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Fludarabine, Cyclophosphamide, and Total-Body Irradiation Followed By Umbilical Cord Blood Stem Cell Transplant, Cyclosporine, and Mycophenolate Mofetil in Treating Patients With Hematologic Cancer and Other Diseases
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), February 2009
First Received: June 22, 2006   Last Updated: February 10, 2009   History of Changes
Sponsors and Collaborators: Fred Hutchinson Cancer Research Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00343798
  Purpose

RATIONALE: Giving total-body irradiation and chemotherapy, such as cyclophosphamide and fludarabine, before a donor umbilical cord blood stem cell transplant helps stop the patient's immune system from rejecting the donor's stem cells and helps stop the growth of cancer or abnormal 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 before or after transplant may stop this from happening.

PURPOSE: This phase I trial is studying the side effects of fludarabine, cyclophosphamide, and total-body irradiation followed by umbilical cord blood stem cell transplant in treating patients with hematologic cancer and other diseases.


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

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Anemia Cancer Leukemia, Adult Acute Leukemia, Adult Chronic Leukemia, Childhood Lymphoma Multiple Myeloma Radiation Therapy
Drug Information available for: Cyclophosphamide Fludarabine Cyclosporine Fludarabine monophosphate Cyclosporin Mycophenolate mofetil hydrochloride Filgrastim Mycophenolate Mofetil
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label
Official Title: A Pilot Study to Evaluate the Co-Infusion of Ex Vivo Expanded Umbilical Cord Blood Progenitors With an Unmanipulated Cord Blood Graft in Patients Undergoing Umbilical Cord Blood Transplantation for Hematologic Malignancies

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

Primary Outcome Measures:
  • Severe (grade 3-4) acute graft-vs-host disease [ Designated as safety issue: No ]
  • Infusional toxicity [ Designated as safety issue: Yes ]
  • Graft failure [ Designated as safety issue: No ]

Estimated Enrollment: 15
Study Start Date: April 2006
Estimated Primary Completion Date: April 2014 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Examine the safety and toxicity when ex vivo-expanded umbilical cord blood (UCB) cells are infused with a second non-HLA-identical UCB graft after myeloablative therapy in patients with hematologic cancer and other diseases.
  • Examine the in vivo persistence of the ex vivo-expanded UCB cells in these patients.
  • Determine the kinetics and durability of hematopoietic reconstitution (time to engraftment) in patients treated with this regimen.
  • Determine the relative contribution to engraftment of the expanded UCB cells and the unmanipulated UCB cells in early and long-term engraftment by donor chimerisms in patients treated with this regimen.

Secondary

  • Estimate the incidence and severity of acute and chronic graft-vs-host disease (GVHD) in patients treated with Notch-expanded UCB cells.
  • Estimate the incidence of transplant-related mortality at day 100 in patients treated with this regimen.
  • Estimate the incidence of malignant relapse and probabilities of overall and event-free survival at 1 and 2 years post transplant in patients treated with this regimen.
  • Obtain preliminary data on the phenotype and function of immune cells recovering in patients treated with expanded and unmanipulated UCB grafts.

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

  • Myeloablative conditioning regimen: Patients receive fludarabine IV over 1 hour on days -8 to -6 and cyclophosphamide IV over 1 hour on days -7 and

    • 6. Patients also undergo total body irradiation (TBI) twice daily on days -4 to -1.
  • Umbilical cord blood transplantation (UCBT): Patients undergo UCBT on day 0 comprising unmanipulated umbilical cord blood IV over approximately 30 minutes followed 4-6 hours later by ex vivo-expanded umbilical cord blood cells IV over approximately 30 minutes. Beginning on day 1, patients receive filgrastim (G-CSF) IV once daily until blood count returns to normal.
  • Immunosuppressive therapy: Patients receive cyclosporine IV twice daily beginning on day -3 and continuing until day 100, followed by a taper (in the absence of graft-vs-host disease) until day 180. Patients also receive mycophenolate mofetil IV 3 times daily on days -3 to 5 and then orally (if tolerated) 3 times daily on days 6-30. After completion of UCBT, patients are followed periodically for 2 years.

PROJECTED ACCRUAL: A total of 15 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 in complete remission (CR), as defined by hematologic recovery and < 5% blasts by morphology within the bone marrow and a cellularity of ≥ 15%

      • Meets 1 of the following criteria:

        • In first complete remission (CR1) with any of the following high-risk features:

          • Preceding myelodysplastic syndromes (MDS)
          • High-risk cytogenetics (e.g., monosomy 5 or 7)
          • At least 2 courses of therapy were required to obtain CR
          • Erythroblastic or megakaryocytic leukemia
        • In ≥ second CR (CR2)
      • No acute leukemia in relapse, as defined by ≥ 5% marrow blasts by morphology

        • Patients < 21 years of age in early relapse, as defined by presence of minimal residual disease but in morphologic remission, are eligible
    • Acute lymphoblastic leukemia in CR, as defined by hematologic recovery and < 5% blasts by morphology within the bone marrow and a cellularity of ≥ 15%

      • Meets 1 of the following criteria:

        • In CR1 with any of the following high-risk features:

          • t[9;22], t[1;19], t[4;11], or other MLL rearrangements
          • Hypodiploid
          • More than 1 course of therapy was required to obtain CR
        • In ≥ CR2
      • No acute leukemia in relapse, as defined by ≥ 5% marrow blasts by morphology
    • Chronic myelogenous leukemia

      • Patients in blast crisis (BC) are eligible provided they received therapy and achieved accelerated or chronic phase

        • Patients who remain in BC are not eligible
      • Patients in first chronic phase are eligible provided they have failed or are intolerant to imatinib mesylate
    • Advanced myelofibrosis
    • MDS

      • Meets 1 of the following criteria:

        • International Prognostic Scoring System (IPSS) score intermediate-2 or high risk (refractory anemia [RA] with excess blasts [RAEB] or RAEB in transformation)
        • RA with severe pancytopenia
        • High-risk cytogenetics
      • Blasts must be < 10% morphologically in representative bone marrow aspirate (obtained < 2 weeks prior to study enrollment)
    • Lymphoblastic lymphoma, Burkitt's lymphoma, or other high-grade non-Hodgkin's lymphoma (NHL)

      • Meets 1 of the following stage criteria:

        • Stage I or II disease (for < 1 year) that progressed
        • Stage III or IV disease that was previously treated with initial therapy and subsequently progressed after being in CR or partial remission (PR)
      • No chemotherapy-refractory disease, defined as progressive disease after > 2 salvage regimens
    • Chronic lymphocytic leukemia/small lymphocytic lymphoma, marginal zone B-cell lymphoma, lymphoplasmacytic lymphoma, or follicular lymphoma

      • Progressed after at least two different prior therapies
      • Patients with bulky disease (nodal mass > 5 cm) should be considered for debulking chemotherapy before transplantation
    • Mantle cell lymphoma or prolymphocytic leukemia

      • Received initial therapy
      • In ≥ CR1 or ≥ first PR (PR1)
    • Large cell NHL

      • In > CR2 or > second PR (PR2)

        • Patients in CR2 or PR2 with initial short remission (< 6 months) are eligible
      • No chemotherapy-refractory disease, defined as progressive disease after > 2 salvage regimens
    • Multiple myeloma

      • In > PR2
      • Patients with chromosome 13 abnormalities, first response lasting < 6 months, or β-2 microglobulin > 3 mg/L, may be eligible provided they have received initial therapy
  • No active CNS leukemia involvement, defined as cerebrospinal fluid with > 5 WBC/mm^3 and malignant cells on cytospin
  • No 5/6 or 6/6 HLA-matched related donor available
  • No existing 0-1 HLA-A, -B, -C, -DRB1 and -DQB1 matched related or unrelated donor available
  • Umbilical cord blood (UCB) units available

    • Two UCB units must be 0-2 HLA-A, -B, and - DRB1 mismatched with the recipient and to each other

      • One unit ≥ 2.5 X 10^7 total nucleated cell (TNC)/kg (for unmanipulated cells) AND one unit ≥ 1.5 X 10^7 TNC/kg (for ex- vivo expansion cells)
    • A third unit of UCB ≥ 1.5 X 10^7 TNC/kg AND 0-2 HLA-A, -B, and -DRB1 mismatched with the recipient and to the other two UCB units 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:

  • Creatinine ≤ 2.0 mg/dL (adults)
  • Creatinine clearance > 60 mL/min (pediatrics)
  • Bilirubin ≤ 2 times upper limit of normal (ULN)
  • AST/ALT ≤ 2 times ULN
  • Corrected DLCO > 50% normal
  • LVEF ≥ 45%
  • Karnofsky performance status 70-100% (adults) OR Lansky performance status 50-100% (pediatrics)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective double-method contraception
  • No uncontrolled viral or bacterial infection
  • No active or recent (within the past 6 months) invasive fungal infection without Infectious Disease consult and approval
  • No HIV seropositivity

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior autologous or allogeneic stem cell transplantation with a myeloablative preparative regimen

    • If ≤ 18 years of age, prior myeloablative transplantation allowed provided it was completed > 6 months ago
  • More than 28 days since prior experimental drugs
  • No other concurrent experimental drugs
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00343798

Locations
United States, Washington
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98109
Contact: Colleen Delaney, MD, MSC     206-667-1385     sdelaney@fhcrc.org    
Seattle Cancer Care Alliance Recruiting
Seattle, Washington, United States, 98109-1023
Contact: Clinical Trials Office - Seattle Cancer Care Alliance     800-804-8824        
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: Colleen Delaney, MD, MSC Fred Hutchinson Cancer Research Center
  More Information

Additional Information:
Publications:
Delaney C: Delta1: a notch up on cord blood transplantation? [Abstract] Biol Blood Marrow Transplant 13 (11): A-9, 1395-6, 2007.

Study ID Numbers: CDR0000482298, FHCRC-2044.00, AMGEN-200981
Study First Received: June 22, 2006
Last Updated: February 10, 2009
ClinicalTrials.gov Identifier: NCT00343798     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
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)
childhood acute myeloid leukemia in remission
secondary acute myeloid leukemia
accelerated phase chronic myelogenous leukemia
childhood chronic myelogenous leukemia
chronic phase chronic myelogenous leukemia
chronic idiopathic myelofibrosis
refractory anemia with excess blasts in transformation
refractory anemia with excess blasts
refractory anemia
de novo myelodysplastic syndromes
secondary myelodysplastic syndromes
contiguous stage II adult lymphoblastic lymphoma
noncontiguous stage II adult lymphoblastic lymphoma
recurrent adult lymphoblastic lymphoma
recurrent childhood lymphoblastic lymphoma
stage I adult lymphoblastic lymphoma
stage I childhood lymphoblastic lymphoma
stage III adult lymphoblastic lymphoma
stage III childhood lymphoblastic lymphoma
stage IV adult lymphoblastic lymphoma
stage IV childhood lymphoblastic lymphoma
contiguous stage II adult Burkitt lymphoma
noncontiguous stage II adult Burkitt lymphoma
recurrent adult Burkitt lymphoma

Study placed in the following topic categories:
Cyclosporine
Miconazole
Lymphoma, Mantle-Cell
Mycophenolic Acid
Mantle Cell Lymphoma
Cyclosporins
Follicular Lymphoma
Refractory Anemia
Acute Erythroblastic Leukemia
Acute Myelocytic Leukemia
Preleukemia
Leukemia, Prolymphocytic
Anemia, Refractory
Hemorrhagic Disorders
Acute Myeloid Leukemia, Adult
Leukemia, Lymphocytic, Chronic, B-Cell
Mycophenolate mofetil
Neoplasm Metastasis
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Blood Coagulation Disorders
Myeloproliferative Disorders
Leukemia, Myeloid
Multiple Myeloma
Waldenstrom Macroglobulinemia
Leukemia, Erythroblastic, Acute
B-cell Lymphomas
Leukemia, Myeloid, Accelerated Phase

Additional relevant MeSH terms:
Anti-Infective Agents
Antimetabolites, Antineoplastic
Cyclosporine
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Mycophenolic Acid
Cyclosporins
Preleukemia
Hemorrhagic Disorders
Pathologic Processes
Therapeutic Uses
Mycophenolate mofetil
Cardiovascular Diseases
Dermatologic Agents
Immunoproliferative Disorders
Immune System Diseases
Hematologic Diseases
Myeloproliferative Disorders
Multiple Myeloma
Neoplasms
Fludarabine
Lymphoma, Non-Hodgkin
Antimetabolites
Precancerous Conditions
Immunologic Factors
Blood Protein Disorders
Antineoplastic Agents
Paraproteinemias
Cyclophosphamide
Antibiotics, Antineoplastic

ClinicalTrials.gov processed this record on May 07, 2009