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Intravenous (IV) AMD3100 for Mobilization and Matched Related Transplant for Advanced Hematological Malignancies

Primary Purpose

Hematologic Neoplasms

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
AMD3100
Leukopheresis
Stem cell transplant
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hematologic Neoplasms

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Donor Eligibility

  • Donor is 18 to 70 years of age inclusive.
  • If female and of child-bearing age: must be non-pregnant, not breast feeding and agree to use adequate contraception.
  • Donor is a 6/6 HLA-matched sibling willing to donate PBSC for transplant.
  • Donor must be willing to provide written informed consent.
  • Adequate cardiac function with no history of congestive heart failure and no history of atrial fibrillation or ventricular tachyarrhythmia.
  • Adequate renal function as defined by a calculated serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation).
  • Adequate hepatic function as defined by a total bilirubin <2x normal or absence of hepatic fibrosis/cirrhosis.
  • Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. No history of cerebrovascular accident or seizure disorder requiring anticonvulsant medication.
  • Donor must be HIV-1&2 antibody and HTLV-I&II antibody sero-negative, by Food and Drug Administration (FDA) licensed test.
  • Donor must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Donor must demonstrate ability to be compliant with study regimen.
  • Donor must not have an active infection at the time of study entry.
  • Donor does not have active alcohol or substance abuse within 6 months of study entry.
  • Donor is not currently enrolled on another investigational agent study.
  • Donor does not have any medical condition, which, in the opinion of the clinical investigator, would interfere with his/her evaluation.

Recipient Eligibility

  • Recipient must have available the successful collection of an AMD3100 mobilized product. When an adequate collection cannot be obtained using G-CSF, some recipients may need to receive a combined product of mobilized cells with AMD3100 and g granulocyte-colony stimulating factor (G-CSF). Recipients who receive less than 2.0 X 106 CD34+ cells/kg/actual recipient weight after two days of IV AMD3100 will not be considered "eligible" but followed per protocol for safety purposes only.
  • Patient is 18 to 65 years of age inclusive.
  • Patient is willing and has a 6/6 HLA-matched sibling willing to donate PBSC for transplant.
  • Patient must provide signed informed consent.
  • If female and of child-bearing age: must be non-pregnant, not breast feeding, and uses adequate contraception.
  • Patient must have one of the following diagnoses:

    • Acute myelogenous leukemia (AML) in 1st or subsequent remission or in relapse,
    • Acute lymphoblastic leukemia (ALL) in 1st or subsequent remission or in relapse,
    • Myelodysplastic syndrome either intermediate 1 or 2, or high risk by the International Prognostic Scoring System,
    • Chronic myelogenous leukemia (CML) in accelerated or second chronic phase,
    • Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) in 2nd or greater complete remission, partial remission, or refractory relapse,
    • Chronic lymphocytic leukemia (CLL), Rai Stage 2-4, failing at least 2 prior regimens, OR
    • Multiple myeloma (MM), Stage 2-3.
  • Adequate cardiac function with a left ventricular ejection fraction ≥ 40%.
  • Adequate pulmonary function defined as NO severe or symptomatic restrictive or obstructive lung disease, and formal pulmonary function testing showing an FEV1 ≥50% of predicted and a DLCO ≥40% of predicted, corrected for hemoglobin.
  • Adequate renal function as defined by a serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation).
  • Adequate hepatic function as defined by a total bilirubin <2x normal or absence of hepatic fibrosis/cirrhosis.
  • Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. Patients with a history of previous central nervous system (CNS) tumor involvement are eligible provided they are without symptoms or signs and the CNS is now free of disease on lumbar puncture and CT scan of the brain.
  • No evidence of active infection at the time of the transplant preparative regimen or at time of transplantation.
  • Patient must be HIV-1&2 antibody and HTLV-I & II antibody sero-negative, by FDA licensed test.
  • Patient has an ECOG performance status of 0 or 1.
  • Patient must demonstrate ability to be compliant with medical regimen.
  • Patient must not have active alcohol or substance abuse within 6 months of study entry.
  • Patient must not be enrolled on another investigational agent concurrently.
  • Patient must not have any medical condition, which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient.

Exclusion Criteria:

  • See Inclusion criteria above

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm 1 - Donor

Arm 2 - Recipient

Arm Description

Day 1 AMD3100 320 ug/kg IV Leukopheresis Day 2 (if peripheral blood stem cell (PBSC) collected is not sufficient) AMD3100 320 ug/kg IV Leukopheresis

Standard of care and physician choice myeloablative or non-myeloablative chemotherapy with or without total body irradiation (permitted = cyclophosphamide and single dose total body irradiation (TBI) / fludarabine and busulfan / fractionated TBI and cyclophosphamide / fractionated TBI, etoposide, and cyclophosphamide / busulfan and cyclophosphamide / fludarabine, busulfan, and ATGAM Day 0 = Stem Cell Transplant

Outcomes

Primary Outcome Measures

Number of Donors Treated With IV AMD3100 Who Required a Second Collection to Obtain the Minimum CD34/kg (2 X 106) Necessary for Allogeneic Stem Cell Transplant

Secondary Outcome Measures

Number of Donors Who Experience Grade 3-4 Infusional Toxicity
Number of Recipients Who Have Neutrophil Engraftment
Pharmacokinetics of IV AMD3100 as Measured by the Mean Maximum Plasma Concentration (Cmax)
-Blood samples for pharmacokinetics were drawn on the following schedule: prior to IV infusion 15 minutes after start of infusion 30 minutes after start of infusion 1 hour after start of infusion 4 hours after start of infusion 6 hours after start of infusion 9 hours after start of infusion 24 hours after start of infusion
Pharmacokinetics of IV AMD3100 as Measured by Half Life
-Blood samples for pharmacokinetics were drawn on the following schedule: prior to IV infusion 15 minutes after start of infusion 30 minutes after start of infusion 1 hour after start of infusion 4 hours after start of infusion 6 hours after start of infusion 9 hours after start of infusion 24 hours after start of infusion
Pharmacokinetics of IV AMD3100 as Measured by Mean Area Under Curve (AUC)
Rate of Acute GVHD (Grade II-IV) in Recipients
Rate of Acute GVHD (Grade III-IV) in Recipients
Time to Neutrophil Engraftment for Recipients
Measured by determine the first 3 consecutive measurement of neutrophil count = 500/ul following conditioning regimen induced nadir.
Time to Platelet Engraftment for Recipients
Measured by determining the first of 3 consecutive measurements of platelet count = 20,000/ul without platelet transfusion support for 7 days.
Transplant Related Mortality Rate for Recipients
Death that results from a transplant procedure related complication rather than from relapse of the underlying disease or unrelated cause.
Grade 3-4 Toxicity for Recipients
Assessed and graded according to NCI Common Terminology for Adverse Events Version 3.0.
Rate of Chronic GVHD in Recipients
Number of Donors Who Experience Grade 3-4 Mobilization Toxicity Due to Pheresis Procedure

Full Information

First Posted
June 1, 2009
Last Updated
April 6, 2017
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT00914849
Brief Title
Intravenous (IV) AMD3100 for Mobilization and Matched Related Transplant for Advanced Hematological Malignancies
Official Title
A Phase II Study Evaluating the Safety and Efficacy of Intravenous AMD3100 for the Mobilization and Transplantation of HLA-Matched Sibling Donor Hematopoietic Stem Cells in Patients With Advanced Hematological Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
August 2009 (undefined)
Primary Completion Date
January 2011 (Actual)
Study Completion Date
February 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
To reduce the number of donors treated with IV AMD3100 who require a second collection to obtain the minimum cells necessary for allogeneic stem cell transplant.
Detailed Description
To reduce the number of donors treated with intravenous (IV) AMD3100 who require a second collection to obtain the minimum CD34/kg (2 X 106) necessary for allogeneic stem cell transplantation when compared to our historic group who received 240ug SC AMD3100 from 33% (8 in 24) to 11% (3 in 27). To estimate with 95% confidence intervals the proportion of human leukocyte antigen (HLA)-identical sibling donors who experience grade 3-4 infusional toxicity and the proportion from whom ≥ 2.0 x 10e6 CD34+ cells/kg recipient weight are safely mobilized following one or two intravenous infusions. To determine the kinetics of stem cell and lymphocyte mobilization using IV AMD3100 and to determine if peripheral blood stem cell products collected after mobilization with IV AMD3100 can be used safely for hematopoietic cell transplantation in HLA-matched recipients as measured by neutrophil engraftment by day +21. To determine the pharmacokinetics and pharmacodynamics of IV AMD3100 on stem cell and T-cell phenotyping and on immune reconstitution after transplantation. To determine the rate of acute graft-versus-host disease (GVHD) and chronic GVHD in patients who receive IV AMD3100 mobilized peripheral blood stem cells.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
68 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 - Donor
Arm Type
Experimental
Arm Description
Day 1 AMD3100 320 ug/kg IV Leukopheresis Day 2 (if peripheral blood stem cell (PBSC) collected is not sufficient) AMD3100 320 ug/kg IV Leukopheresis
Arm Title
Arm 2 - Recipient
Arm Type
Experimental
Arm Description
Standard of care and physician choice myeloablative or non-myeloablative chemotherapy with or without total body irradiation (permitted = cyclophosphamide and single dose total body irradiation (TBI) / fludarabine and busulfan / fractionated TBI and cyclophosphamide / fractionated TBI, etoposide, and cyclophosphamide / busulfan and cyclophosphamide / fludarabine, busulfan, and ATGAM Day 0 = Stem Cell Transplant
Intervention Type
Drug
Intervention Name(s)
AMD3100
Other Intervention Name(s)
Mozobil, Plerixafor
Intervention Type
Procedure
Intervention Name(s)
Leukopheresis
Intervention Type
Procedure
Intervention Name(s)
Stem cell transplant
Primary Outcome Measure Information:
Title
Number of Donors Treated With IV AMD3100 Who Required a Second Collection to Obtain the Minimum CD34/kg (2 X 106) Necessary for Allogeneic Stem Cell Transplant
Time Frame
Completion of enrollment of all donors (17 months)
Secondary Outcome Measure Information:
Title
Number of Donors Who Experience Grade 3-4 Infusional Toxicity
Time Frame
Up to Day 2
Title
Number of Recipients Who Have Neutrophil Engraftment
Time Frame
Day 21
Title
Pharmacokinetics of IV AMD3100 as Measured by the Mean Maximum Plasma Concentration (Cmax)
Description
-Blood samples for pharmacokinetics were drawn on the following schedule: prior to IV infusion 15 minutes after start of infusion 30 minutes after start of infusion 1 hour after start of infusion 4 hours after start of infusion 6 hours after start of infusion 9 hours after start of infusion 24 hours after start of infusion
Time Frame
Day 1 and Day 2
Title
Pharmacokinetics of IV AMD3100 as Measured by Half Life
Description
-Blood samples for pharmacokinetics were drawn on the following schedule: prior to IV infusion 15 minutes after start of infusion 30 minutes after start of infusion 1 hour after start of infusion 4 hours after start of infusion 6 hours after start of infusion 9 hours after start of infusion 24 hours after start of infusion
Time Frame
Day 1 and Day 2
Title
Pharmacokinetics of IV AMD3100 as Measured by Mean Area Under Curve (AUC)
Time Frame
Day 1 and Day 2
Title
Rate of Acute GVHD (Grade II-IV) in Recipients
Time Frame
Day 0-Day 100 (acute)
Title
Rate of Acute GVHD (Grade III-IV) in Recipients
Time Frame
Day 0-Day 100 (acute)
Title
Time to Neutrophil Engraftment for Recipients
Description
Measured by determine the first 3 consecutive measurement of neutrophil count = 500/ul following conditioning regimen induced nadir.
Time Frame
Up through Day 100
Title
Time to Platelet Engraftment for Recipients
Description
Measured by determining the first of 3 consecutive measurements of platelet count = 20,000/ul without platelet transfusion support for 7 days.
Time Frame
Up to Day 100
Title
Transplant Related Mortality Rate for Recipients
Description
Death that results from a transplant procedure related complication rather than from relapse of the underlying disease or unrelated cause.
Time Frame
Day 100
Title
Grade 3-4 Toxicity for Recipients
Description
Assessed and graded according to NCI Common Terminology for Adverse Events Version 3.0.
Time Frame
1 year
Title
Rate of Chronic GVHD in Recipients
Time Frame
Day 101-1 year
Title
Number of Donors Who Experience Grade 3-4 Mobilization Toxicity Due to Pheresis Procedure
Time Frame
Up to Day 2

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Donor Eligibility Donor is 18 to 70 years of age inclusive. If female and of child-bearing age: must be non-pregnant, not breast feeding and agree to use adequate contraception. Donor is a 6/6 HLA-matched sibling willing to donate PBSC for transplant. Donor must be willing to provide written informed consent. Adequate cardiac function with no history of congestive heart failure and no history of atrial fibrillation or ventricular tachyarrhythmia. Adequate renal function as defined by a calculated serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation). Adequate hepatic function as defined by a total bilirubin <2x normal or absence of hepatic fibrosis/cirrhosis. Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. No history of cerebrovascular accident or seizure disorder requiring anticonvulsant medication. Donor must be HIV-1&2 antibody and HTLV-I&II antibody sero-negative, by Food and Drug Administration (FDA) licensed test. Donor must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Donor must demonstrate ability to be compliant with study regimen. Donor must not have an active infection at the time of study entry. Donor does not have active alcohol or substance abuse within 6 months of study entry. Donor is not currently enrolled on another investigational agent study. Donor does not have any medical condition, which, in the opinion of the clinical investigator, would interfere with his/her evaluation. Recipient Eligibility Recipient must have available the successful collection of an AMD3100 mobilized product. When an adequate collection cannot be obtained using G-CSF, some recipients may need to receive a combined product of mobilized cells with AMD3100 and g granulocyte-colony stimulating factor (G-CSF). Recipients who receive less than 2.0 X 106 CD34+ cells/kg/actual recipient weight after two days of IV AMD3100 will not be considered "eligible" but followed per protocol for safety purposes only. Patient is 18 to 65 years of age inclusive. Patient is willing and has a 6/6 HLA-matched sibling willing to donate PBSC for transplant. Patient must provide signed informed consent. If female and of child-bearing age: must be non-pregnant, not breast feeding, and uses adequate contraception. Patient must have one of the following diagnoses: Acute myelogenous leukemia (AML) in 1st or subsequent remission or in relapse, Acute lymphoblastic leukemia (ALL) in 1st or subsequent remission or in relapse, Myelodysplastic syndrome either intermediate 1 or 2, or high risk by the International Prognostic Scoring System, Chronic myelogenous leukemia (CML) in accelerated or second chronic phase, Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) in 2nd or greater complete remission, partial remission, or refractory relapse, Chronic lymphocytic leukemia (CLL), Rai Stage 2-4, failing at least 2 prior regimens, OR Multiple myeloma (MM), Stage 2-3. Adequate cardiac function with a left ventricular ejection fraction ≥ 40%. Adequate pulmonary function defined as NO severe or symptomatic restrictive or obstructive lung disease, and formal pulmonary function testing showing an FEV1 ≥50% of predicted and a DLCO ≥40% of predicted, corrected for hemoglobin. Adequate renal function as defined by a serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation). Adequate hepatic function as defined by a total bilirubin <2x normal or absence of hepatic fibrosis/cirrhosis. Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. Patients with a history of previous central nervous system (CNS) tumor involvement are eligible provided they are without symptoms or signs and the CNS is now free of disease on lumbar puncture and CT scan of the brain. No evidence of active infection at the time of the transplant preparative regimen or at time of transplantation. Patient must be HIV-1&2 antibody and HTLV-I & II antibody sero-negative, by FDA licensed test. Patient has an ECOG performance status of 0 or 1. Patient must demonstrate ability to be compliant with medical regimen. Patient must not have active alcohol or substance abuse within 6 months of study entry. Patient must not be enrolled on another investigational agent concurrently. Patient must not have any medical condition, which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient. Exclusion Criteria: See Inclusion criteria above
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John DiPersio, M.D., Ph.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
12531874
Citation
Levesque JP, Hendy J, Takamatsu Y, Simmons PJ, Bendall LJ. Disruption of the CXCR4/CXCL12 chemotactic interaction during hematopoietic stem cell mobilization induced by GCSF or cyclophosphamide. J Clin Invest. 2003 Jan;111(2):187-96. doi: 10.1172/JCI15994.
Results Reference
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PubMed Identifier
9933168
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Peled A, Petit I, Kollet O, Magid M, Ponomaryov T, Byk T, Nagler A, Ben-Hur H, Many A, Shultz L, Lider O, Alon R, Zipori D, Lapidot T. Dependence of human stem cell engraftment and repopulation of NOD/SCID mice on CXCR4. Science. 1999 Feb 5;283(5403):845-8. doi: 10.1126/science.283.5403.845.
Results Reference
background
Citation
Broxmeyer HE, Hangoc G, Cooper S, Bridger G. Interference of the SDF-1/CXCR4 axis in mice with AMD3100 induces rapid high level mobilization of hematopoietic progenitor cells, and AMD3100 acts synergistically with G-CSF and MIP-1 alpha to mobilize progenitors. Blood. 2001;96:3371a
Results Reference
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Citation
Broxmeyer HE, Hangoc G, Cooper S, Li X, Bridger G, Clapp DW. AMD3100, an antagonist of CXCR4 and mobilizer of myeloid progenitor cells, is a potent mobilizer of competitive repopulating long term marrow self renewing stem cells in mice. Blood. 2002;98:2397a
Results Reference
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Liles WC, Broxmeyer HE, Rodger E, Wood B, Hubel K, Cooper S, Hangoc G, Bridger GJ, Henson GW, Calandra G, Dale DC. Mobilization of hematopoietic progenitor cells in healthy volunteers by AMD3100, a CXCR4 antagonist. Blood. 2003 Oct 15;102(8):2728-30. doi: 10.1182/blood-2003-02-0663. Epub 2003 Jul 10.
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Devine S, Adkins D, Khoury H, Vij R, Goodnough LT, Graubert T, Tomasson M, Blum W, DiPersio J, Brown R. Mobilization of donors with GM-CSF plus G-CSF or GM-CSF alone results in significantly different graft composition compared to G-CSF alone. Blood. 2002;100:825a
Results Reference
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PubMed Identifier
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Citation
Devine SM, Vij R, Rettig M, Todt L, McGlauchlen K, Fisher N, Devine H, Link DC, Calandra G, Bridger G, Westervelt P, Dipersio JF. Rapid mobilization of functional donor hematopoietic cells without G-CSF using AMD3100, an antagonist of the CXCR4/SDF-1 interaction. Blood. 2008 Aug 15;112(4):990-8. doi: 10.1182/blood-2007-12-130179. Epub 2008 Apr 21.
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Broxmeyer HE, Orschell CM, Clapp DW, Hangoc G, Cooper S, Plett PA, Liles WC, Li X, Graham-Evans B, Campbell TB, Calandra G, Bridger G, Dale DC, Srour EF. Rapid mobilization of murine and human hematopoietic stem and progenitor cells with AMD3100, a CXCR4 antagonist. J Exp Med. 2005 Apr 18;201(8):1307-18. doi: 10.1084/jem.20041385.
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Citation
Hess DA, Bonde J, Craft TP, Wirthlin L, Hohm S, Lahey R, Todt LM, Dipersio JF, Devine SM, Nolta JA. Human progenitor cells rapidly mobilized by AMD3100 repopulate NOD/SCID mice with increased frequency in comparison to cells from the same donor mobilized by granulocyte colony stimulating factor. Biol Blood Marrow Transplant. 2007 Apr;13(4):398-411. doi: 10.1016/j.bbmt.2006.12.445. Erratum In: Biol Blood Marrow Transplant. 2007 Jun;13(6):747. Craft, Timothy C [corrected to Craft, Timothy P].
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Results Reference
derived
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Intravenous (IV) AMD3100 for Mobilization and Matched Related Transplant for Advanced Hematological Malignancies

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