Hydroxychloroquine in Treating Patients With Newly Diagnosed Chronic Graft-Versus-Host Disease
Graft Versus Host Disease
About this trial
This is an interventional supportive care trial for Graft Versus Host Disease focused on measuring graft versus host disease
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed* newly diagnosed extensive chronic graft-versus-host disease (GVHD) of ≥ 1 organ system (e.g., lip, skin, or liver) documented by all of the following: Clinicopathologic features of GVHD, including involvement of any of the following organ systems: Skin changes Oral changes Hepatic involvement Gastrointestinal involvement Sicca syndrome Pulmonary involvement Myofascial Skeletal Other inflammatory conditions (e.g., myositis, arthritis, polyserositis, or unexplained pericardial, pleural, or peritoneal effusions) Autoantibodies Extent of disease, defined according to the following classification: Limited chronic GVHD, defined by 1 of the following: Localized skin involvement and/or liver dysfunction Involvement of only 1 target organ Extensive chronic GVHD, defined by 1 of the following: Generalized skin involvement of ≥ 50% of body surface area Localized skin involvement and/or liver dysfunction AND ≥ 1 of the following: Liver histology showing chronic aggressive hepatitis, bridging necrosis, or cirrhosis Eye involvement (Schirmer's test with < 5 mm wetting) Involvement of minor salivary glands or oral mucosa on lip biopsy Involvement of any other target organs Involvement of ≥ 2 target organs Timing of onset, including onset of any of the following types: Progressive onset defined as, evolving directly from acute GVHD, commonly with the development of typical manifestations such as oral or skin lichenoid changes or sclerodermatous skin changes Quiescent onset, defined as developing after the resolution of acute GVHD De novo onset, defined as developing with no prior history of acute GVHD Must have ≥ 1 typical clinical manifestation of chronic GVHD that differs from that of acute GVHD (e.g., rash, anorexia, nausea, emesis, diarrhea, abdominal pain, or cholestasis) Symptoms of acute GVHD allowed at the time of diagnosis of chronic GVHD Prior allogeneic bone marrow, peripheral blood stem cell, or cord blood transplantation from a family member or unrelated donor for malignancy required NOTE: *Histologic confirmation may be "consistent with GVHD" PATIENT CHARACTERISTICS: Age: 1 to 29 Performance status: Lansky 50-100% OR Karnofsky 50-100% Life expectancy: At least 2 months Hematopoietic: Absolute neutrophil count ≥ 1,000/mm^3, unless due to chronic GVHD (i.e., autoimmune neutropenia or bone marrow suppression) Hepatic: See Disease Characteristics Renal: Creatinine < 1.5 times upper limit of normal OR Creatinine clearance ≥ 60 mL/min Other: Not pregnant Negative pregnancy test Fertile patients must use effective contraception during and for 3 months after study participation No lysosomal storage disorder No uncontrolled infection (e.g., persistent bacterial, fungal, or viral infection despite appropriate antimicrobial therapy) No G6PD deficiency No history of psoriasis or porphyria No hypersensitivity to 4-aminoquinolines No prior retinal or visual field changes due to 4-aminoquinolines PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics No concurrent daclizumab or infliximab No concurrent thalidomide Chemotherapy: Not specified Endocrine therapy: Prior topical steroids for treatment of extensive chronic GVHD allowed Prior adjustment to prednisone dose allowed if done as a reversal of a taper Prior steroids (prednisone ≤ 1 mg/kg/day (or equivalent) for symptom management for up to 1 week before study entry allowed Concurrent steroids for treatment and/or prophylaxis of acute GVHD allowed if prednisone dose is ≤ 2 mg/kg/day (or equivalent) Concurrent topical steroids allowed Radiotherapy: Not specified Surgery: Not specified Other: No prior treatment for extensive chronic GVHD except the following: Topical treatment (e.g., tacrolimus ointment or pimecrolimus cream) Adjustments of cyclosporine or tacrolimus doses for GVHD prophylaxis or treatment of acute GVHD Concurrent cyclosporine or tacrolimus allowed Cyclosporine must have been started before study entry No other concurrent systemic or topical immunosuppressants, including any of the following: Azathioprine Mycophenolate mofetil Psoralen-ultraviolet light therapy Photopheresis No administration of any of the following for 1 hour before until 2 hours after study drug administration: Antacids Sucralfate Cholestyramine Bicarbonate
Sites / Locations
- Arizona Cancer Center at University of Arizona Health Sciences Center
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Southern California Permanente Medical Group
- City of Hope Comprehensive Cancer Center
- Children's Hospital Los Angeles
- University Medical Center at Princeton
- Kaiser Permanente Medical Center - Los Angeles
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center
- Jonsson Comprehensive Cancer Center at UCLA
- Children's Hospital and Research Center at Oakland
- Children's Hospital of Orange County
- Lucile Packard Children's Hospital at Stanford University Medical Center
- Children's Hospital and Health Center, San Diego
- UCSF Comprehensive Cancer Center
- Presbyterian - St. Luke's Medical Center
- Children's Hospital Cancer Center
- Lombardi Cancer Center at Georgetown University Medical Center
- Children's National Medical Center
- University of Florida Shands Cancer Center
- Nemours Children's Clinic
- Miami Children's Hospital
- All Children's Hospital
- AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Scottish Rite Campus
- MBCCOP-Medical College of Georgia Cancer Center
- Cancer Research Center of Hawaii
- University of Chicago Cancer Research Center
- Children's Memorial Hospital - Chicago
- Riley Children Cancer Center at Riley Hospital for Children
- Holden Comprehensive Cancer Center at University of Iowa
- Markey Cancer Center at University of Kentucky Chandler Medical Center
- Kosair Children's Hospital
- MBCCOP - LSU Health Sciences Center
- Children's Hospital of New Orleans
- Maine Children's Cancer Program
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Floating Hospital for Children
- Massachusetts General Hospital Cancer Center
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
- University of Michigan Comprehensive Cancer Center
- Children's Hospital of Michigan
- DeVos Children's Hospital
- Children's Hospitals and Clinics - Minneapolis/St. Paul
- University of Minnesota Cancer Center
- University of Mississippi Medical Center
- Children's Mercy Hospital
- Cardinal Glennon Children's Hospital
- Methodist Cancer Center at Methodist Specialty and Transplant Hospital
- St. Louis Children's Hospital
- UNMC Eppley Cancer Center at the University of Nebraska Medical Center
- Cancer Center at Hackensack University Medical Center
- Schneider Children's Hospital
- NYU Cancer Institute at New York University Medical Center
- Memorial Sloan-Kettering Cancer Center
- Herbert Irving Comprehensive Cancer Center at Columbia University
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- SUNY Upstate Medical University Hospital
- New York Medical College
- Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
- Duke Comprehensive Cancer Center
- Cincinnati Children's Hospital Medical Center
- Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University
- Columbus Children's Hospital
- Oklahoma University Medical Center
- CCOP - Columbia River Oncology Program
- Cancer Institute at Oregon Health and Science University
- Doernbecher Children's Hospital at Oregon Health & Science University
- Children's Hospital at Milton S. Hershey Medical Center
- Children's Hospital of Philadelphia
- Children's Hospital of Pittsburgh
- Hollings Cancer Center at Medical University of South Carolina
- St. Jude Children's Research Hospital
- Vanderbilt Children's Hospital
- Simmons Cancer Center at University of Texas Southwestern Medical Center - Dallas
- Cook Children's Medical Center - Fort Worth
- Baylor College of Medicine
- M.D. Anderson Cancer Center at University of Texas
- University of Texas Health Science Center at San Antonio
- MBCCOP - South Texas Pediatrics
- Pediatric Hematology and Oncology Associates of South Texas, PLLC
- CCOP - Scott and White Hospital
- Huntsman Cancer Institute at University of Utah
- INOVA Fairfax Hospital
- Children's Hospital and Regional Medical Center - Seattle
- Deaconess Medical Center
- Madigan Army Medical Center
- CCOP - St. Vincent Hospital Cancer Center, Green Bay
- University of Wisconsin Comprehensive Cancer Center
- CCOP - Marshfield Clinic Research Foundation
- Midwest Children's Cancer Center
- Children's Hospital at Westmead
- Royal Children's Hospital
- Women's and Children's Hospital
- Royal Children's Hospital
- Princess Margaret Hospital for Children
- Alberta Children's Hospital
- British Columbia Children's Hospital
- CancerCare Manitoba
- Hospital for Sick Children
- McGill Cancer Centre at McGill University
- Hopital Sainte Justine
- Starship Children's Health
- San Jorge Children's Hospital
- Swiss Pediatric Oncology Group Bern
- Swiss Pediatric Oncology Group Lausanne