Combination Chemotherapy Followed By Donor Bone Marrow or Umbilical Cord Blood Transplant in Treating Children With Newly Diagnosed Juvenile Myelomonocytic Leukemia
Giving chemotherapy drugs, such as R115777, isotretinoin, cytarabine, and fludarabine, before a donor bone marrow transplant or an umbilical cord transplant helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's 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. This phase II trial is studying how well giving combination chemotherapy together with donor bone marrow or umbilical cord blood transplant works in treating children with newly diagnosed juvenile myelomonocytic leukemia
Juvenile Myelomonocytic Leukemia
Drug: fludarabine phosphate
Radiation: radiation therapy
Biological: anti-thymocyte globulin
Procedure: allogeneic bone marrow transplantation
Procedure: double-unit umbilical cord blood transplantation
Procedure: umbilical cord blood transplantation
Other: laboratory biomarker analysis
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Phase II Window Evaluation of the Farnesyl Transferase Inhibitor (R115777) Followed by 13-CIS Retinoic Acid, Cytosine Arabinoside and Fludarabine Plus Hematopoietic Stem Cell Transplantation in Children With Juvenile Myelomonocytic Leukemia|
- Response rate (CR or PR) [ Time Frame: Up to 6 years ] [ Designated as safety issue: No ]The response rates in the up-front window with respect to whether or not patients had vas activating mutations will also be estimated by proportions.
- Duration of response [ Time Frame: Up to 6 years ] [ Designated as safety issue: No ]Will be estimated by Kaplan-Meier method.
- Progression-free survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]Will be estimated by Kaplan-Meier method.
- Evaluation of prognostic importance of genetic marker [ Time Frame: Up to 6 years ] [ Designated as safety issue: No ]Logrank test and Cox proportional hazards model will be applied.
- Grade 3 or greater toxicities assessed using CTC version 2.0 [ Time Frame: Up to 6 years ] [ Designated as safety issue: Yes ]
- Survival of patients receiving the window vs. not [ Time Frame: Up to 6 years ] [ Designated as safety issue: No ]
- Response status on end of course reports (pre vs.post) [ Time Frame: Up to 6 years ] [ Designated as safety issue: No ]Signed-rank comparison of components of therapy will be done.
|Study Start Date:||June 2001|
|Primary Completion Date:||October 2007 (Final data collection date for primary outcome measure)|
Experimental: Treatment (tipifarnib, bone marrow/umbilical cord transplant)
See detailed description.
Other Names:Drug: isotretinoin
Other Names:Drug: fludarabine phosphate
Other Names:Drug: cytarabine
Other Names:Radiation: radiation therapy
Undergo total body irradiation
Other Names:Drug: cyclophosphamide
Other Names:Biological: anti-thymocyte globulin
Other Names:Procedure: allogeneic bone marrow transplantation
Undergo allogeneic bone marrow transplant
Other Names:Procedure: double-unit umbilical cord blood transplantation Procedure: umbilical cord blood transplantation
Undergo allogeneic cord blood transplant
Other Names:Other: laboratory biomarker analysis
I. Determine the response rate of children with newly diagnosed juvenile myelomonocytic leukemia treated with R115777, isotretinoin, cytarabine, and fludarabine followed by allogeneic bone marrow or umbilical cord blood transplantation.
II. Determine the safety and toxicity of this regimen in these patients. III. Determine the tolerability of this regimen in these patients. IV. Determine the rate of 2-year event-free survival of patients treated with this regimen.
V. Determine whether prognostic subsets of these patients can be identified based on expression of clinical, genetic (NFI, monosomy 7, RAS gene), or hematopoietic characteristics.
OUTLINE: This is a multicenter study.
Patients may choose to receive upfront window induction therapy with oral R115777 twice daily on days 1-21. Treatment repeats every 28 days for 2 courses in the absence of disease progression or unacceptable toxicity.
Patients with progressive disease or stable disease with unacceptable hematopoietic recovery after 1 course proceed to induction chemotherapy. (R11577 portion of the study closed to accrual as of 08/2005)
All patients receive induction chemotherapy comprising oral isotretinoin once daily beginning on day 1 and fludarabine IV over 30 minutes and cytarabine IV over 4 hours on days 1-5. Treatment with fludarabine and cytarabine repeats every 28 days for 2 courses. Treatment with isotretinoin continues until allogeneic bone marrow or umbilical cord blood transplantation. Patients with progressive disease after 1 course proceed to transplantation.
After completion of isotretinoin, patients receive a preparative regimen comprising total body irradiation twice daily on days -7 to -4, cyclophosphamide IV over 2 hours on days -3 and -2, and anti-thymocyte globulin IV over 4-6 hours every 12 hours on days -3 to -1. Patients undergo allogeneic bone marrow or umbilical cord blood transplantation on day 0. Patients receive oral isotretinoin daily beginning on approximately day 60 and continuing for 1 year.
Patients are followed every 6 months for 5 years and then annually thereafter.
PROJECTED ACCRUAL: A maximum of 100 patients (18-46 receiving R115777 with induction chemotherapy [R11577 portion of the study closed to accrual as of 08/2005] and 27-54 receiving induction chemotherapy only) will be accrued for this study within 3.2 years.
|United States, California|
|Children's Oncology Group|
|Arcadia, California, United States, 91006-3776|
|Principal Investigator:||Robert Castleberry||Children's Oncology Group|