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Donor Peripheral Stem Cell Transplant, Fludarabine, and Busulfan in Treating Patients With Hematologic Cancers
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
Sponsors and Collaborators: University of California, Davis
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00619645
  Purpose

RATIONALE: Giving chemotherapy drugs, such as fludarabine and busulfan, before a donor peripheral stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil before and after the transplant may stop this from happening.

PURPOSE: This phase II trial is studying the side effects of giving donor peripheral stem cell transplant together with fludarabine and busulfan and to see how well it works in treating patients with hematologic cancers.


Condition Intervention Phase
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Drug: busulfan
Drug: cyclosporine
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Procedure: allogeneic hematopoietic stem cell transplantation
Procedure: peripheral blood stem cell transplantation
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Anemia Cancer Hodgkin's Disease Leukemia, Adult Acute Leukemia, Adult Chronic Lymphoma Multiple Myeloma
Drug Information available for: Fludarabine Fludarabine monophosphate Cyclosporin Cyclosporine Mycophenolate Mofetil Mycophenolate mofetil hydrochloride Busulfan
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Reduced Intensity Stem Cell Transplantation (RIST) for Patients With Hematological Malignancies Conditioned With Fludarabine and Busulfan

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Day 100 transplant-related mortality [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Response [ Designated as safety issue: Yes ]
  • Engraftment [ Designated as safety issue: Yes ]
  • Acute and chronic graft-versus-host-disease [ Designated as safety issue: Yes ]
  • Degree of chimerism [ Designated as safety issue: No ]
  • Toxicity [ Designated as safety issue: Yes ]
  • Progression-free survival [ Designated as safety issue: Yes ]
  • Overall survival [ Designated as safety issue: Yes ]

Estimated Enrollment: 20
Study Start Date: June 2007
Estimated Primary Completion Date: October 2008 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • To assess the efficacy and toxicity of reduced-intensity allogeneic peripheral blood stem cell transplantation in patients with hematological malignancies treated with conditioning therapy comprising fludarabine phosphate and busulfan.
  • To evaluate progression-free survival and overall survival in patients treated with this regimen.
  • To determine donor chimerism.
  • To access the risk of acute and chronic graft-versus-host-disease (GVHD) in patients treated with this regimen.

OUTLINE:

  • Conditioning regimen: Patients receive busulfan IV over 3 hours on days -6 and -5 and fludarabine phosphate IV over 30 minutes on days -6 to -2.
  • Allogeneic peripheral blood stem cell transplant (PBSC): Patients undergo allogeneic PBSC on day 0.
  • Immunosuppressive therapy/graft-versus-host disease (GVHD) prophylaxis: Patients achieve100% donor T-cell chimerism on day 30 without disease recurrence, and cyclosporine A (CSA) IV continuously over 24 hours or orally every 12 hours on days -1 to 60 followed by a taper until day 100 and oral mycophenolate mofetil (MMF) once every 12 hours on days 1-40, in the absence of ≥ grade 2 GVHD.

Patients with recurrent disease or < 100% donor T-cell chimerism (on day 30) undergo a 12-day CSA and MMF taper followed by escalating doses of previously collected donor leukocyte infusion every 4 weeks until 100% donor T-cell chimerism or disease regression, in the absence of ≥ grade 2 GVHD.

After completion of study treatment, patients are followed periodically.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosed with any of the following:

    • Acute myeloid leukemia (AML), meeting 1 of the following criteria:

      • Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
      • In first complete remission (CR1) with poor-risk cytogenetics, antecedent hematological disease (i.e., myelodysplasia), or treatment-related leukemia
    • Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria:

      • Recurrent disease in remission, defined as morphological remission with bone marrow aspirate/biopsy showing ≤ 5% within 4 weeks before the start of study treatment (cytogenetic or molecular remission is not required)
      • CR1 with Philadelphia chromosome or poor-risk cytogenetics
    • Chronic myelogenous leukemia (CML), meeting the following criteria:

      • First or second chronic phase

        • Must be documented disease progression after imatinib mesylate therapy OR documented lack of cytogenetic response 6 months post-imatinib mesylate initiation OR imatinib mesylate intolerance
    • Chronic lymphocytic leukemia (CLL), meeting the following criteria:

      • Recurrent disease after fludarabine-based therapy

        • Must have chemosensitive disease at the time of relapse, defined as greater than 50% reduction of WBC and lymphadenopathy
    • Recurrent Hodgkin lymphoma, recurrent non-Hodgkin lymphoma (NHL) (low-, intermediate-, or high-grade disease*), or transformed NHL, meeting 1 of the following criteria:

      • Received prior autologous transplantation and cytoreductive therapy at the time of relapse to achieve complete remission (CR) or CR/unconfirmed (CRu) as defined by the International Workshop
      • Relapsed disease that required more than 2 salvage regimens to achieve CR or CRu
    • Recurrent multiple myeloma, meeting the following criteria:

      • Must have received prior autologous transplantation and demonstrate chemosensitivity at the time of relapse, defined as greater than 50% reduction of M-component or plasma-cell marrow infiltration
    • Myelodysplastic syndrome

      • Refractory anemia (RA)/RA with ringed sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD)/refractory cytopenia with multilineage dysplasia with ringed sideroblasts (RCMD-RS), or RA with excess blasts (RAEB) I, meeting the following criteria:

        • Must be transfusion-dependent and have an IPSS score ≥ 1.5, based on WHO criteria
        • No RAEB II or del(5q)
  • No uncontrolled CNS metastases
  • 5-6/6 HLA-matched sibling or 9-10/10 matched unrelated donor (both patient and donor) available NOTE: *A new classification scheme for adult non-Hodgkin 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.

PATIENT CHARACTERISTICS:

  • Karnofsky performance status ≥ 50%
  • Serum creatinine ≤ 2 mg/dL
  • Not pregnant
  • Fertile patients must use effective contraception
  • 50 years of age or older

    • Patients 18-50 years of age are eligible if meeting 1 of the following criteria:

      • Have a preexisting medical condition
      • Received prior therapy (i.e., autologous transplantation) and are considered to be too high risk for conventional myeloablative transplantation
  • Must be willing to accept or comprehend irreversible sterility as a side effect of therapy
  • No uncontrolled active infection
  • No psychiatric illness or mental deficiency making compliance with treatment or informed consent impossible
  • Cardiac ejection fraction ≥ 30%
  • Corrected pulmonary-diffusing capacity ≥ 35%
  • No serologic evidence of infection with HIV
  • No decompensated liver disease with serum bilirubin > 2.0 mg/dL

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00619645

Locations
United States, California
University of California Davis Cancer Center Recruiting
Sacramento, California, United States, 95817
Contact: Clinical Trials Office - University of California Davis Cancer     916-734-3089        
Sponsors and Collaborators
University of California, Davis
Investigators
Study Chair: Carol M. Richman, MD University of California, Davis
Investigator: Corinne Turrell, CCRP University of California, Davis
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: University of California Davis Cancer Center ( Carol M. Richman )
Study ID Numbers: CDR0000583059, UCD-196, UCD-200715041
Study First Received: February 20, 2008
Last Updated: December 23, 2008
ClinicalTrials.gov Identifier: NCT00619645  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent adult acute myeloid leukemia
adult acute lymphoblastic leukemia in remission
refractory anemia with excess blasts
refractory anemia with ringed sideroblasts
refractory anemia
refractory cytopenia with multilineage dysplasia
previously treated myelodysplastic syndromes
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia in remission
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
chronic phase chronic myelogenous leukemia
relapsing chronic myelogenous leukemia
refractory chronic lymphocytic leukemia
recurrent adult Hodgkin lymphoma
refractory multiple myeloma
recurrent adult acute lymphoblastic leukemia
stage III chronic lymphocytic leukemia
stage IV chronic lymphocytic leukemia
stage III adult Hodgkin lymphoma
stage IV adult Hodgkin lymphoma
secondary acute myeloid leukemia
recurrent small lymphocytic lymphoma
stage III small lymphocytic lymphoma
stage IV small lymphocytic lymphoma
stage III grade 1 follicular lymphoma
stage III grade 2 follicular lymphoma
stage III grade 3 follicular lymphoma

Study placed in the following topic categories:
Cyclosporine
Chronic myelogenous leukemia
Refractory anemia
Miconazole
Hodgkin lymphoma, adult
Lymphoma, small cleaved-cell, diffuse
Cyclosporins
Lymphoma, large-cell, immunoblastic
Preleukemia
Anemia, Refractory
Hemorrhagic Disorders
Multiple myeloma
Leukemia, Lymphocytic, Chronic, B-Cell
Mycophenolate mofetil
Neoplasm Metastasis
Acute myeloid leukemia, adult
Hodgkin Disease
Myelodysplastic syndromes
Chronic lymphocytic leukemia
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Leukemia, B-cell, chronic
Blood Coagulation Disorders
Acute myelogenous leukemia
Leukemia, Myeloid
Multiple Myeloma
Fludarabine
Lymphoma, Non-Hodgkin

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Antimetabolites, Antineoplastic
Neoplasms by Histologic Type
Disease
Molecular Mechanisms of Pharmacological Action
Immune System Diseases
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Enzyme Inhibitors
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Pathologic Processes
Antifungal Agents
Therapeutic Uses
Syndrome
Myeloablative Agonists
Cardiovascular Diseases
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Dermatologic Agents
Alkylating Agents

ClinicalTrials.gov processed this record on January 16, 2009