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Phase II Study of Nonmyeloablative Allogeneic Peripheral Blood Stem Cell Transplantation in Patients With Hematologic Malignancy or Aplastic Anemia
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Trial Contact Information Registry Information
Alternate Title
Peripheral Stem Cell Transplant in Treating Patients With Hematologic Cancer or Aplastic Anemia
Basic Trial Information
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Phase
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Type
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Status
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Age
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Sponsor
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Protocol IDs
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Phase II
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Treatment
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Active
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5 to 70
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NCI
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RPCI-RP-0105 NCT00053989, RP 01-05
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Objectives - Determine the safety and toxic effects of nonmyeloablative allogeneic peripheral blood stem cell transplantation in patients with a hematologic malignancy or aplastic anemia.
- Determine clinical response and overall outcome of patients treated with this regimen.
- Determine the incidence of graft-vs-tumor effect, graft-vs-host disease, and chimerism in patients treated with this regimen.
Entry Criteria Disease Characteristics:
- Diagnosis of aplastic anemia
- Severe disease
- Failed at least 1 course of standard immunosuppressive regimen with cyclosporine and anti-thymocyte globulin
OR
- Histologically confirmed hematologic malignancy including the following:
- Acute leukemia
- Any of the following types:
- Acute myeloid leukemia (AML) with antecedent myelodysplastic syndromes
- Secondary AML
- AML with high-risk cytogenetic abnormalities
- Acute lymphoblastic leukemia with high-risk cytogenetic abnormalities
- Resistant or recurrent disease after combination chemotherapy with at least 1 standard regimen
OR - In first remission at high risk of relapse
- Chronic myelogenous leukemia
- Chronic phase meeting at least 1 of the following criteria:
- Failed imatinib mesylate
- Failed interferon after at least 6 months of treatment with minimum of 21 million units of interferon per week
- Unable to tolerate interferon
- Accelerated phase (blasts less than 20%)
- Myeloproliferative and myelodysplastic syndromes
- Myelofibrosis (after splenectomy)
- Refractory anemia
- Refractory anemia with excess blasts
- Chronic myelomonocytic leukemia
- Lymphoproliferative disease
- Chronic lymphocytic leukemia
- Symptomatic disease after first-line chemotherapy
- Low-grade non-Hodgkin's lymphoma (recurrent or persistent)
- Symptomatic disease after first-line chemotherapy
- Multiple myeloma
- Progressive disease after autologous stem cell transplantation
- Waldenstrom's macroglobulinemia
- Failed 1 standard regimen
- Non-Hodgkin's lymphoma meeting the following criteria:
- Intermediate or high grade
- Controlled and chemosensitive disease
- First remission lymphoblastic or small non-cleaved cell lymphoma at high risk of relapse
- Hodgkin's lymphoma
- Relapsed and chemosensitive disease
- Not eligible for standard myeloablative allogeneic stem cell transplantation
- Availability of any of the following donor types:
- No uncontrolled CNS disease (for hematologic malignancies)
[Note: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.] Prior/Concurrent Therapy:
Biologic therapy - See Disease Characteristics
- At least 6 months since prior autologous bone marrow transplantation (BMT)
- At least 12 months since prior allogeneic BMT
Chemotherapy - See Disease Characteristics
- At least 4 weeks since prior chemotherapy
Endocrine therapy Radiotherapy - At least 4 weeks since prior radiotherapy
Surgery - At least 4 weeks since prior surgery
Patient Characteristics:
Age - 5 to 70 (if related donor transplantation)
- 5 to 55 (if unrelated donor transplantation)
Performance status Life expectancy Hematopoietic Hepatic - Bilirubin less than 3 times normal
- Alkaline phosphatase less than 3 times normal
- AST/ALT less than 3 times normal
- No Child's class B or C liver failure
Renal - Creatinine clearance greater than 40 mL/min
Cardiovascular - Cardiac ventricular ejection fraction at least 35% by MUGA
- No cardiovascular disease
Pulmonary - DLCO at least 40% of predicted, corrected for hemoglobin and/or alveolar ventilation
Other - Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- HIV antibody negative
- No uncontrolled diabetes mellitus
- No active serious infection
- No other disease that would preclude study therapy
- No other concurrent malignancy except non-melanoma skin cancer
- No concurrent serious psychiatric illness
Expected Enrollment 60A total of 30-60 patients will be accrued for this study within 6-7 years. Outcomes Primary Outcome(s)Safety Toxicity Clinical response Overall outcome Incidence of graft-vs-tumor effect, graft-vs-host disease, and chimerism
Outline - Preparative regimen:
- Matched related and unrelated donor transplantation:
- Patients receive cyclophosphamide IV over 2 hours on days -5 and -4 and fludarabine IV over 30 minutes on days -5 to -1.
- Cord blood transplantation:
- Patients receive the same regimen as above plus anti-thymocyte globulin IV over 4 hours on days -3 to -1.
- Graft-vs-host disease (GVHD) prophylaxis:
- Matched related and unrelated donor transplantation:
- Cord blood transplantation:
- Patients receive tacrolimus and MMF in the same regimen as above plus methylprednisolone twice daily on days 1-19 or until blood counts recover.
- Allogeneic stem cell reinfusion: Patients undergo allogeneic bone marrow or peripheral blood stem cell transplantation on day 0. Patients then receive sargramostim (GM-CSF) subcutaneously daily beginning on day 7 and continuing until blood counts recover.
- Donor lymphocyte infusion (DLI): Patients not converting to 100% donor T-cell chimerism by day 120 and showing signs of progresson of disease after tacrolimus and MMF withdrawal may receive DLI every 8 weeks for up to 3 infusions. Cord blood recipients do not receive DLI.
Patients are followed at day 100-120, every 3 months for 2 years, and then every 6 months for 3 years.
Trial Contact Information
Trial Lead Organizations Roswell Park Cancer Institute ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Philip McCarthy, MD, Protocol chair | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Trial Sites
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U.S.A. |
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New York |
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Buffalo |
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| | | | | | | | Roswell Park Cancer Institute |
| | Clinical Trials Office - Roswell Park Cancer Institute | |
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Registry Information | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Official Title | | Non-Myeloablative Allogeneic Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies and Aplastic Anemia | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Trial Start Date | | 2001-12-07 | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Trial Completion Date | | 2010-10-18 (estimated) | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Registered in ClinicalTrials.gov | | NCT00053989 | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Date Submitted to PDQ | | 2002-12-13 | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | Information Last Verified | | 2008-08-28 | ![](https://webarchive.library.unt.edu/eot2008/20081017234639im_/http://www.cancer.gov/images/spacer.gif) | NCI Grant/Contract Number | | CA16056 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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