Chronic Lymphocytic Leukemia Clinical Trial
Official title:
Allogeneic Hematopoietic Stem Cell Transplantation With Nonmyeloablative Conditioning for Patients With Chronic Lymphocytic Leukemia - A Multi-center Trial
This clinical trial studies how well giving fludarabine phosphate together with total-body irradiation (TBI) before donor peripheral blood stem cell transplant works in treating patients with chronic lymphocytic leukemia or small lymphocytic leukemia. Giving low doses of chemotherapy, such as fludarabine phosphate, and TBI before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. Giving chemotherapy before or after peripheral blood stem cell transplant also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil before and after the transplant may stop this from happening.
PRIMARY OBJECTIVES:
I. To determine whether nonmyeloablative allogeneic hematopoietic stem cell transplantation
(HSCT) from matched-related donors can improve the probability of survival 18 months after
treatment for fludarabine (fludarabine phosphate)-refractory, fludarabine phosphate,
cyclophosphamide, and rituximab (FCR)-failed, or del 17p chronic lymphocytic leukemia (CLL)
beyond that observed in historical controls (30%).
SECONDARY OBJECTIVES:
I. To assess the rate of relapse with allogeneic HSCT using nonmyeloablative conditioning for
patients with fludarabine-refractory, FCR-failed, or del 17p CLL compared with historical
data on autologous HSCT.
II. To estimate the incidence of grade 2-4 acute graft-versus-host disease (GVHD) and chronic
GVHD in patients with CLL treated with low-dose TBI, fludarabine, peripheral blood stem cell
(PBSC) infusion and immunosuppression with cyclosporine and mycophenolate mofetil.
III. To characterize the rate and types of infections with this regimen.
IV. To estimate the rate of transplant-related mortality in the first 200 days.
OUTLINE:
NONMYELOABLATIVE CONDITIONING: Patients receive fludarabine phosphate intravenously (IV) on
days -4 to -2 and TBI on day 0.
TRANSPLANT: Patients undergo allogeneic peripheral blood stem cell transplant on day 0.
GVHD PROPHYLAXIS: Patients receive cyclosporine orally (PO) every 12 hours on days -3 to 180
with taper beginning on day 56 and mycophenolate mofetil PO every 12 hours on days 0-27.
After completion of study treatment, patients are followed up at 12 and 18 months and then
annually for 5 years.
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