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A Trial of Extracorporeal Photopheresis, Pentostatin, and Total Body Irradiation in Patients Undergoing Reduced Intensity Allogeneic Stem Cell Transplantation for the Treatment of Malignancies

Primary Purpose

Hematologic Malignancies

Status

Completed

Phase

Phase 2

Locations

United States

Study Type

Interventional

Intervention

extracorporeal photopheresis

Pentostatin

Total Body Irradiation

Pentostatin

Total Body Irradiation

About this trial

This is an interventional treatment trial for Hematologic Malignancies focused on measuring Allogeneic Stem Cell Transplant

Eligibility Criteria

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

Inclusion Criteria:

Patients must give informed consent to receive study treatment.
Availability of a suitable 5/6 (Class I mismatch) or 6/6 HLA-matched related or 10 or 10 matched unrelated donor.
Adequate cardiac function with an ejection fraction ≥ 35% by echocardiography or nuclear cardiography within three months of transplantation
Adequate pulmonary function with corrected DLCO ≥ 40% by pulmonary function testing within the past three months of transplantation
Adequate renal function with creatinine clearance ≥ 30 ml/min. as calculated by the Cockroft and Gault method.
Adequate hepatic function with AST, ALT, alkaline phosphatase, and total bilirubin no more than 3 x ULN unless related to neoplastic disease.
Adequate vascular access, either by pheresis flow catheter or peripheral vein intravenous catheter, to perform ECP, should the patient be randomized to ECP.
Patients with prior autologous stem cell transplantation are eligible.
Age 18 to 75 years.
Life expectancy of greater than 3 months.
ECOG performance status of 0, 1, or 2.
Platelet counts ≥ 20,000/microliter, with or without transfusion support, at the time of ECP, should the patient be randomized to ECP.
Weight ≥ 40 kg.
Systolic blood pressure ≥ 90 mmHg on the day randomization occurs
Negative pregnancy test. The effects of ECP on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, women of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
Able to receive 600 cGy of total body irradiation. If patient previously treated by TBI then must be able to receive 400cGY of total body irradiation.
Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

Hypersensitivity or allergy to 8-methoxypsoralen.
Prior allogeneic stem cell transplantation
HLA-DR mismatch or no worse than one antigen-mismatched unrelated donor.
Patients with acute leukemia or acute lymphocytic leukemia with > 5% circulating blasts in peripheral blood or > 5% blasts in bone marrow aspirate and biopsy at the time of registration
Patients with chemorefractory non-Hodgkin's lymphoma or Hodgkin's disease or multiple myeloma
Diagnosis of myelofibrosis
Patients known to be positive for antibodies to HIC or have evidence for active HIC viral replication.
Participation in another clinical trial for prevention of GVHD.
Patient is pregnant or lactating.
Lack adequate vascular access for ECP.
Systolic blood pressure < 90 mmHg at the time of randomization, should the patient be randomized to ECP.
Evidence of active, ongoing infection.
Unwilling to comply with all study procedures.
Unable or unwilling to give signed informed consent.

Sites / Locations

Yale Comprehensive Cancer Center at Yale University School of Medicine
Tufts-New England Medical Center
Methodist Hospital - Texas Transplant Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Arm Label

Arm Description

Extracorporeal photopheresis, pentostatin and total body irradiation

Pentostatin and total body irradiation

Outcomes

Primary Outcome Measures

Incidence of Grade 2-4 Acute Graft Versus Host Disease Following Allogeneic Stem Cell Transplantation in Patients Randomized to Photopheresis vs. no Photopheresis

Secondary Outcome Measures

Overall Survival

Full Information

NCT ID

NCT00402714

First Posted

November 20, 2006

Last Updated

November 23, 2016

Sponsor

Yale University

Collaborators

Hospira, now a wholly owned subsidiary of Pfizer

1. Study Identification

Unique Protocol Identification Number

NCT00402714

Brief Title

A Trial of Extracorporeal Photopheresis, Pentostatin, and Total Body Irradiation in Patients Undergoing Reduced Intensity Allogeneic Stem Cell Transplantation for the Treatment of Malignancies

Official Title

A Randomized Trial of Extracorporeal Photopheresis, Pentostatin, and Total Body Irradiation Versus Pentostatin and Total Body Irradiation in Patients Undergoing Reduced Intensity Allogeneic Stem Cell Transplantation for the Treatment of Malignancies

Study Type

Interventional

2. Study Status

Record Verification Date

November 2016

Overall Recruitment Status

Completed

Study Start Date

July 2006 (undefined)

Primary Completion Date

July 2009 (Actual)

Study Completion Date

August 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Yale University

Collaborators

Hospira, now a wholly owned subsidiary of Pfizer

4. Oversight

Data Monitoring Committee

5. Study Description

Brief Summary

This is a study to explore the use of a reduced intensity transplant conditioning regimen. A conditioning regimen is the treatment that is given to prepare a body for the new bone marrow that will be received from a donor. Reduced intensity conditioning uses lower doses of chemotherapy than conventional conditioning regimens. The use of lower doses of drugs and radiation cause fewer side effects. Reduced intensity regimens have been offered to older patients or patients at increased risk for transplant-related side effects and have been shown to be safe and effective. Reduced intensity conditioning regimens are now considered for many patients who are undergoing transplant.

Detailed Description

One of the complications of allogeneic stem cell transplant (ASCT) is graft versus host disease (GVHD). This is when the donor cells that are infused attack the body organs. This can cause serious illness and even death. The chance of getting serious life threatening GVHD with conventional transplant conditioning regimens is 25-50% depending on whether the donor bone marrow is from a family member or an unrelated person. The reduced intensity conditioning regimen used in this study involves a drug called pentostatin as well as a reduced dose of radiation and a treatment called photopheresis. This regimen has been successfully used in 106 patients. The incidence of serious GVHD in those patients was much less than expected: 8% for patients getting bone marrow from a family member and 23% for those getting bone marrow from an unrelated person. The pentostatin and radiation parts of this reduced intensity conditioning regimen are similar to other types of reduced intensity regimens, which use drugs similar to pentostatin. The unique part of this regimen compared to others is the use of extracorporeal photopheresis (ECP). While ECP has been used in 106 patients as part of a reduced intensity conditioning regimen, it is unknown whether adding ECP to pentostatin and radiation is what caused the reduced rate of GVHD that was seen in the previous study that was done. The use of ECP as part of a conditioning regimen is investigational. ECP is approved by the U.S. Food and Drug Administration (FDA) for the treatment of cutaneous T-cell lymphoma, but is not approved by the FDA for use prior to ASCT. Because it is not known whether the use of ECP in the reduced intensity conditioning regimen was what caused the low incidence of GVHD, this research study will look at differences in getting GVHD based on whether you receive ECP. Half the patients in this research study will receive ECP as part of their reduced intensity-conditioning regimen and the other half will not. Patients will be randomized (50% chance you will receive ECP and 50% chance you will not). Both groups will receive pentostatin and reduced dose total body irradiation. The primary purpose of this research study is to look at the chance of developing serious GVHD within the first 100 days after transplant within each group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Hematologic Malignancies

Keywords

Allogeneic Stem Cell Transplant

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

14 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Arm Type

Active Comparator

Arm Description

Extracorporeal photopheresis, pentostatin and total body irradiation

Arm Title

Arm Type

Active Comparator

Arm Description

Pentostatin and total body irradiation

Intervention Type

Procedure

Intervention Name(s)

extracorporeal photopheresis

Other Intervention Name(s)

UVAR® XTS Photopheresis System, UVADEX®, 8-methoxypsoralen, methoxsalen

Intervention Description

Extracorporeal photopheresis (ECP) is the ex vivo exposure of the leukocyte rich fraction to ultraviolet light in the presence of 8-methoxypsoralen.

Intervention Type

Drug

Intervention Name(s)

Pentostatin

Other Intervention Name(s)

DCF, 2-Deoxycoformycin, Nipent

Intervention Description

pentostatin 8mg/m2 over 48 hours by continuous infusion

Intervention Type

Radiation

Intervention Name(s)

Total Body Irradiation

Intervention Description

600cGy TBI in 3 200cGy TBI fractions

Intervention Type

Drug

Intervention Name(s)

Pentostatin

Other Intervention Name(s)

DCF, 2-Deoxycoformycin, Nipent

Intervention Description

pentostatin 8mg/m2 over 48 hours by continuous infusion

Intervention Type

Radiation

Intervention Name(s)

Total Body Irradiation

Intervention Description

600cGy TBI in 3 200cGy TBI fractions

Primary Outcome Measure Information:

Title

Incidence of Grade 2-4 Acute Graft Versus Host Disease Following Allogeneic Stem Cell Transplantation in Patients Randomized to Photopheresis vs. no Photopheresis

Time Frame

Day +100 following allogeneic stem cell transplant

Secondary Outcome Measure Information:

Title

Overall Survival

Time Frame

2 years following stem cell transplant

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

75 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Patients must give informed consent to receive study treatment. Availability of a suitable 5/6 (Class I mismatch) or 6/6 HLA-matched related or 10 or 10 matched unrelated donor. Adequate cardiac function with an ejection fraction ≥ 35% by echocardiography or nuclear cardiography within three months of transplantation Adequate pulmonary function with corrected DLCO ≥ 40% by pulmonary function testing within the past three months of transplantation Adequate renal function with creatinine clearance ≥ 30 ml/min. as calculated by the Cockroft and Gault method. Adequate hepatic function with AST, ALT, alkaline phosphatase, and total bilirubin no more than 3 x ULN unless related to neoplastic disease. Adequate vascular access, either by pheresis flow catheter or peripheral vein intravenous catheter, to perform ECP, should the patient be randomized to ECP. Patients with prior autologous stem cell transplantation are eligible. Age 18 to 75 years. Life expectancy of greater than 3 months. ECOG performance status of 0, 1, or 2. Platelet counts ≥ 20,000/microliter, with or without transfusion support, at the time of ECP, should the patient be randomized to ECP. Weight ≥ 40 kg. Systolic blood pressure ≥ 90 mmHg on the day randomization occurs Negative pregnancy test. The effects of ECP on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, women of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Able to receive 600 cGy of total body irradiation. If patient previously treated by TBI then must be able to receive 400cGY of total body irradiation. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Hypersensitivity or allergy to 8-methoxypsoralen. Prior allogeneic stem cell transplantation HLA-DR mismatch or no worse than one antigen-mismatched unrelated donor. Patients with acute leukemia or acute lymphocytic leukemia with > 5% circulating blasts in peripheral blood or > 5% blasts in bone marrow aspirate and biopsy at the time of registration Patients with chemorefractory non-Hodgkin's lymphoma or Hodgkin's disease or multiple myeloma Diagnosis of myelofibrosis Patients known to be positive for antibodies to HIC or have evidence for active HIC viral replication. Participation in another clinical trial for prevention of GVHD. Patient is pregnant or lactating. Lack adequate vascular access for ECP. Systolic blood pressure < 90 mmHg at the time of randomization, should the patient be randomized to ECP. Evidence of active, ongoing infection. Unwilling to comply with all study procedures. Unable or unwilling to give signed informed consent.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Francine Foss, M.D.

Organizational Affiliation

Yale University

Official's Role

Principal Investigator

Facility Information:

Facility Name

Yale Comprehensive Cancer Center at Yale University School of Medicine

City

New Haven

State/Province

Connecticut

ZIP/Postal Code

06520

Country

United States

Facility Name

Tufts-New England Medical Center

City

Boston

State/Province

Massachusetts

ZIP/Postal Code

02111

Country

United States

Facility Name

Methodist Hospital - Texas Transplant Institute

City

San Antonio

State/Province

Texas

ZIP/Postal Code

78229

Country

United States

12. IPD Sharing Statement

Learn more about this trial

A Trial of Extracorporeal Photopheresis, Pentostatin, and Total Body Irradiation in Patients Undergoing Reduced Intensity Allogeneic Stem Cell Transplantation for the Treatment of Malignancies

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