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Donor Lymphocytes to Prevent Graft-Versus-Host Disease in Patients With Chronic Myeloid Leukemia

This study is ongoing, but not recruiting participants.

Sponsors and Collaborators: Jonsson Comprehensive Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00004878
  Purpose

RATIONALE: Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy used to kill cancer cells. Sometimes the transplanted cells can be rejected by the body's normal tissues. Donor lymphocytes that have been treated in the laboratory may prevent this from happening.

PURPOSE: Randomized phase II trial to study the effectiveness of donor lymphocytes to prevent graft-versus-host disease in patients who are undergoing peripheral stem cell transplantation for chronic myeloid leukemia.


Condition Intervention Phase
Graft Versus Host Disease
Leukemia
Drug: cytarabine
Drug: fludarabine phosphate
Drug: idarubicin
Drug: methotrexate
Drug: tacrolimus
Drug: therapeutic allogeneic lymphocytes
Procedure: in vitro-treated peripheral blood stem cell transplantation
Procedure: peripheral blood stem cell transplantation
Phase II

MedlinePlus related topics:   Cancer    Leukemia, Adult Acute    Leukemia, Adult Chronic   

Drug Information available for:   Cytarabine    Cytarabine hydrochloride    Idarubicin    Idarubicin hydrochloride    Methotrexate    Fludarabine    Fludarabine monophosphate    Tacrolimus    Tacrolimus anhydrous   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Supportive Care, Randomized
Official Title:   A Study to Determine the Safety and Efficacy of Using CD8-High Density Microparticles (CD8-HDM) to Deplete CD8+ Cells From Donor Lymphocyte Infusion in Order to Reduce Graft-Versus-Host Disease (GvHD) Without Compromising an Anti-Leukemia Effect in Patients With Chronic Myeloid Leukemia Given HLA-Identical Sibling Peripheral Blood Stem Cell Transplants After Non-Myeloablative Conditioning

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

Study Start Date:   June 2000

Detailed Description:

OBJECTIVES: I. Compare the incidence of acute graft versus host disease (GVHD) grades II-IV and extensive chronic GVHD in chronic myeloid leukemia patients treated with purged donor lymphocyte infusion (DLI) processed with CD8 high density microparticles (HDM) vs unpurged DLI following nonmyeloablative, HLA identical sibling peripheral blood stem cell transplantation. II. Compare the rates of complete cytogenetic, clinical, and hematologic remission and mortality and GVHD in patients treated with these regimens. III. Determine the efficacy of CD8 HDM in depleting greater than 95% of CD8+ cells in donor lymphocytes. IV. Compare the safety and toxicity of these regimens in these patients.

OUTLINE: This is a randomized, double blind, multicenter study. Patients are stratified by age (under 60 vs 60 and over) and center. Allogeneic peripheral blood stem cells (PBSC) are harvested and selected for CD34+ cells on days 5-8. Nonmyeloablative conditioning: Patients receive fludarabine IV over 30 minutes and cytarabine IV over 4 hours (beginning 4 hours after the start of fludarabine infusion) on days -6 to -3 and idarubicin IV over 1-5 minutes on days -6 to -4. Filgrastim (G-CSF) is administered subcutaneously daily beginning on day -2 and continues until blood counts recover. Graft versus host disease prevention: Beginning on day -2, patients receive tacrolimus IV continuously until oral dosing is tolerated. Patients receive tacrolimus in combination with methotrexate on days 1, 3, and 6 after completion of transplantation. Beginning 12 weeks after completion of transplantation, oral tacrolimus is tapered and stopped over 4 weeks. Transplantation: Allogeneic PBSC are infused on day 0. At 4 months posttransplantation, patients with residual Ph+ cells by cytogenetics or FISH OR hematologic or clinical evidence of chronic myeloid leukemia AND without symptomatic chronic graft versus host disease requiring immunosuppressive therapy are randomized to 1 of 2 treatment arms: Arm I: Lymphocytes harvested from the original PBSC donor are processed with the CD8 high density microparticle device to remove all or most CD8+ cells. Patients receive CD8+ cell depleted donor lymphocyte infusion (DLI) IV over 15-30 minutes on the same day of collection. Arm II: Lymphocytes are harvested from the original PBSC donor. Patients receive undepleted DLI IV over 15-30 minutes on the same day of collection. Patients are followed at days 30, 60, 100, and 180, and then periodically through year 5.

PROJECTED ACCRUAL: A maximum of 110 patients (55 per arm) will be accrued for this study within 1 year.

  Eligibility
Ages Eligible for Study:   50 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

DISEASE CHARACTERISTICS: Histologically proven chronic myeloid leukemia (CML) in first chronic phase or with cytogenetic but not hematologic evidence of acceleration (clonal evolution) Availability of 6 antigen (A, B, and DR loci) HLA identical sibling donor Eligible for randomization to donor lymphocyte infusion (DLI) if: Residual Ph+ cells by cytogenetics or FISH or hematologic or clinical evidence of CML AND No graft versus host disease requiring immunosuppressive therapy within the past 2 weeks AND Evidence of donor hematopoiesis after completion of transplantation Ineligible for randomization to DLI if: Blast transformation of CML OR Prior interferon alfa for relapse after completion of transplantation

PATIENT CHARACTERISTICS: Age: 50 to 70 Performance status: Zubrod 0-2 Life expectancy: Not specified Hematopoietic: See Disease Characteristics Hepatic: Bilirubin less than 3 mg/dL Renal: Creatinine less than 2 mg/dL Cardiovascular: Cardiac ejection fraction greater than 40% Pulmonary: DLCO greater than 45% predicted Other: No active infection Not pregnant Negative pregnancy test No hypersensitivity to nickel No hypersensitivity to mouse proteins Human antimouse antibody positivity allowed if no allergic history HIV negative HTLV antibody negative

PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics No concurrent hematopoietic growth factors other than filgrastim (G-CSF) No other biologic therapy (e.g., interferon alfa) for 6 months after completion of study therapy Chemotherapy: No other chemotherapy for 6 months after completion of study therapy Concurrent hydroxyurea allowed for CML relapse Endocrine therapy: Concurrent methylprednisolone allowed if grade II or worse GVHD develops Radiotherapy: No radiotherapy for 6 months after completion of study therapy Surgery: Not specified

  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00004878

Locations
United States, California
Jonsson Comprehensive Cancer Center, UCLA    
      Los Angeles, California, United States, 90095-1781

Sponsors and Collaborators
Jonsson Comprehensive Cancer Center
National Cancer Institute (NCI)

Investigators
Study Chair:     Gary J. Schiller, MD     Jonsson Comprehensive Cancer Center    
  More Information


Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site
 

Study ID Numbers:   CDR0000067538, UCLA-9905097, CCT-C99-101, NCI-G00-1672
First Received:   March 7, 2000
Last Updated:   July 23, 2008
ClinicalTrials.gov Identifier:   NCT00004878
Health Authority:   United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
chronic phase chronic myelogenous leukemia  
accelerated phase chronic myelogenous leukemia  
Philadelphia chromosome positive chronic myelogenous leukemia  
graft versus host disease  

Study placed in the following topic categories:
Philadelphia Chromosome
Chronic myelogenous leukemia
Hematologic Diseases
Graft versus host disease
Myeloproliferative Disorders
Tacrolimus
Fludarabine monophosphate
Leukemia, Myeloid
Leukemia, Myeloid, Chronic-Phase
Homologous wasting disease
Folic Acid
Leukemia
Idarubicin
Leukemia, Myeloid, Accelerated Phase
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Methotrexate
Graft vs Host Disease
Fludarabine
Bone Marrow Diseases
Cytarabine

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Neoplasms by Histologic Type
Antimetabolites, Antineoplastic
Immune System Diseases
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Enzyme Inhibitors
Reproductive Control Agents
Folic Acid Antagonists
Abortifacient Agents, Nonsteroidal
Antibiotics, Antineoplastic
Antiviral Agents
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Therapeutic Uses
Abortifacient Agents
Antirheumatic Agents
Dermatologic Agents
Nucleic Acid Synthesis Inhibitors

ClinicalTrials.gov processed this record on December 03, 2008




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