Treatment of Hematologic Malignancies With Single-Unit or Double-Unit Cord Blood Transplantation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00328237
Recruitment Status : Unknown
Verified November 2005 by Colorado Blood Cancer Institute.
Recruitment status was:  Recruiting
First Posted : May 19, 2006
Last Update Posted : June 26, 2006
Information provided by:
Colorado Blood Cancer Institute

Brief Summary:
The purpose of this study is to evaluate the incidence of neutrophil engraftment after transplantation of one or two cord blood units meeting a predetermined total minimum cell dose of 2.0 x 10 to the seventh total nucleated cell (TNC)/kg.

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Acute Lymphoblastic Leukemia Chronic Myeloid Leukemia Non-Hodgkin Lymphoma Myelodysplastic Syndromes Procedure: Cord Blood Transplant Phase 2

Detailed Description:

This is a non-randomized, phase II protocol to evaluate engraftment of cord blood after treatment with myeloablative conditioning of fludarabine, total body irradiation and cyclophosphamide. All patients will receive tacrolimus and mycophenolate mofetil as prophylaxis for graft-vs-host disease.

Conditioning Regimen:

  • Days -10 to -7: Fludarabine 30mg/m2/day IV
  • Days -7 to -4: TBI 165 centigray BID
  • Days -3 to -2: Cyclophosphamide 40mg/kg/day IV

Day 0: Infusion of Cord Blood Cells

Graft-vs-Host Disease Prophylaxis

  • Day -1: Start tacrolimus 0.03mg/kg/day IV
  • Day 0: Start MMF 7.5mg/kg IV BID

Study Type : Interventional  (Clinical Trial)
Enrollment : 20 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Treatment of Hematologic Malignancies With High-Dose Chemo-Radiotherapy Followed by Single-Unit or Double-Unit Cord Blood Transplantation: A Phase II Study
Study Start Date : November 2005

Primary Outcome Measures :
  1. Evaluate the incidence of neutrophil engraftment after transplantation of one or two cord blood units

Secondary Outcome Measures :
  1. Evaluate safety as measured by day 100 treatment related mortality
  2. Evaluate incidence of platelet engraftment
  3. Evaluate incidences of acute and chronic graft-versus-host disease (GVHD)
  4. Evaluate efficacy as measured by survival at 1 and 2 years after transplant
  5. Evaluate chimerism from double cord transplants to determine source of long term engraftment

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Ages Eligible for Study:   18 Years to 49 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Patients must:

  • Be between the ages of 18 and 49 years inclusive.
  • Have histologically proven hematologic malignancy and must meet accepted indications for allogeneic stem cell transplantation:

    • Acute myeloid leukemia (AML): high-risk in first complete remission (CR), near first CR (< 20% marrow blasts after induction therapy), or beyond first remission.
    • Acute lymphoblastic leukemia with high-risk features in first remission (Philadelphia chromosome positive or other similar high-risk features), near first CR (< 20% marrow blasts after induction therapy), or beyond first remission.
    • Chronic myeloid leukemia: in chronic phase (CP) and have failed Gleevec or are intolerant and have signs of failing other treatments, or have history of accelerated or blast phases. Storage of autologous peripheral blood stem cells is recommended for this group for patients, particularly if in chronic phase.
    • Non-Hodgkin’s lymphoma: aggressive histology with relapsed or primary refractory disease and not eligible for autologous transplantation. Patients with low-grade histology must have either failed 2 or more lines of systemic chemotherapy including one rituximab-based regimen. Radioimmunotherapy will be considered the equivalent of one line of chemotherapy. Excluded if prior radiotherapy to chest or prior autologous transplantation.
    • Myelodysplastic syndromes with International Prognostic Scoring System (IPSS) score of 1.5 or greater.
    • Other hematological malignancies if approved by the pipeline meeting on a case by case basis. Must also be approved by principal investigator.
  • Have no HLA-matched or 1-antigen mismatched related donors and no HLA-matched unrelated stem cell donors, or delays involved in performing a search are likely to be detrimental to the patient.
  • Have an ECOG performance status of 0 or 1 at the time of transplant.
  • Have major end organs (heart, lungs, liver, and kidneys) assessed and deemed adequate to withstand the effects of high-dose therapy planned for this protocol.
  • Have given voluntary informed consent.

Exclusion Criteria:

Patients are ineligible for this protocol if they:

  • Have a co-morbid medical condition, a psychiatric condition, or organ dysfunction that makes them at high-risk for treatment failure, for failed medical compliance, or for regimen-related toxicity from high-dose therapy.
  • Patients with any of the following will be excluded:

    • Pulmonary: hemoglobin (Hb)-adjusted diffusing capacity of lung for carbon monoxide (DLCO) < 60%, forced expiratory volume in 1 second (FEV1) < 70% of predicted, or receive continuous supplemental oxygen;
    • Cardiac: left ventricular ejection fraction (LVEF) < 50% or on any treatment for congestive heart failure;
    • Renal: serum creatinine greater than 2.0 or calculated creatinine clearance < 50 cc/min;
    • Liver: ALT, AST, or serum bilirubin > 1.5 x upper limit of normal (ULN). Any patient with elevated transaminases should have careful evaluation for the cause and liver biopsy may be required by the principle investigator. An elevated alkaline phosphatase should be fractionated and, if of liver origin, should be evaluated as for transaminases.
  • Are female and are pregnant, lactating, or have a positive pregnancy test.
  • Have a history of previous malignancy except for non-melanoma skin cancer and in-situ carcinoma of the cervix, unless the patient has been progression-free for > 5 years
  • Are HIV positive
  • Refractory malignancy: acute leukemia with greater than 30% blasts in bone marrow unless with untreated first relapse of AML or untreated myelodysplastic syndrome evolved to AML.
  • Acute leukemia with greater than 1000 blasts/ul in peripheral blood.
  • Uncontrolled central nervous system (CNS) leukemia or lymphoma.
  • Prior autologous or allogeneic transplantation using a myeloablative regimen.
  • Uncontrolled hypertension (systolic blood pressure [SBP] > 140, diastolic blood pressure [DBP] > 90) or hypertension requiring > 2 drugs for good control (SBP < 130, DBP < 90).
  • Invasive mold infection that is uncontrolled or has received less than one month of antifungal therapy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00328237

Contact: Nicole Stephens, RN, BSN, OCN 303-336-2183
Contact: Juli Murphy, CCRC 303-285-5087

United States, Colorado
Rocky Mountain Blood and Marrow Transplant Program Recruiting
Denver, Colorado, United States, 80218
Sub-Investigator: Scott Bearman, MD         
Sub-Investigator: Robert Rifkin, MD         
Sub-Investigator: Mark Brunvand, MD         
Sub-Investigator: Jeffrey Matous, MD         
Sub-Investigator: Michael Maris, MD         
Sponsors and Collaborators
Colorado Blood Cancer Institute
Principal Investigator: Peter McSweeney, MD Colorado Blood Cancer Institute Identifier: NCT00328237     History of Changes
Other Study ID Numbers: RMBMT-149
First Posted: May 19, 2006    Key Record Dates
Last Update Posted: June 26, 2006
Last Verified: November 2005

Keywords provided by Colorado Blood Cancer Institute:
Cord Blood Transplant
Umbilical cord blood transplant
Total Body Irradiation

Additional relevant MeSH terms:
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Lymphoma, Non-Hodgkin
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Neoplasms by Histologic Type
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Myeloproliferative Disorders