Kidney Cancer Clinical Trial
Official title:
A Phase II Study of HLA-Matched Peripheral Blood Mobilized Hematopoietic Progenitor Cell Transplantation for Metastatic Renal Cell Carcinoma Followed by Allogeneic T-Cell Infusion as Adoptive Immunotherapy
RATIONALE: Giving low doses of chemotherapy, such as cyclophosphamide and fludarabine, before
a donor peripheral blood stem cell transplant helps stop the growth of tumor cells. It may
also stop 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 tumor cells
(graft-versus-tumor effect). Giving an infusion of the donor's T cells (donor lymphocyte
infusion) after the transplant may help increase this effect. Sometimes the transplanted
cells from a donor can also make an immune response against the body's normal cells. Giving
cyclosporine with or without mycophenolate mofetil or methotrexate after the transplant may
stop this from happening.
PURPOSE: This phase II trial is studying how well peripheral stem cell transplant works in
treating patients with metastatic kidney cancer.
OBJECTIVES:
- Determine the antitumor effect of allogeneic peripheral blood stem cell transplantation
(PBSCT) in patients with metastatic renal cell carcinoma.
- Evaluate the safety and toxicity of a nonmyeloablative, low-intensity, preparative
regimen followed by an HLA-matched allogeneic PBSCT in these patients.
- Determine engraftment by measuring donor-recipient chimerism in lymphoid and myeloid
lineages in patients treated with this regimen.
- Determine the relationship between donor-host chimerism and the incidence of acute and
chronic graft-versus-host disease in patients treated with this regimen.
- Determine the effect of lymphocyte infusions on donor-host chimerism in this patient
population.
- Determine the response rate, disease-free survival, overall survival, and mortality from
the procedure or tumor progression in patients treated with this regimen.
OUTLINE:
- Nonmyeloablative preparative regimen: Patients receive 1 of 3 preparative regimens prior
to peripheral blood progenitor cell (PBPC) transplantation. (Regimens 2 and 3 closed to
accrual as of 10/1/03.)
- Regimen 1: Patients receive cyclophosphamide IV over 1 hour on days -7 and -6 and
fludarabine IV over 30 minutes on days -5 to -1.
- Regimen 2 (closed to accrual as of 10/1/03): Patients receive cyclophosphamide IV
over 1 hour on days -7 and -6, fludarabine IV over 30 minutes on days -5 to -1, and
antithymocyte globulin on days -5 to -2.
- Regimen 3 (closed to accrual as of 10/1/03): Patients receive cyclophosphamide IV
over 1 hour on days -8 to -6, fludarabine IV over 30 minutes on days -5 to -1, and
antithymocyte globulin on days -5 to -2.
- PBPC transplantation: Patients undergo mobilized CD34+ PBPC transplantation on day 0.
PBPC transplantation may be repeated on days 1 and 2, if deemed necessary.
- Graft-versus-host disease (GVHD) prophylaxis: Patients receive 1 of 3 GVHD prophylaxis
regimens.
- Regimen 1 (closed to accrual as of 10/17/00): Patients receive cyclosporine IV over
12 hours or orally beginning on day -4 and continuing for up to approximately 3
months.
- Regimen 2 (open to accrual from 10/17/00 through 2/11/02): Patients receive
cyclosporine as in regimen 1. Patients also receive mycophenolate mofetil.
- Regimen 3 (open to accrual as of 2/11/02): Patients receive cyclosporine as in
regimen 1. Patients also receive methotrexate.
- Donor lymphocyte infusions: Patients with progressive disease on days 15-30, day 60, or
day 100, without GVHD, receive infusion(s) of donor lymphocytes. Further donor
lymphocyte infusions after day 100 may be given at the discretion of the attending
physician.
Patients are followed every 2 months for 6 months, every 3 months for 2 years, and then every
6 months for 2½ years.
PROJECTED ACCRUAL: A total of 80 patients will be accrued for this study.
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