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Fludarabine and Radiation Therapy in Treating Patients Who Are Undergoing Donor Stem Cell Transplant for Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma That Did Not Respond to Fludarabine
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), February 2009
First Received: March 3, 2005   Last Updated: February 4, 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: NCT00104858
  Purpose

RATIONALE: Giving low doses of chemotherapy, such as fludarabine, 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 how well giving fludarabine together with radiation therapy works in treating patients who are undergoing donor stem cell transplant for chronic lymphocytic leukemia or small lymphocytic lymphoma that did not respond to fludarabine.


Condition Intervention Phase
Leukemia
Lymphoma
Drug: cyclosporine
Drug: fludarabine phosphate
Drug: mycophenolate mofetil
Procedure: peripheral blood stem cell transplantation
Radiation: radiation therapy
Phase II

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic Leukemia, Childhood Lymphoma Radiation Therapy
Drug Information available for: Fludarabine Cyclosporine Fludarabine monophosphate Cyclosporin Mycophenolate mofetil hydrochloride Mycophenolate Mofetil
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Nonmyeloablative Conditioning Followed By Unrelated Donor Hematopoietic Cell Transplantation For Patients With Fludarabine-Refractory Chronic Lymphocytic Leukemia: A Multi-Center Trial

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

Primary Outcome Measures:
  • Compare survival to the survival of historical controls treated with alemtuzumab at 18 months [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall response rate (complete response and partial response) by standard morphologic, flow cytometric, and molecular techniques [ Designated as safety issue: No ]
  • Rate of relapse and/or progression [ Designated as safety issue: No ]
  • Regimen-related toxicity and infections within the first 200 days [ Designated as safety issue: Yes ]
  • Treatment-related mortality within the first year [ Designated as safety issue: Yes ]
  • Incidence of grade II-III and III-IV acute graft-versus-host disease (GVHD) and chronic GVHD [ Designated as safety issue: Yes ]
  • Graft-versus-leukemia analysis by mechanism of disease resistance in relapsed or non-responding patients and isolation of donor cytotoxic T lymphocytes specific for host minor histocompatibility antigens [ Designated as safety issue: No ]

Estimated Enrollment: 40
Study Start Date: December 2004
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Compare 18-month survival of patients with fludarabine-refractory chronic lymphocytic leukemia or small lymphocytic lymphoma treated with nonmyeloablative conditioning comprising fludarabine and low-dose total-body irradiation followed by allogeneic hematopoietic stem cell transplantation with that of historical controls treated with alemtuzumab.

Secondary

  • Determine the overall response rate (complete response and partial response) by standard morphologic, flow cytometric, and molecular techniques in patients treated with this regimen.
  • Determine the rate of relapse or disease progression in patients treated with this regimen.
  • Determine the incidence of regimen-related toxicity and infections within the first 200 days after transplantation in patients treated with this regimen.
  • Determine the incidence of transplant-related mortality within the first year after transplantation in patients treated with this regimen.
  • Determine the incidence of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD in patients treated with this regimen.
  • Determine the graft vs leukemia effect in terms of the mechanism of resistance in relapsed or non-responding patients treated with this regimen.

OUTLINE: This is a multicenter study.

  • Conditioning regimen: Patients receive fludarabine IV on days -4 to -2. Patients undergo single fraction low-dose total-body irradiation (TBI) on day 0.
  • Allogeneic stem cell transplantation: After completion of TBI, patients undergo allogeneic hematopoietic stem cell transplantation on day 0.
  • Immunosuppression: Patients receive oral cyclosporine twice daily on days -3 to 100 followed by a taper to day 177. Patients also receive oral mycophenolate mofetil 3 times daily on days 0-40 followed by a taper to day 96 .

After completion of study treatment, patients are followed at 6 months, 1 year, and then annually thereafter.

PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma, as defined by all of the following criteria:

    • Absolute peripheral lymphocyte count (mature-appearing lymphocytes) > 5,000/mm^3 that has persisted for ≥ 4 weeks
    • Mature lymphocytes with < 55% cells comprising atypical lymphocytes, prolymphocytes, or lymphoblasts in peripheral blood
    • Normal or hypercellular bone marrow aspirate and biopsy with ≥ 30% of nucleated cells of lymphoid origin
    • At least 1 B-cell marker (CD19, CD20, or CD23) AND CD5 in peripheral blood or bone marrow by flow cytometry
  • T-cell CLL OR CLL that has progressed to prolymphocytic leukemia (PLL) allowed
  • B-Cell CLL or PLL patients who:

    • Failed to meet NCI Working Group criteria for complete or partial response after therapy with regimens containing fludarabine (or another nucleoside analog [e.g., cladribine or pentostatin]) or with disease relapse within 12 months after completing therapy with a regimen containing fludarabine (or another nucleoside analog)
    • Failed FCR combination chemotherapy at any time point
    • have de novo of acquired "17p deletion" cytogenetic abnormality

      • Patients should have received induction chemotherapy but could be transplanted in first complete response
  • Suitable unrelated donor available

    • Matched for HLA-A, -B, -C, -DRB1, and -DQB1 by high resolution typing

      • Only a single allele disparity for HLA-A, -B, or -C by high resolution typing allowed
    • No marrow donor
    • No HLA-matched related donor
  • No active CNS involvement with CLL

PATIENT CHARACTERISTICS:

Age

  • Any age

Performance status

  • Karnofsky 60-100% for adult patients
  • Lansky 40-60% for pediatric patients

Life expectancy

  • Not specified

Hematopoietic

  • See Disease Characteristics

Hepatic

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

Renal

  • Not specified

Cardiovascular

  • Ejection fraction ≥ 40% by MUGA or echocardiogram
  • No poorly controlled hypertension despite multiple hypertensives

Pulmonary

  • DLCO ≥ 40%
  • Pulmonary nodules allowed at the discretion of the principal investigator
  • No requirement for continuous supplementary oxygen
  • No severe deficits in pulmonary function as determined by pulmonary consultant

Immunologic

  • HIV negative

Other

  • Not pregnant or nursing
  • Fertile patients must use effective contraception before, during, and for 12 months after transplantation
  • No solid tumor or melanoma > stage I within the past 5 years
  • No other prior (i.e., within the past 5 years) or concurrent malignancy except nonmelanoma skin cancer unless in complete remission and ≤ 20% chance of recurrence
  • No active bacterial or fungal infections unresponsive to medical therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Chemotherapy

Chemotherapy

  • See Disease Characteristics
  • More than 3 weeks since prior intensive systemic chemotherapy* for cytoreduction NOTE: *Cytokine therapy, low-dose cytarabine, chlorambucil, and rituximab are not considered systemic chemotherapy

Endocrine therapy

  • Not specified

Radiotherapy

  • Prior radiotherapy to high-risk sites of bulky disease or skeletal lesions allowed for cytoreduction

Surgery

  • Not specified

Other

  • More than 2 weeks since other prior cytotoxic agents for cytoreduction
  • No other concurrent anticancer therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00104858

Locations
United States, Washington
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98109-1024
Contact: David G. Maloney, MD, PhD     206-667-5616     dmaloney@fhcrc.org    
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     206-762-1010        
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: David G. Maloney, MD, PhD Fred Hutchinson Cancer Research Center
  More Information

Additional Information:
No publications provided

Responsible Party: Fred Hutchinson Cancer Research Center ( David G. Maloney )
Study ID Numbers: CDR0000415556, FHCRC-1840.00
Study First Received: March 3, 2005
Last Updated: February 4, 2009
ClinicalTrials.gov Identifier: NCT00104858     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
refractory chronic lymphocytic leukemia
recurrent small lymphocytic lymphoma
B-cell chronic lymphocytic leukemia
T-cell large granular lymphocyte leukemia
prolymphocytic leukemia

Study placed in the following topic categories:
Antimetabolites
Leukemia, Lymphoid
Cyclosporine
Immunologic Factors
Large Granular Lymphocyte Leukemia
Clotrimazole
Miconazole
Cyclosporins
Leukemia
Leukemia, Prolymphocytic
Leukemia, Lymphocytic, Chronic, B-Cell
Antifungal Agents
Mycophenolate mofetil
Leukemia, B-cell, Chronic
Lymphoma
Prolymphocytic Leukemia
Immunoproliferative Disorders
Tioconazole
Fludarabine monophosphate
Immunosuppressive Agents
Recurrence
Lymphatic Diseases
Chronic Lymphocytic Leukemia
Fludarabine
Antirheumatic Agents
Lymphoproliferative Disorders
Leukemia, B-Cell

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Leukemia, Lymphoid
Antimetabolites, Antineoplastic
Cyclosporine
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Cyclosporins
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell
Antifungal Agents
Therapeutic Uses
Mycophenolate mofetil
Dermatologic Agents
Lymphoma
Immunoproliferative Disorders
Neoplasms by Histologic Type
Immune System Diseases
Enzyme Inhibitors
Fludarabine monophosphate
Immunosuppressive Agents
Pharmacologic Actions
Lymphatic Diseases
Neoplasms
Fludarabine
Antirheumatic Agents
Lymphoproliferative Disorders
Leukemia, B-Cell

ClinicalTrials.gov processed this record on May 07, 2009