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Haploidentical Stem Cell Transplant for Children Less Than Two Years With Hematologic Malignancies
This study is currently recruiting participants.
Verified by St. Jude Children's Research Hospital, November 2008
Sponsored by: St. Jude Children's Research Hospital
Information provided by: St. Jude Children's Research Hospital
ClinicalTrials.gov Identifier: NCT00145626
  Purpose

Recent studies of conventional chemotherapy for infants with high-risk hematologic malignancies show that the long-term disease-free survival is low. Although blood and marrow stem cell transplantation using an HLA identical sibling has improved the outcome for these children, less than 25% have this donor source available. Another option is haploidentical transplantation using a partially matched family member donor (i.e. parental donor).

Although haploidentical transplantation has proven curative for some patients, this procedure has been hindered by significant complications, primarily regimen-related toxicity including infection and graft versus host disease (GVHD). Building on prior institutional trials, this study will provide patients a haploidentical graft depleted of T lymphocytes using the investigational device, CliniMACS selection system. One week after the transplant procedure, patients will also receive an infusion of additional donor derived white blood cells called Natural Killer (NK) cells in an effort to decrease risks for rejection of the graft, disease relapse, and regimen related toxicity. The primary objective of the study is to evaluate 1 year survival in infants with high risk hematologic malignancies who receive this study treatment.


Condition Intervention Phase
Acute Myeloid Leukemia
Acute Lymphocytic Leukemia
Myelodysplasia
Chronic Myeloid Leukemia
Histiocytosis
Drug: Chemotherapy and antibodies
Device: Miltenyi Biotec CliniMACS
Procedure: Allogeneic stem cell transplantation
Phase II

MedlinePlus related topics: Cancer Leukemia, Childhood
Drug Information available for: Cyclophosphamide Melphalan Thiotepa Fludarabine Fludarabine monophosphate Immunoglobulins Globulin, Immune Melphalan hydrochloride Sarcolysin Muromonab CD3
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Efficacy Study
Official Title: HLA-Nonidentical Stem Cell and Natural Killer Cell Transplantation for Children Less the Two Years of Age With Hematologic Malignancies

Further study details as provided by St. Jude Children's Research Hospital:

Primary Outcome Measures:
  • To evaluate the one-year survival of infants with high-risk hematologic malignancies who receive a haploidentical transplant procedure using a non-TBI based preparative regimen and T-lymphocyte depleted graft with a subsequent infusion of donor NK cells. [ Time Frame: May 2009 ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 33
Study Start Date: May 2004
Estimated Study Completion Date: May 2011
Estimated Primary Completion Date: May 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1 Drug: Chemotherapy and antibodies
Study participants will receive a non-TBI based preparative regimen consisting of Cyclophosphamide, fludarabine, thiotepa, melphalan, and OKT3 followed by an infusion of a T-lymphocyte depleted haploidentical hematopoietic stem cell graft. Seven days posttransplant, participants will receive an infusion of additional donor derived cells called NK cells.
Device: Miltenyi Biotec CliniMACS
Stem cell selection device
Procedure: Allogeneic stem cell transplantation
Allogeneic natural killer (NK)cell infusion

Detailed Description:

Secondary objectives for this study include the following:

  • To estimate the incidence of three transplant-related adverse outcomes (i.e., regimen-related mortality, engraftment failure, and fatal acute GVHD) in the first 100 days after transplantation.
  • To estimate the incidence of chronic graft-versus-host disease.
  • To evaluate those factors that affect one-year survival.
  • To assess the kinetics of lymphohematopoietic reconstitution.
  • To assess the frequency and clinical relevance of minimal residual disease (MRD) before and after transplantation.
  • To evaluate the incidence of and risk factors for long-term neurocognitive deficit and organ dysfunction.
  Eligibility

Ages Eligible for Study:   up to 24 Months
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Must have one of the following diagnosis:

  • AML in remission or relapse (e.g., FAB M7 or biphenotypic leukemia)
  • High-risk ALL in first remission (e.g., poor responder to prednisone, Ph+ ALL)
  • ALL beyond first remission
  • Secondary leukemia
  • Primary myelodysplasia (including RAEB, RAEB-T, CMML, JCML, and JMML)
  • Chronic myeloid leukemia
  • Histiocytoses (including multi-system Langerhans' cell histiocytosis and hemophagocytic lymphohistiocytosis
  • Cannot have a suitable matched sibling donor available
  • Subjects must have adequate cardiac (heart), pulmonary (lung), renal (kidney), and hepatic (liver) function
  • Must not have any known allergies to mouse or rabbit proteins.
  • Must not have Down's syndrome.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00145626

Contacts
Contact: Wing H. Leung, M.D., PhD 1-866-278-5833 info@stjude.org

Locations
United States, Tennessee
St. Jude Children's Research Hospital Recruiting
Memphis, Tennessee, United States, 38105
Contact: Wing H. Leung, M.D., PhD     866-278-5833     info@stjude.org    
Principal Investigator: Wing H. Leung, M.D., PhD            
Sponsors and Collaborators
St. Jude Children's Research Hospital
Investigators
Principal Investigator: Wing H. Leung, M.D., PhD St. Jude Children's Research Hospital
  More Information

St. Jude Children's Research Hospital  This link exits the ClinicalTrials.gov site

Responsible Party: St. Jude Children's Research Hospital ( Wing H. Leung, M.D., PhD / Principal Investigator )
Study ID Numbers: INF-T2
Study First Received: September 1, 2005
Last Updated: November 4, 2008
ClinicalTrials.gov Identifier: NCT00145626  
Health Authority: United States: Food and Drug Administration

Keywords provided by St. Jude Children's Research Hospital:
Stem cell transplantation
Stem cell transplant
Haploidentical transplant

Study placed in the following topic categories:
Neural Tube Defects
Melphalan
Leukemia, Lymphoid
Hematologic Neoplasms
Precancerous Conditions
Chronic myelogenous leukemia
Nervous System Malformations
Cyclophosphamide
Leukemia, Myeloid, Acute
Muromonab-CD3
Leukemia
Preleukemia
Histiocytosis
Congenital Abnormalities
Lymphoma
Acute myelocytic leukemia
Immunoglobulins
Myelodysplastic syndromes
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Myelodysplastic Syndromes
Myelodysplasia
Acute myelogenous leukemia
Myeloproliferative Disorders
Fludarabine monophosphate
Leukemia, Myeloid
Thiotepa
Lymphatic Diseases
Antibodies

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Site
Neoplasms by Histologic Type
Reticuloendotheliosis
Immune System Diseases
Nervous System Diseases

ClinicalTrials.gov processed this record on January 16, 2009