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Addition of Etanercept and Extracorporeal Photopheresis (ECP) to Standard Graft-Versus-Host Disease (GVHD) Prophylaxis in Stem Cell Transplant

Primary Purpose

Graft Versus Host Disease

Status

Completed

Phase

Phase 2

Locations

United States

Study Type

Interventional

Intervention

stem cell transplant

tacrolimus (standard GVHD prophylaxis)

mycophenolate (standard GVHD prophylaxis)

etanercept

methoxsalen

About this trial

This is an interventional prevention trial for Graft Versus Host Disease focused on measuring GVHD

Eligibility Criteria

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

Inclusion Criteria:

Candidate for unrelated donor (allogeneic) HSCT for hematologic conditions, either malignant or non-malignant.
Donor can be unrelated marrow, blood or cord blood.
Any disease for which unrelated donor transplant is appropriate is eligible except:
- Progressive or poorly controlled malignancies for which the likelihood of durable disease control [i.e., patients expected to have at least 6 months PFS from date of transplant] is <25%.
- This determination of likelihood of durable disease control must take into account the patient's disease status and consideration of the agents and doses used in the reduced intensity conditioning regimen.
- The determination of adequate disease control will be certified by the PI or designee on the eligibility checklist.
- Patients may be consented to this trial based on disease control at the time of consent, but later removed from the trial prior to initiation of transplant conditioning regimen if disease status confirmation between consenting and transplant changes. In the event this occurs these patients will be replaced.
Must be receiving a recognized reduced intensity transplant as determined by the University of Michigan Blood and Marrow Transplantation Program.
Patients age 50 or older are eligible based on age.
Patients may be <50 years old if they are eligible for a reduced intensity conditioning regimen based on disease type (eg, indolent lymphoma) or if comorbidities preclude a full-intensity transplant.
Patients must have adequate venous access by either peripheral vein or central line so that ECP can be performed.
Patients must be expected to tolerate the fluid shifts associated with ECP. The primary reason for expected intolerance of ECP is small size (ie, <30kg weight), but other factors may also be considered in this determination.

Exclusion Criteria:

Not a candidate for a reduced intensity transplant conditioning regimen (based on the current U-M BMT program clinical guidelines).
Patient has a suitable related donor available for transplant.
Karnofsky or Lansky performance status of < 50% at the time of admission for HSCT
Patients with evidence of HIV infection or other opportunistic infection including but not limited to Tuberculosis and Histoplasmosis.
Patients with active bacterial, fungal or viral infection not responding to treatment.
Any medical or psychological conditions that would keep the patient from complying with the protocol and/or would markedly increase the morbidity and mortality from the procedure.
Pregnancy.
T-cell depleted allograft

Sites / Locations

University of Michigan Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Etanercept and ECP

Arm Description

Etanercept and ECP (Extracorporeal Photopheresis) in addition to standard GVHD prevention: Etanercept will be given twice weekly by subcutaneous injection starting on the day of HSCT (Hematopoietic stem cell transplantation) conditioning until 8 weeks post transplant. ECP treatments will begin at once weekly starting at 4 weeks post transplant and continue at less frequent intervals until 6 months post transplant. GVHD prophylaxis will consist of a standard two drug regimen: mycophenolate for 4 weeks and tacrolimus (titrated to a therapeutic level) for 8 weeks, then weaned over 4 months with discontinuation by 6 months post-transplant.

Outcomes

Primary Outcome Measures

Percentage of Patients Alive at 6 Months

Overall survival at 6 months

Percentage of Patients Who Experienced Relapse by 6 Months

Relapse rate at 6 months. Relapse is defined as recurrence of disease.

Secondary Outcome Measures

The Percentage of Patients That Experienced Graft Versus Host Disease

Incidence of acute GVHD grades 2-4 and chronic GVHD in this study population

Measured Level of Circulating Plasma Markers After Transplant

Regulatory T Cell Numbers Post-transplant

Full Information

NCT ID

NCT00639717

First Posted

March 11, 2008

Last Updated

July 3, 2017

Sponsor

University of Michigan Rogel Cancer Center

Collaborators

Mallinckrodt, Amgen

1. Study Identification

Unique Protocol Identification Number

NCT00639717

Brief Title

Addition of Etanercept and Extracorporeal Photopheresis (ECP) to Standard Graft-Versus-Host Disease (GVHD) Prophylaxis in Stem Cell Transplant

Official Title

Addition of Etanercept and Extracorporeal Photopheresis to Standard GVHD Prophylaxis in Patients Undergoing Reduced Intensity Unrelated Donor Hematopoietic Stem Cell Transplant

Study Type

Interventional

2. Study Status

Record Verification Date

July 2017

Overall Recruitment Status

Completed

Study Start Date

March 2009 (undefined)

Primary Completion Date

January 2012 (Actual)

Study Completion Date

April 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

University of Michigan Rogel Cancer Center

Collaborators

Mallinckrodt, Amgen

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

This research study investigates the benefits and possible risks of adding both etanercept (Enbrel) and ECP (extracorporeal photopheresis) to the conventional preventative (or prophylactic) treatments for graft-versus-host disease (GVHD). GVHD is a common, serious, and too often fatal, complication after matched unrelated donor stem cell transplantation, regardless of the pre-transplant conditioning regimen used (full or reduced intensity). Reduced intensity transplants which employ lower doses of chemotherapy during the conditioning phase of the transplant, are less toxic than full intensity transplants. Reduced intensity transplants may extend the unrelated donor transplant option to older patients or to patients with existing medical conditions or illness, where a full intensity transplant is not possible. To be successful, reduced intensity transplants need to offset any lower effectiveness in killing cancer cells during the conditioning phase, with the establishment of a donor cell, graft-versus-leukemia effect (GVL). The GVL effect and GVHD are associated with each other and therefore, the goal of GVHD prophylaxis for this study is not so much to prevent all GVHD, but rather to prevent serious and fatal acute GVHD. Most GVHD-related deaths are either the direct consequence of severe GVHD or from infections associated with intense immunosuppression, a consequence of the standard treatments for acute GVHD, which almost always include high-dose steroids. A more effective prophylaxis therapy that allows for the GVL effect to develop, while limiting the exposure to high-dose steroids may reduce transplant mortality and morbidity. We also will study how key chemical and cellular factors relate to clinical outcome.

6. Conditions and Keywords

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

Graft Versus Host Disease

Keywords

GVHD

7. Study Design

Primary Purpose

Prevention

Study Phase

Phase 2

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

N/A

Enrollment

48 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Etanercept and ECP

Arm Type

Experimental

Arm Description

Intervention Type

Procedure

Intervention Name(s)

stem cell transplant

Intervention Description

reduced intensity, matched unrelated donor stem cell transplant

Intervention Type

Drug

Intervention Name(s)

tacrolimus (standard GVHD prophylaxis)

Intervention Description

Tacrolimus(or cyclosporine when necessary) Tacrolimus will begin on day -3, IV or oral. Target trough level for tacrolimus is 8-12 ng/ml. In the absence of GVHD, tacrolimus tapering will begin on day +56 post transplant

Intervention Type

Drug

Intervention Name(s)

mycophenolate (standard GVHD prophylaxis)

Intervention Description

Mycophenolate will begin on day 0 at 10 mg/kg/dose (up to 1 gram per dose) every 8 hours orally or intravenously and will continue until day 28.

Intervention Type

Drug

Intervention Name(s)

etanercept

Other Intervention Name(s)

Enbrel

Intervention Description

Etanercept will be given at a dose 0.4 mg/kg (actual weight) up to a maximum dose of 25 mg, subcutaneously, twice weekly from day 0 to day 56 (16 doses)

Intervention Type

Drug

Intervention Name(s)

methoxsalen

Other Intervention Name(s)

UVADEX

Intervention Description

Methoxsalen (UVADEX) treatments by Extracorporeal photopheresis (ECP) will be started day +28 post transplant and given weekly. On day +70 post transplant ECP frequency will be given every other week. On day +100 post transplant ECP will be given monthly until day +180 and stopped.

Primary Outcome Measure Information:

Title

Percentage of Patients Alive at 6 Months

Description

Overall survival at 6 months

Time Frame

6 months

Title

Percentage of Patients Who Experienced Relapse by 6 Months

Description

Relapse rate at 6 months. Relapse is defined as recurrence of disease.

Time Frame

6 months

Secondary Outcome Measure Information:

Title

The Percentage of Patients That Experienced Graft Versus Host Disease

Description

Incidence of acute GVHD grades 2-4 and chronic GVHD in this study population

Time Frame

6 Months

Title

Measured Level of Circulating Plasma Markers After Transplant

Time Frame

100 days

Title

Regulatory T Cell Numbers Post-transplant

Time Frame

180 days

10. Eligibility

Sex

All

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Candidate for unrelated donor (allogeneic) HSCT for hematologic conditions, either malignant or non-malignant. Donor can be unrelated marrow, blood or cord blood. Any disease for which unrelated donor transplant is appropriate is eligible except: Progressive or poorly controlled malignancies for which the likelihood of durable disease control [i.e., patients expected to have at least 6 months PFS from date of transplant] is <25%. This determination of likelihood of durable disease control must take into account the patient's disease status and consideration of the agents and doses used in the reduced intensity conditioning regimen. The determination of adequate disease control will be certified by the PI or designee on the eligibility checklist. Patients may be consented to this trial based on disease control at the time of consent, but later removed from the trial prior to initiation of transplant conditioning regimen if disease status confirmation between consenting and transplant changes. In the event this occurs these patients will be replaced. Must be receiving a recognized reduced intensity transplant as determined by the University of Michigan Blood and Marrow Transplantation Program. Patients age 50 or older are eligible based on age. Patients may be <50 years old if they are eligible for a reduced intensity conditioning regimen based on disease type (eg, indolent lymphoma) or if comorbidities preclude a full-intensity transplant. Patients must have adequate venous access by either peripheral vein or central line so that ECP can be performed. Patients must be expected to tolerate the fluid shifts associated with ECP. The primary reason for expected intolerance of ECP is small size (ie, <30kg weight), but other factors may also be considered in this determination. Exclusion Criteria: Not a candidate for a reduced intensity transplant conditioning regimen (based on the current U-M BMT program clinical guidelines). Patient has a suitable related donor available for transplant. Karnofsky or Lansky performance status of < 50% at the time of admission for HSCT Patients with evidence of HIV infection or other opportunistic infection including but not limited to Tuberculosis and Histoplasmosis. Patients with active bacterial, fungal or viral infection not responding to treatment. Any medical or psychological conditions that would keep the patient from complying with the protocol and/or would markedly increase the morbidity and mortality from the procedure. Pregnancy. T-cell depleted allograft

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Gregory Yanik, MD

Organizational Affiliation

University of Michigan Rogel Cancer Center

Official's Role

Principal Investigator

Facility Information:

Facility Name

University of Michigan Cancer Center

City

Ann Arbor

State/Province

Michigan

ZIP/Postal Code

48109

Country

United States

12. IPD Sharing Statement

Learn more about this trial

Addition of Etanercept and Extracorporeal Photopheresis (ECP) to Standard Graft-Versus-Host Disease (GVHD) Prophylaxis in Stem Cell Transplant

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