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Transplantation of Hematopoietic Stem Cells From HLA-compatible Donors in Patients With B-Cell Lymphoid Malignancies

Primary Purpose

B-Cell Lymphoid Malignancies, Hematologic Malignancy, Non-Hodgkin Lymphoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Hematopoietic Stem Cells from HLA-compatible Related
Hematopoietic Stem Cells from HLA Unrelated
Sponsored by
Baptist Health South Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for B-Cell Lymphoid Malignancies focused on measuring Hematologic Malignancies, NHL

Eligibility Criteria

18 Years - 74 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • :

    • Patients aged 18-74 years at initial referral with a suitably matched related or unrelated donor who have provided their informed consent to participate in the clinical trial.
    • If post-pubertal, females agree to take hormonal therapy to suppress menses unless a specific contra-indication to estrogen exists

Diagnosis:

  • Patients with CD20+ aggressive B cell NHL (DLBCL, large cell transformation of indolent NHL/CLL, or mantle cell) OR CD20+ indolent NHL/CLL. Relapsed disease must be biopsy proven and CD20 positivity must be demonstrated within the 12 months prior to protocol enrollment.

Eligible patients with DLBCL NHL will:

  • have relapsed disease following initial therapy but failed to mobilize or had bone marrow involvement and therefore are not suitable for an autologous transplant OR
  • have high-intermediate or high-risk second-line age-adjusted International Prognostic Index score and be in 2nd CR/PR following an autologous transplant OR
  • have failed an autologous transplant and be in PR or better after salvage chemotherapy.

Eligible patients with transformed indolent NHL/CLL will:

• have CR/PR of the large cell component of their disease after either salvage chemotherapy or an autologous transplant.

Eligible patients with mantle cell NHL will:

  • be high-risk such as p53 positivity and be in 1st CR/PR after initial therapy OR
  • have relapsed disease following initial therapy and be in 2nd or 3rd CR/PR after salvage chemotherapy.

Eligible patients with indolent B cell NHL (such as, but not limited to, follicular, small cell or marginal zone NHL) or CLL will:

• have 1st or subsequent progression or primary refractory disease (pre-allograft cytoreduction necessary but CR/PR not required).

Pre-allograft Salvage Chemotherapy:

  • This can include a single autologous transplant using high dose chemotherapy conditioning if appropriate OR ≥ 2 cycles of intensive combination chemotherapy (e.g. RICE) as appropriate according to diagnosis and prior therapy.
  • CLL patients who have received CAMPATH do not have to receive pre-allograft salvage chemotherapy.

Timing of PBSCT:

• Admission for PBSCT must be within 120 days of autologous transplantation OR 80 days of the last cycle of chemotherapy.

Organ Function and Performance Status Criteria:

  • Karnofsky score ≥ 70 %
  • calculated creatinine clearance ≥ 50 mL/min OR if creatinine ≥ 1.2, a history of renal dysfunction, age > 50 years, prior transplant, and/or a single kidney, the patient must have a measured creatinine clearance (using 24 hour urine collection) ≥ 50 mL/min
  • bilirubin < 2.5, AST/ALT ≤ 3 x upper limit of normal (unless benign congenital hyperbilirubinemia)
  • pulmonary function (spirometry and corrected DLCO) ≥ 50% normal
  • left ventricular ejection fraction ≥ 40%
  • albumin ≥ 2.5. Donor HLA-compatible related donors
  • Patients who have an HLA-matched or one allele mismatched related donor are eligible for entry on this protocol. This will include a healthy related donor who is genotypically or phenotypically matched at least 9/10 of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution.

HLA-compatible Unrelated donors • Patients who do not have a related HLA-matched donor but have an unrelated donor who is matched at

≥ 9/10 (allele mismatch only) of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution.

Exclusion Criteria:

  • Diagnosis: known negativity for CD20 pre-allograft; mantle cell or DLBCL NHL with progressive disease at allograft work-up

    • Prior Therapy: prior allogeneic transplant (prior autologous transplant is acceptable)
    • Cytoreduction and timing of NMA PBSCT: patients unable to complete planned cytoreduction due to therapy complications, or who undergo cytoreduction but are unable to proceed to allografting within the defined time period, are ineligible for allograft on protocol
    • Active and uncontrolled infection at time of transplantation including active infection with Aspergillus or other mold, or HIV infection
    • Patients positive for Hepatitis B or C at risk for viral reactivation.
    • Inadequate performance status/organ function
    • Pregnant or breast feeding
    • Patient or guardian unable to give informed consent or unable to comply with the treatment protocol including appropriate supportive care, follow-up and research tests.

Sites / Locations

  • Miami Cancer Institute at Baptist Health of South FloridaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

HLA-compatible Related Donor

Unrelated Donor

Arm Description

This is a phase 2 study to evaluate NMA PBSCT incorporating peri-transplant rituximab and utilizing PBSC to augment graft cell dose in patients with selected B lymphoid malignancies. Salvage chemotherapy will be required as part of transplant eligibility, both to achieve debulking of disease to allow sufficient time for the development of a post-transplant GVL effect, and to contribute to recipient immune suppression and thus facilitate donor engraftment.

This is a phase 2 study to evaluate NMA PBSCT incorporating peri-transplant rituximab and utilizing PBSC to augment graft cell dose in patients with selected B lymphoid malignancies. Salvage chemotherapy will be required as part of transplant eligibility, both to achieve debulking of disease to allow sufficient time for the development of a post-transplant GVL effect, and to contribute to recipient immune suppression and thus facilitate donor engraftment.

Outcomes

Primary Outcome Measures

Estimate the overall and event-free survival
The primary aim of this study is to obtain a preliminary estimate of the overall and event-free survival at 1 year after NMA PBSCT with peri-transplant rituximab using an HLA matched or single HLA allele disparate related or unrelated donors

Secondary Outcome Measures

Speed of Recovery Post Allograft
the speed of neutrophil and platelet recovery post allograft
Response to Engraftment
the incidence and speed of donor-derived engraftment
Status of Graft Versus Host Disease
The incidence and severity of acute GVHD(Graft Versus Host Disease) at 100 days
Number of Participants with Graft Versus Host Disease
The incidence and severity of chronic GVHD (Graft Versus Host Disease) at 1 year
Number of Participants with Complications
the incidence of serious infectious complications with their correlation with laboratory measurements of immune recovery
Response Rate to Vaccination
the response to vaccination after PBSCT (Peripheral Blood Stem Cells Transplantation)
Number of Transplant Related Mortality Incidences
the incidence of Transplant Related Mortality at 100 and 180 days
Number of Relapse or Disease Progression Instances
the incidence of malignant relapse or disease progression at 1 and 2 years
Number of Overall and Event Free Survival
the probabilities of overall and event-free survival at 2 years after Peripheral Blood Stem Cells Transplantation

Full Information

First Posted
December 22, 2020
Last Updated
April 27, 2023
Sponsor
Baptist Health South Florida
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1. Study Identification

Unique Protocol Identification Number
NCT04684979
Brief Title
Transplantation of Hematopoietic Stem Cells From HLA-compatible Donors in Patients With B-Cell Lymphoid Malignancies
Official Title
A Non-Myeloablative Conditioning Regimen With Peri-Transplant Rituximab and the Transplantation of Hematopoietic Stem Cells From HLA-compatible Related or Unrelated Donors in Patients With B-Cell Lymphoid Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 28, 2022 (Actual)
Primary Completion Date
March 2026 (Anticipated)
Study Completion Date
March 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Baptist Health South Florida

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 research study is being conducted to treat patients with B-cell lymphoid malignancies. These types of cancers include diffuse large cell (DLBCL) non-Hodgkin's lymphoma (NHL), mantle cell NHL, any indolent B cell NHL (such as follicular, small cell or marginal zone NHL), or chronic lymphocytic leukemia (CLL). Patients with these types of lymphomas have been shown to benefit from peripheral blood stem cell transplantation (PBSCT). PBSCT uses healthy blood stem cells from a donor to replace your diseased or damaged bone marrow. Before undergoing PBSCT, you'll receive chemotherapy and/or radiation to destroy your diseased cells and prepare your body for the donor cells. This is called a "conditioning regimen." Non-myeloablative (NMA) conditioning causes minimal cell death. This research study will look at a course of treatment using NMA conditioning regimen including low dose chemotherapy and low dose radiation as well as rituximab and PBSCT from a compatible donor. The primary aim is to obtain a preliminary estimate of the overall and event-free survival 1 year post-transplant after NMA.
Detailed Description
This is a phase 2 study of a treatment regimen consisting of a non-myeloablative (NMA) conditioning regimen incorporating low dose chemotherapy and low dose radiation as well as peri-transplant Rituximab and the transplantation of peripheral blood stem cells (PBSC) from an HLA compatible related or unrelated donor in patients with B cell lymphoid malignancies including diffuse large cell (DLBCLC) and mantle cell non-Hodgkin's lymphoma (MCL), indolent B cell NHL, or chronic lymphocytic leukemia (CLL). The study design will be based on a total of 90 patients, 30 recipients of related matched and 60 recipients of mismatched related or unrelated PBSCT. It is anticipated that the accrual will last 5-6 years. At the conclusion of the study, the safety and a preliminary assessment of efficacy of NMA PBSCT will be determined. The treatment will be declared efficacious if the disease-free survival at 1 year in this patient population is at least 50%.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
B-Cell Lymphoid Malignancies, Hematologic Malignancy, Non-Hodgkin Lymphoma
Keywords
Hematologic Malignancies, NHL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
The study design will be based on a total of 90 patients, 30 recipients of related matched and 60 recipients of mismatched related or unrelated PBSCT.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
HLA-compatible Related Donor
Arm Type
Experimental
Arm Description
This is a phase 2 study to evaluate NMA PBSCT incorporating peri-transplant rituximab and utilizing PBSC to augment graft cell dose in patients with selected B lymphoid malignancies. Salvage chemotherapy will be required as part of transplant eligibility, both to achieve debulking of disease to allow sufficient time for the development of a post-transplant GVL effect, and to contribute to recipient immune suppression and thus facilitate donor engraftment.
Arm Title
Unrelated Donor
Arm Type
Experimental
Arm Description
This is a phase 2 study to evaluate NMA PBSCT incorporating peri-transplant rituximab and utilizing PBSC to augment graft cell dose in patients with selected B lymphoid malignancies. Salvage chemotherapy will be required as part of transplant eligibility, both to achieve debulking of disease to allow sufficient time for the development of a post-transplant GVL effect, and to contribute to recipient immune suppression and thus facilitate donor engraftment.
Intervention Type
Biological
Intervention Name(s)
Hematopoietic Stem Cells from HLA-compatible Related
Intervention Description
NMA PBSCT (Non-Myeloablative peripheral blood stem cell transplantation) incorporating rituximab and utilizing PBSC (Peripheral blood stem cells) to increase graft cell dose in patients with selected B lymphoid malignancies.
Intervention Type
Biological
Intervention Name(s)
Hematopoietic Stem Cells from HLA Unrelated
Intervention Description
NMA PBSCT (Non-Myeloablative peripheral blood stem cell transplantation) incorporating rituximab and utilizing PBSC (Peripheral blood stem cells) to increase graft cell dose in patients with selected B lymphoid malignancies.
Primary Outcome Measure Information:
Title
Estimate the overall and event-free survival
Description
The primary aim of this study is to obtain a preliminary estimate of the overall and event-free survival at 1 year after NMA PBSCT with peri-transplant rituximab using an HLA matched or single HLA allele disparate related or unrelated donors
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Speed of Recovery Post Allograft
Description
the speed of neutrophil and platelet recovery post allograft
Time Frame
100 days
Title
Response to Engraftment
Description
the incidence and speed of donor-derived engraftment
Time Frame
100 days
Title
Status of Graft Versus Host Disease
Description
The incidence and severity of acute GVHD(Graft Versus Host Disease) at 100 days
Time Frame
100 days
Title
Number of Participants with Graft Versus Host Disease
Description
The incidence and severity of chronic GVHD (Graft Versus Host Disease) at 1 year
Time Frame
1 year
Title
Number of Participants with Complications
Description
the incidence of serious infectious complications with their correlation with laboratory measurements of immune recovery
Time Frame
100 days
Title
Response Rate to Vaccination
Description
the response to vaccination after PBSCT (Peripheral Blood Stem Cells Transplantation)
Time Frame
100 days
Title
Number of Transplant Related Mortality Incidences
Description
the incidence of Transplant Related Mortality at 100 and 180 days
Time Frame
100 and 180 days
Title
Number of Relapse or Disease Progression Instances
Description
the incidence of malignant relapse or disease progression at 1 and 2 years
Time Frame
1 and 2 years
Title
Number of Overall and Event Free Survival
Description
the probabilities of overall and event-free survival at 2 years after Peripheral Blood Stem Cells Transplantation
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
74 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: : Patients aged 18-74 years at initial referral with a suitably matched related or unrelated donor who have provided their informed consent to participate in the clinical trial. If post-pubertal, females agree to take hormonal therapy to suppress menses unless a specific contra-indication to estrogen exists Diagnosis: Patients with CD20+ aggressive B cell NHL (DLBCL, large cell transformation of indolent NHL/CLL, or mantle cell) OR CD20+ indolent NHL/CLL. Relapsed disease must be biopsy proven and CD20 positivity must be demonstrated within the 12 months prior to protocol enrollment. Eligible patients with DLBCL NHL will: have relapsed disease following initial therapy but failed to mobilize or had bone marrow involvement and therefore are not suitable for an autologous transplant OR have high-intermediate or high-risk second-line age-adjusted International Prognostic Index score and be in 2nd CR/PR following an autologous transplant OR have failed an autologous transplant and be in PR or better after salvage chemotherapy. Eligible patients with transformed indolent NHL/CLL will: • have CR/PR of the large cell component of their disease after either salvage chemotherapy or an autologous transplant. Eligible patients with mantle cell NHL will: be high-risk such as p53 positivity and be in 1st CR/PR after initial therapy OR have relapsed disease following initial therapy and be in 2nd or 3rd CR/PR after salvage chemotherapy. Eligible patients with indolent B cell NHL (such as, but not limited to, follicular, small cell or marginal zone NHL) or CLL will: • have 1st or subsequent progression or primary refractory disease (pre-allograft cytoreduction necessary but CR/PR not required). Pre-allograft Salvage Chemotherapy: This can include a single autologous transplant using high dose chemotherapy conditioning if appropriate OR ≥ 2 cycles of intensive combination chemotherapy (e.g. RICE) as appropriate according to diagnosis and prior therapy. CLL patients who have received CAMPATH do not have to receive pre-allograft salvage chemotherapy. Timing of PBSCT: • Admission for PBSCT must be within 120 days of autologous transplantation OR 80 days of the last cycle of chemotherapy. Organ Function and Performance Status Criteria: Karnofsky score ≥ 70 % calculated creatinine clearance ≥ 50 mL/min OR if creatinine ≥ 1.2, a history of renal dysfunction, age > 50 years, prior transplant, and/or a single kidney, the patient must have a measured creatinine clearance (using 24 hour urine collection) ≥ 50 mL/min bilirubin < 2.5, AST/ALT ≤ 3 x upper limit of normal (unless benign congenital hyperbilirubinemia) pulmonary function (spirometry and corrected DLCO) ≥ 50% normal left ventricular ejection fraction ≥ 40% albumin ≥ 2.5. Donor HLA-compatible related donors Patients who have an HLA-matched or one allele mismatched related donor are eligible for entry on this protocol. This will include a healthy related donor who is genotypically or phenotypically matched at least 9/10 of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution. HLA-compatible Unrelated donors • Patients who do not have a related HLA-matched donor but have an unrelated donor who is matched at ≥ 9/10 (allele mismatch only) of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution. Exclusion Criteria: Diagnosis: known negativity for CD20 pre-allograft; mantle cell or DLBCL NHL with progressive disease at allograft work-up Prior Therapy: prior allogeneic transplant (prior autologous transplant is acceptable) Cytoreduction and timing of NMA PBSCT: patients unable to complete planned cytoreduction due to therapy complications, or who undergo cytoreduction but are unable to proceed to allografting within the defined time period, are ineligible for allograft on protocol Active and uncontrolled infection at time of transplantation including active infection with Aspergillus or other mold, or HIV infection Patients positive for Hepatitis B or C at risk for viral reactivation. Inadequate performance status/organ function Pregnant or breast feeding Patient or guardian unable to give informed consent or unable to comply with the treatment protocol including appropriate supportive care, follow-up and research tests.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Guenther Koehne, MD, PhD
Phone
786-596-2000
Email
GuentherK@Baptisthealth.net
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Guenther Koehne, MD, PhD
Organizational Affiliation
Miami Cancer Institute at Baptist Health of South Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
Miami Cancer Institute at Baptist Health of South Florida
City
Miami
State/Province
Florida
ZIP/Postal Code
33176
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Guenther Koehne, MD, PhD
Phone
786-596-2000
Email
GuentherK@Baptisthealth.net
First Name & Middle Initial & Last Name & Degree
Guenther Koehne, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://baptisthealth.net/cancer-care/home
Description
Miami Cancer Institute Website

Learn more about this trial

Transplantation of Hematopoietic Stem Cells From HLA-compatible Donors in Patients With B-Cell Lymphoid Malignancies

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