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High-Dose Chemotherapy Plus Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer

Primary Purpose

Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
filgrastim
busulfan
cyclophosphamide
cyclosporine
bone marrow ablation with stem cell support
peripheral blood stem cell transplantation
Sponsored by
Case Comprehensive Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent childhood acute lymphoblastic leukemia, recurrent adult Hodgkin lymphoma, refractory multiple myeloma, recurrent childhood lymphoblastic lymphoma, recurrent childhood acute myeloid leukemia, recurrent adult acute myeloid leukemia, recurrent adult acute lymphoblastic leukemia, adult acute myeloid leukemia in remission, adult acute lymphoblastic leukemia in remission, childhood acute myeloid leukemia in remission, childhood acute lymphoblastic leukemia in remission, recurrent/refractory childhood Hodgkin lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent adult Burkitt lymphoma, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, recurrent childhood small noncleaved cell lymphoma, recurrent childhood large cell lymphoma, recurrent mantle cell lymphoma, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12), childhood myelodysplastic syndromes

Eligibility Criteria

4 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically diagnosed: Acute myeloid leukemia in first, second, or third complete remission or first or second early relapse Acute lymphoblastic leukemia in first, second, or third complete remission or first or second early relapse Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory Non-Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory Multiple myeloma and plasma cell leukemia in second or third remission or first, second, or third relapse, or refractory Myelodysplastic syndrome deemed suitable for allogeneic bone marrow transplantation No symptoms or signs of CNS involvement and CNS is disease free on lumbar puncture and brain CT scan No active meningeal cancer PATIENT CHARACTERISTICS: Age: 4 to 55 (4 to 60 if donor is identical twin) Performance status: ECOG 0-2 Life expectancy: Not specified Hematopoietic: Not specified Hepatic: SGOT/SGPT less than 3 times normal Bilirubin less than 2.0 mg/dL Renal: Creatinine less than 2.1 mg/dL Creatinine clearance at least 60 mL/min (no greater than 1.5 times normal for children under 40 kg) Cardiovascular: No uncontrolled hypertension No uncontrolled congestive heart failure No active angina pectoris requiring nitrates At least 6 months since prior myocardial infarction No major ventricular arrhythmia Left ventricular ejection fraction at least 45% on MUGA Pulmonary: No severe or symptomatic restrictive or obstructive lung disease FEV_1 greater than 50% of predicted DLCO greater than 50% of predicted Neurologic: No severe central or peripheral neurologic abnormality Other: Must have HLA-A,B,C,D/DR identical sibling age 4 to 65, in good health No insulin-dependent diabetes mellitus No major thyroid or major adrenal dysfunction No active infection No other active malignancy Not pregnant HIV negative HTLV-I and HTLV-II negative PRIOR CONCURRENT THERAPY: Biologic therapy: No excessive anthracycline exposure, unless endomyocardial biopsy shows less than grade 2 drug effect and cardiac scan shows at least 50% ejection fraction At least 1 year since prior autologous bone marrow or peripheral blood progenitor cell transplant or allogeneic bone marrow transplant Chemotherapy: At least 3 weeks since prior chemotherapy No prior excessive carmustine and bleomycin Endocrine therapy: Not specified Radiotherapy: At least 3 weeks since prior radiotherapy Surgery: Not specified Other: No concurrent nitroglycerin for angina pectoris No concurrent anti-arrhythmic drugs for major ventricular dysrhythmias

Sites / Locations

  • Ireland Cancer Center at University Hosptials Case Medical Center, Case Comprehensive Cancer Center

Outcomes

Primary Outcome Measures

Hematopoietic reconstitution measured daily during transplant

Secondary Outcome Measures

Full Information

First Posted
November 1, 1999
Last Updated
June 9, 2010
Sponsor
Case Comprehensive Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00003116
Brief Title
High-Dose Chemotherapy Plus Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer
Official Title
Allogeneic Peripheral Blood Progenitor Cell Transplantation Using Histocompatible Sibling-Matched Donor Cells After High-Dose Busulfan/Cyclophosphamide as Therapy for Hematologic Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
June 2010
Overall Recruitment Status
Completed
Study Start Date
May 1997 (undefined)
Primary Completion Date
March 2006 (Actual)
Study Completion Date
June 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Case Comprehensive Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. PURPOSE: This phase II trial is studying how well giving busulfan, cyclophosphamide, and filgrastim together with peripheral stem cell transplantation from a sibling donor works in treating patients with hematologic cancer.
Detailed Description
OBJECTIVES: Determine the safety and feasibility of using allogeneic peripheral blood progenitor cell infusions obtained from normal histocompatible sibling donors for reconstituting bone marrow and immunologic function when given after high-dose busulfan/cyclophosphamide in patients with a hematologic malignancy. Determine the efficacy of this treatment in these patients. Determine the ability to mobilize hematopoietic progenitor cells from normal donors given filgrastim (G-CSF) by determining the hematopoietic progenitor cell content of allogeneic peripheral blood progenitor cell collections. Determine the incidence of engraftment failures in these patients. Determine the incidence of severe acute graft-versus-host disease in these patients. OUTLINE: Patients receive high-dose oral busulfan every 6 hours on days -8 to -5, cyclophosphamide IV twice a day on days -4 and -3, and cyclosporine IV over 6 hours on day -1 and then 10 hours on day 0 for 2 doses (allogeneic only). Allogeneic peripheral blood progenitor cells IV are administered on day 0. Filgrastim (G-CSF) is administered subcutaneously twice a day beginning 3 hours after completion of cell infusion and continuing until blood counts recover. Patients are followed every month for 2 months, every 3 months for 6 months, and then every 6 months until disease progression. PROJECTED ACCRUAL: A total of 40 patients will be accrued over a 15 month period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases
Keywords
recurrent childhood acute lymphoblastic leukemia, recurrent adult Hodgkin lymphoma, refractory multiple myeloma, recurrent childhood lymphoblastic lymphoma, recurrent childhood acute myeloid leukemia, recurrent adult acute myeloid leukemia, recurrent adult acute lymphoblastic leukemia, adult acute myeloid leukemia in remission, adult acute lymphoblastic leukemia in remission, childhood acute myeloid leukemia in remission, childhood acute lymphoblastic leukemia in remission, recurrent/refractory childhood Hodgkin lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent adult Burkitt lymphoma, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, recurrent childhood small noncleaved cell lymphoma, recurrent childhood large cell lymphoma, recurrent mantle cell lymphoma, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12), childhood myelodysplastic syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
66 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
filgrastim
Intervention Description
Filgrastim (G-CSF) is administered subcutaneously twice a day beginning 3 hours after completion of cell infusion and continuing until blood counts recover.
Intervention Type
Drug
Intervention Name(s)
busulfan
Intervention Description
high-dose oral busulfan every 6 hours on days -8 to -5
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Intervention Description
cyclophosphamide IV twice a day on days -4 and -3
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Intervention Description
cyclosporine IV over 6 hours on day -1 and then 10 hours on day 0 for 2 doses (allogeneic only)
Intervention Type
Procedure
Intervention Name(s)
bone marrow ablation with stem cell support
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation
Intervention Description
Allogeneic peripheral blood progenitor cells IV are administered on day 0.
Primary Outcome Measure Information:
Title
Hematopoietic reconstitution measured daily during transplant
Time Frame
at months 2, 4, 7, and 10, and then every 6 months until disease progression

10. Eligibility

Sex
All
Minimum Age & Unit of Time
4 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically diagnosed: Acute myeloid leukemia in first, second, or third complete remission or first or second early relapse Acute lymphoblastic leukemia in first, second, or third complete remission or first or second early relapse Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory Non-Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory Multiple myeloma and plasma cell leukemia in second or third remission or first, second, or third relapse, or refractory Myelodysplastic syndrome deemed suitable for allogeneic bone marrow transplantation No symptoms or signs of CNS involvement and CNS is disease free on lumbar puncture and brain CT scan No active meningeal cancer PATIENT CHARACTERISTICS: Age: 4 to 55 (4 to 60 if donor is identical twin) Performance status: ECOG 0-2 Life expectancy: Not specified Hematopoietic: Not specified Hepatic: SGOT/SGPT less than 3 times normal Bilirubin less than 2.0 mg/dL Renal: Creatinine less than 2.1 mg/dL Creatinine clearance at least 60 mL/min (no greater than 1.5 times normal for children under 40 kg) Cardiovascular: No uncontrolled hypertension No uncontrolled congestive heart failure No active angina pectoris requiring nitrates At least 6 months since prior myocardial infarction No major ventricular arrhythmia Left ventricular ejection fraction at least 45% on MUGA Pulmonary: No severe or symptomatic restrictive or obstructive lung disease FEV_1 greater than 50% of predicted DLCO greater than 50% of predicted Neurologic: No severe central or peripheral neurologic abnormality Other: Must have HLA-A,B,C,D/DR identical sibling age 4 to 65, in good health No insulin-dependent diabetes mellitus No major thyroid or major adrenal dysfunction No active infection No other active malignancy Not pregnant HIV negative HTLV-I and HTLV-II negative PRIOR CONCURRENT THERAPY: Biologic therapy: No excessive anthracycline exposure, unless endomyocardial biopsy shows less than grade 2 drug effect and cardiac scan shows at least 50% ejection fraction At least 1 year since prior autologous bone marrow or peripheral blood progenitor cell transplant or allogeneic bone marrow transplant Chemotherapy: At least 3 weeks since prior chemotherapy No prior excessive carmustine and bleomycin Endocrine therapy: Not specified Radiotherapy: At least 3 weeks since prior radiotherapy Surgery: Not specified Other: No concurrent nitroglycerin for angina pectoris No concurrent anti-arrhythmic drugs for major ventricular dysrhythmias
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hillard M. Lazarus, MD
Organizational Affiliation
Ireland Cancer Center at University Hosptials Case Medical Center, Case Comprehensive Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Ireland Cancer Center at University Hosptials Case Medical Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106-5065
Country
United States

12. IPD Sharing Statement

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High-Dose Chemotherapy Plus Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer

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