Expanded Cord Blood Cell Infusion Following Combination Chemotherapy in Younger Patients With Relapsed or Refractory Acute Myeloid Leukemia
Primary Purpose
Acute Leukemia of Ambiguous Lineage, Acute Myeloid Leukemia
Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ex-Vivo Expanded Cord Blood Progenitor Cell Infusion
Cytarabine
Filgrastim
Fludarabine Phosphate
Sponsored by
About this trial
This is an interventional treatment trial for Acute Leukemia of Ambiguous Lineage
Eligibility Criteria
Inclusion Criteria:
- Patients must have a diagnosis of AML or acute leukemia of ambiguous lineage according to World Health Organization (WHO) classification with >= 5% of disease in bone marrow (BM)
- Recipients of prior allogeneic hematopoietic stem cell transplantation for AML or acute leukemia of ambiguous lineage are eligible if they do not have graft-versus-host disease (GVHD) or they have quiescent GVHD whether or not they are receiving immunosuppressive therapy
- Must have a Lansky or Karnofsky performance status of >= 50; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
- Patients must have recovered from the acute toxicity of all prior chemotherapy
The following amounts of time must have elapsed prior to entry on study:
- 2 weeks from local radiation therapy (XRT)
- 8 weeks from prior craniospinal or if > 50% of the pelvis has been irradiated
- 6 weeks must have elapsed if other bone marrow radiation has occurred
- Adequate cardiac, renal, pulmonary, and hepatic function
- Patient must have a life expectancy of at least 2 months
- Females of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment
- Females of childbearing potential and males should agree to use adequate contraception (barrier method of birth control) prior to study entry and for the duration of study participation
Exclusion Criteria:
- Recipients of prior allogeneic hematopoietic stem cell transplant (HSCT) with active acute or chronic GVHD
- Patients with history of Down's syndrome, Fanconi anemia or other known marrow failure condition
- Patients currently receiving other investigational drugs are not eligible
- Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol with the exception of intrathecal chemotherapy; this includes the tyrosine kinase inhibitor sorafenib which must not be initiated until patient demonstrates count recovery
- Patients with a systemic fungal, bacterial, viral, or other infection not controlled despite appropriate antibiotics or other treatment; uncontrolled systemic infections require infectious disease consultation for verification
- Patients who are platelet refractory prior to initiation of protocol therapy
- Pregnant or lactating patients
- Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results
Sites / Locations
- Emory University/Winship Cancer Institute
- Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Treatment (Ex-vivo expanded cord blood progenitors)
Arm Description
Patients receive filgrastim SC or IV on days 1-7, fludarabine phosphate IV QD over 30 minutes on days 2-6, cytarabine IV QD over 4 hours on days 2-6, and ex-vivo expanded cord blood progenitor cells IV over 30 minutes on day 8.
Outcomes
Primary Outcome Measures
Incidence of NCI CTCAE grade > 3 infusional toxicities
Occurrence of transfusion associated graft versus host disease
Incidence of platelet refractoriness in the presence of alloimmunization as a direct result of ex vivo expanded cord blood product infusion
Incidence of delayed marrow recovery
Failure to achieve ANC >= 500 cells/µl by day 42 post treatment with marrow cellularity < 5% and marrow blast count < 5%.
Rate of treatment related mortality
Secondary Outcome Measures
Time to neutrophil recovery
ANC >= 100 cells/ul and 500 cells/ul
In vivo persistence of ex vivo expanded cellular therapy
Assessed by peripheral blood cell sorted deoxyribonucleic acid (DNA) chimerisms of the cluster of differentiation myeloid and lymphoid cell lineages as well as whole marrow chimerisms.
Patient and infused expanded cord blood cells immune interaction
Assessed by performing host-donor studies.
Incidence of NCI CTCAE grade 3 or 4 infections
Incidence of NCI CTCAE grade > 3 chemotherapy-related toxicity in the first 30 days following fludarabine phosphate, cytarabine, and filgrastim (FLAG) therapy
Rate of complete remission
Leukemia-free survival
Overall survival
Full Information
NCT ID
NCT01701323
First Posted
October 3, 2012
Last Updated
February 27, 2019
Sponsor
Nohla Therapeutics, Inc.
Collaborators
National Cancer Institute (NCI), Fred Hutchinson Cancer Center
1. Study Identification
Unique Protocol Identification Number
NCT01701323
Brief Title
Expanded Cord Blood Cell Infusion Following Combination Chemotherapy in Younger Patients With Relapsed or Refractory Acute Myeloid Leukemia
Official Title
Pilot Study Evaluating the Use of Ex Vivo Expanded Cord Blood Progenitors as Supportive Care Following Chemotherapy (FLAG) in Patients With AML or Acute Leukemia of Ambiguous Lineage
Study Type
Interventional
2. Study Status
Record Verification Date
February 2019
Overall Recruitment Status
Terminated
Study Start Date
December 10, 2012 (Actual)
Primary Completion Date
May 10, 2018 (Actual)
Study Completion Date
May 10, 2018 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nohla Therapeutics, Inc.
Collaborators
National Cancer Institute (NCI), Fred Hutchinson Cancer Center
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This pilot clinical trial studies infusion of expanded cord blood hematopoietic progenitor cells following combination chemotherapy in treating younger patients with acute myeloid leukemia that has relapsed or has not responded to treatment. Chemotherapy drugs work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Chemotherapy also kills healthy infection-fighting cells, increasing the risk of infection. The infusion of expanded cord blood hematopoietic progenitor cells may be able to replace blood-forming cells that were destroyed by chemotherapy. This cellular therapy may decrease the risk of infection following chemotherapy.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Leukemia of Ambiguous Lineage, Acute Myeloid Leukemia
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
7 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Treatment (Ex-vivo expanded cord blood progenitors)
Arm Type
Experimental
Arm Description
Patients receive filgrastim SC or IV on days 1-7, fludarabine phosphate IV QD over 30 minutes on days 2-6, cytarabine IV QD over 4 hours on days 2-6, and ex-vivo expanded cord blood progenitor cells IV over 30 minutes on day 8.
Intervention Type
Biological
Intervention Name(s)
Ex-Vivo Expanded Cord Blood Progenitor Cell Infusion
Other Intervention Name(s)
NLA101, Dilanubicel
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Cytarabine
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Filgrastim
Intervention Description
Given SC or IV
Intervention Type
Drug
Intervention Name(s)
Fludarabine Phosphate
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Incidence of NCI CTCAE grade > 3 infusional toxicities
Time Frame
Up to 2 years
Title
Occurrence of transfusion associated graft versus host disease
Time Frame
Up to 2 years
Title
Incidence of platelet refractoriness in the presence of alloimmunization as a direct result of ex vivo expanded cord blood product infusion
Time Frame
Up to 2 years
Title
Incidence of delayed marrow recovery
Description
Failure to achieve ANC >= 500 cells/µl by day 42 post treatment with marrow cellularity < 5% and marrow blast count < 5%.
Time Frame
Up to day 42
Title
Rate of treatment related mortality
Time Frame
Up to 2 years
Secondary Outcome Measure Information:
Title
Time to neutrophil recovery
Description
ANC >= 100 cells/ul and 500 cells/ul
Time Frame
Up to 2 years
Title
In vivo persistence of ex vivo expanded cellular therapy
Description
Assessed by peripheral blood cell sorted deoxyribonucleic acid (DNA) chimerisms of the cluster of differentiation myeloid and lymphoid cell lineages as well as whole marrow chimerisms.
Time Frame
Up to 2 years
Title
Patient and infused expanded cord blood cells immune interaction
Description
Assessed by performing host-donor studies.
Time Frame
Up to 2 years
Title
Incidence of NCI CTCAE grade 3 or 4 infections
Time Frame
First 30 days following FLAG administration
Title
Incidence of NCI CTCAE grade > 3 chemotherapy-related toxicity in the first 30 days following fludarabine phosphate, cytarabine, and filgrastim (FLAG) therapy
Time Frame
First 30 days following FLAG administration
Title
Rate of complete remission
Time Frame
Up to 2 years
Title
Leukemia-free survival
Time Frame
Up to 2 years
Title
Overall survival
Time Frame
Up to 2 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
6 Months
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients must have a diagnosis of AML or acute leukemia of ambiguous lineage according to World Health Organization (WHO) classification with >= 5% of disease in bone marrow (BM)
Recipients of prior allogeneic hematopoietic stem cell transplantation for AML or acute leukemia of ambiguous lineage are eligible if they do not have graft-versus-host disease (GVHD) or they have quiescent GVHD whether or not they are receiving immunosuppressive therapy
Must have a Lansky or Karnofsky performance status of >= 50; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
Patients must have recovered from the acute toxicity of all prior chemotherapy
The following amounts of time must have elapsed prior to entry on study:
2 weeks from local radiation therapy (XRT)
8 weeks from prior craniospinal or if > 50% of the pelvis has been irradiated
6 weeks must have elapsed if other bone marrow radiation has occurred
Adequate cardiac, renal, pulmonary, and hepatic function
Patient must have a life expectancy of at least 2 months
Females of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment
Females of childbearing potential and males should agree to use adequate contraception (barrier method of birth control) prior to study entry and for the duration of study participation
Exclusion Criteria:
Recipients of prior allogeneic hematopoietic stem cell transplant (HSCT) with active acute or chronic GVHD
Patients with history of Down's syndrome, Fanconi anemia or other known marrow failure condition
Patients currently receiving other investigational drugs are not eligible
Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol with the exception of intrathecal chemotherapy; this includes the tyrosine kinase inhibitor sorafenib which must not be initiated until patient demonstrates count recovery
Patients with a systemic fungal, bacterial, viral, or other infection not controlled despite appropriate antibiotics or other treatment; uncontrolled systemic infections require infectious disease consultation for verification
Patients who are platelet refractory prior to initiation of protocol therapy
Pregnant or lactating patients
Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ann Dahlberg
Organizational Affiliation
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University/Winship Cancer Institute
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Expanded Cord Blood Cell Infusion Following Combination Chemotherapy in Younger Patients With Relapsed or Refractory Acute Myeloid Leukemia
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