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Umbilical Cord Blood T-Regulatory Cell Infusion Followed by Donor Umbilical Cord Blood Transplant in Treating Patients With High-Risk Leukemia or Other Hematologic Diseases
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: Masonic Cancer Center, University of Minnesota
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00376519
  Purpose

RATIONALE: Giving chemotherapy, such as fludarabine and cyclophosphamide, and total-body irradiation before a donor umbilical cord blood stem cell transplant helps stop the growth of cancer or abnormal 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. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer or abnormal cells (graft-versus-tumor effect). Giving an infusion of the donor's T-regulatory cells before the transplant may help increase this effect. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after the transplant may stop this from happening.

PURPOSE: This phase I trial is studying the side effects and best dose of umbilical cord blood T-regulatory cell infusion followed by donor umbilical cord blood transplant in treating patients with high-risk leukemia or other hematologic diseases.


Condition Intervention Phase
Cancer-Related Problem/Condition
Chronic Myeloproliferative Disorders
Graft Versus Host Disease
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Drug: cyclophosphamide
Drug: cyclosporine
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Procedure: allogeneic hematopoietic stem cell transplantation
Procedure: total-body irradiation
Procedure: umbilical cord blood transplantation
Phase I

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Anemia Cancer Leukemia, Adult Acute Leukemia, Adult Chronic Lymphoma Multiple Myeloma
Drug Information available for: Cyclophosphamide Fludarabine Fludarabine monophosphate Cyclosporin Cyclosporine Mycophenolate Mofetil Mycophenolate mofetil hydrochloride
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Umbilical Cord Blood Transplant With Co-Infusion of T Regulatory Cells

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

Primary Outcome Measures:
  • Maximum tolerated dose of umbilical cord blood (UCB)-derived T-regulatory cells [ Designated as safety issue: Yes ]
  • Safety profile of UCB-derived T-regulatory cells [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Incidence of neutrophil recovery at day 42 and platelet recovery at day 180 [ Designated as safety issue: No ]
  • Incidence of double chimerism at day 21 [ Designated as safety issue: No ]
  • Incidence of grades II-IV and III-IV acute graft-versus-host disease (GVHD) at day 100 [ Designated as safety issue: No ]
  • Incidence of chronic GVHD at 1 year [ Designated as safety issue: No ]
  • Probability of survival at 100 days and 1 year [ Designated as safety issue: No ]

Estimated Enrollment: 24
Study Start Date: May 2007
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose of umbilical cord blood (UCB)-derived CD4- and CD25-positive T-regulatory (Treg) cell infusion followed by double unrelated donor UCB transplantation in patients with high-risk leukemia or other hematologic diseases.

Secondary

  • Determine the speed of neutrophil and platelet recovery at day 42 in these patients.
  • Determine the incidence of "double chimerism" (e.g., engraftment of both UCB units) at day 21 in these patients.
  • Determine the risk of severe grade III-IV acute graft-versus-host disease (GVHD) at day 100 in these patients.
  • Determine the risk of chronic GVHD at 1 year post transplantation in these patients.
  • Determine the probability of survival at 100 days and 1 year post transplantation in these patients.

OUTLINE: This is an open-label, dose-escalation study of CD4- and CD25-positive umbilical cord blood (UCB)-derived T-regulatory cells (Treg).

  • Preparative therapy: Patients receive fludarabine phosphate IV over 1 hour on days -9 to -7 and cyclophosphamide IV over 2 hours on days -8 and -7 (1 hour after fludarabine infusion). Patients then undergo total-body irradiation (TBI) twice daily on days -5 to -2.
  • UCB-derived Treg infusion: Patients receive UCB-derived Treg cells IV on day -1.
  • Double unrelated donor UCB transplantation: Patients undergo double unrelated donor UCB transplantation by IV infusion on day 0.
  • Graft-versus-host disease (GVHD) prophylaxis: Patients receive cyclosporine IV over 2 hours or orally 2 or 3 times daily beginning on day -3 and continuing until day 100, followed by a taper to day 180, in the absence of GVHD. Patients also receive mycophenolate mofetil (MMF) orally or IV twice daily on days -3 to 30 or 7 days after engraftment, whichever is later, in the absence of acute GVHD*. If no donor engraftment occurs, MMF may be continued at the discretion of the attending physician.

NOTE: *If the patient has acute GVHD requiring systemic therapy, MMF may be stopped 7 days after GVHD is controlled (e.g., resolution of skin rash, vomiting, and diarrhea).

Cohorts of 3-6 patients receive escalating doses of UCB-derived Treg cells until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience nonhematologic dose-limiting toxicity within 48 hours of Treg cell infusion. At least 6 patients are treated at the MTD.

PROJECTED ACCRUAL: A total of 24 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years 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)

      • In complete remission (CR) by morphology (< 5% blasts within normocellular bone marrow)
      • In second or greater CR OR in high-risk first CR (CR1) as evidenced by any of the following:

        • Preceding myelodysplastic syndromes (MDS)
        • High-risk cytogenetics (e.g., those associated with MDS or complex karyotype)
        • More than 2 courses were required to obtain CR
    • Acute lymphocytic leukemia (ALL) meeting 1 of the following criteria:

      • In high-risk CR1 as evidenced by either of the following:

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

      • Resistant to imatinib mesylate therapy
      • No active blast crisis
    • Myelodysplasia

      • Blasts < 10% by a representative bone marrow aspirate morphology (otherwise induction chemotherapy required pre-transplantation)
      • Meets 1 of the following criteria:

        • Intermediate-2 or high-risk (e.g., refractory anemia with excess blasts [RAEB] or refractory anemia with excess blasts in transformation [RAEBt]) International Prognostic Scoring System (IPSS) score
        • Refractory anemia with severe pancytopenia
        • High-risk cytogenetics
    • Advanced myelofibrosis
    • Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), marginal zone B-cell lymphoma or follicular lymphoma

      • Progressed after ≥ 2 prior therapies
      • Patients with bulky disease (nodal mass > 5 cm) should be considered for debulking chemotherapy before transplant
    • Lymphoplasmacytic lymphoma, mantle-cell lymphoma, or prolymphocytic leukemia

      • In CR1 or greater or in first partial remission (PR1) or greater after initial therapy
    • Large cell non-Hodgkin lymphoma (NHL)

      • Beyond CR2 or PR2
      • Patients in CR2 or PR2 with initial short remission (< 6 months) are eligible
    • Lymphoblastic lymphoma, Burkitt lymphoma, or other high-grade NHL

      • Patients with stage I or II disease must have progressed within the past year
      • Patients with stage III or IV disease must have completed initial therapy in CR1 or PR1
    • Multiple myeloma

      • Beyond PR2
      • Patients with chromosome 13 abnormalities, first response lasting < 6 months, or β-2 microglobulin > 3 mg/L maybe eligible after initial therapy
  • No available HLA-matched sibling donor
  • Must have 3 units of partially HLA-matched umbilical cord blood (UCB) available

    • One UCB unit identified as T-regulatory cells source

      • HLA-matched at 4-6/6 HLA antigens with the patient
    • Two UCB units identified as the hematopoietic stem cell (HSC) source

      • Each unit must be HLA-matched at 4-6/6 HLA-A and -B (at low to intermediate resolution) and -DRB1 (at high resolution) antigens with each other
      • The two UCB units must be ABO-matched
      • Total cryopreserved HSC graft cell dose must be > 2.5 x 10^7nucleated cells/kg recipient body weight
  • Must also be enrolled on UMN-2000LS068 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 80-100%
  • Creatinine ≤ 2.0 mg/dL OR creatinine clearance > 40 mL/min (if creatinine > 1.2 mg/dL or history of renal dysfunction)
  • Bilirubin ≤ 2 times normal
  • AST and ALT ≤ 2 times normal
  • Alkaline phosphatase ≤ 2 times normal
  • Pulmonary function > 50% normal
  • LVEF ≥ 45%
  • No evidence of HIV infection or known HIV-positive serology
  • No current active infection
  • Not pregnant or nursing

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No steroids prior to UCB infusion
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00376519

Locations
United States, Minnesota
Masonic Cancer Center at University of Minnesota
Minneapolis, Minnesota, United States, 55455
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
Principal Investigator: 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

Study ID Numbers: CDR0000491190, UMN-2005LS011, UMN-0502M67473, UMN-MT2005-01
Study First Received: September 13, 2006
Last Updated: November 16, 2008
ClinicalTrials.gov Identifier: NCT00376519  
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
graft versus host disease
adult acute lymphoblastic leukemia in remission
adult acute myeloid leukemia in remission
secondary acute myeloid leukemia
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)
refractory anemia with excess blasts in transformation
refractory anemia with excess blasts
de novo myelodysplastic syndromes
secondary myelodysplastic syndromes
previously treated myelodysplastic syndromes
chronic phase chronic myelogenous leukemia
relapsing chronic myelogenous leukemia
accelerated phase chronic myelogenous leukemia
refractory anemia
blastic phase chronic myelogenous leukemia
prolymphocytic leukemia
stage IV adult lymphoblastic lymphoma
recurrent adult Burkitt lymphoma
stage I adult Burkitt lymphoma
stage III adult Burkitt lymphoma
stage IV adult Burkitt lymphoma
noncontiguous stage II grade 3 follicular lymphoma
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
noncontiguous stage II mantle cell lymphoma

Study placed in the following topic categories:
Blast Crisis
Cyclosporine
Chronic myelogenous leukemia
Refractory anemia
Graft versus host disease
Miconazole
Lymphoma, Mantle-Cell
Cyclosporins
Lymphoma, large-cell, immunoblastic
Preleukemia
Leukemia, Prolymphocytic
Anemia, Refractory
Hemorrhagic Disorders
Multiple myeloma
Leukemia, Lymphocytic, Chronic, B-Cell
Mycophenolate mofetil
Lymphoma, Large-Cell, Anaplastic
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
Blood Coagulation Disorders
Acute myelogenous leukemia
Myeloproliferative Disorders
Leukemia, Myeloid

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 15, 2009