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Sponsors and Collaborators: |
University of Michigan Cancer Center Therakos Amgen |
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Information provided by: | University of Michigan Cancer Center |
ClinicalTrials.gov Identifier: | NCT00639717 |
This research study investigates the benefits and possible risks of adding both etanercept (Enbrel) and ECP (extracorporeal photopheresis) to the conventional preventative (or prophylactic) treatments for graft-versus-host disease (GVHD). GVHD is a common, serious, and too often fatal, complication after matched unrelated donor stem cell transplantation, regardless of the pre-transplant conditioning regimen used (full or reduced intensity).
Reduced intensity transplants which employ lower doses of chemotherapy during the conditioning phase of the transplant, are less toxic than full intensity transplants. Reduced intensity transplants may extend the unrelated donor transplant option to older patients or to patients with existing medical conditions or illness, where a full intensity transplant is not possible. To be successful, reduced intensity transplants need to offset any lower effectiveness in killing cancer cells during the conditioning phase, with the establishment of a donor cell, graft-versus-leukemia effect (GVL). The GVL effect and GVHD are associated with each other and therefore, the goal of GVHD prophylaxis for this study is not so much to prevent all GVHD, but rather to prevent serious and fatal acute GVHD.
Most GVHD-related deaths are either the direct consequence of severe GVHD or from infections associated with intense immunosuppression, a consequence of the standard treatments for acute GVHD, which almost always include high-dose steroids. A more effective prophylaxis therapy that allows for the GVL effect to develop, while limiting the exposure to high-dose steroids may reduce transplant mortality and morbidity. We also will study how key chemical and cellular factors relate to clinical outcome.
Condition | Intervention | Phase |
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Graft Versus Host Disease |
Procedure: stem cell transplant Drug: tacrolimus (standard GVHD prophylaxis) Drug: mycophenolate (standard GVHD prophylaxis) Drug: etanercept Drug: methoxsalen |
Phase II |
Study Type: | Interventional |
Study Design: | Prevention, Non-Randomized, Open Label, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Addition of Etanercept and Extracorporeal Photopheresis to Standard GVHD Prophylaxis in Patients Undergoing Reduced Intensity Unrelated Donor Hematopoietic Stem Cell Transplant |
Estimated Enrollment: | 48 |
Study Start Date: | October 2008 |
Estimated Study Completion Date: | September 2011 |
Estimated Primary Completion Date: | September 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
etanercept and ECP in addition to standard GVHD prevention
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Procedure: stem cell transplant
reduced intensity, matched unrelated donor stem cell transplant
Drug: tacrolimus (standard GVHD prophylaxis)
Tacrolimus(or cyclosporine when necessary) Tacrolimus will begin on day -3, IV or oral. Target trough level for tacrolimus is 8-12 ng/ml. In the absence of GVHD, tacrolimus tapering will begin on day +56 post transplant
Mycophenolate will begin on day 0 at 10 mg/kg/dose (up to 1 gram per dose) every 8 hours orally or intravenously and will continue until day 28.
Drug: etanercept
Etanercept will be given at a dose 0.4 mg/kg (actual weight) up to a maximum dose of 25 mg, subcutaneously, twice weekly from day 0 to day 56 (16 doses)
Drug: methoxsalen
Methoxsalen (UVADEX) treatments by Extracorporeal photopheresis (ECP) will be started day +28 post transplant and given weekly. On day +70 post transplant ECP frequency will be given every other week. On day +100 post transplant ECP will be given monthly until day +180 and stopped. |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Any disease for which unrelated donor transplant is appropriate is eligible except:
Exclusion Criteria:
Contact: Cancer Answer Line | 1 (800) 865 -1125 | canceranswerline@umich.edu |
United States, Michigan | |
University of Michigan Cancer Center | |
Ann Arbor, Michigan, United States, 48109 |
Principal Investigator: | John E Levine, MD | University of Michigan Cancer Center |
Responsible Party: | University of Michigan Cancer Center ( John E. Levine MD /Associate Professor, Departments of Pediatrics and Int. Medicine ) |
Study ID Numbers: | umcc 2008.003 |
Study First Received: | March 11, 2008 |
Last Updated: | September 25, 2008 |
ClinicalTrials.gov Identifier: | NCT00639717 |
Health Authority: | United States: Institutional Review Board |
GVHD |
Cyclosporine Methoxsalen Graft versus host disease Mycophenolate mofetil Graft vs Host Disease |
Tacrolimus TNFR-Fc fusion protein Cyclosporins Homologous wasting disease |
Anti-Inflammatory Agents Immune System Diseases Immunologic Factors Physiological Effects of Drugs Gastrointestinal Agents Immunosuppressive Agents Pharmacologic Actions Photosensitizing Agents Radiation-Sensitizing Agents |
Analgesics, Non-Narcotic Sensory System Agents Therapeutic Uses Anti-Inflammatory Agents, Non-Steroidal Peripheral Nervous System Agents Analgesics Antirheumatic Agents Central Nervous System Agents Dermatologic Agents |