Reduced Intensity Donor Peripheral Blood Stem Cell Transplant in Treating Patients With De Novo or Secondary Acute Myeloid Leukemia in Remission

Study Description

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Brief Summary:

This phase II trial studies how well reduced intensity donor peripheral blood stem cell (PBSC) transplant works in treating patients with de novo or secondary acute myeloid leukemia (AML) in remission. Giving low doses of chemotherapy, such as fludarabine phosphate, and total-body irradiation (TBI) before a donor PBSC transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells 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 the transplant may stop this from happening

Condition or disease	Intervention/treatment	Phase
Acute Myeloid Leukemia With Multilineage Dysplasia Following Myelodysplastic Syndrome; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Secondary Acute Myeloid Leukemia	Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation; Drug: fludarabine phosphate; Radiation: total-body irradiation; Drug: cyclosporine; Drug: mycophenolate mofetil; Procedure: peripheral blood stem cell transplantation	Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine if a one-year disease free survival of >= 35% can be achieved among patients >= 55 years old with de novo and secondary AML in first complete remission (CR1) who undergo nonmyeloablative hematopoietic stem cell transplant (HSCT) from human leukocyte antigen (HLA) identical related donors.

II. To determine if a day +200 nonrelapse related mortality of < 15% can be achieved among patients >= 55 years old with de novo and secondary AML in CR1 who undergo nonmyeloablative HSCT from HLA identical related donors.

OUTLINE:

CONDITIONING REGIMEN: Patients receive fludarabine phosphate intravenously (IV) on days -4 to -2 and undergo TBI on day 0.

TRANSPLANT: Patients undergo allogeneic PBSC transplant on day 0.

IMMUNOSUPPRESSION: Patients receive cyclosporine (CSP) orally (PO) twice daily (BID) on days -3 to 56 with taper to day 77. Patients also receive mycophenolate mofetil (MMF) PO BID on days 0-27.

After completion of study treatment, patients are followed up on days 28, 56, and 84; months 6, 12, 18, and 24; and then yearly for 5 years.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	17 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Nonmyeloablative Allogeneic Peripheral Blood Stem Cell Transplantation From HLA Matched Related Donors for Treatment of Older Patients With De Novo or Secondary Acute Myeloid Leukemia in First Complete Remission
Study Start Date :	April 2002
Actual Primary Completion Date :	June 2009

Arms and Interventions

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Arm

Intervention/treatment

Experimental: Treatment (nonmyeloablative donor PBSC transplant); CONDITIONING REGIMEN: Patients receive fludarabine phosphate IV on days -4 to -2 and undergo TBI on day 0. TRANSPLANT: Patients undergo allogeneic PBSC transplant on day 0. IMMUNOSUPPRESSION: Patients receive CSP PO BID on days -3 to 56 with taper to day 77. Patients also receive MMF PO BID on days 0-27.

Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation; Undergo nonmyeloablative allogeneic PBSC transplant; Drug: fludarabine phosphate; Given IV; Other Names: 2-F-ara-AMP; Beneflur; Fludara; Radiation: total-body irradiation; Undergo TBI; Other Name: TBI; Drug: cyclosporine; Given PO; Other Names: ciclosporin; cyclosporin; cyclosporin A; CYSP; Sandimmune; Drug: mycophenolate mofetil; Given PO; Other Names: Cellcept; MMF; Procedure: peripheral blood stem cell transplantation; Undergo nonmyeloablative allogeneic PBSC transplant; Other Names: PBPC transplantation; PBSC transplantation; peripheral blood progenitor cell transplantation; transplantation, peripheral blood stem cell

Outcome Measures

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Primary Outcome Measures :

1. Disease-free Survival-incidence of Survival Without Relapse [ Time Frame: By 1 year after transplant ]
   Sufficient evidence will be taken to be an observed rate of DFS at one year after transplant that corresponds to a one-sided 95% confidence interval with an upper limit lower than 35%.
2. Nonrelapse Mortality (NRM)-Incidence of Nonrelapse Death [ Time Frame: 200 days after transplant ]
   Defined as death without morphologic evidence of disease. Sufficient evidence will be taken to be an observed rate of NRM within 200 days of transplant that corresponds to a one-sided 80% confidence interval with a lower limit greater than 15%.

Secondary Outcome Measures :

1. Overall Survival [ Time Frame: By 1 year after transplant ]
   Percent patients surviving.
2. Incidence of Relapse [ Time Frame: By 1 year after transplant ]
   Percent patients with relapsed disease post-transplant.
3. Incidence of Rejection [ Time Frame: By 1 year after transplant ]
   Percent patients who developed infections post-transplant.
4. Incidence of Acute and Chronic GVHD [ Time Frame: aGVHD: 100 days after transplant; cGVHD: 1 Year after transplant. ]
   Percent patients with acute/chronic GVHD

Eligibility Criteria

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Ages Eligible for Study:	55 Years and older (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patients with de novo AML (French-American-British [FAB] MO-M2, M4-M7) or secondary AML who achieve CR1 after induction chemotherapy and one or two cycles of consolidation chemotherapy
• Transplant conditioning must occur within 6 months of diagnosis
• Patient enrollment must be approved by the Fred Hutchinson Cancer Research Center (FHCRC) principal investigator (PI) or the PI's designee
• DONOR: Related donor who is genotypically or phenotypically identical
• DONOR: Age >= 12 years
• DONOR: Donor must consent to filgrastim (G-CSF) administration and leukapheresis
• DONOR: Donor must have adequate veins for leukapheresis or agree to placement of central venous catheter (femoral, subclavian)

Exclusion Criteria:

• AML FAB M3
• AML involvement of the central nervous system (CNS) as defined by a positive cytospin of cerebral spinal fluid at the time of enrollment
• Presence of circulating leukemic blasts (in the peripheral blood) detected by standard pathology
• Human immunodeficiency virus (HIV) seropositivity
• Fungal infections with radiographic progression after receipt of amphotericin B or active triazole for greater than one month
• Diffusion capacity of carbon monoxide (DLCO) corrected < 40%
• Total lung capacity (TLC) < 40%
• Forced expiratory volume in one second (FEV1) < 40% or requiring supplementary oxygen
• The FHCRC principal investigator of the study must approve enrollment of all patients with pulmonary nodules
• Cardiac ejection fraction < 40%
• Patients with clinical or laboratory evidence of liver disease would be evaluated for the cause of liver disease, its clinical severity in terms of liver function, bridging fibrosis, and the degree of portal hypertension; patients will be excluded if they are found to have fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin > 3mg/dL, or symptomatic biliary disease
• Karnofsky Performance Score < 70
• Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment
• Females who are pregnant or breastfeeding
• No intensive chemotherapy can be given within three weeks (or the interval in which a cycle of standard chemotherapy would be administered in a non-transplant setting) prior to initiating the nonmyeloablative transplant conditioning
• Patients with active non-hematologic malignancies (except non-melanoma skin cancers)
• Patients with a history of non-hematologic malignancies (except non-melanoma skin cancers) currently in a complete remission, who are less than 5 years from the time of complete remission, and have a > 20% risk of disease recurrence
• Patients with active bacterial or fungal infections unresponsive to medical therapy
• DONOR: Identical twin
• DONOR: Pregnancy
• DONOR: HIV seropositivity
• DONOR: Inability to achieve adequate venous access
• DONOR: Known allergy to G-CSF
• DONOR: Current serious systemic illness

Contacts and Locations

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Locations

United States, Oregon
OHSU Cancer Institute
Portland, Oregon, United States, 97210
United States, Washington
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States, 98109

Sponsors and Collaborators

Fred Hutchinson Cancer Research Center

National Cancer Institute (NCI)

Investigators

Principal Investigator:	Brenda Sandmaier	Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium

More Information

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Responsible Party:	Brenda Sandmaier, Principal Investigator, Fred Hutchinson Cancer Research Center
ClinicalTrials.gov Identifier:	NCT00045435 History of Changes
Other Study ID Numbers:	1654.00; NCI-2011-01307 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted:	January 27, 2003
Results First Posted:	March 16, 2017
Last Update Posted:	June 20, 2018
Last Verified:	May 2018

Additional relevant MeSH terms:

Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Myelodysplastic Syndromes; Preleukemia; Neoplasm Metastasis; Leukemia, Monocytic, Acute; Leukemia, Myelomonocytic, Acute; Leukemia, Megakaryoblastic, Acute; Leukemia, Erythroblastic, Acute; Neoplasms by Histologic Type; Neoplasms; Bone Marrow Diseases; Hematologic Diseases; Precancerous Conditions	Neoplastic Processes; Pathologic Processes; Myeloproliferative Disorders; Fludarabine; Fludarabine phosphate; Mycophenolic Acid; Cyclosporins; Cyclosporine; Vidarabine; Antineoplastic Agents; Antimetabolites, Antineoplastic; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Immunosuppressive Agents; Immunologic Factors