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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00849147
Other study ID # BMTCTN0603
Secondary ID U01HL0692945U24C
Status Completed
Phase Phase 2
First received
Last updated
Start date October 2008
Est. completion date November 2013

Study information

Verified date December 2022
Source Medical College of Wisconsin
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Bone marrow transplants are one treatment option for people with leukemia or lymphoma. Family members or unrelated donors with a similar type of bone marrow usually donate their bone marrow to the transplant patients. This study will evaluate the effectiveness of a new type of bone marrow transplant-one that uses lower doses of chemotherapy and bone marrow donated from family members with only partially matched bone marrow-in people with leukemia or lymphoma.


Description:

Leukemia and lymphoma are types of blood cancers. Chemotherapy is a common treatment option for people with these types of cancers, but if the cancer does not respond well to chemotherapy, or if the cancer returns, a bone marrow transplant is another treatment option. In a bone marrow transplant procedure, healthy bone marrow is taken from a donor and transplanted into the patient. Bone marrow can be donated by a family member or an unrelated donor who has a similar type of bone marrow. Most bone marrow transplants are performed using a donor who is a perfect or close-to-perfect tissue match. However, for participants in this study, researchers have determined that a completely matched donor is unavailable within participants' families, and an unrelated donor match has not been found either. Participants do, however, have a family member who is a partial tissue match. Typically, people who are undergoing a bone marrow transplant receive high doses of chemotherapy before the transplant to prepare their bodies to accept the donor bone marrow. In this study, participants will undergo a new type of bone marrow transplant called a nonmyeloablative transplant, which is a reduced intensity method of transplantation that does not require high doses of chemotherapy. The purpose of the study is to examine the safety and effectiveness of a nonmyeloablative bone marrow transplant that uses partially matched bone marrow donated by a family member as a treatment option for people with leukemia or lymphoma. This study will enroll people with leukemia or lymphoma who have a family member with a partial tissue match. Participants will be admitted to the hospital and will first receive a type of chemotherapy called fludarabine, which will be given intravenously for 5 days. In addition, another type of chemotherapy, cyclophosphamide, will be given intravenously on the first and second day. After 5 days, participants will receive a small dose of radiation. The next day, participants will undergo the bone marrow transplant. The third and fourth day after the transplant, participants will receive high doses of cyclophosphamide to help prevent two complications, graft rejection, which occurs when the body's immune system rejects the donor bone marrow, and graft-versus-host disease (GVHD), which is an attack by the donor cells on the body's normal tissues. On the fifth day after the transplant, participants will receive two additional medications, tacrolimus and mycophenolate mofetil (MMF), to help prevent GVHD; some participants may receive cyclosporine instead of tacrolimus. Participants will receive MMF for about 5 weeks and tacrolimus for about 6 months. Also beginning on the fifth day after the transplant, participants will receive daily injections of a growth factor called granulocyte-colony stimulating factor (G-CSF), which is a natural protein that increases the white blood cell count; G-CSF will be continued until a participant's white blood cell count is normal again. Participants will remain in the hospital for approximately 2 to 3 months, but possibly longer if there are complications. While participants are in the hospital, blood samples will be collected regularly to evaluate the response and possible side effects to treatment, including GVHD. If necessary, participants will receive platelet and red blood cell transfusions. Follow-up study visits will occur 6 months and 1 year after the transplant. At Months 1, 2, 6, and 12 after the transplant, blood or bone marrow samples will be obtained. Study researchers will keep track of participants' medical condition through phone calls or mailings to participants and their doctors once a year for the rest of the participants' lives.


Recruitment information / eligibility

Status Completed
Enrollment 55
Est. completion date November 2013
Est. primary completion date June 2011
Accepts healthy volunteers No
Gender All
Age group 1 Year to 70 Years
Eligibility Inclusion Criteria: - Participants must be 21 to 70 years old; participants 1 to 21 years old are also eligible if they are ineligible for BMT CTN #0501 (NCT00412360) - Donor must be at least 18 years of age - Human leucocyte antigen (HLA) typing will be performed at high resolution (allele level) for the HLA-A, -B, Cw, DRB1, and -DQB1 loci. A minimum match of 5/10 is required. An unrelated donor search is not required for a person to be eligible for this study if the clinical situation dictates an urgent transplant. Clinical urgency is defined as 6 to 8 weeks from referral to transplant center or low likelihood of finding a matched, unrelated donor. The donor and recipient must be identical, as determined by high resolution typing, on at least one allele of each of the following genetic loci: HLA-A, HLA-B, HLA-Cw, HLA-DRB1, and HLA-DQB1. Fulfillment of this criterion shall be considered sufficient evidence that the donor and recipient share one HLA haplotype, and typing of additional family members is not required. - Must have received cytotoxic chemotherapy within 3 months of the consent date (measured from the start date of chemotherapy) - Acute leukemias (includes T lymphoblastic lymphoma) in the second or subsequent complete remission (CR) - Burkitt's lymphoma in the second or subsequent CR - Lymphoma - Patients with adequate physical function as measured by the following: 1. Heart: left ventricular ejection fraction at rest must be greater than or equal to 35%, or shortening fraction greater than 25% 2. Liver: bilirubin less than or equal to 2.5 mg/dL and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase less than five times the upper limit of normal 3. Kidney: serum creatinine within normal range for age, or if serum creatinine is outside the normal range for age, then kidney function (creatinine clearance or glomerular filtration rate (GFR) is greater than 40 mL/min/1.73m^2 4. Pulmonary: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and carbon monoxide diffusing capacity (DLCO) greater than 50% predicted (corrected for hemoglobin). If unable to perform pulmonary function tests, then oxygen (O2) saturation must be greater than 92% on room air. 5. Performance status: Karnofsky/Lansky score greater than or equal to 60% Exclusion Criteria: - Have an HLA-matched, related, or 7 or 8/8 allele matched (HLA-A, -B, -Cw, -DRB1) related donor able to donate - Had an autologous hematopoietic stem cell transplant in the 3 months before study entry - Pregnant or breastfeeding - Evidence of HIV infection or known HIV positive serology - Current uncontrolled bacterial, viral, or fungal infection (i.e., currently taking medication with evidence of progression of clinical symptoms or radiologic findings) - Prior allogeneic hematopoietic stem cell transplant - History of primary idiopathic myelofibrosis

Study Design


Related Conditions & MeSH terms


Intervention

Biological:
Haploidentical Bone Marrow Transplantation
The transplant preparative regimen is listed below. The - sign is the number of days before the transplant. Fludarabine: 30 mg/m2 intravenously (IV) on Days -6, -5, -4, -3, and -2 Cyclophosphamide (Cy): 14.5 mg/kg IV on Days -6 and -5 Total body irradiation (TBI): 200 centigray (cGy) on Day -1 Day 0 is the day of the infusion of non-T-cell depleted bone marrow. The bone marrow will be obtained from haploidentical related donor.
GVHD prophylaxis
The GVHD prophylaxis regimen will consist of the following: Cy: 50 mg/kg IV on Days 3 and 4 Tacrolimus: (IV or orally) beginning on Day 5 with dose adjusted to maintain a level of 5 to 15 mg/mL Mycophenolate mofetil (MMF): 15 mg/kg orally three times a day (TID) beginning on Day 5; maximum dose will be 1 g orally TID Granulocyte-colony stimulating factor (G-CSF) 5 mcg/kg/day beginning on Day 5 until absolute neutrophil count (ANC) is greater than or equal to 1,000/mm^3 for 3 consecutive days

Locations

Country Name City State
United States Bone Marrow Transplant Group of Georgia, Northside Hospital Atlanta Georgia
United States Johns Hopkins University/Sidney Kimmel Comprehensive Cancer Center (SKCCC) Baltimore Maryland
United States University of Maryland, Greenbaum Cancer Center Baltimore Maryland
United States DFCI, Massachusetts General Hospital Boston Massachusetts
United States Medical University of South Carolina Charleston South Carolina
United States Baylor University Medical Center Dallas Texas
United States Karmanos Cancer Institute, Children's Hospital of Michigan Detroit Michigan
United States City of Hope National Medical Center Duarte California
United States University of Florida College of Medicine (Shands) Gainesville Florida
United States Kapi'olani Medical Center for Women and Children, University of Hawaii Honolulu Hawaii
United States University of California San Diego Medical Center La Jolla California
United States Vanderbilt University Medical Center Nashville Tennessee
United States Fox Chase, Temple University Philadelphia Pennsylvania
United States Oregon Health & Science University Portland Oregon
United States Washington University, Barnes Jewish Hospital Saint Louis Missouri
United States Texas Transplant Institute San Antonio Texas
United States Fred Hutchinson Cancer Research Center Seattle Washington

Sponsors (5)

Lead Sponsor Collaborator
Medical College of Wisconsin Blood and Marrow Transplant Clinical Trials Network, National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), National Marrow Donor Program

Country where clinical trial is conducted

United States, 

References & Publications (2)

Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J, Devine SM, Wingard JR, Aljitawi OS, Cutler CS, Jagasia MH, Ballen KK, Eapen M, O'Donnell PV; Blood and Marrow Transplant Clinical Trials Network. Alternative donor transplantation after reduced — View Citation

Eapen M, O'Donnell P, Brunstein CG, Wu J, Barowski K, Mendizabal A, Fuchs EJ. Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies. Biol Blood Marrow Transplant. 2014 Oct;20(10) — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Overall Survival at 180 Days From the Time of Transplant Measured at Month 6 and Year 1
Secondary Neutrophil Recovery Cumulative incidence of neutrophil recovery >500/µL at day +56 Measured at Days 28, 56, 90, and 100
Secondary Primary Graft Failure Primary graft failure is defined as < 5% donor chimerism on all measurements. Measured at Day 67
Secondary Secondary Graft Failure Secondary graft failure is defined as initial recovery followed by neutropenia with < 5% donor chimerism. If no chimerism assays were performed and absolute neutrophil count is < 500/mm3, then it will be counted as a secondary graft failure. Measured at Day 100
Secondary Platelet Recovery Platelet Recovery to 20K Measured at Days 56, 90, and 100
Secondary Platelet Recovery Platelet Recovery to 50K Measured at Days 56, 90, and 100
Secondary Donor Cell Engraftment Marrow or Blood Sample. Donor cell engraftment is defined as donor chimerism = 5% on Day = 56 after transplantation. Chimerism should be evaluated on Days ~28, ~56, ~180, and ~365 after transplantation. Chimerism may be evaluated in whole blood or mononuclear fraction. Measured at Day 56
Secondary Acute Graft-versus-host Disease (GVHD) Measured at Day 100
Secondary Chronic GVHD Measured at Year 1
Secondary Progression-free Survival Progression-free survival is defined as the minimum time interval of the times to relapse/recurrence, to death or to last follow-up. Measured at Year 1
Secondary Treatment-related Mortality (TRM) Measured at 6 months and 1 year
Secondary Infections Number of infections; infections will be reported by anatomic site, date of onset, organism and resolution, if any. Patients will be followed for infection for 1 year post-transplant. Measured at Year 1
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