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Fludarabine, Cyclophosphamide, and Total-Body Irradiation in Treating Patients Who Are Undergoing an Umbilical Cord Blood Transplant for Hematologic Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), October 2008
Sponsors and Collaborators: Masonic Cancer Center, University of Minnesota
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00309842
  Purpose

RATIONALE: Giving chemotherapy drugs, such as fludarabine and cyclophosphamide, and total-body irradiation before a donor umbilical cord blood stem cell transplant helps stop the growth of cancer cells and prepares the patient's bone marrow for the stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil may stop this from happening.

PURPOSE: This phase II trial is studying how well giving fludarabine and cyclophosphamide together with total-body irradiation works in treating patients who are undergoing an umbilical cord blood transplant for hematologic cancer.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Drug: cyclophosphamide
Drug: cyclosporine
Drug: filgrastim
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Procedure: total-body irradiation
Procedure: umbilical cord blood transplantation
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Anemia Cancer Leukemia, Adult Acute Leukemia, Adult Chronic Leukemia, Childhood Lymphoma Multiple Myeloma
Drug Information available for: Cyclophosphamide Filgrastim Fludarabine Fludarabine monophosphate Cyclosporin Cyclosporine Mycophenolate Mofetil Mycophenolate mofetil hydrochloride
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label
Official Title: Transplantation of Unrelated Umbilical Cord Blood for Patients With Hematological Diseases With Cyclophosphamide/Fludarabine/Total Body Irradiation Myeloablative Preparative Regimen

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

Primary Outcome Measures:
  • Overall survival at 1 year [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Transplant-related mortality at 6 months after umbilical cord blood transplantation (UCBT) [ Designated as safety issue: No ]
  • Chimerism [ Designated as safety issue: No ]

Estimated Enrollment: 150
Study Start Date: July 2005
Estimated Primary Completion Date: August 2013 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the 1-year survival of patients undergoing unrelated umbilical cord blood transplantation (UCBT) for hematologic malignancies treated with myeloablative preparative regimen comprising fludarabine, cyclophosphamide, and fractionated total-body irradiation.

Secondary

  • Determine the incidence of transplant-related mortality at 6 months after UCBT.
  • Evaluate the pattern of chimerism after double UCBT.
  • Determine the incidence of neutrophil engraftment at day 42 after UCBT.
  • Determine the incidence of platelet engraftment at 1 year after UCBT.
  • Determine the incidence of grade II-IV and grade III-IV acute graft-versus-host disease (GVHD) at day 100 after UCBT.
  • Determine the incidence of chronic GVHD at 1 year after UCBT.
  • Determine the disease-free survival at 1 and 2 years after UCBT.
  • Determine the incidence of relapse at 1 and 2 years after UCBT.

OUTLINE: This is a nonrandomized, open-label, multicenter study.

  • Preparative Regimen: Patients receive fludarabine IV over 1 hour on days -8 to -6 and cyclophosphamide IV on days -7 and -6. Patients also undergo total-body irradiation twice daily on days -4 to -1.
  • Umbilical Cord Blood Transplantation (UCBT): Patients undergo 1 or 2 units of UCBT on day 0. Patients receive filgrastim (G-CSF) IV once daily beginning on day 1 and continuing until blood counts recover.
  • Graft-versus-host disease (GVHD) prophylaxis: Patients receive cyclosporine IV over 2 hours 2 or 3 times daily beginning on day -3 and continuing until day 100 followed by a taper until day 180. Patients also receive mycophenolate mofetil IV or orally 2 or 3 times a day beginning on day -3 and continuing until day 30 or 7 days after engraftment in the absence of acute GVHD.

After completion of study treatment, patients are followed periodically for at least 5 years.

PROJECTED ACCRUAL: A total of 150 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   up to 45 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following hematologic malignancies:

    • Acute myeloid leukemia (AML)

      • Disease in second or subsequent complete remission (CR)* OR in first CR* with high-risk features, as defined by 1 of the following:

        • Preceding myelodysplastic syndromes (MDS)
        • High-risk cytogenetics
        • Two or more courses of therapy required to obtain CR*
        • Erythroblastic or megakaryocytic leukemia
      • Very high-risk pediatric patients (< 21 years of age) are eligible provided M2 marrow ≤ 25% blasts after failing ≥ 1 course of prior chemotherapy
    • Acute lymphocytic leukemia (ALL)

      • Disease in second or subsequent CR* OR in first CR* with high-risk features, as defined by 1 of the following:

        • High-risk cytogenetics [t(9;22), t(1;19), t(4;11), or other MLL rearrangements]
        • More than 1 course of therapy required to obtain CR*
    • Chronic myelogenous leukemia

      • Not in refractory blast crisis
      • Must have failed or be intolerant to imatinib mesylate (for patients in first chronic phase)
    • Advanced myelofibrosis
    • MDS

      • Refractory anemia with severe pancytopenia or high-risk cytogenetics OR intermediate-2- or high-risk MDS by International Prognostic Scoring System, including any of the following:

        • Refractory anemia with excess blasts (RAEB)
        • RAEB in transformation
      • Blasts < 10% by a representative bone marrow aspirate morphology
    • Chronic lymphocytic leukemia

      • Disease progressed after ≥ 2 prior therapies
      • Patients with bulky disease (nodal mass > 5cm) may undergo debulking chemotherapy before transplantation
    • Prolymphocytic leukemia

      • Disease in first or subsequent CR or partial remission (PR) after initial therapy
    • Multiple myeloma, meeting 1 of the following criteria:

      • Beyond second PR
      • Completed initial therapy AND meets 1 of the following criteria:

        • Chromosome 13 abnormalities
        • First response lasted < 6 months
        • Beta-2 microglobulin > 3 mg/L
    • Any of the following non-Hodgkin's lymphoma (NHL)

      • Patients with small lymphocytic lymphoma, marginal zone B-Cell lymphoma, or follicular lymphoma must have disease progression after ≥ 2 prior therapies

        • Patients with bulky disease (nodal mass > 5cm) may undergo debulking chemotherapy before transplantation
      • Patients with lymphoplasmacytic lymphoma or mantle cell lymphoma must have undergone initial therapy and be in first or subsequent CR or PR
      • Patients with large cell NHL must meet both of the following criteria:

        • In second CR or PR with initial short remission (< 6 months) OR beyond second CR or PR
        • Not refractory to chemotherapy (i.e., progressive disease after > 2 salvage regimens)
      • Patients with lymphoblastic lymphoma, Burkitt's lymphoma, or other high-grade NHL must meet the following criteria:

        • Disease progressed within 1 year after initial therapy (for patients with stage I or II disease)
        • Competed initial therapy AND disease in first CR or PR (for patients with stage III or IV disease)
        • Not refractory to chemotherapy (i.e., progressive disease after > 2 salvage regimens) NOTE: *CR is defined by hematologic recovery AND marrow < 5% blasts by light microscopy with ≥ 15% cellularity (for patients with AML or ALL)
  • Must have HLA matched unrelated umbilical cord blood (UCB) donor available

    • Must be 4/6, 5/6, or 6/6 HLA-A, -B, and -DRB1 matched
    • May use 1 or 2 units of UCB

      • If using 2 units, each unit must be 4/6 HLA-A, -B, and -DRB1 matched to both the patient and the other unit
  • No HLA-identical related donor available 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.

PATIENT CHARACTERISTICS:

  • Karnofsky performance status (PS) 80-100% (for adult patients) OR Lansky PS 50-100% (for pediatric patients)
  • Creatinine ≤ 2.0 mg/dL (for adult patients) OR creatinine clearance > 40 mL/min (for pediatric patients)
  • AST and ALT ≤ 2 times upper limit of normal (ULN)
  • Alkaline phosphatase ≤ 2 times ULN
  • Bilirubin ≤ 2 times ULN
  • DLCO_corr > 50% of normal
  • LVEF ≥ 45%
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No Aspergillus or other mold infection within the past 30 days
  • No history of HIV infection
  • No other active infection at the time of study transplantation

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior alkylator therapy lasting > 12 months (6 months for alkylator therapy with extensive radiotherapy)
  • More than 6 months since prior myeloablative transplantation (for patients ≤ 18 years of age)
  • No prior myeloablative allogeneic or autologous transplantation (for patients > 18 years of age)
  • No other prior extensive therapy
  • No prior salvage therapy with yttrium Y 90 ibritumomab tiuxetan or iodine I 131 tositumomab
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00309842

Locations
United States, Minnesota
Masonic Cancer Center at University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Clinical Trials Office - Masonic Cancer Center at University o     612-624-2620        
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
Study Chair: Claudio G. Brunstein, MD, PhD Masonic Cancer Center, University of Minnesota
  More Information

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

Responsible Party: Masonic Cancer Center at University of Minnesota ( Claudio G. Brunstein )
Study ID Numbers: CDR0000450160, UMN-2005LS043, UMN-BMT-MT2005-10, UMN-MT2005-10, UMN-0507M71475
Study First Received: March 29, 2006
Last Updated: November 13, 2008
ClinicalTrials.gov Identifier: NCT00309842  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
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)
accelerated phase chronic myelogenous leukemia
adult acute lymphoblastic leukemia in remission
adult acute myeloid leukemia in remission
atypical chronic myeloid leukemia
childhood acute lymphoblastic leukemia in remission
childhood acute myeloid leukemia in remission
childhood chronic myelogenous leukemia
blastic phase chronic myelogenous leukemia
chronic idiopathic myelofibrosis
chronic myelomonocytic leukemia
childhood immunoblastic large cell lymphoma
chronic phase chronic myelogenous leukemia
de novo myelodysplastic syndromes
meningeal chronic myelogenous leukemia
extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
juvenile myelomonocytic leukemia
stage I adult Burkitt lymphoma
nodal marginal zone B-cell lymphoma
contiguous stage II adult Burkitt lymphoma
noncontiguous stage II adult Burkitt lymphoma
Waldenstrom macroglobulinemia
noncontiguous stage II adult immunoblastic large cell lymphoma
contiguous stage II adult immunoblastic large cell lymphoma
stage I adult immunoblastic large cell lymphoma
previously treated myelodysplastic syndromes

Study placed in the following topic categories:
Juvenile myelomonocytic leukemia
Blast Crisis
Cyclosporine
Chronic myelogenous leukemia
Chronic myelomonocytic leukemia
Refractory anemia
Miconazole
Lymphoma, Mantle-Cell
Cyclosporins
Small non-cleaved cell lymphoma
Lymphoma, large-cell, immunoblastic
Preleukemia
Leukemia, Prolymphocytic
Anemia, Refractory
Hemorrhagic Disorders
Multiple myeloma
Leukemia, Lymphocytic, Chronic, B-Cell
Mycophenolate mofetil
Neoplasm Metastasis
Acute myeloid leukemia, adult
Chronic lymphocytic leukemia
Myelodysplastic syndromes
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Leukemia, B-cell, chronic
Leukemia, Myelomonocytic, Chronic
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative
Blood Coagulation Disorders

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
Syndrome
Therapeutic Uses
Myeloablative Agonists
Cardiovascular Diseases
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Dermatologic Agents
Alkylating Agents

ClinicalTrials.gov processed this record on January 14, 2009