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Alemtuzumab, Fludarabine, and Total-Body Irradiation Followed by Cyclosporine and Mycophenolate Mofetil in Treating Patients Who Are Undergoing a Donor Stem Cell Transplant for Hematologic Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), July 2009
First Received: July 8, 2005   Last Updated: July 7, 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: NCT00118352
  Purpose

RATIONALE: Giving low doses of chemotherapy, such as fludarabine, a monoclonal antibody such as alemtuzumab, and radiation therapy before a donor stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after transplant may stop this from happening.

PURPOSE: This phase II trial is studying the side effects and best dose of alemtuzumab when given together with fludarabine and total-body irradiation followed by cyclosporine and mycophenolate mofetil in treating patients who are undergoing a donor stem cell transplant for hematologic cancer.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Biological: alemtuzumab
Drug: cyclosporine
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Procedure: peripheral blood stem cell transplantation
Radiation: radiation therapy
Phase II

Study Type: Interventional
Study Design: Treatment
Official Title: Campath® (Alemtuzumab) Dose Escalation, Low-Dose TBI and Fludarabine Followed by HLA Class II Mismatched Donor Stem Cell Transplantation for Patients With Hematologic Malignancies: A Multicenter Trial

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Incidence of grade III-IV graft-vs-host disease (GVHD) < 40% [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Incidence of graft rejection [ Designated as safety issue: No ]
  • Number of days of steroids ≥ 1 mg/kg [ Designated as safety issue: No ]
  • Incidence of nonrelapse mortality [ Designated as safety issue: Yes ]
  • Risk or incidence of infections [ Designated as safety issue: Yes ]
  • Immune reconstitution [ Designated as safety issue: No ]
  • Risk for disease progression and relapse [ Designated as safety issue: No ]

Estimated Enrollment: 100
Study Start Date: March 2005
Estimated Primary Completion Date: March 2011 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the dose of alemtuzumab that has a rate of grade 3 or 4 graft-versus-host disease of < 40% when given together with fludarabine and low-dose total-body irradiation as a nonmyeloablative conditioning regimen followed by immunosuppression comprising cyclosporine and mycophenolate mofetil in patients undergoing allogeneic peripheral blood stem cell transplantation for hematologic malignancy.

Secondary

  • Determine the incidence of graft rejection in patients treated with this regimen.
  • Determine the risk for disease progression and relapse in patients treated with this regimen.
  • Determine the incidence of nonrelapse mortality in patients treated with this regimen.
  • Determine the risk and incidence of infections in patients treated with this regimen.
  • Determine the number of days that steroid therapy is required (at a dose ≥ 1 mg/kg) before day 100 post-transplantation in patients treated with this regimen.
  • Determine immune reconstitution in patients treated with this regimen.

OUTLINE: This is a multicenter, dose-escalation study of alemtuzumab.

  • Nonmyeloablative conditioning regimen: Patients receive alemtuzumab* IV over 6 hours once daily on days -6 to

    • 4 OR days -5 and -4 and fludarabine IV over 30 minutes once daily on days -4 to -2. Patients undergo low-dose total-body irradiation (TBI) on day 0. NOTE: *The first cohort of patients do not receive alemtuzumab.
  • Allogeneic peripheral blood stem cell transplantation (PBSCT): After the completion of TBI, patients undergo allogeneic PBSCT on day 0.
  • Immunosuppression: Beginning 4-6 hours after completion of allogeneic PBSCT, patients receive oral mycophenolate mofetil 3 times daily on days 0-100 followed by a taper until day 156 in the absence of graft-vs-host disease (GVHD). Patients also receive cyclosporine orally or IV 2-3 times daily on days -3 to 180 followed by a taper until day 365 in the absence of GVHD. Cohorts of 25-50 patients receive escalating doses of alemtuzumab* until an acceptable dose is determined. An acceptable dose is defined as the dose at which ≤ 7 of 25 or ≤ 16 of 50 patients experience grade 3 or 4 GVHD.

NOTE: *The first cohort of patients do not receive alemtuzumab.

After completion of study transplantation, patients are followed periodically for 3 months, at 6, 12, and 18 months, and then annually for 5 years.

PROJECTED ACCRUAL: A total of 25-100 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   up to 74 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following hematologic malignancies:

    • Aggressive non-Hodgkin's lymphoma (NHL), including, but not limited to, diffuse large B-cell NHL, meeting 1 of the following criteria:

      • Failed prior autologous hematopoietic stem cell transplantation (HSCT)
      • Not eligible for autologous HSCT or conventional myeloablative HSCT
    • Low-grade NHL

      • Achieved complete remission (CR) that lasted < 6 months after completion of prior conventional therapy
    • Mantle cell NHL

      • First CR allowed
    • Chronic lymphocytic lymphoma, meeting both of the following criteria:

      • Failed 2 lines of prior conventional therapy
      • Refractory to fludarabine, defined as failure to achieve a complete or partial response after treatment with a fludarabine-containing regimen (or another nucleoside analog [e.g., cladribine or pentostatin]) OR relapse within 12 months after completion of a fludarabine-containing regimen (or another nucleoside analog)
    • Hodgkin's lymphoma, meeting both of the following criteria:

      • Failed prior front-line therapy
      • Failed OR not eligible for autologous HSCT
    • Multiple myeloma, meeting 1 of the following criteria:

      • Received prior chemotherapy
      • Failed autografting
    • Acute myeloid leukemia

      • Must have < 5% marrow blasts at the time of study transplantation
      • No circulating leukemic blasts in the peripheral blood
    • Acute lymphoblastic leukemia

      • Must have < 5% blasts at the time of study transplantation
      • No circulating leukemic blasts in the peripheral blood
    • Chronic myelogenous leukemia

      • Beyond first chronic phase allowed provided patients received prior myelosuppressive chemotherapy or HSCT AND has < 5% marrow blasts at the time of study transplantation
      • No circulating leukemic blasts in the peripheral blood
    • Myelodysplastic syndromes or myeloproliferative diseases, meeting both of the following criteria:

      • Failed prior myelosuppressive chemotherapy or HSCT
      • Must have < 5% marrow blasts at the time of study transplantation
    • Waldenstrom Macroglobulinemia

      • Must have failed 2 courses of therapy
  • Disease treatable by HSCT

    • Refused or not eligible for treatment on a conventional transplantation protocol
    • Autologous HSCT is not a treatment option
  • Disease expected to be stable without chemotherapy for ≥ 100 days
  • No CNS involvement with disease refractory to intrathecal chemotherapy
  • Related or unrelated donor available

    • Matched for ≥ 1 HLA-DRB1 allele AND 1 HLA-DQB1 allele
    • No 10/10 HLA-A, -B, -C, -D, -DRB1, or -DQB1 matched unrelated donor available
    • Disease likely to progress during HLA typing
    • No marrow donors
    • Crossmatch negative 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:

Age

  • Under 75

Performance status

  • Lansky 70-100% (for pediatric patients) OR
  • Karnofsky 70-100% (for adult patients)

Life expectancy

  • Not severely limited by diseases other than malignancy

Hematopoietic

  • Not specified

Hepatic

  • No cirrhosis of the liver with evidence of portal hypertension
  • No alcoholic hepatitis
  • No fulminant liver failure
  • No chronic viral hepatitis with bilirubin > 3 mg/dL
  • No ascites related to portal hypertension
  • No esophageal varices
  • No history of bleeding esophageal varices
  • No hepatic encephalopathy
  • No uncorrectable hepatic synthetic dysfunction evidenced by prolongation of PT
  • No bacterial or fungal liver abscess
  • No symptomatic biliary disease
  • No biliary obstruction

Renal

  • Not specified

Cardiovascular

  • No symptomatic coronary artery disease
  • Ejection fraction ≥ 35% (required for patients with a history of taking anthracyclines or cardiac disease)
  • No other cardiac failure requiring therapy
  • No poorly controlled hypertension despite use of multiple antihypertensive drugs

Pulmonary

  • DLCO ≥ 35%
  • No requirement for supplementary continuous oxygen
  • Total lung capactiy ≥ 35%
  • FEV_1 ≥ 35%

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for up to 12 months after completion of study treatment
  • HIV negative
  • No other disease that would severely limit life expectancy
  • No active non-hematologic malignancy within the past 5 years except nonmelanoma skin cancer

    • No more than 20% risk of disease recurrence from prior non-hematologic malignancy
  • No fungal infection with radiological progression after receiving amphotericin B or active triazole for > 1 month

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics

Chemotherapy

  • See Disease Characteristics
  • More than 3 weeks since prior intensive cytotoxic chemotherapy for cytoreduction except hydroxyurea or imatinib mesylate

Endocrine therapy

  • Not specified

Radiotherapy

  • Not specified

Surgery

  • Not specified
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00118352

Locations
United States, Colorado
Rocky Mountain Cancer Centers - Denver Midtown Recruiting
Denver, Colorado, United States, 80218
Contact: Michael B. Maris, MD     303-388-4876        
United States, Utah
LDS Hospital Recruiting
Salt Lake City, Utah, United States, 84143
Contact: Finn B. Petersen, MD     801-408-1818     ldfpeter@ihc.com    
United States, Washington
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98109-1024
Contact: Brenda Sandmaier, MD     206-667-4961        
Seattle Cancer Care Alliance Recruiting
Seattle, Washington, United States, 98109-1023
Contact: Clinical Trials Office - Seattle Cancer Care Alliance     800-804-8824        
Veterans Affairs Medical Center - Seattle Recruiting
Seattle, Washington, United States, 98108
Contact: Thomas R. Chauncey, MD, PhD     206-764-2709        
Italy
Universita di Torino Recruiting
Turin, Italy, 10126
Contact: Benedetto Bruno, MD, PhD     39-0339-112-9064        
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: Brenda Sandmaier, MD Fred Hutchinson Cancer Research Center
  More Information

Additional Information:
No publications provided

Responsible Party: Fred Hutchinson Cancer Research Center ( Brenda Sandmaier )
Study ID Numbers: CDR0000430704, FHCRC-1959.00
Study First Received: July 8, 2005
Last Updated: July 7, 2009
ClinicalTrials.gov Identifier: NCT00118352     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
noncontiguous stage II adult Burkitt lymphoma
noncontiguous stage II adult diffuse large cell lymphoma
noncontiguous stage II adult diffuse mixed cell lymphoma
noncontiguous stage II adult diffuse small cleaved cell lymphoma
noncontiguous stage II adult immunoblastic large cell lymphoma
noncontiguous stage II adult lymphoblastic lymphoma
noncontiguous stage II grade 1 follicular lymphoma
noncontiguous stage II grade 2 follicular lymphoma
noncontiguous stage II grade 3 follicular lymphoma
noncontiguous stage II mantle cell lymphoma
noncontiguous stage II marginal zone lymphoma
noncontiguous stage II small lymphocytic lymphoma
recurrent adult Hodgkin lymphoma
recurrent adult Burkitt lymphoma
stage III adult Burkitt lymphoma
stage IV adult Burkitt lymphoma
recurrent adult diffuse large cell lymphoma
recurrent adult diffuse mixed cell lymphoma
recurrent adult diffuse small cleaved cell lymphoma
stage III adult diffuse large cell lymphoma
stage III adult diffuse mixed cell lymphoma
stage III adult diffuse small cleaved cell lymphoma
stage IV adult diffuse large cell lymphoma
stage IV adult diffuse mixed cell lymphoma
stage IV adult diffuse small cleaved cell lymphoma
recurrent adult immunoblastic large cell lymphoma
stage III adult immunoblastic large cell lymphoma
stage IV adult immunoblastic large cell lymphoma
recurrent adult lymphoblastic lymphoma
stage III adult lymphoblastic lymphoma

Study placed in the following topic categories:
Anti-Infective Agents
Chronic Myelomonocytic Leukemia
Cyclosporine
Lymphoma, Mantle-Cell
Mycophenolic Acid
Mantle Cell Lymphoma
Cyclosporins
Follicular Lymphoma
Acute Myelocytic Leukemia
Preleukemia
Hemorrhagic Disorders
Acute Myeloid Leukemia, Adult
Leukemia, Lymphocytic, Chronic, B-Cell
Alemtuzumab
Mycophenolate mofetil
Neoplasm Metastasis
Hodgkin Disease
Myelodysplastic Myeloproliferative Disease
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Leukemia, Myelomonocytic, Chronic
Blood Coagulation Disorders
Myeloproliferative Disorders
Juvenile Myelomonocytic Leukemia
Leukemia, Myeloid
Multiple Myeloma
Waldenstrom Macroglobulinemia
B-cell Lymphomas

Additional relevant MeSH terms:
Anti-Infective Agents
Cyclosporine
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Mycophenolic Acid
Cyclosporins
Preleukemia
Hemorrhagic Disorders
Pathologic Processes
Alemtuzumab
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
Antibiotics, Antineoplastic

ClinicalTrials.gov processed this record on September 09, 2009