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HLA-Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation With Reduced Dose Post Transplantation Cyclophosphamide GvHD Prophylaxis (OPTIMIZE)

Primary Purpose

Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Acute Leukemia

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Busulfan
Fludarabine
PBSC Hematopoietic Stem Cell Transplantation (HSCT)
Post-Transplant Cyclophosphamide
Mesna
Tacrolimus
Mycophenolate Mofetil
Patient Reported Outcomes
Melphalan
Total-body irradiation
Cyclophosphamide
Sponsored by
Center for International Blood and Marrow Transplant Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Lymphoblastic Leukemia focused on measuring Lymphoma, Leukemia, Hematologic Diseases, Myelodysplastic Syndromes, Preleukemia, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia , Lymphocytic, Chronic, B-Cell, Leukemia, Myeloid, Acute, Leukemia, Biphenotypic, Acute, Neoplasms by Histologic Type, Neoplasms, Lymphoproliferative Disorders, Lymphatic Diseases, Immunoproliferative Disorders, Immune System Disorders, Bone Marrow Diseases, Precancerous Conditions, Leukemia, Lymphoid, Leukemia, B-Cell, Leukemia, Myeloid, Cyclophosphamide, Mesna, Tacrolimus, Busulfan, Fludarabine, Total Body Irradiation, Melphalan, Mycophenolate mofetil, Reduced Dose Cyclophosphamide, Immunosuppressive Agents, Immunologic Factors, Physiological Effects of Drugs, Hematopoietic Stem Cell Transplantation, Peripheral Blood Stem Cells, Unrelated Donors

Eligibility Criteria

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

Stratum 1 Recipient Inclusion Criteria: Age ≥ 18 years and < 66 years (chemotherapy-based conditioning) or < 61 years (total body irradiation [TBI]-based conditioning) at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned MAC regimen as defined per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft HCT-CI < 5. The presence of prior malignancy will not be used to calculate HCT-CI for this trial to allow for the inclusion of patients with secondary or therapy-related AML or MDS. One of the following diagnoses: Acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or other acute leukemia in 1st remission or beyond with ≤ 5% marrow blasts and no circulating blasts or evidence of extra-medullary disease. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with MDS with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS). Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Cardiac function: Left ventricular ejection fraction ≥ 45% based on most recent echocardiogram or multi-gated acquisition scan (MUGA) results. Estimated creatinine clearance ≥ 45mL/min calculated by equation. Pulmonary function: diffusing capacity of the lungs for carbon monoxide (DLCO) corrected for hemoglobin > 50% and forced expiratory volume in first second (FEV1) predicted > 50% based on most recent pulmonary function test (PFT) results Liver function acceptable per local institutional guidelines KPS of ≥ 70% Stratum 2 Recipient Inclusion Criteria: Age ≥18 years at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and local institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned NMA/RIC regimen per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft One of the following diagnoses: Patients with acute leukemia or chronic myeloid leukemia (CML) with no circulating blasts, no evidence of extramedullary disease, and with < 5% blasts in the bone marrow. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with MDS with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS.) Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with chronic lymphocytic leukemia (CLL) or other leukemias (including prolymphocytic leukemia) with chemosensitive disease at time of transplantation Higher risk CMML according to CMML-specific prognostic scoring system or high risk MDS/MPN not otherwise specified are eligible, provided there is no evidence of high-grade bone marrow fibrosis or massive splenomegaly at the time of enrollment. Patients with lymphoma with chemosensitive disease at the time of transplantation Cardiac function: Left ventricular ejection fraction ≥ 40% based on most recent echocardiogram or MUGA results with no clinical evidence of heart failure Estimated creatinine clearance ≥ 45mL/min calculated by equation Pulmonary function: DLCO corrected for hemoglobin > 50% and FEV1 predicted >50% based on most recent PFT results Liver function acceptable per local institutional guidelines KPS of ≥ 60% Stratum 3 Recipient Inclusion Criteria: Age ≥18 years at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and local institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned NMA/RIC regimen per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft Diagnosis of primary myelofibrosis with risk features making them eligible for HCT. Myelofibrosis secondary to essential thrombocythemia, polycythemia vera, or MDS with grade 4 fibrosis are also eligible. Patients with a myelofibrosis diagnosis require sponsor approval before enrolling. Cardiac function: Left ventricular ejection fraction ≥ 40% based on most recent echocardiogram or MUGA results with no clinical evidence of heart failure Estimated creatinine clearance ≥ 45 mL/min calculated by equation Pulmonary function: DLCO corrected for hemoglobin > 50% and FEV1 predicted >50% based on most recent PFT results Liver function acceptable per local institutional guidelines KPS of ≥ 60% Donor Inclusion Criteria (note: donors are not research subjects): Must be unrelated to the subject and high-resolution HLA-matched at 4/8, 5/8, 6/8, or 7/8 (HLA-A, -B, -C, and -DRB1. Donor must be typed at high-resolution for a minimum of HLA-A, -B, -C, -DQB1, and -DPB1. Age ≥ 18 years and ≤ 40 years at the time of signing informed consent for PBSC donation. Note: donors are preferred to be ≤ 35. Meet the donor registries' medical suitability requirements for PBSC donation. Must undergo eligibility screening according to current Food and Drug Administration (FDA) requirements. Donors who do not meet one or more of the donor screening requirements may donate under urgent medical need. Must agree to donate PBSC. Must have the ability to give informed consent according to standard (non-study) informed consent according to applicable donor regulatory requirements. Recipient Exclusion Criteria (Strata 1, 2, and 3): Suitable HLA-matched related or 8/8 high-resolution matched unrelated donor available Subject unwilling or unable to give informed consent, or unable to comply with the protocol including required follow-up and testing Subjects with a prior allogeneic transplant Subjects with an autologous transplant within the past 3 months Females who are breast-feeding or pregnant Uncontrolled bacterial, viral, or fungal infection at the time of the transplant preparative regimen Concurrent enrollment on a preventative GvHD and/or infectious disease prevention clinical trial. Subjects who undergo desensitization to reduce anti-donor HLA antibody levels prior to transplant. Patients who are HIV+ with persistently positive viral load. HIV-infected patients on effective anti-retroviral therapy (ART) with undetectable viral load within 6 months are eligible for this trial. Patients with well controlled HIV are eligible provided resistance panels are negative, the patient is compliant with ART, and their disease remains well controlled. Donor Exclusion Criteria: Donor unwilling or unable to donate. Recipient positive for HLA antibodies against a mismatched HLA in the selected donor determined by the presence of donor specific HLA antibodies (DSA) to any mismatched HLA allele/antigen at any of the following loci (HLA-A, -B, -C, -DRB1, DRB3, DRB4, DRB5, -DQA1, - DQB1, -DPA1, -DPB1) with median fluorescence intensity (MFI) >3000 by microarray-based single antigen bead testing. In patients receiving red blood cell or platelet transfusions, DSA evaluation must be performed or repeated post-transfusion and prior to donor mobilization and initiation of recipient preparative regimen.

Sites / Locations

  • Mayo Clinic - Jacksonville
  • University of Miami Sylvester Cancer Center
  • Dana Farber Cancer Institute
  • Karmanos Cancer Institute
  • Memorial Sloan Kettering Cancer Center - Adults
  • Froedtert & the Medical College of Wisconsin

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Regimen A (MAC: Busulfan and Fludarabine, PBSC HCT; Reduce Dose PTCy

Regimen B (MAC: Fludarabine and TBI, PBSC HCT; Reduce Dose PTCy

Regimen C (RIC: Fludarabine and Busulfan; PBSCT HCT; Reduced Dose PTCy

Regimen D (RIC: Fludarabine and Melphalan; PBSCT HCT; Reduced Dose PTCy

Regimen E (NMA: Fludarabine, Cyclophosphamide, and TBI; PBSCT HCT; Reduced Dose PTCy

Arm Description

Patients Receive: Patients receive: Busulfan (≥ 9 mg/kg total dose) IV or PO on days -6 to -3 Fludarabine (150 mg/m2 total dose) IV on days -6 to -2 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.

Patients receive: Fludarabine (90 mg/m2 total dose) IV on days -7 to -5 Total body irradiation (TBI) (1200 cGy total dose) on days -4 to -1 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.

Patients receive: Fludarabine (150-180 mg/m2 total dose) IV on days -6 to -2 Busulfan (less than or equal to 8 mg/kg PO or 6.4 mg/kg IV) on days -5 and -4 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.

Patients receive: Fludarabine (125-150 mg/m2 total dose) IV on days -7 to -3 Melphalan (100-140 mg/m2) IV on day -1 Patients receive a PBSC graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.

Patients receive: Fludarabine (150mg/m2 total dose) IV on days -6 to -2 Cyclophosphamide (29-50mg/kg) IV on days -6 and -5 TBI (200cGy) on day -1 Patients receive a PBSC graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.

Outcomes

Primary Outcome Measures

Infection Free Survival
Survival at 100 days without grades 2-3 infections (per BMT CTN grading criteria)

Secondary Outcome Measures

Overall Survival
Defined as time interval between date of transplant and death from any cause
Progression-free survival
Defined as disease relapse or progression, or death by any cause
Infection-free survival
Defined as death and grades II-III infection (per BMT CTN criteria)
Graft versus host disease relapse free survival
Defined as relapse or progression of underling disease (by 1 year), grade III-IV acute GvHD (by 6 months), chronic GvHD requiring systemic immune suppression (by 1 year), or death by any cause (by 1 year).
Non-relapse mortality
Defined as death without evidence of disease progression or recurrence
Cumulative incidence of neutrophil recovery
Defined as achieving an absolute neutrophil count (ANC) greater than or equal to 500/mm3 for three consecutive measurements on three different days
Cumulative incidence of platelet recovery
Defined as platelet count ≥20,000/mm^3 or ≥50,000/mm^3 with no platelet transfusions within seven days.
Cumulative incidence of primary and secondary graft failure
Primary graft failure is defined as no neutrophil recovery to ≥ 500 cells/mm3 by Day 28 post HCT. Secondary graft failure is defined as as initial neutrophil count recovery followed by subsequent decline in absolute neutrophil counts <500 cells/mm3, unresponsive to growth factor therapy, but cannot be explained by infection, disease relapse, or medications.
Donor T-Cell Chimerism
Defined as percent of donor chimerism via peripheral blood
Cumulative incidence of acute GvHD
Defined as cumulative incidence of grades II-IV acute GvHD
Cumulative incidence of chronic GvHD
Cumulative incidence of grade 2-3 bacterial, fungal, and viral infections
Defined as grades 2-3 infection as defined by BMT CTN grading criteria.
Cumulative incidence of grades 2-3 BK virus hemorrhagic cystitis
Defined as incidence of BK virus hemorrhagic cystitis per BMT CTN grading criteria
Cumulative incidence of relapse/progression
Defined as disease relapse or progression from Day 0 to 1-year post-HCT
Overall Toxicity
To tabulate adverse events (AEs, experienced by recipients, defined as grade 3-5 unexpected and grade 5 expected AEs according to CTCAE v5
Incidence and Severity of cytokine release syndrome
Defined and graded using the ASTCT grading criteria.

Full Information

First Posted
August 14, 2023
Last Updated
August 14, 2023
Sponsor
Center for International Blood and Marrow Transplant Research
Collaborators
National Marrow Donor Program
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1. Study Identification

Unique Protocol Identification Number
NCT06001385
Brief Title
HLA-Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation With Reduced Dose Post Transplantation Cyclophosphamide GvHD Prophylaxis
Acronym
OPTIMIZE
Official Title
A Phase II Study of Reduced Dose Post Transplantation Cyclophosphamide as GvHD Prophylaxis in Adult Patients With Hematologic Malignancies Receiving HLA-Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
November 1, 2023 (Anticipated)
Primary Completion Date
February 1, 2026 (Anticipated)
Study Completion Date
June 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Center for International Blood and Marrow Transplant Research
Collaborators
National Marrow Donor Program

4. Oversight

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

5. Study Description

Brief Summary
The goal of this clinical trial is to determine the effectiveness of Reduced Dose Post-Transplant Cyclophosphamide (PTCy) in patients with hematologic malignancies after receiving an HLA-Mismatched Unrelated Donor (MMUD) . The main question[s] it aims to answer are: Does a reduced dose of PTCy reduce the occurrence of infections in the first 100 days after transplant? Does a reduced dose of PTCy maintain the same level of protection against Graft Versus Host Disease (GvHD) as the standard dose of PTCy?

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Acute Leukemia, Myelodysplastic Syndromes, Chronic Myeloid Leukemia, Chronic Lymphocytic Leukemia, Myeloproliferative Neoplasm, Lymphoma, Chronic Myelomonocytic Leukemia, Pro-Lymphocytic Leukemia, Myelofibrosis
Keywords
Lymphoma, Leukemia, Hematologic Diseases, Myelodysplastic Syndromes, Preleukemia, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia , Lymphocytic, Chronic, B-Cell, Leukemia, Myeloid, Acute, Leukemia, Biphenotypic, Acute, Neoplasms by Histologic Type, Neoplasms, Lymphoproliferative Disorders, Lymphatic Diseases, Immunoproliferative Disorders, Immune System Disorders, Bone Marrow Diseases, Precancerous Conditions, Leukemia, Lymphoid, Leukemia, B-Cell, Leukemia, Myeloid, Cyclophosphamide, Mesna, Tacrolimus, Busulfan, Fludarabine, Total Body Irradiation, Melphalan, Mycophenolate mofetil, Reduced Dose Cyclophosphamide, Immunosuppressive Agents, Immunologic Factors, Physiological Effects of Drugs, Hematopoietic Stem Cell Transplantation, Peripheral Blood Stem Cells, Unrelated Donors

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Regimen A (MAC: Busulfan and Fludarabine, PBSC HCT; Reduce Dose PTCy
Arm Type
Experimental
Arm Description
Patients Receive: Patients receive: Busulfan (≥ 9 mg/kg total dose) IV or PO on days -6 to -3 Fludarabine (150 mg/m2 total dose) IV on days -6 to -2 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.
Arm Title
Regimen B (MAC: Fludarabine and TBI, PBSC HCT; Reduce Dose PTCy
Arm Type
Experimental
Arm Description
Patients receive: Fludarabine (90 mg/m2 total dose) IV on days -7 to -5 Total body irradiation (TBI) (1200 cGy total dose) on days -4 to -1 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.
Arm Title
Regimen C (RIC: Fludarabine and Busulfan; PBSCT HCT; Reduced Dose PTCy
Arm Type
Experimental
Arm Description
Patients receive: Fludarabine (150-180 mg/m2 total dose) IV on days -6 to -2 Busulfan (less than or equal to 8 mg/kg PO or 6.4 mg/kg IV) on days -5 and -4 Patients receive a peripheral blood stem cell (PBSC) graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.
Arm Title
Regimen D (RIC: Fludarabine and Melphalan; PBSCT HCT; Reduced Dose PTCy
Arm Type
Experimental
Arm Description
Patients receive: Fludarabine (125-150 mg/m2 total dose) IV on days -7 to -3 Melphalan (100-140 mg/m2) IV on day -1 Patients receive a PBSC graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.
Arm Title
Regimen E (NMA: Fludarabine, Cyclophosphamide, and TBI; PBSCT HCT; Reduced Dose PTCy
Arm Type
Experimental
Arm Description
Patients receive: Fludarabine (150mg/m2 total dose) IV on days -6 to -2 Cyclophosphamide (29-50mg/kg) IV on days -6 and -5 TBI (200cGy) on day -1 Patients receive a PBSC graft infusion from a mismatched unrelated donor on Day 0. Patients receive a reduced dose of cyclophosphamide (25mg/kg per dose) on Day 3 and Day 4 post-transplant.
Intervention Type
Drug
Intervention Name(s)
Busulfan
Other Intervention Name(s)
Busulfex®
Intervention Description
Given IV or PO pre-transplant as part of conditioning regimen
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
Fludara®
Intervention Description
Given IV pre-transplant as part of conditioning regimen
Intervention Type
Procedure
Intervention Name(s)
PBSC Hematopoietic Stem Cell Transplantation (HSCT)
Other Intervention Name(s)
PBSC HSCT, PBSC HCT, PBSC Transplantation, PBSCT
Intervention Description
Peripheral blood stem cell graft is infused from a mismatched unrelated donor on Day 0
Intervention Type
Drug
Intervention Name(s)
Post-Transplant Cyclophosphamide
Other Intervention Name(s)
Cytoxan®, PTCy
Intervention Description
Cyclophosphamide (25mg/kg) is administered on Day 3 and Day 4 post-transplant as an IV infusion over 1-2 hours.
Intervention Type
Drug
Intervention Name(s)
Mesna
Other Intervention Name(s)
Mesnex®
Intervention Description
Mesna is given in divided doses IV 30 min pre- and at 3, 6, and 8 hours post cyclophosphamide.
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Intervention Description
Tacrolimus is given at a dose of 0.05 mg/kg PO or an IV dose of 0.03 mg/kg of ideal body weight (IBW) starting on Day +5 post-transplant with taper recommended at Day + 90 and finished by Day +180.
Intervention Type
Drug
Intervention Name(s)
Mycophenolate Mofetil
Other Intervention Name(s)
MMF, Cellcept®
Intervention Description
Mycophenolate mofetil (MMF) is given at a dose of 15 mg/kg three times daily IV or PO from Day +5 to Day +35 post-transplant.
Intervention Type
Other
Intervention Name(s)
Patient Reported Outcomes
Other Intervention Name(s)
PRO
Intervention Description
Survey assessments will be administered to study participants pre transplant, at Day + 100, Day + 180, and Day +365 post transplant.
Intervention Type
Drug
Intervention Name(s)
Melphalan
Intervention Description
Given IV pre transplant as part of conditioning regimen
Intervention Type
Radiation
Intervention Name(s)
Total-body irradiation
Other Intervention Name(s)
TBI
Intervention Description
Administered pre-transplant as part of conditioning regimen
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
Cytoxan®
Intervention Description
Given IV pre-transplant as part of conditioning regimen
Primary Outcome Measure Information:
Title
Infection Free Survival
Description
Survival at 100 days without grades 2-3 infections (per BMT CTN grading criteria)
Time Frame
100 days post-HCT
Secondary Outcome Measure Information:
Title
Overall Survival
Description
Defined as time interval between date of transplant and death from any cause
Time Frame
1-year post-HCT
Title
Progression-free survival
Description
Defined as disease relapse or progression, or death by any cause
Time Frame
1-year post-HCT
Title
Infection-free survival
Description
Defined as death and grades II-III infection (per BMT CTN criteria)
Time Frame
1-year post-HCT
Title
Graft versus host disease relapse free survival
Description
Defined as relapse or progression of underling disease (by 1 year), grade III-IV acute GvHD (by 6 months), chronic GvHD requiring systemic immune suppression (by 1 year), or death by any cause (by 1 year).
Time Frame
1-year post-HCT
Title
Non-relapse mortality
Description
Defined as death without evidence of disease progression or recurrence
Time Frame
1-year post-HCT
Title
Cumulative incidence of neutrophil recovery
Description
Defined as achieving an absolute neutrophil count (ANC) greater than or equal to 500/mm3 for three consecutive measurements on three different days
Time Frame
Day 28 post-HCT
Title
Cumulative incidence of platelet recovery
Description
Defined as platelet count ≥20,000/mm^3 or ≥50,000/mm^3 with no platelet transfusions within seven days.
Time Frame
Day 28 post-HCT
Title
Cumulative incidence of primary and secondary graft failure
Description
Primary graft failure is defined as no neutrophil recovery to ≥ 500 cells/mm3 by Day 28 post HCT. Secondary graft failure is defined as as initial neutrophil count recovery followed by subsequent decline in absolute neutrophil counts <500 cells/mm3, unresponsive to growth factor therapy, but cannot be explained by infection, disease relapse, or medications.
Time Frame
Day 28 and 1-year post-HCT
Title
Donor T-Cell Chimerism
Description
Defined as percent of donor chimerism via peripheral blood
Time Frame
Day 28, 100 and 365 post-HCT
Title
Cumulative incidence of acute GvHD
Description
Defined as cumulative incidence of grades II-IV acute GvHD
Time Frame
Day 100 and Day 180 post-HCT
Title
Cumulative incidence of chronic GvHD
Time Frame
1-year post-HCT
Title
Cumulative incidence of grade 2-3 bacterial, fungal, and viral infections
Description
Defined as grades 2-3 infection as defined by BMT CTN grading criteria.
Time Frame
Day 100 and 1-year post-HCT
Title
Cumulative incidence of grades 2-3 BK virus hemorrhagic cystitis
Description
Defined as incidence of BK virus hemorrhagic cystitis per BMT CTN grading criteria
Time Frame
1-year post-HCT
Title
Cumulative incidence of relapse/progression
Description
Defined as disease relapse or progression from Day 0 to 1-year post-HCT
Time Frame
1-year post-HCT
Title
Overall Toxicity
Description
To tabulate adverse events (AEs, experienced by recipients, defined as grade 3-5 unexpected and grade 5 expected AEs according to CTCAE v5
Time Frame
1-year post-HCT
Title
Incidence and Severity of cytokine release syndrome
Description
Defined and graded using the ASTCT grading criteria.
Time Frame
within 14 days post-HCT

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Stratum 1 Recipient Inclusion Criteria: Age ≥ 18 years and < 66 years (chemotherapy-based conditioning) or < 61 years (total body irradiation [TBI]-based conditioning) at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned MAC regimen as defined per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft HCT-CI < 5. The presence of prior malignancy will not be used to calculate HCT-CI for this trial to allow for the inclusion of patients with secondary or therapy-related AML or MDS. One of the following diagnoses: Acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or other acute leukemia in 1st remission or beyond with ≤ 5% marrow blasts and no circulating blasts or evidence of extra-medullary disease. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with MDS with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS). Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Cardiac function: Left ventricular ejection fraction ≥ 45% based on most recent echocardiogram or multi-gated acquisition scan (MUGA) results. Estimated creatinine clearance ≥ 45mL/min calculated by equation. Pulmonary function: diffusing capacity of the lungs for carbon monoxide (DLCO) corrected for hemoglobin > 50% and forced expiratory volume in first second (FEV1) predicted > 50% based on most recent pulmonary function test (PFT) results Liver function acceptable per local institutional guidelines KPS of ≥ 70% Stratum 2 Recipient Inclusion Criteria: Age ≥18 years at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and local institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned NMA/RIC regimen per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft One of the following diagnoses: Patients with acute leukemia or chronic myeloid leukemia (CML) with no circulating blasts, no evidence of extramedullary disease, and with < 5% blasts in the bone marrow. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with MDS with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS.) Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning. Patients with chronic lymphocytic leukemia (CLL) or other leukemias (including prolymphocytic leukemia) with chemosensitive disease at time of transplantation Higher risk CMML according to CMML-specific prognostic scoring system or high risk MDS/MPN not otherwise specified are eligible, provided there is no evidence of high-grade bone marrow fibrosis or massive splenomegaly at the time of enrollment. Patients with lymphoma with chemosensitive disease at the time of transplantation Cardiac function: Left ventricular ejection fraction ≥ 40% based on most recent echocardiogram or MUGA results with no clinical evidence of heart failure Estimated creatinine clearance ≥ 45mL/min calculated by equation Pulmonary function: DLCO corrected for hemoglobin > 50% and FEV1 predicted >50% based on most recent PFT results Liver function acceptable per local institutional guidelines KPS of ≥ 60% Stratum 3 Recipient Inclusion Criteria: Age ≥18 years at the time of signing informed consent Patient or legally authorized representative has the ability to provide informed consent according to the applicable regulatory and local institutional requirements. Stated willingness to comply with all study procedures and availability for the duration of the study. Planned NMA/RIC regimen per study protocol Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age ≥ 18 and ≤ 40 years (≤ 35 preferred). Product planned for infusion is MMUD T-cell replete PBSC allograft Diagnosis of primary myelofibrosis with risk features making them eligible for HCT. Myelofibrosis secondary to essential thrombocythemia, polycythemia vera, or MDS with grade 4 fibrosis are also eligible. Patients with a myelofibrosis diagnosis require sponsor approval before enrolling. Cardiac function: Left ventricular ejection fraction ≥ 40% based on most recent echocardiogram or MUGA results with no clinical evidence of heart failure Estimated creatinine clearance ≥ 45 mL/min calculated by equation Pulmonary function: DLCO corrected for hemoglobin > 50% and FEV1 predicted >50% based on most recent PFT results Liver function acceptable per local institutional guidelines KPS of ≥ 60% Donor Inclusion Criteria (note: donors are not research subjects): Must be unrelated to the subject and high-resolution HLA-matched at 4/8, 5/8, 6/8, or 7/8 (HLA-A, -B, -C, and -DRB1. Donor must be typed at high-resolution for a minimum of HLA-A, -B, -C, -DQB1, and -DPB1. Age ≥ 18 years and ≤ 40 years at the time of signing informed consent for PBSC donation. Note: donors are preferred to be ≤ 35. Meet the donor registries' medical suitability requirements for PBSC donation. Must undergo eligibility screening according to current Food and Drug Administration (FDA) requirements. Donors who do not meet one or more of the donor screening requirements may donate under urgent medical need. Must agree to donate PBSC. Must have the ability to give informed consent according to standard (non-study) informed consent according to applicable donor regulatory requirements. Recipient Exclusion Criteria (Strata 1, 2, and 3): Suitable HLA-matched related or 8/8 high-resolution matched unrelated donor available Subject unwilling or unable to give informed consent, or unable to comply with the protocol including required follow-up and testing Subjects with a prior allogeneic transplant Subjects with an autologous transplant within the past 3 months Females who are breast-feeding or pregnant Uncontrolled bacterial, viral, or fungal infection at the time of the transplant preparative regimen Concurrent enrollment on a preventative GvHD and/or infectious disease prevention clinical trial. Subjects who undergo desensitization to reduce anti-donor HLA antibody levels prior to transplant. Patients who are HIV+ with persistently positive viral load. HIV-infected patients on effective anti-retroviral therapy (ART) with undetectable viral load within 6 months are eligible for this trial. Patients with well controlled HIV are eligible provided resistance panels are negative, the patient is compliant with ART, and their disease remains well controlled. Donor Exclusion Criteria: Donor unwilling or unable to donate. Recipient positive for HLA antibodies against a mismatched HLA in the selected donor determined by the presence of donor specific HLA antibodies (DSA) to any mismatched HLA allele/antigen at any of the following loci (HLA-A, -B, -C, -DRB1, DRB3, DRB4, DRB5, -DQA1, - DQB1, -DPA1, -DPB1) with median fluorescence intensity (MFI) >3000 by microarray-based single antigen bead testing. In patients receiving red blood cell or platelet transfusions, DSA evaluation must be performed or repeated post-transfusion and prior to donor mobilization and initiation of recipient preparative regimen.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Brandan Butler, MBA
Phone
763-406-3280
Email
bbutler@nmdp.org
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa Erickson
Phone
763-406-4710
Email
lericks2@NMDP.ORG
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven Devine, MD
Organizational Affiliation
NMDP/Be The Match
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jeffery Auletta, MD
Organizational Affiliation
NMDP/Be The Match
Official's Role
Study Chair
Facility Information:
Facility Name
Mayo Clinic - Jacksonville
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hemant Murthy, MD
Email
Murthy.Hemant@mayo.edu
First Name & Middle Initial & Last Name & Degree
Hemant Murthy, MD
Facility Name
University of Miami Sylvester Cancer Center
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Antonio M Jimenez Jimenez, MD
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mahasweta Gooptu, MD
Facility Name
Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dipenkumar Modi, MD
Facility Name
Memorial Sloan Kettering Cancer Center - Adults
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Brian Shaffer, MD
Email
shaffeb1@mskcc.org
First Name & Middle Initial & Last Name & Degree
Brian Shaffer, MD
Facility Name
Froedtert & the Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sameem Abedin, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

HLA-Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation With Reduced Dose Post Transplantation Cyclophosphamide GvHD Prophylaxis

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