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TBI Dose De-escalation for Fanconi Anemia

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.
 
ClinicalTrials.gov Identifier: NCT00352976
Recruitment Status : Completed
First Posted : July 17, 2006
Results First Posted : November 24, 2021
Last Update Posted : November 24, 2021
Sponsor:
Information provided by (Responsible Party):
Masonic Cancer Center, University of Minnesota

Brief Summary:
This is a single arm, total body irradiation (TBI) trial. All patients will be prescribed TBI 300 cGy with the goal of evaluating secondary endpoints.

Condition or disease Intervention/treatment Phase
Fanconi Anemia Drug: Cyclophosphamide Drug: Fludarabine Procedure: Total Body Irradiation Procedure: Bone Marrow Transplantation Drug: Mycophenolate Mofetil Drug: Sirolimus Phase 2 Phase 3

Detailed Description:
Study Treatment: Patients will receive voriconazole (antifungal therapy) by mouth beginning 1 month prior to conditioning therapy, if possible. 1) The subject is to receive total body irradiation (300 cGy) with thymic shielding; it will be given six days before the stem cells are given (day -6). 2) Day -5 through Day -2, subjects will receive a chemotherapy regimen of Fludarabine and Cyclophosphamide via central line (i.e. Hickman or Broviac). Starting Day -3, patients will receive sirolimus therapy with a taper commencing on day +180 and also mycophenolate mofetil (MMF) through day +30 or for 7 days after engraftment, whichever day is later, if no acute graft-versus-host disease (GVHD). 4) If the subject is receiving bone marrow or "peripheral" stem cells (cells collected from the donor's arm via a cell separator), on the day of transplantation, the stem cells taken from the donor will be put into a machine which will separate the lymphocytes (the cells that cause graft-versus-host disease [GVHD]) from the stem cells. If the subject is receiving an umbilical cord blood, the lymphocytes will not be removed because the risk of GVHD is not as high. Otherwise all patients will receive the same treatment. The stem cells are given as an infusion into the subject's existing catheter over 1-2 hours on day 0.5. On the day after transplant (day +1) subjects will be given G-CSF to stimulate the growth of the transplanted cells. 6. While receiving treatment and until the subject's blood counts recover he/she will have daily blood tests, and several bone marrow biopsies and aspirates. After recovery, subjects will be seen once a month for a health assessment and blood tests until at least 3 months after the cells have been infused. Additional blood tests or assessments may be done as medically indicated.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 83 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Total Body Irradiation Dose De-escalation Study in Patients With Fanconi Anemia Undergoing Alternate Donor Hematopoietic Cell Transplantation
Actual Study Start Date : May 18, 2006
Actual Primary Completion Date : October 9, 2020
Actual Study Completion Date : October 9, 2020


Arm Intervention/treatment
Experimental: Treatment with TBI
Patients treated with total body irradiation, Fludarabine, Cyclophosphamide, Bone Marrow Transplantation, Mycophenolate Mofetil, and Sirolimus.
Drug: Cyclophosphamide
Day -5 through Day -2, subjects will receive chemotherapy of Cyclophosphamide via central line (i.e. Hickman or Broviac),10 mg/kg intravenously (IV)
Other Name: cytoxan

Drug: Fludarabine
Day -5 through Day -2 prior to transplant; subjects will receive chemotherapy of Fludarabine via central line (i.e. Hickman or Broviac),35 mg/m^2 intravenous (IV)
Other Name: fludara

Procedure: Total Body Irradiation
total body irradiation (300 cGy) with thymic shielding will be given six days before the stem cells are given (day -6). Thymic shielding is done by placing a piece of lead on the chest during the irradiation treatment so that the irradiation beams do not go to the thymus.
Other Name: Radiation Therapy, Therapeutic radiation

Procedure: Bone Marrow Transplantation
A target of 5 * 10^6/kg and a minimum of 4 * 10^6 CD34+ cell/kg recipient weight will be collected by apheresis and used for transplant. In most cases this dose will be recovered in a single apheresis; however, a second or rarely third apheresis performed on the following days may be required to achieve the minimum dose.
Other Name: Stem Cell transplantation

Drug: Mycophenolate Mofetil
Patients will receive MMF therapy beginning on day -3 through day +30 or for 7 days after engraftment, whichever day is later, if no acute graft-versus-host disease (GVHD). Engraftment is defined as 1st day of 3 consecutive days of absolute neutrophil count [ANC] > 0.5 * 10^9/L. MMF will be given at a dose of 15 mg/kg/dose every 8 hours by mouth(to a maximum dose of 1 gram).
Other Name: MMF

Drug: Sirolimus
Sirolimus will be administered starting at day -3 with 8mg-12mg mg oral loading dose followed by single dose 4 mg/day with a target serum concentration of 3 to 12 mg/mL by high-performance liquid chromatography (HPLC). Levels are to be monitored 3 times/week in the first 2 weeks, weekly until day +60, and as clinically indicated until day +100 post-transplantation. In the absence of acute GVHD sirolimus may be tapered starting at day +100 and eliminated by day +180 post-transplantation.
Other Name: Rapamycin




Primary Outcome Measures :
  1. Number of Participant With Neutrophil Recovery [ Time Frame: by day 42 ]
    Number of participant with neutrophil recovery. Neutrophil recovery is defined as absolute neutrophil count ≥500/µL for three consecutive days


Secondary Outcome Measures :
  1. Number of Participants Experiencing Grade ≥3 Regimen Related Toxicity [ Time Frame: by day 100 ]
    Regimen related toxicities (RRT) include: significant hemorrhagic cystitis, pulmonary hemorrhage, interstitial pneumonitis, GI hemorrhage, renal failure, erythroderma, and severe hepatic veno-occlusive disease

  2. Number of Participants With Secondary Graft Failure at 100 Days [ Time Frame: 100 days ]
    Secondary Graft Rejection by day 100

  3. Number of Participants Experiencing Acute Graft-versus-host Disease (GVHD) [ Time Frame: at 100 days ]
    Number of participants experiencing acute GVHD (all grades) by day 100

  4. Number of Participants Experiencing Chronic GVHD [ Time Frame: at one year ]
    Number of participants experiencing chronic Graft Vs Host Disease by 1 year

  5. Number of Participants Experiencing Overall Survival [ Time Frame: at one year ]
    Number of participants experiencing overall survival by 1 year

  6. Number of Participants Experiencing Infections by Day 100 [ Time Frame: by day 100 ]
  7. Number of Participants Experiencing Infections by Day 180 [ Time Frame: by day 180 ]
  8. Number of Participants Experiencing Infections by Day 365 [ Time Frame: by day 365 ]
  9. Average Immunoglobulin G (IgG) Levels as a Measure of Immune Reconstitution After Transplant, by 100 Days [ Time Frame: by 100 days ]
  10. Average IgG Levels as a Measure of Immune Reconstitution After Transplant, by 180 Days [ Time Frame: by 180 days ]
  11. Average IgG Levels as a Measure of Immune Reconstitution After Transplant by 365 Days [ Time Frame: by 365 days ]
  12. Average IgA Levels as a Measure of Immune Reconstitution After Transplant by 100 Days [ Time Frame: by 100 days ]
  13. Average IgA Levels as a Measure of Immune Reconstitution After Transplant by 180 Days [ Time Frame: by 180 days ]
  14. Average IgA Levels as a Measure of Immune Reconstitution After Transplant by 365 Days [ Time Frame: by 365 days ]
  15. Average IgM Levels as a Measure of Immune Reconstitution After Transplant by 100 Days [ Time Frame: by 100 days ]
  16. Average IgM Levels as a Measure of Immune Reconstitution After Transplant by 180 Days [ Time Frame: by 180 days ]
  17. Average IgM Levels as a Measure of Immune Reconstitution After Transplant by 365 Days [ Time Frame: by 365 days ]


Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Meeting the definition of standard risk or high risk Fanconi anemia as defined in the next two sections:

  • Standard risk patients must be <18 years of age with a diagnosis of Fanconi anemia with aplastic anemia (AA), myelodysplastic syndrome without excess blasts, or high risk genotype as defined below:

    • Aplastic anemia is defined as having at least one of the following when not receiving growth factors or transfusions:

      • platelet count <20 * 10^9/L
      • ANC <5 * 10^8/L
      • Hemoglobin <8 g/dL
    • Myelodysplastic syndrome (MDS) with multilineage dysplasia with or without chromosomal anomalies
    • High risk genotype (e.g. IVS-4 or exon 14 FANCC mutations, or BRCA1 or 2 mutations)
  • High risk patients must have one or more of the following high risk features:

    • Advanced MDS (≥ 5% blast) or acute leukemia
    • Require additional HSCT for graft failure
    • History at any time of systemic fungal or gram negative infection
    • Severe renal disease with a creatinine clearance <40 mL/min
    • Age > 18 years
  • Very high risk patients must have Advanced MDS (≥ 5% blast) or acute leukemia after initial hematopoietic stem cell transplant (HSCT)
  • Patients must have an appropriate source of stem cells. Patients and donors will be typed for HLA-A, B, C and DRB1 using high resolution molecular typing.
  • Adequate major organ function including:

    • Cardiac: ejection fraction >45%
    • Hepatic: bilirubin, AST or ALT, ALP <5 x normal
    • Karnofsky performance status >70% or Lansky >50 (if < 16 years of age)
  • Women of child-bearing age must be using adequate birth control and have a negative pregnancy test.
  • Written consent.

Exclusion Criteria:

  • Available HLA-genotypically identical related donor in standard risk patients.
  • Active central nervous system (CNS) leukemia at time of study enrollment.
  • History of squamous cell carcinoma of the head/neck/cervix within previous 2 years.
  • Prior radiation therapy that prevents further total body irradiation (TBI).

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 ClinicalTrials.gov identifier (NCT number): NCT00352976


Locations
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United States, Minnesota
University of Minnesota Medical Center
Minneapolis, Minnesota, United States, 55455
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
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Principal Investigator: Margaret L MacMillan, M.D. University of Minnesota Medical Center
  Study Documents (Full-Text)

Documents provided by Masonic Cancer Center, University of Minnesota:
Additional Information:
Publications:
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Responsible Party: Masonic Cancer Center, University of Minnesota
ClinicalTrials.gov Identifier: NCT00352976    
Other Study ID Numbers: MT2006-05
0605M85788 ( Other Identifier: IRB, University of Minnesota )
First Posted: July 17, 2006    Key Record Dates
Results First Posted: November 24, 2021
Last Update Posted: November 24, 2021
Last Verified: October 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Masonic Cancer Center, University of Minnesota:
Bone Marrow transplant
stem cell transplant
cord blood transplant
total body irradiation
thymic shielding
Additional relevant MeSH terms:
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Fanconi Syndrome
Anemia
Fanconi Anemia
Hematologic Diseases
Anemia, Hypoplastic, Congenital
Anemia, Aplastic
Congenital Bone Marrow Failure Syndromes
Bone Marrow Failure Disorders
Bone Marrow Diseases
Genetic Diseases, Inborn
DNA Repair-Deficiency Disorders
Metabolic Diseases
Renal Tubular Transport, Inborn Errors
Kidney Diseases
Urologic Diseases
Mycophenolic Acid
Sirolimus
Cyclophosphamide
Fludarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Antibiotics, Antitubercular