EWINGS SARCOMA Clinical Trial
Official title:
A Phase I Study to Examine the Toxicity of Allogeneneic Stem Cell Transplantation for Relapsed or Therapy Refractory Ewings
The purpose of this study is to examine the toxicity of using allogeneic stem cell transplantation for treatment of subjects with relapsed or refractory ES and rhabdomyosarcoma. This is a nanrandomized two-arm study is designed to determine the safety and incidence of graft versus host disease (GVHD) in patients with relapsed, refractory Ewings sarcoma receiving related and unrelated, allogeneic stem cell transplants.
This study will examine the toxicity of using allogeneic stem cell transplantation for
treatment of subjects with relapsed or refractory ES and rhabdomyosarcoma. Donors will
consist of either HLA identical or 9/10 (A, B, C, DR, DQ) matched related or unrelated
donors. Specifically, we will examine the toxicity of allogeneic stem cell transplant (SCT)
in this patient population, as related to incidence of grade 3-4 acute GVHD and the
incidence of transplant related mortality at 100 days by using the following treatment
plans.
Rabbit anti-thymocyte globulin (ATG; thymoglobulin) will be given only to unrelated donor
transplant recipients at a dose of 3 mg/kg/day I.V. for 3 consecutive days (Days -8 to-6).
Equine ATG at a dose of 30mg/kg/day may be substituted in the event of severe allergic
reaction to the rabbit ATG.
Busulfan (BU) will be given at a dose of 0.8 mg/kg IV q 6 hours, for 16 doses on days -8
through -5. Busulfan doses will be modified based upon pharmacokinetics data to maintain
steady state levels of 600-900 ng/dl. Patients should start seizure prophylaxis with
levetiracetam prior to the first dose of busulfan and discontinued 24 hours after the last
dose of busulfan.
Melphalan will be given at a dose of 60 mg/m2 I.V. over 15-20 min on days -4 through -2 as
per Pediatric SCT Standards of Practice Manual.
Fludarabine will be given at a dose of 30 mg/m2/day IV over 30 minutes for 5 doses on days
-8 through -4.
Cyclophosphamide will be given at a dose of 50 mg/kg/day IV over 2 hours for 4 doses on days
-5 through -2.
Subjects will receive tacrolimus and short course mycophenolate for prohpylactic Therapy
incase of Acute Graft-versus-Host Disease.
The following procedures will also be completed throughout this study.
Physical exams and medical histories Frequent blood tests to monitor blood counts, blood
chemistries, liver and kidney function Blood tests to determine exposure to various viruses,
including viruses that cause hepatitis (inflammation of the liver), the human
immunodeficiency virus (HIV, the virus that causes AIDS) and cytomegalovirus Pregnancy test
for females of childbearing age Bone Marrow biopsies and aspirates Tests to monitor lung and
heart function Evaluations and biopsies to monitor GVHD X-rays, CT or MRI scans for tumor
measurements at 1, 3, 6 and 12 months and then at least annually thereafter.
If subjects agree to participate in this research study, they will receive several drugs
before the SCT. Various methods will be used to administer medications such asPO, IV, or
Central Line placement.
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