StemRegenin-1 Expanded vs Unexpanded UCB for High Risk Heme Malignancies

Acute Myeloid Leukemia Clinical Trial

Official title:

Single-Center, Open Label, Randomized Trial Comparing StemRegenin-1 Expanded Versus Unmanipulated Umbilical Cord Blood Transplantation In Patients With High-Risk Malignancy

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02765997
• Other study ID #: 2016LS006
• Secondary ID: MT2016-01
• Status: Withdrawn
• Phase: Phase 2
• First received: May 5, 2016
• Last updated: December 3, 2017
• Start date: April 2017
• Est. completion date: June 2022

Study information

• Verified date: December 2017
• Source: Masonic Cancer Center, University of Minnesota
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an open label, interventional, randomized phase II trial comparing StemRegenin-1 (SR-1) cultured umbilical cord blood (experimental arm) to unmanipulated umbilical cord blood (standard of care arm) transplantation after a myeloablative CY/FLU/TBI conditioning. A 2:1 randomization will be employed with a higher chance of being assigned to the experimental arm.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: June 2022
• Est. primary completion date: June 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Years to 35 Years

Eligibility

Inclusion Criteria:

• Must have a partially HLA matched UCB unit with a pre-cryopreserved TNC dose >2.5 x 107 per kilogram recipient weight. HLA matching is initially based on 4 of 6 HLA-A and B (at low or intermediate resolution by molecular typing) and DRB1 (at high resolution by molecular typing).

• Eligible Diseases

• Acute myelogenous leukemia (AML) at the following stages:

• Intermediate to high risk leukemia in first complete remission (CR1) based on institutional criteria.

• Any second or subsequent CR.

• Secondary AML with prior malignancy that has been in remission for at least 12 months.

• Acute lymphocytic leukemia (ALL) at the following stages:

• High risk first remission.

1. Ph+ ALL, or

2. MLL rearrangement with slow early response at Day 14, or

3. Hypodiploidy (< 44 chromosomes or DNA index < 0.81), or

4. End of induction M3 bone marrow, or

5. End of induction M2 with M2-3 at Day 42.

• High risk second CR based on institutional criteria (eg, for children, bone marrow relapse <36 months from induction or T-lineage bone marrow relapse or very early isolated central nervous system (CNS) relapse <6 months from diagnosis, or slow re-induction (stage M2-3 at day 28 after induction) regardless of length remission.

• Any third or subsequent CR.

• Biphenotypic/undifferentiated leukemia in CR

• Chronic myelogenous leukemia (CML) excluding refractory blast crisis

• Myelodysplasia (MDS) IPSS Int-2 or High risk (i.e. RAEB, RAEBt) or refractory anemia

• Other Inclusion Criteria

• Karnofsky score >70% (16 years and older) or a Lansky play score >70 (children <16 years) - appendix II

• Adequate organ function defined as:

• Renal: Serum creatinine within normal range for age, or if serum creatinine outside normal range for age, then renal function (creatinine clearance or GFR) >70 mL/min/1.73 m2.

• Hepatic: Bilirubin =2.5 x mg/dL; AST, ALT, alkaline phosphatase <5 x upper limit of normal,

• Pulmonary function: DLCO, FEV1, FEC (diffusion capacity) >50% of predicted (corrected for hemoglobin); if unable to perform pulmonary function tests, then normal O2 saturation on room air.

• Cardiac: Left ventricular ejection fraction at rest must be >45%

• Available 'back-up' HSPC graft (e.g, second partially HLA matched UCB unit, haploidentical related donor).

• Voluntary written consent signed (adult or parental) before performance of any study-related procedure not part of normal medical care

Exclusion Criteria:

• Pregnant or breast feeding. The agents used in this study may be teratogenic to a fetus and there is no information on the excretion of agents into breast milk. Females of childbearing potential must have a blood test or urine study within 14 days prior to study enrollment to rule out pregnancy.

• Evidence of human immunodeficiency virus (HIV) infection or known HIV positive serology.

• Active bacterial, viral or fungal infection (currently taking medication and progression of clinical symptoms).

• Prior autologous or allogeneic transplant within past 12 months.

• Other active malignancy.

• Inability to receive TBI 1320 cGy (e.g., extensive prior therapy including >12 months alkylator therapy or >6 months alkylator therapy with extensive radiation. Or prior Y-90 ibritumomab (Zevalin) or I-131 tostumomab (Bexxar), as part of their salvage therapy.

Related Conditions & MeSH terms

• Acute Lymphocytic Leukemia
• Acute Myeloid Leukemia
• Chronic Myelogenous Leukemia
• Leukemia
• Leukemia, Lymphoid
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive
• Leukemia, Myeloid
• Leukemia, Myeloid, Acute
• Myelodysplasia
• Myelodysplastic Syndromes
• Precursor Cell Lymphoblastic Leukemia-Lymphoma
• Preleukemia

Intervention

Biological:
• Unmanipulated UCB
Unmanipulated UCB infusion given on Day 0. All patients will receive the same conditioning and immunoprophylaxis for the prevention of acute and chronic GVHD, previously demonstrated to offer the best outcomes in recipients of partially HLA matched UCB. Standard supportive care, including the use of Neupogen [G-CSF] and prophylactic anti-bacterial, protozoal, viral and fungal agents, will also be prescribed. Supportive care will be modified throughout the transplant course at the treating physician's judgement.
• SR-1 UCB
SR-1 UCB infusion given on Day 0. All patients will receive the same conditioning and immunoprophylaxis for the prevention of acute and chronic GVHD, previously demonstrated to offer the best outcomes in recipients of partially HLA matched UCB. Standard supportive care, including the use of Neupogen [G-CSF] and prophylactic anti-bacterial, protozoal, viral and fungal agents, will also be prescribed. Supportive care will be modified throughout the transplant course at the treating physician's judgement.

Locations

Country	Name	City	State
United States	University of Minnesota Cancer Center	Minneapolis	Minnesota

Sponsors (1)

Lead Sponsor	Collaborator
Masonic Cancer Center, University of Minnesota

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Neutrophil Recovery	Percentage of patients with neutrophil recovery	Day 14 after transplantation
Secondary	Secondary Graft Failure	Percentage of patients with secondary graft failure	Day 100 after transplantation
Secondary	Platelet Recovery	Percentage of patients with platelet recovery	Day 100 after transplantation
Secondary	Transplant-Related Mortality		6 months after transplantation