary estimates of gut microbiome diversity, as assessed by the inverse Simpson Index, in CBM588-treated/untreated patients. V. Obtain a preliminary estimate of the possible association between gut microbiome diversity and acute GVHD cumulative incidence, including time to onset. VI. Characterize and compare urinary uindoxyl sulfate, tryptophan and kynurenine levels between CBM588- treated and untreated patients. VII. To obtain a preliminary estimate of gut microbiome diversity and calorie intake. VIII. Characterize and compare impact of CBM588 administration on regulatory T cells (T regs) reconstitution between CBM588-treated and untreated patients. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I (CBM588): Patients receive standard peri-/post-transplant supportive care and CBM588 orally (PO) twice daily (BID) from day of admission to day 28 in the absence of disease progression or unacceptable toxicity. ARM II (STANDARD OF CARE): Patients receive standard peri-/post-transplant supportive care. After completion of study treatment, patients are followed up for 100 days and then up to 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hematopoietic and Lymphoid Cell Neoplasm

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I (CBM588)
Arm Type
Experimental
Arm Description
Patients receive standard peri-/post-transplant supportive care and CBM588 PO BID from day of admission to day 28 in the absence of disease progression or unacceptable toxicity.
Arm Title
Arm II (standard of care)
Arm Type
Active Comparator
Arm Description
Patients receive standard peri-/post-transplant supportive care.
Intervention Type
Other
Intervention Name(s)
Best Practice
Other Intervention Name(s)
standard of care, standard therapy
Intervention Description
Receive standard peri-/post-transplant supportive care
Intervention Type
Drug
Intervention Name(s)
Clostridium butyricum CBM 588 Probiotic Strain
Other Intervention Name(s)
C. butyricum CBM 588 Probiotic Strain, C. butyricum MIYAIRI Strain, C. butyricum Strain MIYAIRI 588, CBM 588, CBM588, Clostridium butyricum MIYAIRI 588, Clostridium butyricum MIYAIRI 588 Probiotic Strain, MIYAIRI 588, MIYAIRI 588 Strain of C. butyricum
Intervention Description
Given PO
Primary Outcome Measure Information:
Title
Incidence of adverse events
Description
Will be scored according to the modified Bearman Scale and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5 scale. Observed toxicities will be summarized in terms of type (organ affected or laboratory determination), severity, time of onset, duration, probable association with the study treatment and reversibility or outcome.
Time Frame
From initiation of treatment until end of treatment assessed up to 100 days
Title
Feasibility of CBM588
Description
Will be evaluated by assessment of patients' ability to take half of the specified dose.
Time Frame
During the safety lead-in phase
Secondary Outcome Measure Information:
Title
Incidence and severity of adverse events
Description
Assessed by modified Bearman criteria and NCI CTCAE version 5 scale. Will be compared among CBM588 treated and untreated patients.
Time Frame
Up to 2 years
Title
Overall survival
Description
Will be estimated using the product-limit method of Kaplan and Meier.
Time Frame
Up to 2 years
Title
Cumulative incidence (CI) of chronic graft versus host disease (cGVHD)
Description
Will be estimated using the method described by Gooley et al (1999).
Time Frame
Up to 2 years
Title
CI of acute graft versus host disease (aGVHD)
Description
Will be estimated using the method described by Gooley et al (1999).
Time Frame
Up to 2 years
Title
CI of relapse/progression of disease
Description
Will be estimated using the method described by Gooley et al (1999).
Time Frame
Up to 2 years
Title
Non-relapse mortality
Description
Will be estimated using the method described by Gooley et al (1999).
Time Frame
Up to 2 years
Other Pre-specified Outcome Measures:
Title
Gut microbiome diversity
Description
Will be assessed by the inverse Simpson index. Will be compared among CBM588-treated/untreated patients and assessed by Fisher's exact test or two-sample Wilcoxon test whenever appropriate.
Time Frame
Up to 2 years
Title
Gut microbiome diversity and bloodstream infection
Description
Incidence of bloodstream infections and infectious enterocolitis will be evaluated and a preliminary estimate of the association between gut microbiome diversity and blood stream infections will be obtained.
Time Frame
Up to 2 years
Title
Gut microbiome diversity aGVHD incidence
Description
Will be obtained based on: 1) evaluation and comparison of presence and levels GVHD/inflammatory biomarkers including TNFR1, ST2, Reg3 alpha, TNF-alpha, IL-8 and TGF-beta 1 between the 2 study arms, and 2) incidence, site (gastrointestinal [GI], liver, and skin), severity (grade III-IV GI toxicity per the NCI CTCAE version 5 Scale) and time to onset of aGVHD among treated and untreated patients.
Time Frame
Up to 2 years
Title
Levels of tryptophan metabolites
Description
Presence and levels of urinary uindoxyl sulfate, tryptophan and kynurenine (markers of GI GVHD complications) will be evaluated and compared between CBM588-treated and untreated patients.
Time Frame
Up to 2 years
Title
Impact on regulatory T cells (T regs)
Description
Presence and levels T regs will be evaluated and compared in blood samples from patients among treated and untreated patients.
Time Frame
Up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented informed consent of the participant and/or legally authorized representative. Assent, when appropriate, will be obtained per institutional guidelines. Willingness to be followed for the planned duration of the trial (2 years). Karnofsky performance status must be >= 60%. Any hematologic disorders receiving allogeneic hematopoietic stem cell transplant with reduced intensity conditioning. Planned 8/8 or 7/8 (human leukocyte antigens [HLA]-A, B, C, DR) related or unrelated donor hematopoietic cell transplantation (HCT). Clinical Laboratory and Organ Function Criteria: Consistent with City of Hope (COH) standard operating procedure (SOP) for "patient evaluation for selection for hematopoietic cell transplantation. Patient is eligible to receive allogeneic hematopoietic cell transplantation with reduced intensity conditioning. Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy. Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only). Exclusion Criteria: Failure of research participant to understand the basic elements of the protocol and/or the risks/benefits of participating in this pilot study. A legal guardian may substitute for the research participant. Refusing to use contraception up to 90 days post-HCT. Pregnant and/or breast feeding if a female recipient. Patients with history of chronic intestinal disease (e.g., Crohn's disease, ulcerative colitis). In the opinion of the principal investigator (PI), the participant has a condition that will preclude them from complying with study treatment. Research participants receiving any other investigational agents. Known or documented history of hypersensitivity to all the listed antibiotics, used for severe infections related to CBM588: Ampicillin. Chloramphenicol. Clindamycin. Erythromycin. Metronidazole. Tetracycline. Vancomycin. Research participants with presence of other active malignancy within 2 years of study entry. Participants with history of prior malignancy treated with curative intent who achieved complete response (CR) more than 2 years before study entry are eligible. This exclusion rule does not apply to non-melanoma skin tumors and in-situ cervical cancer. History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent (i.e., research participants whom are severe lactose intolerance or intolerance to milk products). Research participants having any uncontrolled illness including ongoing or active infection. Research participants with known active hepatitis B or C infection; research participants who are human immunodeficiency virus (HIV) seropositive based on testing performed within 4 weeks of enrollment; research participants with any signs or symptoms of active infection, positive blood cultures, or radiological evidence of infections. Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures. Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ryotaro Nakamura
Organizational Affiliation
City of Hope Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope Medical Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States

12. IPD Sharing Statement

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CBM588 in Improving Clinical Outcomes in Patients Who Have Undergone Donor Hematopoietic Stem Cell Transplant

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