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High-Dose Cyclophosphamide in Treating Patients With Acute Graft-Versus-Host Disease That Did Not Respond to Steroid Therapy

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ClinicalTrials.gov Identifier: NCT00492921
Recruitment Status : Completed
First Posted : June 27, 2007
Last Update Posted : June 5, 2013
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Brief Summary:

RATIONALE: High-dose cyclophosphamide may be an effective treatment for acute graft-versus-host disease that did not respond to steroid therapy.

PURPOSE: This phase II trial is studying the side effects, best dose, and how well high-dose cyclophosphamide works in treating patients with acute graft-versus-host disease that did not respond to steroid therapy.


Condition or disease Intervention/treatment Phase
Graft Versus Host Disease Biological: filgrastim Drug: cyclophosphamide Phase 2

Detailed Description:

OBJECTIVES:

  • Determine the maximum tolerated dose of high-dose cyclophosphamide in patients with steroid refractory acute graft-versus-host disease.
  • Determine the efficacy of this regimen at 28 days post-treatment in these patients.

OUTLINE: This is a dose-escalation study.

Patients receive high-dose cyclophosphamide once daily for 1-4 days beginning on day 1 and filgrastim (G-CSF) subcutaneously once daily beginning on day 10 and continuing until blood counts recover.

Cohorts of 3-6 patients receive escalating doses of high-dose cyclophosphamide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

After completion of study treatment, patients are followed weekly for 4 weeks.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 12 participants
Primary Purpose: Supportive Care
Study Start Date : May 2007
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013





Primary Outcome Measures :
  1. Maximum tolerated dose of high-dose cyclophosphamide


Information from the National Library of Medicine

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Ages Eligible for Study:   up to 75 Years   (Child, Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed acute graft-versus-host disease (GVHD) ≥ clinical grade II, that is steroid refractory

    • Steroid refractory GVHD is defined as GVHD that has progressed (increasing in grading) despite 49 hours of treatment with methylprednisolone of ≥ 2.0 mg/kg OR GVHD that has failed to improve (no change in grading stage) despite 4 days of treatment with methylprednisolone of ≥ 2.0 mg/kg
  • Prior allogeneic hematopoietic stem cell transplantation using either bone marrow, peripheral blood stem cells, or cord blood OR prior donor lymphocyte infusion required
  • Evidence of myeloid engraftment
  • No chronic GVHD

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
  • ANC > 500/mm³
  • Not pregnant or nursing
  • Fertile patients must use effective contraception
  • Must be geographically accessible
  • No allergy or intolerance to cyclophosphamide or mesna
  • No HIV positivity
  • No mechanical ventilation
  • No active bleeding (excluding gastrointestinal bleeding) or history of hemorrhagic cystitis
  • No other uncontrolled illness including, but not limited to, the following:

    • Ongoing or active infection
    • Medical condition precluding patient from stopping azoles (e.g., fluconazole, itraconazole, or voriconazole) or other adequate antifungal therapy during cyclophosphamide administration
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Psychiatric illness/social situations that would preclude compliance

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics

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): NCT00492921


Locations
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
National Cancer Institute (NCI)
Investigators
Principal Investigator: Javier Bolanos-Meade, MD Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Responsible Party: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
ClinicalTrials.gov Identifier: NCT00492921     History of Changes
Other Study ID Numbers: J06116 CDR0000549900
P01CA015396 ( U.S. NIH Grant/Contract )
P30CA006973 ( U.S. NIH Grant/Contract )
JHOC-J06116
JHOC-NA_00003256
First Posted: June 27, 2007    Key Record Dates
Last Update Posted: June 5, 2013
Last Verified: June 2013

Keywords provided by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins:
graft versus host disease

Additional relevant MeSH terms:
Graft vs Host Disease
Immune System Diseases
Cyclophosphamide
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists