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Sirolimus in Preventing Graft-Versus-Host Disease in Patients With Hematologic Malignancies Who Are Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2007

Sponsors and Collaborators: NCI - Center for Cancer Research-Medical Oncology
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00077480
  Purpose

RATIONALE: Sirolimus may be effective in preventing graft-versus-host disease in patients who are undergoing allogeneic stem cell transplantation.

PURPOSE: This phase II trial is studying four different regimens of sirolimus-treated T cells and/or sirolimus by mouth and comparing how well they work in preventing graft-versus-host disease in patients who are undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancies .


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Graft Versus Host Disease
Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Drug: sirolimus
Drug: therapeutic allogeneic lymphocytes
Phase II

Genetics Home Reference related topics:   aceruloplasminemia    hemophilia   

MedlinePlus related topics:   Cancer    Leukemia, Adult Acute    Leukemia, Adult Chronic    Lymphoma    Multiple Myeloma   

Drug Information available for:   Sirolimus   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Supportive Care, Active Control
Official Title:   Pilot Study Of Sirolimus (Rapamycin) Generated Donor Th2 Cells And In Vivo Sirolimus For GVHD Prevention After Allogeneic HSCT For Hematologic Malignancy

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

Primary Outcome Measures:
  • Safety and feasibility
  • Graft-versus-host disease rate

Secondary Outcome Measures:
  • Pattern of post-transplantation CD4+ and CD8+ T-cell production of Th1- and Th2-type cytokines
  • Kinetics of alloengraftment
  • Incidence of opportunistic infection
  • Incidence of malignant disease in complete remission
  • Reactivity of T cells collected after transplantation
  • Pattern of post-transplantation CD14+ monocyte production of inflammatory cytokines, interleukin-1-alpha, and tumor necrosis factor alpha

Estimated Enrollment:   190
Study Start Date:   December 2003

Arms Assigned Interventions
Group 1 (allogeneic transplantation): Experimental
Patients receive donor Th2 cells IV on day 1.
Drug: therapeutic allogeneic lymphocytes
Given IV
Group 2 (allogeneic transplantation): Experimental
Patients receive donor Th2 cells IV on day 14. Patients also receive an initial loading dose of oral sirolimus once on day -2 and then oral sirolimus once daily on days -1 to 14.
Drug: sirolimus
Given orally
Drug: therapeutic allogeneic lymphocytes
Given IV
Group 3 (allogeneic transplantation): Experimental
Patients receive oral sirolimus as in group 2.
Drug: sirolimus
Given orally
Group 4 (allogeneic transplantation): Experimental
Patients receive donor Th2 cells and sirolimus as in group 2.
Drug: sirolimus
Given orally
Drug: therapeutic allogeneic lymphocytes
Given IV
Group 5 (allogeneic transplantation): Experimental
Patients receive donor Th2 cells IV on day 0. Patients also receive sirolimus as in group 2.
Drug: sirolimus
Given orally
Drug: therapeutic allogeneic lymphocytes
Given IV

Show detailed description  Show Detailed Description

  Eligibility
Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

DISEASE CHARACTERISTICS:

  • Histological diagnosis of 1 of the following hematologic malignancies, myelodysplasia, or myeloproliferative disorders:

    • Chronic lymphocytic leukemia

      • Relapsed after fludarabine
      • Non-complete remission (CR) after salvage regimen
    • Hodgkin's or non-Hodgkin's lymphoma (all types, including mantle cell lymphoma)

      • Primary treatment failure
      • Relapsed after autologous stem cell transplantation (SCT)
      • Non-CR after salvage regimen
    • Multiple myeloma

      • Primary treatment failure
      • Relapsed after autologous SCT
      • Non-CR after salvage regimen
    • Acute myeloid leukemia

      • In first CR (CR1) and at high risk [excludes t(8;21), t(15;17), or inv(16)]
      • In second CR (CR2) or greater
    • Acute lymphoblastic leukemia

      • In CR1 and at high risk [t(9;22) or bcr-abl+; t(4;11), 1(1;19), t(8;14)]
      • In CR2 or greater
    • Myelodysplastic syndromes

      • Refractory anemia with excess blasts (RAEB)
      • RAEB in transformation (requires bone marrow and blood blasts of less than 10% after induction chemotherapy)
    • Myeloproliferative disorders*

      • Idiopathic myelofibrosis
      • Polycythemia vera
      • Essential thrombocythemia
      • Chronic myelomonocytic leukemia NOTE: *Patients must be end-stage, primarily defined as disease severity refractory to splenectomy
    • Chronic myelogenous leukemia

      • Chronic phase refractory to imatinib mesylate
      • Accelerated phase
  • Acute leukemia must be in hematologic remission (less than 5% of blood or marrow blasts)
  • Must have a first-degree relative donor matched at 6/6 HLA antigens (A, B, and DR)
  • No active CNS involvement by malignancy

PATIENT CHARACTERISTICS:

Age

  • 18 to 75

Performance status

  • ECOG 0-1

Life expectancy

  • At least 3 months

Hematopoietic

  • Not specified

Hepatic

  • ALT and AST no greater than 2.5 times upper limit of normal*
  • Bilirubin less than 2.5 mg/dL* NOTE: *Values above these levels may be accepted, at the discretion of the principal investigator or study chairman, if the elevations are due to liver involvement

Renal

  • Creatinine no greater than 1.5 mg/dL
  • Creatinine clearance at least 50 mL/min

Cardiovascular

  • LVEF greater than 45% by 2-dimensional ECHO or MUGA

Pulmonary

  • DLCO greater than 50% of expected

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for at least 1 year after study participation
  • HIV negative
  • No active infection that is not responding to antimicrobial therapy
  • No psychiatric illness that would preclude study compliance or informed consent

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics

Chemotherapy

  • See Disease Characteristics

Endocrine therapy

  • No concurrent steroids as antiemetics during chemotherapy
  • No concurrent steroids during transplantation

Surgery

  • See Disease Characteristics

Other

  • At least 2 weeks since prior therapy and recovered
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00077480

Locations
United States, Maryland
NCI - Center for Cancer Research-Medical Oncology     Recruiting
      Bethesda, Maryland, United States, 20892
      Contact: Clinical Trials Office - NCI - Center for Cancer Research     888-624-1937        
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office     Recruiting
      Bethesda, Maryland, United States, 20892-1182
      Contact: Clinical Trials Office - Warren Grant Magnusen Clinical Center     888-NCI-1937        
United States, New Jersey
Hackensack University Medical Center Cancer Center     Recruiting
      Hackensack, New Jersey, United States, 07601
      Contact: Clinical Trials Office - Hackensack University Medical Center     201-996-2879        

Sponsors and Collaborators
NCI - Center for Cancer Research-Medical Oncology
National Cancer Institute (NCI)

Investigators
Study Chair:     Daniel Fowler, MD     NCI - Center for Cancer Research-Medical Oncology    
  More Information


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

Study ID Numbers:   CDR0000350350, NCI-04-C-0055
First Received:   February 10, 2004
Last Updated:   November 13, 2008
ClinicalTrials.gov Identifier:   NCT00077480
Health Authority:   Unspecified

Keywords provided by National Cancer Institute (NCI):
graft versus host disease  
refractory chronic lymphocytic leukemia  
accelerated phase chronic myelogenous leukemia  
chronic phase chronic myelogenous leukemia  
refractory anemia with excess blasts in transformation  
refractory anemia with excess blasts  
relapsing chronic myelogenous leukemia  
recurrent adult Hodgkin lymphoma  
refractory multiple myeloma  
chronic idiopathic myelofibrosis  
recurrent adult Burkitt lymphoma  
recurrent adult diffuse large cell lymphoma  
recurrent adult diffuse mixed cell lymphoma  
recurrent adult diffuse small cleaved cell lymphoma  
recurrent adult immunoblastic large cell lymphoma  
recurrent mantle cell lymphoma
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
recurrent adult lymphoblastic lymphoma
secondary myelodysplastic syndromes
adult acute lymphoblastic leukemia in remission
adult acute myeloid leukemia in remission
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
chronic myelomonocytic leukemia
polycythemia vera
essential thrombocythemia
myelodysplastic/myeloproliferative disease, unclassifiable
recurrent marginal zone lymphoma

Study placed in the following topic categories:
Polycythemia
Chronic myelogenous leukemia
Chronic myelomonocytic leukemia
Refractory anemia
Graft versus host disease
Miconazole
Hodgkin lymphoma, adult
Lymphoma, Mantle-Cell
Lymphoma, small cleaved-cell, diffuse
Lymphoma, large-cell, immunoblastic
Preleukemia
Anemia, Refractory
Hemorrhagic Disorders
Multiple myeloma
Hemorrhagic thrombocythemia
Neoplasm Metastasis
Thrombocythemia, Hemorrhagic
Acute myeloid leukemia, adult
Hodgkin Disease
Essential thrombocytosis
Chronic lymphocytic leukemia
Myelodysplastic syndromes
Lymphoma, Large B-Cell, Diffuse
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Immunoproliferative Disorders
Hematologic Diseases
Leukemia, B-cell, chronic
Leukemia, Myelomonocytic, Chronic
Blood Coagulation Disorders
Acute myelogenous leukemia

Additional relevant MeSH terms:
Anti-Infective Agents
Neoplasms by Histologic Type
Disease
Immunologic Factors
Immune System Diseases
Antineoplastic Agents
Physiological Effects of Drugs
Antibiotics, Antineoplastic
Immunosuppressive Agents
Pharmacologic Actions
Anti-Bacterial Agents
Neoplasms
Pathologic Processes
Neoplasms by Site
Syndrome
Therapeutic Uses
Antifungal Agents
Cardiovascular Diseases

ClinicalTrials.gov processed this record on November 19, 2008




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