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Phase II/III Study of Standard and Novel Conditioning Therapy Followed By Allogeneic Stem Cell Transplantation in Patients With Severe Aplastic Anemia or Hematologic Malignancy
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Trial Contact Information Registry Information
Alternate Title
Combination Chemotherapy and Donor Stem Cell Transplant in Treating Patients With Aplastic Anemia or Hematologic Cancer
Basic Trial Information
Phase | Type | Status | Age | Protocol IDs |
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Phase III, Phase II | Treatment | Active | 4 to 70 | RPCI-RP-9815 NCI-V99-1527, NCT00003816, RP 98-15 |
Objectives - Compare the morbidity, mortality, and overall outcome of patients with severe aplastic anemia or hematologic malignancy treated with standard vs novel conditioning regimens followed by allogeneic stem cell transplantation.
- Examine the influence of donor histocompatibility on outcome by comparing matched/related, mismatched/related (with or without T-cell depletion), and matched/unrelated transplants with stratification for type of preparative regimen.
- Ensure that
patients with uncommon diagnoses will be treated in a uniform fashion with the best therapy
available.
Entry Criteria Disease Characteristics:
[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.] Prior/Concurrent Therapy:
Biologic therapy: Chemotherapy: - See Disease Characteristics
- Pretransplant cytoreductive chemotherapy allowed for patients
with relapsed or refractory disease
Endocrine therapy: Radiotherapy: - Not eligible for total-body irradiation if prior radiotherapy exceeded the
following limits:
- Mediastinum: 3,600 cGy
- Heart: 3,600 cGy
- Whole lungs: 1,200 cGy
- Small bowel: 3,600 cGy
- Kidneys: 1,200 cGy
- Whole liver: 1,600 cGy
- Cranial spinal: 3,600 cGy
- Brain: 4,000 cGy
- Retina: 4,000 cGy
Surgery: Patient Characteristics:
Age: Performance status: - Zubrod 0-2
OR - Karnofsky 70-100%
Life expectancy: Hematopoietic: - See Disease Characteristics
Hepatic: - Bilirubin < 3 times normal (unless due to
disease)
- Alkaline phosphatase < 3 times normal (unless due to
disease)
- SGOT < 3 times normal (unless due to disease)
- Hepatitis B surface antigen negative
- No severe hepatic disease that would preclude study participation
Renal: - Creatinine normal
- Creatinine clearance ≥ 50 mL/min
- No severe renal disease that would preclude study participation
Cardiovascular: - Cardiac ventricular ejection fraction ≥ 50% by
MUGA or echocardiogram
- No uncontrolled or severe cardiovascular disease (e.g., myocardial infarction, congestive
heart failure, symptomatic angina, life threatening arrhythmia, or
hypertension within the past 6 months)
Pulmonary: - DLCO or DLVA ≥ 50%
predicted (corrected for
hemoglobin or alveolar ventilation)
Other: - No serious concurrent medical or psychiatric illness
- No other serious organ dysfunction (unless due to underlying
disease), including the following:
- Uncontrolled bacterial, viral, or fungal infection
- Uncontrolled peptic ulcer disease
- Uncontrolled diabetes mellitus
- HIV negative
- Cytomegalovirus
status known
- Not pregnant
Expected Enrollment 405At least 405 patients will be accrued for this study within 5 years. Outcomes Primary Outcome(s)Activity of allogeneic stem cell transplant
Secondary Outcome(s)Influence of donor histocompatibility on outcome
Outline Patients are stratified according to risk of relapse
(standard-risk: acute leukemia in first complete remission, chronic
myelogenous leukemia in first chronic phase, lymphoma in sensitive first
relapse or second remission, primary or untreated myelodysplastic syndromes,
or untreated severe aplastic anemia vs high-risk: all others). Patients are assigned to one of the following conditioning regimens based on diagnosis, risk of relapse, and donor relatedness: - Regimen 1: Patients receive busulfan IV over 2 hours every 6 hours on days -7 to -4 and cyclophosphamide IV over 2 hours on days -3 and -2.
- Regimen 2: Patients receive cyclophosphamide IV over 2 hours on days -5 to -2
and anti-thymocyte globulin IV over 4-8 hours on days -5 to -3.
- Regimen 3: Patients receive cyclophosphamide IV over 2 hours on days -5 and -4
and total-body irradiation (TBI) twice daily on days -3 to -1.
- Regimen 4: Patients receive fludarabine IV over 30 minutes on days -6 to -2
and melphalan IV over 1 hour on days -3 and -2.
- Regimen 5: Patients receive etoposide IV over 26 hours beginning on day -5, cyclophosphamide IV over 2 hours on day -4, and TBI twice daily on days -3 to -1.
- Regimen 6: Patients receive cyclophosphamide IV over 24 hours, carboplatin IV over 24 hours, and thiotepa IV over 24 hours on days -7 to -4.
- Regimen 7: Patients receive fludarabine IV over 30 minutes on days -5 to -1 and anti-thymocyte globulin IV over 4-8 hours on days -5 to -2.
- Regimen 8: Patients receive cyclophosphamide IV over 2 hours on days -5 and -4, TBI twice daily on days -3 to -1, and anti-thymocyte globulin IV over 4-8 hours on days -3 to -1.
- Regimen 9: Patients receive busulfan IV over 2 hours every 6 hours and anti-thymocyte globulin IV over 4-8 hours on days -7 to -4 and cyclophosphamide IV over 2 hours on days -3 and -2.
All patients then receive donor stem cell infusions on day 0. Some patients may undergo involved-field radiotherapy 4-8 weeks after transplant. Patients are followed periodically post-transplant.
Trial Contact Information
Trial Lead Organizations Roswell Park Cancer Institute ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Philip McCarthy, MD, Protocol chair | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Trial Sites
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U.S.A. |
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New York |
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Buffalo |
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| | | | | | | | Roswell Park Cancer Institute |
| | Clinical Trials Office - Roswell Park Cancer Institute | |
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Registry Information | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Official Title | | Allogeneic Blood or Marrow Transplantation for Hematologic Malignancy and Aplastic Anemia | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Trial Start Date | | 1998-10-19 | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Trial Completion Date | | 2012-07-28 (estimated) | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Registered in ClinicalTrials.gov | | NCT00003816 | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Date Submitted to PDQ | | 1999-03-12 | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | Information Last Verified | | 2008-11-30 | ![](https://webarchive.library.unt.edu/eot2008/20090514020114im_/http://www.cancer.gov/images/spacer.gif) | NCI Grant/Contract Number | | CA16056 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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