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Peripheral Stem Cell Transplantation in Treating Patients With Metastatic or Recurrent Kidney Cancer

Primary Purpose

Kidney Cancer

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
therapeutic allogeneic lymphocytes
fludarabine phosphate
mycophenolate mofetil
tacrolimus
thalidomide
peripheral blood stem cell transplantation
radiation therapy
Sponsored by
Fox Chase Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Kidney Cancer focused on measuring stage IV renal cell cancer, recurrent renal cell cancer, clear cell renal cell carcinoma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed renal cell carcinoma (RCC) Histology demonstrates major clear cell component Metastatic (stage IV) or recurrent disease Prior debulking nephrectomy required Disease not amenable to complete surgical resection Must have HLA-identical donor Matched related sibling donors must have 6/6 serologic HLA A, B, and DR match with molecular confirmation at DRB1 A 5/6 serologic mismatch with one antigen mismatch at locus A or B (not DR) with molecular confirmation at locus A, B, and DRB1 allowed Matched unrelated donors must have a minimum of 8 out of 10 molecular matches at loci A, B, C, DRB1, and DQB1 No brain metastases Negative MRI required PATIENT CHARACTERISTICS: Age: 18 to 65 Performance status: Karnofsky 80-100% OR ECOG 0-1 Life expectancy: Not specified Hematopoietic: Not specified Hepatic: Bilirubin less than 2 times upper limit of normal (ULN) ALT/AST less than 2 times ULN Alkaline phosphatase less than 2 times ULN Hepatitis A, B, and C negative Renal: Creatinine clearance greater than 50 mL/min Calcium less than 10.5 mg/dL (bisphosphonates allowed) Cardiovascular: LVEF no less than 10% below lower limit of normal Pulmonary: FEV_1 and DLCO greater than 50% Other: HIV negative No active bacterial, fungal, or viral (including cytomegalovirus) infections No intolerance or allergy to tacrolimus, mycophenolate mofetil, or fludarabine No intolerance to 200 cGy of total body irradiation No other serious comorbid disease, neurologic condition, or psychosocial condition that would preclude study follow-up Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception for at least 1 month before, during, and for at least 3 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy: Prior interleukin-2 allowed Prior interferon alfa allowed Chemotherapy: Prior chemotherapy allowed No other concurrent chemotherapy for RCC Endocrine therapy: No concurrent corticosteroids for other comorbid disease Radiotherapy: No prior extensive radiotherapy to marrow microenvironment greater than 20% of total marrow mass No prior radiotherapy that has reached tissue tolerance for heart, lung, liver, kidney, or spinal cord Surgery: See Disease Characteristics Other: No other concurrent therapy for RCC No concurrent enrollment on another investigational protocol for treatment of RCC No other concurrent immunosuppressive medications No other concurrent investigational drugs

Sites / Locations

    Outcomes

    Primary Outcome Measures

    Secondary Outcome Measures

    Full Information

    First Posted
    October 11, 2001
    Last Updated
    July 10, 2013
    Sponsor
    Fox Chase Cancer Center
    Collaborators
    National Cancer Institute (NCI)
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00025519
    Brief Title
    Peripheral Stem Cell Transplantation in Treating Patients With Metastatic or Recurrent Kidney Cancer
    Official Title
    Submyeloablative Allogeneic Blood Stem Cell Transplantation With HLA Identical Donor Lymphocyte Infusions From Matched Related and Matched Unrelated Donors for Treatment of Metastatic Renal Cell Carcinoma
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2013
    Overall Recruitment Status
    Withdrawn
    Study Start Date
    June 2001 (undefined)
    Primary Completion Date
    October 2006 (Actual)
    Study Completion Date
    October 2006 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Fox Chase Cancer Center
    Collaborators
    National Cancer Institute (NCI)

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    RATIONALE: Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy and radiation therapy used to kill cancer cells. Sometimes the transplanted cells can be rejected by the body's tissues. Mycophenolate mofetil, tacrolimus, and donor white blood cells may prevent this from happening. PURPOSE: Phase II trial to study the effectiveness of chemotherapy followed by peripheral stem cell transplantation in treating patients who have metastatic or recurrent kidney cancer.
    Detailed Description
    OBJECTIVES: Determine the feasibility of submyeloablative HLA-identical allogeneic peripheral blood stem cell transplantation in patients with metastatic or recurrent renal cell carcinoma. Determine the toxicity of this regimen, in terms of incidence and severity of graft rejection, acute graft-vs-host disease (GVHD), chronic GVHD, adverse effects from the preparative regimen and thalidomide, and infection and bleeding, in these patients. Determine the efficacy of this regimen, in terms of objective partial and complete response rates, in these patients. Determine the engraftment rates and extent of chimerism in patients treated with this regimen. Determine the overall survival and time to treatment failure rate in patients treated with this regimen. Determine the impact of thalidomide on the treatment of chronic GVHD in patients treated with this regimen. OUTLINE: Patients are stratified according to risk (low vs high). Patients receive fludarabine IV over 30 minutes once daily on days -4 to -2 followed by total body irradiation on day -1. Patients receive tacrolimus IV over 24 hours or orally daily on days -3 to 35 and oral mycophenolate mofetil twice daily on days -3 to 28 as graft-vs-host disease (GVHD) prophylaxis. Patients undergo allogeneic peripheral blood stem cell transplantation over 1-2 hours on day 0. Patients maintaining a mixed chimerism with no evidence of grade III or IV GVHD receive donor lymphocyte infusions (DLI) on days 60, 90, and 120. Patients may receive additional DLI as needed. Patients with limited chronic GVHD receive oral thalidomide daily beginning after day 80 and continuing for 1 year or until disease progression or resolution of chronic GVHD. Patients are followed at 1, 3, 6, and 12 months and then every 6 months thereafter. PROJECTED ACCRUAL: A maximum of 20-40 patients (10-20 per stratum) will be accrued for this study.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Kidney Cancer
    Keywords
    stage IV renal cell cancer, recurrent renal cell cancer, clear cell renal cell carcinoma

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Masking
    None (Open Label)
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Intervention Type
    Biological
    Intervention Name(s)
    therapeutic allogeneic lymphocytes
    Intervention Type
    Drug
    Intervention Name(s)
    fludarabine phosphate
    Intervention Type
    Drug
    Intervention Name(s)
    mycophenolate mofetil
    Intervention Type
    Drug
    Intervention Name(s)
    tacrolimus
    Intervention Type
    Drug
    Intervention Name(s)
    thalidomide
    Intervention Type
    Procedure
    Intervention Name(s)
    peripheral blood stem cell transplantation
    Intervention Type
    Radiation
    Intervention Name(s)
    radiation therapy

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    DISEASE CHARACTERISTICS: Histologically confirmed renal cell carcinoma (RCC) Histology demonstrates major clear cell component Metastatic (stage IV) or recurrent disease Prior debulking nephrectomy required Disease not amenable to complete surgical resection Must have HLA-identical donor Matched related sibling donors must have 6/6 serologic HLA A, B, and DR match with molecular confirmation at DRB1 A 5/6 serologic mismatch with one antigen mismatch at locus A or B (not DR) with molecular confirmation at locus A, B, and DRB1 allowed Matched unrelated donors must have a minimum of 8 out of 10 molecular matches at loci A, B, C, DRB1, and DQB1 No brain metastases Negative MRI required PATIENT CHARACTERISTICS: Age: 18 to 65 Performance status: Karnofsky 80-100% OR ECOG 0-1 Life expectancy: Not specified Hematopoietic: Not specified Hepatic: Bilirubin less than 2 times upper limit of normal (ULN) ALT/AST less than 2 times ULN Alkaline phosphatase less than 2 times ULN Hepatitis A, B, and C negative Renal: Creatinine clearance greater than 50 mL/min Calcium less than 10.5 mg/dL (bisphosphonates allowed) Cardiovascular: LVEF no less than 10% below lower limit of normal Pulmonary: FEV_1 and DLCO greater than 50% Other: HIV negative No active bacterial, fungal, or viral (including cytomegalovirus) infections No intolerance or allergy to tacrolimus, mycophenolate mofetil, or fludarabine No intolerance to 200 cGy of total body irradiation No other serious comorbid disease, neurologic condition, or psychosocial condition that would preclude study follow-up Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception for at least 1 month before, during, and for at least 3 months after study participation PRIOR CONCURRENT THERAPY: Biologic therapy: Prior interleukin-2 allowed Prior interferon alfa allowed Chemotherapy: Prior chemotherapy allowed No other concurrent chemotherapy for RCC Endocrine therapy: No concurrent corticosteroids for other comorbid disease Radiotherapy: No prior extensive radiotherapy to marrow microenvironment greater than 20% of total marrow mass No prior radiotherapy that has reached tissue tolerance for heart, lung, liver, kidney, or spinal cord Surgery: See Disease Characteristics Other: No other concurrent therapy for RCC No concurrent enrollment on another investigational protocol for treatment of RCC No other concurrent immunosuppressive medications No other concurrent investigational drugs
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Gary R. Hudes, MD
    Organizational Affiliation
    Fox Chase Cancer Center
    Official's Role
    Study Chair

    12. IPD Sharing Statement

    Learn more about this trial

    Peripheral Stem Cell Transplantation in Treating Patients With Metastatic or Recurrent Kidney Cancer

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