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Sponsored by: |
National Heart, Lung, and Blood Institute (NHLBI) |
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Information provided by: | National Institutes of Health Clinical Center (CC) |
ClinicalTrials.gov Identifier: | NCT00859586 |
Patients receiving allogeneic stem cell transplantation for hematological malignancies who suffer a relapse of their disease post-transplant have limited treatment options and a poor prognosis. With the exception of patients with chronic leukemias who may achieve prolonged remissions after donor lymphocyte infusions (DLIs), treatments using either chemotherapy or a DLI achieve less than a 10% median survival beyond 6 months. Most of these patients die of progressive leukemia, underlying the need for new therapeutic approaches.
HLA-mismatched DLIs appear to possess a more potent graft-versus-leukemia (GvL) effect. However, when given after an HLA-mismatched transplant DLIs have a high risk of causing graft-versus-host disease (GvHD) which can be severe. To reduce the risk of GvHD, infusions of mismatched lymphocytes from an alternative donor may be used to avoid permanent engraftment and associated risk of GvHD.
In this study, we propose to use a novel strategy to treat leukemias relapsing after HLA matched allogeneic stem cell transplantation by using haplo-identical DLIs to promote the associated antileukemic effect while minimizing the possibility of permanent engraftment and associated GvHD. To achieve only temporary engraftment and to promote disease control we will give cyclophosphamide and fludarabine immunosuppression prior to the DLI. We anticipate the infusion of HLA-mismatched donor lymphocytes in this setting will produce no detectible engraftment or only temporary engraftment, but may result in a strong GvL effect regardless of engraftment outcome. We will select patients for this protocol who fall into the worst category for post-transplant relapse. Specifically, we will enroll patients with acute leukemia or MDS relapsing within 6 months of transplant, of which less than 5% survive beyond a year from relapse.
The primary objective of this phase II clinical trial will be to evaluate the safety and efficacy of using a non-engraftment model and a lymphocytes infusion from a haplo-identical donor to treat relapsed disease following matched sibling stem cell transplantation in subjects who are not candidates for alternative treatment options.
We therefore propose this is a phase II clinical trial the primary objective of which is to evaluate the safety and efficacy of a novel non-myeloablative but highly immunosuppressive disease specific conditioning regimen and infusion of unmanipulated lymphocytes from a haplo-identical donor ...
Condition | Intervention | Phase |
---|---|---|
Leukemia, Myeloid, Acute Leukemia, Lymphoblastic, Acute Leukemia, Myelocytic, Chronic |
Other: Allogeneic Lymphocytes Drug: Fludarabine Drug: Cyclophosphamide Drug: Methylprednisolone Drug: Cyclosporine |
Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Factorial Assignment, Safety/Efficacy Study |
Official Title: | Mismatched Donor Lymphocyte Infusions for Relapsed Disease Following Allogeneic Stem Cell Transplantation |
Estimated Enrollment: | 40 |
Study Start Date: | February 2009 |
Patients receiving allogeneic stem cell transplantation for hematological malignancies who suffer a relapse of their disease post-transplant have limited treatment options and a poor prognosis. With the exception of patients with chronic leukemias who may achieve prolonged remissions after donor lymphocyte infusions (DLIs), treatments using either chemotherapy or a DLI achieve less than a 10% median survival beyond 6 months. Most of these patients die of progressive leukemia, underlying the need for new therapeutic approaches.
HLA-mismatched DLIs appear to possess a more potent graft-versus-leukemia (GvL) effect. However, when given after an HLA-mismatched transplant DLIs have a high risk of causing graft-versus-host disease (GvHD) which can be severe. To reduce the risk of GvHD, infusions of mismatched lymphocytes from an alternative donor may be used to avoid permanent engraftment and associated risk of GvHD.
In this study, we propose to use a novel strategy to treat leukemias relapsing after HLA matched allogeneic stem cell transplantation by using haplo-identical DLIs to promote the associated antileukemic effect while minimizing the possibility of permanent engraftment and associated GvHD. To achieve only temporary engraftment and to promote disease control we will give cyclophosphamide and fludarabine immunosuppression prior to the DLI. We anticipate the infusion of HLA-mismatched donor lymphocytes in this setting will produce no detectible engraftment or only temporary engraftment, but may result in a strong GvL effect regardless of engraftment outcome. We will select patients for this protocol who fall into the worst category for post-transplant relapse. Specifically, we will enroll patients with acute leukemia or MDS relapsing within 6 months of transplant, of which less than 5% survive beyond a year from relapse.
The primary objective of this phase II clinical trial will be to evaluate the safety and efficacy of using a non-engraftment model and a lymphocytes infusion from a haplo-identical donor to treat relapsed disease following matched sibling stem cell transplantation in subjects who are not candidates for alternative treatment options.
We therefore propose this is a phase II clinical trial the primary objective of which is to evaluate the safety and efficacy of a novel non-myeloablative but highly immunosuppressive disease specific conditioning regimen and infusion of unmanipulated lymphocytes from a haplo-identical donor in subjects with relapsed disease following matched sibling stem cell transplantation who are not candidates for alternative treatment options.
The primary endpoint of this phase 2 study is survival at 6 month post-relapse of disease. Successful outcome of the study will be a survival 100% greater than the NHLBI historical 25% at 6 months.
Secondary endpoints will include: incidence and severity induced GvHD, proportion of DLI engraftment, peak chimerism, leukemia response at days post DLI, residual leukemia measured by patient chimerism, leukemia free survival from date relapse, safety of the mismatched DLI procedure.
Ages Eligible for Study: | 8 Years to 75 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria- Recipient:
Diagnosed with one of the following hematological conditions:
Exclusion Criteria - Recipient (any of the following):
Inclusion Criteria- Stem Cell Donors:
Exclusion Criteria - Stem Cell Donor (any of the following):
Inclusion criteria- Haplo Lymphocyte Donors:
Exclusion Criteria - Haplo Lymphocyte Donor (any of the following):
Contact: Patient Recruitment and Public Liaison Office | (800) 411-1222 | prpl@mail.cc.nih.gov |
Contact: TTY | 1-866-411-1010 |
United States, Maryland | |
National Institutes of Health Clinical Center, 9000 Rockville Pike | Recruiting |
Bethesda, Maryland, United States, 20892 |
Responsible Party: | National Institutes of Health ( Zachariah A. McIver, D.O./National Heart, Lung, and Blood Institute ) |
Study ID Numbers: | 090087, 09-H-0087 |
Study First Received: | March 10, 2009 |
Last Updated: | May 1, 2009 |
ClinicalTrials.gov Identifier: | NCT00859586 History of Changes |
Health Authority: | United States: Federal Government |
Acute Myelogenous Leukemia (AML) Acute Lymphoblastic Leukemia (ALL) Chronic Lymphocytic Leukemia Myelodyplastic Syndrome (MDS) Acute Myelogenous Leukemia AML |
Acute Lymphoblastic Leukemia ALL Chronic Lymphocytic Leukemia Myelodysplastic Syndrome MDS |
Anti-Inflammatory Agents Cyclosporine Methylprednisolone Miconazole Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Antiemetics Cyclosporins Hormones Acute Myelocytic Leukemia Preleukemia Acute Myeloid Leukemia, Adult Leukemia, Lymphocytic, Chronic, B-Cell Methylprednisolone Hemisuccinate Precursor Cell Lymphoblastic Leukemia-Lymphoma |
Immunoproliferative Disorders Antineoplastic Agents, Hormonal Hematologic Diseases Myeloproliferative Disorders Leukemia, Myeloid Glucocorticoids Fludarabine Leukemia, Lymphoid Immunologic Factors Clotrimazole Prednisolone acetate Cyclophosphamide Leukemia, Myeloid, Acute Neuroprotective Agents Leukemia |
Anti-Inflammatory Agents Anti-Infective Agents Cyclosporine Molecular Mechanisms of Pharmacological Action Methylprednisolone Physiological Effects of Drugs Hormones, Hormone Substitutes, and Hormone Antagonists Antiemetics Cyclosporins Hormones Therapeutic Uses Dermatologic Agents Methylprednisolone Hemisuccinate Precursor Cell Lymphoblastic Leukemia-Lymphoma Immunoproliferative Disorders |
Antineoplastic Agents, Hormonal Immune System Diseases Hematologic Diseases Myeloproliferative Disorders Leukemia, Myeloid Glucocorticoids Neoplasms Fludarabine Leukemia, Lymphoid Immunologic Factors Antineoplastic Agents Prednisolone acetate Cyclophosphamide Leukemia, Myeloid, Acute Neuroprotective Agents |