Donor Peripheral Stem Cell Transplant and Donor Natural Killer Cell Transplant After Total-Body Irradiation, Thiotepa, Fludarabine, and Muromonab-CD3 in Treating Patients With Leukemia or Other Blood Diseases

This study has been completed.
Sponsor:
Collaborator:
Information provided by:
Fred Hutchinson Cancer Research Center
ClinicalTrials.gov Identifier:
NCT00450983
First received: March 20, 2007
Last updated: August 24, 2010
Last verified: August 2010
  Purpose

RATIONALE: Giving chemotherapy and total-body irradiation before a donor peripheral blood stem cell and donor natural killer cell transplant helps stop the growth of cancer and abnormal cells and helps stop the patient's immune system from rejecting the donor's stem cells. When certain 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. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Removing the T cells from the donor cells before transplant may stop this from happening.

PURPOSE: This phase II trial is studying how well giving a donor peripheral stem cell transplant and a donor natural killer cell transplant after total-body irradiation, thiotepa, fludarabine, and muromonab-CD3 works in treating patients with leukemia or other blood diseases.


Condition Intervention Phase
Graft Versus Host Disease
Leukemia
Myelodysplastic Syndromes
Biological: muromonab-CD3
Biological: natural killer cell therapy
Drug: fludarabine phosphate
Drug: methotrexate
Drug: thiotepa
Genetic: gene expression analysis
Other: flow cytometry
Other: immunologic technique
Procedure: allogeneic hematopoietic stem cell transplantation
Procedure: in vitro-treated peripheral blood stem cell transplantation
Radiation: total-body irradiation
Phase 2

Study Type: Interventional
Study Design: Masking: Open Label
Primary Purpose: Treatment
Official Title: Transplantation of Haploidentical CD34+ Purified Peripheral Blood Stem Cells With NK-Cell Add-Back Following Conditioning With Total Body Irradiation, Thiotepa, Fludarabine and OKT3

Resource links provided by NLM:


Further study details as provided by Fred Hutchinson Cancer Research Center:

Primary Outcome Measures:
  • Risk of developing grades III-IV acute graft-vs-host disease (GVHD) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Risk for mortality from infection before day 180 [ Designated as safety issue: No ]
  • Risk for graft failure [ Designated as safety issue: No ]
  • Risk for life-threatening infections [ Designated as safety issue: No ]
  • Concentration of NK, NK-T, T-cells, and dendritic cell subsets in the CD34+ NK/NK-T-enriched graft [ Designated as safety issue: No ]
  • Cytomegalovirus-specific T cells in product and donor graft [ Designated as safety issue: No ]
  • Genotype and phenotype of donor killer cell immunoglobulin-like receptor expression according to time after hematopoietic stem cell transplantation (HSCT) [ Designated as safety issue: No ]
  • Reconstitution of NK function according to time after HSCT [ Designated as safety issue: No ]
  • Expression of NKG2 ligands of leukemic blasts [ Designated as safety issue: No ]

Estimated Enrollment: 20
Study Start Date: December 2006
Study Completion Date: July 2010
Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the effect of haploidentical donor CD34+ purified peripheral blood stem cells and donor natural killer (NK) cells on the risk of developing grades III-IV acute graft-vs-host disease in patients with leukemia or other hematologic diseases.

Secondary

  • Determine the risk for mortality from infection before day 180 in patients treated with this regimen.
  • Determine the risk for graft rejection in patients treated with this regimen.
  • Determine the risk for life-threatening infections in patients treated with this regimen.
  • Determine the concentration of subsets of NK, NK-T, T cells, and dendritic cells in the CD34+ NK/NK-T-enriched graft.
  • Determine cytomegalovirus-specific T-cells in product and donor graft.
  • Determine the genotype and phenotype of donor killer cell immunoglobulin-like receptor expression according to time after hematopoietic stem cell transplantation (HSCT).
  • Determine the reconstitution of NK function according to time after HSCT.
  • Determine the expression of NKG2 ligands of leukemic blasts.

OUTLINE: Patients are stratified according to age (≤ 7 years vs > 7 years).

  • Conditioning regimen: Patients 7 years of age or younger undergo total-body irradiation (TBI) twice daily on days -11 to -9. Patients over 7 years of age undergo TBI once on day -9. All patients receive thiotepa IV over 2 hours on days -8 and -7, fludarabine phosphate IV on days -6 to -3 and muromonab-CD3 on days -6 to 6. Patients with acute lymphoblastic leukemia or leukemia in the spinal fluid also receive methotrexate intrathecally prior to and after donor peripheral blood stem cell (PBSC) transplantation .
  • Donor PBSC transplantation: Patients undergo donor PBSC transplantation comprising CD34+ purified PBSCs and natural killer (NK) cells on day 0.

Blood samples are collected in weeks 1-4, 6, 8, and 12. Analysis of samples includes quantitation of NK, NK-T, and T-cell subsets (CD3, CD4, and CD8) by flow cytometry; donor killer cell immunoglobulin-like receptor genotype and phenotype; interferon-gamma levels; and NK cytotoxicity. Samples are also analyzed by leukemic blast assay to determine if ligands that activate NK cells are expressed.

After completion of study therapy, patients are followed periodically.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   up to 45 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following life-threatening hematological malignancies:

    • Acute lymphoblastic leukemia meeting 1 of the following criteria:

      • Advanced beyond first remission
      • In first remission with high-risk prognostic features, including any of the following:

        • Philadelphia chromosome-positive disease
        • Chromosome 11q23 abnormality
        • Hypodiploid
        • Failed to achieve first remission within 1 month after induction
    • Acute myeloid leukemia (AML) meeting 1 of the following criteria:

      • Advanced beyond first remission
      • First remission with high-risk prognostic features, including any of the following:

        • Chromosome 11q23 abnormality
        • Chromosome del 7q
        • Secondary AML
        • Failed to achieve first remission within 1 month after induction
    • Myelodysplastic syndromes with International Prognostic Score > 1
    • Chronic myelogenous leukemia in accelerated or blastic phase
  • No active CNS disease
  • No suitable HLA-matched related or unrelated donor available
  • Haploidentical family member available as donor of partially HLA-matched peripheral blood stem cells

    • Least degree of mismatch to HLA-A, B, C, DRB1, and DQB1
    • No mismatch for a single HLA-A, B, C, DRB1, or DQB1 antigen
    • Donor killer cell immunoglobulin-like receptor ligand group expression preferably different than patient

PATIENT CHARACTERISTICS:

  • LVEF ≥ 45%
  • DLCO ≥ 60% of predicted
  • AST and ALT ≤ 2 times upper limit of normal (ULN) (unless due to malignancy)
  • Bilirubin ≤ 2 times ULN (unless due to malignancy)
  • No life expectancy < 6 months due to coexisting disease other than the malignancy
  • No active infection (e.g., polymerase chain reaction [PCR] evidence for cytomegalovirus, human herpes virus 6, or invasive fungal infection)
  • No prior infections without evidence of resolution by PCR or imaging studies within the past 2 months
  • No hypersensitivity to murine antibodies
  • No known HIV positivity
  • Not pregnant or nursing
  • Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

  • No prior marrow transplantation with total body irradiation > 400 cGy
  • No concurrent therapies for seizure disorder
  • No growth factors for 21 days after transplantation
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00450983

Locations
United States, Washington
Fred Hutchinson Cancer Research Center
Seattle, Washington, United States, 98109-1024
Seattle Cancer Care Alliance
Seattle, Washington, United States, 98109-1023
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: Ann Woolfrey, MD Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
  More Information

Additional Information:
No publications provided

Responsible Party: Ann Woolfrey, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
ClinicalTrials.gov Identifier: NCT00450983     History of Changes
Other Study ID Numbers: 1965.00, R01AI053193, P30CA015704, FHCRC-1965.00, CDR0000533834
Study First Received: March 20, 2007
Last Updated: August 24, 2010
Health Authority: United States: Food and Drug Administration

Keywords provided by Fred Hutchinson Cancer Research Center:
graft versus host disease
adult acute lymphoblastic leukemia in remission
recurrent adult acute lymphoblastic leukemia
childhood acute lymphoblastic leukemia in remission
recurrent childhood acute lymphoblastic leukemia
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia in remission
recurrent adult acute myeloid leukemia
childhood acute myeloid leukemia in remission
recurrent childhood acute myeloid leukemia
secondary acute myeloid leukemia
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
secondary myelodysplastic syndromes
accelerated phase chronic myelogenous leukemia
blastic phase chronic myelogenous leukemia
childhood chronic myelogenous leukemia
relapsing chronic myelogenous leukemia
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
childhood myelodysplastic syndromes

Additional relevant MeSH terms:
Graft vs Host Disease
Leukemia
Myelodysplastic Syndromes
Preleukemia
Syndrome
Bone Marrow Diseases
Disease
Hematologic Diseases
Immune System Diseases
Neoplasms
Neoplasms by Histologic Type
Pathologic Processes
Precancerous Conditions
Fludarabine
Fludarabine phosphate
Methotrexate
Muromonab-CD3
Thiotepa
Abortifacient Agents
Abortifacient Agents, Nonsteroidal
Alkylating Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Dermatologic Agents
Enzyme Inhibitors
Folic Acid Antagonists
Immunologic Factors

ClinicalTrials.gov processed this record on October 23, 2014