Bortezomib Plus Tacrolimus and Methotrexate to Prevent Graft Versus Host Disease (GVHD) After Mismatched Allogeneic Non-Myeloablative Blood Stem Cell Transplantation
This study has been completed.
Sponsor:
Dana-Farber Cancer Institute
Collaborators:
Brigham and Women's Hospital
Millennium Pharmaceuticals, Inc.
Information provided by (Responsible Party):
John Koreth, MD, Dana-Farber Cancer Institute
ClinicalTrials.gov Identifier:
NCT00369226
First received: August 24, 2006
Last updated: June 19, 2013
Last verified: June 2013
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Purpose
The purpose of this study is to determine if Velcade (also known as bortezomib) can help prevent graft versus host disease (GVHD) developing after transplantation. This is done by using a combination of three immune suppressive medications: Velcade, tacrolimus and methotrexate. Stem cell transplantation is one of the options for patients with cancer of the blood or blood forming organs. Recently, allogeneic stem cell transplants have been performed using lower doses of chemotherapy and radiotherapy: non-myeloablative or "mini" transplants. GVHD is a significant problem that may occur even after "mini" transplantations. Information from other research studies, suggests that Velcade may help to reduce the risk of developing GVHD when given early after transplantation.
| Condition | Intervention | Phase |
|---|---|---|
|
Hematologic Malignancies |
Drug: Bortezomib (Velcade) Drug: Tacrolimus Drug: Methotrexate Procedure: blood stem cell transplantation |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Safety Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | Phase I/II Trial of Bortezomib (Velcade) in Addition to Tacrolimus and Methotrexate to Prevent Graft Versus Host Disease (GVHD) After Mismatched Allogeneic Non-Myeloablative Peripheral Blood Stem Cell Transplantation |
Resource links provided by NLM:
Further study details as provided by Dana-Farber Cancer Institute:
Primary Outcome Measures:
- The Maximally Tolerated Dose (MTD) of Bortezomib (Velcade) That Can be Administered With Tacrolimus and Methotrexate After Mismatched Allogeneic Non-myeloablative Peripheral Blood Stem Cell (PBSC) Transplantation [ Time Frame: by day 45 post PBSC infusion ] [ Designated as safety issue: Yes ]
The MTD of bortezomib was evaluated at 3 dose levels:
Dose level 1: 1.0 mg/m^2 Dose level 2: 1.3 mg/m^2 Dose level 3: 1.5 mg/m^2 Cohorts of 3-5 pts were enrolled at each dose level. At any dose level, if no DLT in the first 3, 4, or 5 pts, then dose escalation would occur.
If 3 evaluable pts in cohort, and 1 of 3 experiences DLT then 2 additional pts treated at the same dose level. If >=1 of 2 additional pts experience DLT then previous dose level will be MTD. If no DLT in additional 2 pts then dose escalation will occur. If 4 evaluable pts in cohort, and 1 of the 4 experiences DLT then 1 additional pt treated at same dose level. If this additional pt experiences DLT then the previous dose will be declared to be the MTD. If additional pt does not experience DLT, then dose escalation will take place. If 5 evaluable pts in cohort, and 1 experiences DLT, then dose escalation will take place. If >=2 of first 3, 4, or 5 pts experience DLT then the previous dose will be declared MTD.
- Successful Initial Engraftment by Day 45 Post Peripheral Blood Stem Cell (PBSC) Infusion and Administration of Bortezomib (Velcade), Tacrolimus and Methotrexate [ Time Frame: by day 45 post PBSC infusion ] [ Designated as safety issue: No ]Percentage of participants who did not experience failure to engraft or relapse or death before assessment.
- Incidence of Grade II-IV Acute Graft Versus Host Disease (GVHD) by Day 100. [ Time Frame: by day 100 after peripheral blood stem cell (PBSC) infusion ] [ Designated as safety issue: Yes ]
Secondary Outcome Measures:
- Sustained Engraftment Following Transplant. [ Time Frame: by day 100 post transplant ] [ Designated as safety issue: No ]As measured by median total donor chimerism at day 100.
- Incidence of Chronic Graft Versus Host Disease (Chronic GVHD). [ Time Frame: by 1 year after PBSC infusion ] [ Designated as safety issue: Yes ]Number of participants with chronic GVHD at 1 year post transplant.
- Overall Survival and Progression-free Survival. [ Time Frame: by 1 year after PBSC infusion ] [ Designated as safety issue: No ]Progression is defined as disease relapse or disease progression since transplant.
| Enrollment: | 45 |
| Study Start Date: | August 2006 |
| Study Completion Date: | September 2011 |
| Primary Completion Date: | July 2010 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: Bortezomib/Tacrolimus/Methotrexate post HSCT |
Drug: Bortezomib (Velcade)
Infusion for a total of 3 doses
Drug: Tacrolimus
Taken until Doctor determines it is not necessary any more
Drug: Methotrexate
Infusion for a total of 4 doses
Procedure: blood stem cell transplantation
Allogeneic Non-myeloablative peripheral blood stem cell transplantation
|
Detailed Description:
- In this study we are looking for the highest dose of Velcade that can be given to people safely when given with tacrolimus and methotrexate. Not everyone who participates in the study will receive the same amount of the study drug. The dose the participant will receive depends upon the number of subjects enrolled on the study and how well they have tolerated their doses of the drug.
- Before Transplant: In addition to the chemotherapy drugs, fludarabine and busulfex, for the participants non-myeloablative transplant, they will also start taking tacrolimus orally three days before their transplant.
- After Transplant Medication: Methotrexate; Intravenously on days 1, 3, 6 & 11 after transplant for a total of 4 doses. Tacrolimus; Continue taking orally once daily. Velcade: Intravenously on days 1, 4 & 7 after transplant, a total of 3 doses. Filgrastim: Subcutaneous injection daily starting the day after transplant and continuing until the participant blood counts have recovered.
- After Transplant Physical Exams & Tests: Participants will have physical exams and blood tests every week for 1 month. After 1 month, a none marrow biopsy will be performed to look for evidence of the donor's cells in the participants bone marrow.
- Following the 1 month period of time, participants will be seen every few weeks. Another bone marrow biopsy, as well as blood tests, will be taken 3-4 months after the transplant to review the disease status. At this point, participants will come into the clinic about every 3 months, or as determined by their physician for about one year.
- While the study ends at 12 months after transplant, we would like to keep track of the participants medical condition for the rest of their life.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- Patients with hematologic malignancies including myelodysplastic syndrome (MDS), who are at a high risk of complications after myeloablative transplantation
- Patients have a donor (both related and unrelated) who are mismatched according to protocol criteria
- 18 years of age or older
- Performance status 0-2
- Life expectancy of > 100 days
- Female subject is either post-menopausal or sterilized or willing to use an acceptable form of birth control
- Male subject agrees to use an acceptable form of birth control
Exclusion Criteria:
- Evidence of HIV infection
- Total bilirubin > 2.0mg/dl that is due to hepatocellular dysfunction
- Aspartate aminotransferase (AST) > 90
- Known active hepatitis B or C
- Serum creatinine > 2.0
- Greater than or equal to Grade 2 peripheral neuropathy within 21 days of enrollment
- Prior allogeneic stem cell transplant
- Patients with myeloproliferative disease (e.g. myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia)
- Myocardial infarction within 6 months prior to enrollment or has NYHA Class III or IV hear failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
- Hypersensitivity to Velcade, boron or mannitol
- Pregnant or breast feeding
- Patient has received other investigational drugs 14 days before enrollment
- Serious medical or psychiatric illness
- Another active solid tumor malignancy at the time of study entry
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: NCT00369226
Please refer to this study by its ClinicalTrials.gov identifier: NCT00369226
Locations
| United States, Massachusetts | |
| Brigham and Women's Hospital | |
| Boston, Massachusetts, United States, 02115 | |
| Dana-Farber Cancer Institute | |
| Boston, Massachusetts, United States, 02115 | |
Sponsors and Collaborators
Dana-Farber Cancer Institute
Brigham and Women's Hospital
Millennium Pharmaceuticals, Inc.
Investigators
| Principal Investigator: | John Koreth, MD | Dana-Farber Cance Institute |
More Information
No publications provided by Dana-Farber Cancer Institute
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | John Koreth, MD, Principal Investigator, Dana-Farber Cancer Institute |
| ClinicalTrials.gov Identifier: | NCT00369226 History of Changes |
| Other Study ID Numbers: | 06-065, X05175 |
| Study First Received: | August 24, 2006 |
| Results First Received: | August 8, 2012 |
| Last Updated: | June 19, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Dana-Farber Cancer Institute:
|
Velcade Bortezomib Allogeneic Stem Cell Transplant GVHD |
Additional relevant MeSH terms:
|
Graft vs Host Disease Immune System Diseases Bortezomib Methotrexate Tacrolimus Abortifacient Agents Abortifacient Agents, Nonsteroidal Antimetabolites Antimetabolites, Antineoplastic Antineoplastic Agents Antirheumatic Agents |
Dermatologic Agents Enzyme Inhibitors Folic Acid Antagonists Immunologic Factors Immunosuppressive Agents Molecular Mechanisms of Pharmacological Action Nucleic Acid Synthesis Inhibitors Pharmacologic Actions Physiological Effects of Drugs Reproductive Control Agents Therapeutic Uses |
ClinicalTrials.gov processed this record on March 01, 2015