Pentostatin in Treating Patients With Refractory Chronic Graft-Versus-Host Disease

Graft Versus Host Disease Clinical Trial

Official title:

A Phase II Trial Of Intravenous Pentostatin For The Treatment Of Patients With Refractory Chronic Graft-Versus-Host Disease

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00074035
• Other study ID #: CALGB-100101
• Secondary ID: U10CA031946CDR00
• Status: Completed
• Phase: Phase 2
• Start date: December 2003
• Est. completion date: November 1, 2014

Study information

• Verified date: October 2021
• Source: Alliance for Clinical Trials in Oncology
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

RATIONALE: Pentostatin may be effective in treating chronic graft-versus-host disease by stopping the immune system from rejecting donor stem cells or donor white blood cells.

PURPOSE: This phase II trial is studying how well pentostatin works in treating patients with chronic graft-versus-host disease that is refractory (not responsive) to treatment with steroids.

Description:

OBJECTIVES:

Primary

• Determine the response rate in patients with refractory chronic graft-versus-host disease treated with pentostatin.

Secondary

• Determine the time to next immunosuppressive agent (i.e., the time to progression from best response) in patients treated with this drug.

• Determine the toxicity of this drug in these patients.

• Determine the infection rate in patients treated with this drug.

• Determine the pharmacokinetics of this drug in these patients.

• Determine the changes in lymphocyte populations in patients treated with this drug.

• Determine the survival of patients treated with this drug.

OUTLINE: This is a multicenter study.

Patients receive pentostatin IV over 20-30 minutes on day 1. Treatment repeats every 14 days for 6 courses in the absence of disease progression or unacceptable toxicity.

Patients who achieve a complete response after 6 courses receive 4 additional courses. Patients who achieve a partial response, minor response, or stable disease after 6 courses may receive up to 6 additional courses.

Patients are followed every 4 weeks for 1 year, every 3 months for 2 years, and then annually for 5 years.

PROJECTED ACCRUAL: Approximately 37 patients will be accrued for this study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 39
• Est. completion date: November 1, 2014
• Est. primary completion date: August 2008
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

1. Histologic documentation of chronic GvHD following allogeneic HCT or donor lymphocyte infusion.

2. Patients may have progressive, quiescent, or de novo onset chronic GvHD.

3. Patients with extensive stage chronic GvHD requiring systemic immunosuppressive therapy are eligible. Patients with limited stage disease are excluded. Extensive stage is defined according to Seattle criteria (9) as either:

• Generalized skin involvement or

• Limited skin involvement or hepatic involvement with any one of the following:

• Liver histology showing chronic progressive hepatitis, bridging necrosis or cirrhosis

• Eye involvement (Schirmer's test with < 5 mm wetting)

• Involvement of minor salivary glands or oral mucosa

• Involvement of any other organ

4. Patients must have failed treatment with, or experience progression after, prior corticosteroids for extensive stage chronic GvHD, as defined below.

4.1 Patients will be considered to have failed corticosteroids if they have any one of the following criteria:

• Progressive disease or less than a minor response in any organ system despite 2 weeks on corticosteroid treatment at least 1 mg/kg methylprednisolone or equivalent.

• Failure to achieve at least a minor response after at least 4 weeks of treatment with a dose of = 0.5 mg/kg methylprednisolone or equivalent.

• Achievement of less than a partial response at 8 weeks of corticosteroid treatment despite use of a dose = 0.5 mg/kg methylprednisolone or equivalent.

• Requirement of = 0.5 mg/kg methylprednisolone or equivalent to maintain a partial response or better at 12 weeks of corticosteroid treatment.

• Requirement of > 10 mg/kg methylprednisolone or equivalent to maintain a partial response or better at 18 weeks of corticosteroid treatment.

4.2 Patients with progression of extensive stage chronic GvHD after a prior history of treatment with at least 18 weeks of corticosteroids, now requiring the reintroduction of corticosteroids (> 10 mg/day methylprednisolone or equivalent) or an additional agent (including photopheresis, PUVA) for treatment.

5. Patients with established chronic GvHD not improving or progressing on other immunosuppressive agents are also eligible if steroid refractoriness has been established previously.

6. Age = 18 years

7. Performance Status 0-3

8. Patients on mechanical ventilation are excluded.

9. No active infection. Patients with active infection requiring antibiotic therapy are not eligible until infection is controlled.

10. No HIV infection. Patients with HIV infection are excluded because of safety concerns in this patient population.

11. Non-pregnant and non-nursing. Women and men of reproductive potential should agree to use an appropriate method of birth control throughout their participation in this study due to the teratogenic potential of the therapy utilized in this trial (although it is unlikely that successful pregnancy will occur in patients with chronic GvHD). Appropriate methods of birth control include oral contraceptives, implantable hormonal contraceptives (Norplant®), or double barrier method (diaphragm plus condom).

12. Required Initial Laboratory Values:

• Calc. Creatinine Clearance = 30 mL/min/1.73 m^2

• ANC > 1000/µL

• Platelets > 50,000/µL without transfusion

Related Conditions & MeSH terms

• Graft Versus Host Disease
• Graft vs Host Disease

Intervention

Drug:
• pentostatin
4 mg/sq m IV infusion over 20-30 min q 2 weeks

Locations

Country	Name	City	State
United States	Greenebaum Cancer Center at University of Maryland Medical Center	Baltimore	Maryland
United States	University of Chicago Cancer Research Center	Chicago	Illinois
United States	University of Illinois Cancer Center	Chicago	Illinois
United States	Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center	Columbus	Ohio
United States	Duke Comprehensive Cancer Center	Durham	North Carolina
United States	Union Hospital Cancer Program at Union Hospital	Elkton	Maryland
United States	Tunnell Cancer Center at Beebe Medical Center	Lewes	Delaware
United States	New York Weill Cornell Cancer Center at Cornell University	New York	New York
United States	CCOP - Christiana Care Health Services	Newark	Delaware
United States	Abramson Cancer Center of the University of Pennsylvania	Philadelphia	Pennsylvania
United States	Fox Chase Cancer Center - Philadelphia	Philadelphia	Pennsylvania
United States	Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital	Pittsburgh	Pennsylvania
United States	Virginia Commonwealth University Massey Cancer Center	Richmond	Virginia
United States	Mayo Clinic Cancer Center	Rochester	Minnesota
United States	Cancer Institute of New Jersey at Cooper - Voorhees	Voorhees	New Jersey
United States	Wake Forest University Comprehensive Cancer Center	Winston-Salem	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
Alliance for Clinical Trials in Oncology	National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Pharmacokinetics Association Between Exposure and Response At 3 Months	The individual PK parameters will be derived by using a noncompartmental analysis of the plasma-concentration-time data	3 months
Primary	Response Rate	Percentage of participants who had a complete or partial response defined by the Hopkins scoring system.; A complete response is defined as the disappearance of signs and symptoms of chronic GVHD in all involved systems that is sustained for at lest 4 weeks. A partial response is an improvement by 2 or more points in at least one system score, which is sustained for at least 4 weeks, with no signs of worsening in others.	3 months
Secondary	Grade 3 or Higher Non-hematologic Adverse Events	Number of participants experiencing a grade 3, 4 or 5 clinically significant non-hematologic adverse events, at least possibly related to treatment.	Duration of treatment (up to 5 years)
Secondary	Overall Survival At 1 Year	Percentage of patients who were alive at 1 year.	1 year
Secondary	Overall Survival At 2 Years	Percentage of patients who were alive at 2 years.	2 year