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Phase II Study of a Non-Myeloablative Conditioning Regimen Comprising Fludarabine and Total Body Irradiation Followed By Allogeneic Peripheral Blood Stem Cell Transplantation in Patients With Imatinib Mesylate, Dasatinib, or Nilotinib-Responsive Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia or Chronic Myelogenous Leukemia in Blast Crisis
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Published Results Trial Contact Information Registry Information
Alternate Title
Fludarabine and Total-Body Irradiation Followed By Donor Peripheral
Stem Cell Transplant in Treating Patients With Acute Lymphoblastic Leukemia or
Chronic Myelogenous Leukemia That Has Responded to Treatment With Imatinib
Mesylate, Dasatinib, or Nilotinib
Basic Trial Information
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Protocol IDs
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Phase II, Phase I
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Treatment
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Active
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70 and under
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NCI
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FHCRC-1581.00 NCI-H02-0087, NCT00036738
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Objectives Primary - Determine whether the rate of leukemic relapse can be decreased for patients with imatinib mesylate, dasatinib, or nilotinib-responsive Philadelphia chromosome-positive acute lymphoblastic leukemia or chronic myelogenous leukemia in blast crisis treated with a non-myeloablative conditioning regimen comprising fludarabine and total body irradiation followed by allogeneic peripheral blood stem cell (PBSC) transplantation, compared to historical controls treated with high-dose conventional chemotherapy followed by allogeneic PBSC transplantation.
- Determine whether the rate of transplant-related mortality can be decreased in patients treated with this regimen.
Secondary - Evaluate whether donor lymphocyte infusions can be safely used in patients with mixed or full donor chimerism treated with this regimen as preemptive therapy to eliminate minimal residual disease.
Entry Criteria Disease Characteristics:
- Diagnosis of Philadelphia chromosome-positive
acute
lymphoblastic leukemia (Ph+ ALL) or chronic myelogenous leukemia in blast crisis
- Less than 15% blasts on morphologic bone marrow
evaluation after receiving
imatinib mesylate, dasatinib, or nilotinib
- Patients with no detectable Ph+ ALL by morphologic or molecular assay (i.e., complete remission) after treatment with imatinib mesylate, dasatinib, or nilotinib are eligible
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Patients who initially respond to imatinib mesylate, dasatinib, or nilotinib and then
progress are ineligible for nonmyeloablative stem cell transplantation on this protocol
- No CNS involvement with leukemia refractory to intrathecal chemotherapy
- Availability of an HLA-matched related or unrelated peripheral blood
stem cell
donor
- Related donors HLA genotypically identical for at
least 1 haplotype and may
be genotypically or phenotypically identical for
HLA-A, -B, -C, -DRB1, and -DQB1 alleles
OR - Unrelated donors meeting the following criteria:
- Matched for HLA-A, -B, -C, -DRB1, and -DQB1 by high-resolution typing
- Only a single allele disparity allowed for HLA-A, -B, or -C by high-resolution typing
- No bone marrow donors
Prior/Concurrent Therapy:
Biologic therapy: - See Disease Characteristics
- No concurrent growth factors until after day 21 post-transplantation
Chemotherapy: - See Disease Characteristics
Endocrine therapy: Radiotherapy: Surgery: Patient Characteristics:
Age: - 70 and under
- Patients age 12 and under are allowed at the discretion of the
protocol investigator
Performance status: - Karnofsky 60-100%
- Lansky play performance score 40-100% (for pediatric patients)
Life expectancy: Hematopoietic: - See Disease Characteristics
Hepatic: - No fulminant liver failure
- No cirrhosis of the liver with evidence of portal
hypertension
- No alcoholic hepatitis
- No esophageal varices
- No history of bleeding esophageal varices
- No hepatic encephalopathy
- No uncorrectable hepatic synthetic dysfunction, evidenced by
prolongation of PT
- No ascites related to portal hypertension
- No bacterial or fungal liver abscess
- No biliary obstruction
- No chronic viral hepatitis (with bilirubin greater than 3
mg/dL)
- No symptomatic biliary disease
Renal: - Creatinine ≤ 2 times upper limit of
normal
Cardiovascular: Pulmonary: - DLCO ≥ 30% predicted
- Total lung capacity ≥ 30%
- FEV1 ≥ 30%
- No requirement for continuous supplementary oxygen
Other: - Not pregnant or nursing
- Fertile patients must use effective barrier-method contraception
during and for 1 year after study completion of study treatment
- HIV negative
Expected Enrollment 25A total of 25 patients will be accrued for this study within 5 years. Outcomes Primary Outcome(s)Relapse-free survival < 40% at 1 year Transplant related mortality < 40% at 1 year
Outline This is a multicenter study. Patients receive oral imatinib mesylate, dasatinib, or nilotinib once daily beginning before study and
continuing until day -2 of study. Patients resume oral imatinib mesylate, dasatinib, or nilotinib once daily
beginning on day 14 or when blood counts recover after peripheral blood stem cell (PBSC) transplantation. - Transplantation: Patients receive a non-myeloablative conditioning
regimen comprising fludarabine IV on days -4 to -2 and total body irradiation
followed by filgrastim (G-CSF)-mobilized allogeneic PBSC transplantation on day 0.
- Graft-versus-host-disease (GVHD) prophylaxis: Patients receiving related
PBSC receive oral mycophenolate mofetil (MMF) twice daily on days 0-27 without
tapering. Patients receiving unrelated PBSC receive oral MMF three times daily on
days 0-40 followed by a taper on days 41-96 in the absence of GVHD or disease
progression. Adults receiving related PBSC receive cyclosporine (CYSP) orally
twice daily on days -3 to 56 followed by a taper on days 57-100. Children
receiving related donor PBSC receive CYSP IV twice or three times daily on days -3 to
56 followed by a taper on days 57-100. Adults receiving unrelated donor PBSC
receive oral CYSP twice daily on days -3 to 100 followed by a taper on days
101-177. Children receiving unrelated donor PBSC receive CYSP IV twice or three times daily on days -3 to 100 followed by a taper on days 101-177.
- CNS prophylaxis: Patients receive six doses of intrathecal methotrexate
or cytarabine beginning on day 32 after PBSC transplantation or when there is no evidence of
gross systemic leukemia. Patients who have a history of CNS leukemia at any
time and have not received prior cranio-spinal irradiation (CSI) before study
entry receive CSI for 11 days after PBSC transplantation when there is no evidence of gross
systemic leukemia.
Patients with persistent disease and no GVHD after stopping GVHD
prophylaxis receive donor lymphocyte infusion IV over 30 minutes once every 28 days for 3
doses. Patients are followed at 6, 9, 12, 18, and 24 months and then annually for 5 years. Published ResultsNorasetthada L, Maris MB, Sandmaier BM, et al.: Feasibility and toxicity of nonmyeloablative hematopoietic cell transplantation (HCT) with or without imatinib for Philadelphia chromosome (Ph+) acute lymphoblastic leukemia (ALL). [Abstract] Blood 104 (11): A-5056, 2004.
Trial Contact Information
Trial Lead Organizations Fred Hutchinson Cancer Research Center | | | George Georges, MD, Protocol chair | | | | Trial Sites
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U.S.A. |
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Colorado |
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Denver |
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| | | | | | | | Rocky Mountain Cancer Centers - Denver Midtown |
| | Michael Maris, MD | |
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Seattle |
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| | | Fred Hutchinson Cancer Research Center |
| | George Georges, MD | |
| Email:
ggeorges@fhcrc.org |
| | Seattle Cancer Care Alliance |
| | Clinical Trials Office - Seattle Cancer Care Alliance | |
| | Veterans Affairs Medical Center - Seattle |
| | Thomas R. Chauncey, MD, PhD | Ph: | 206-764-2709 | | 800-329-8387 |
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Registry Information | | Official Title | | Allogeneic Nonmyeloablative Hematopoietic Stem Cell Transplant for Patients with BCR-ABL Tyrosine Kinase Inhibitor Responsive PH+ Acute Leukemia - A Multi-Center Trial | | Trial Start Date | | 2001-07-13 | | Trial Completion Date | | 2010-07-13 (estimated) | | Registered in ClinicalTrials.gov | | NCT00036738 | | Date Submitted to PDQ | | 2002-02-27 | | Information Last Verified | | 2008-09-22 | | NCI Grant/Contract Number | | CA18029, CA15704, CA92058 |
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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