Imatinib Mesylate, Busulfan, Fludarabine, and Antithymocyte Globulin for CML Patients
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Purpose
Primary Objective:
To estimate the probability of molecular complete remission at one year for the described sequential treatment approach, with nonablative hematopoietic transplantation, post transplant imatinib mesylate and donor lymphocyte infusion, in patients with Ph-positive Chronic Myelogenous Leukemia (CML) not in blastic transformation.
Secondary Objective:
Response to post transplant Imatinib mesylate therapy for 12 weeks as treatment of residual disease, response to donor lymphocyte infusion (DLI) for residual disease following imatinib mesylate therapy, as well as engraftment, toxicity, disease free survival and survival, effect of busulfan pharmacokinetics on study outcome.
| Condition | Intervention | Phase |
|---|---|---|
| Leukemia | Drug: Imatinib Mesylate Drug: Fludarabine (Fludara) Drug: Busulfan Drug: Antithymocyte Globulin (ATG) Drug: Tacrolimus Drug: Methotrexate Procedure: Donor lymphocyte infusion (DLI) Procedure: Stem Cell Transplant | Phase 2 |
| Study Type: | Interventional |
| Study Design: | Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment |
| Official Title: | Imatinib Mesylate, Busulfan, Fludarabine, Antithymocyte Globulin and Allogeneic Stem Cell Transplantation for Chronic Myelogenous Leukemia |
- Number of Participants in Complete Molecular Remission at 1 Year [ Time Frame: Baseline to 1 year ]Participants at 1 year in molecular remission, post transplant, post imatinib mesylate and donor lymphocyte infusion (DLI). Molecular remission is a complete remission with no evidence of disease in the blood cells and/or bone marrow using sensitive polymerase chain reaction (PCR) tests (this test is most commonly used in clinical trials).
- Participants' With mCR Response to Post Transplant Imatinib Mesylate Therapy [ Time Frame: 1 Year ]Number of participants with response of molecular complete remission (mCR) to Imatinib Mesylate therapy as treatment for residual disease after transplant. Molecular remission is a complete remission with no evidence of disease in the blood cells and/or bone marrow using sensitive polymerase chain reaction (PCR) tests.
- Participants' With mCR Response to Post Transplant DLI [ Time Frame: 1 year ]Number of participants with response of molecular complete remission (mCR) to DLI as treatment for residual disease after transplant. Molecular remission is a complete remission with no evidence of disease in the blood cells and/or bone marrow using sensitive polymerase chain reaction (PCR) tests.
| Enrollment: | 42 |
| Study Start Date: | February 2003 |
| Study Completion Date: | November 2009 |
| Primary Completion Date: | November 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
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Experimental: Imatinib, Busulfan, Fludara + Antithymocyte Globulin
Oral Imatinib Mesylate 400 mg twice a day for 9 Days; Busulfan 130 mg/m^2 by vein (IV) daily for 2 Days; Fludara 40 mg/m^2 IV daily for 4 Days; Antithymocyte Globulin (ATG) 2.5 mg/kg IV daily for 3 Days; Tacrolimus levels maintained between 5-15 ng/dl, Day -2 to Day 180; Methotrexate 5 mg/m2 on days 1, 3, 6 and 11; and Donor bone marrow or blood stem cells infused on day 0 with possible donor lymphocyte infusion (DLI) for progressive disease.
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Drug: Imatinib Mesylate
400 mg by mouth twice daily for 9 Days
Other Names:
Drug: Fludarabine (Fludara)
40 mg/m^2 by vein daily for 4 Days
Other Names:
Drug: Busulfan
130 mg/m^2 by vein daily for 2 Days
Other Names:
Drug: Antithymocyte Globulin (ATG)
2.5 mg/kg by vein daily for 3 Days
Other Names:
Drug: Tacrolimus
Tacrolimus levels maintained between 5-15 ng/dl, first as continuous IV infusion, and converted to oral every 12 hour dosing as tolerated. Starting day -2 until day 180.
Other Name: Prograf
Drug: Methotrexate
5 mg/m2 on days 1, 3, 6 and 11.
Procedure: Donor lymphocyte infusion (DLI)
Infusion of lymphocytes from the original bone marrow donor by vein if relapse after >4 weeks of imatinib.
Other Names:
Procedure: Stem Cell Transplant
Infusion of donor bone marrow or blood stem cells by vein over approximately one hour on day 0.
Other Names:
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Detailed Description:
Patients will have blood and bone marrow tests performed as well as chest and sinus X-rays and tests of their heart and lung function. Approximately 5 tablespoons of blood will be drawn.
All patients in this study will receive imatinib mesylate by mouth for 9 days, unless the patient is known to be allergic or have symptomatic intolerance to the drug, or if the leukemia has failed to respond to imatinib. Fludarabine 40 mg/m2 by vein for 4 days (days -5 to -2), busulfan 130 mg/m2 by vein for 2 days (days -3 and -2), and ATG (Antithymocyte Globulin) 2.5 mg/kg by vein for 3 days (-3,-2 and -1).
Patients will then receive the donor bone marrow or blood stem cells by vein over approximately one hour on day 0.
After the infusion of the donor cells, you will receive immunosuppressive therapy with tacrolimus and methotrexate to decrease the risk of developing graft-vs-host disease (GvHD).
Patients will need frequent blood tests to monitor their counts and blood chemistries. This is generally done daily while in hospital and at least twice per week for the first 100 days post transplant. You may need frequent blood transfusions and may have to be admitted to the hospital to receive antibiotics if they develop fever. Bone marrow will be examined frequently beginning four weeks after treatment to evaluate response to treatment; Blood and bone marrow exams are to be performed at one, two three, six, 12 and 18 months post transplant and yearly thereafter for 5 years. To collect a bone marrow sample, an area of the hip or chest bone is numbed with anesthetic and a small amount of bone marrow is withdrawn through a large needle.
Patients in whom treatment produces a remission, in which no sign of the leukemia can be detected, will receive no further therapy unless the leukemia recurs. Patients with evidence of leukemia after 3 months from the transplant will receive additional treatment with imatinib mesylate; those with detectable leukemia after an additional 3 months may receive an infusion of immune cells from the transplant donor.
If there is evidence of leukemia after the transplant, you will receive additional treatment with imatinib mesylate. If leukemia cells can still be detected, additional donor immune cells will be given to you by vein.
Patients are considered on the study for 5 years after the transplant.
A total of 90 patients will take part in this study. All will be enrolled at M. D. Anderson.
Eligibility
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, Learn About Clinical Studies.
| Ages Eligible for Study: | up to 70 Years (Child, Adult, Senior) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Diagnosis of Ph+ chronic myelogenous leukemia (CML) in first chronic phase without a complete hematologic response after 3 months of Imatinib mesylate therapy, or >=35% Ph+ cells despite > 6 months of Imatinib mesylate treatment, or after disease progression from a complete or partial response. Any patient with accelerated phase or blast crisis who achieves a subsequent chronic phase is eligible. Patients must have an HLA matched related or unrelated donor or one antigen mismatched related donor.
- Patients should be less than 70 years of age. Patients less than 30 years of age who achieve a hematologic remission with imatinib therapy are eligible regardless of cytogenetic response.
- Patients are stratified as Group 1: First chronic phase, Group 2 Accelerated phase or blast crisis that achieved a hematologic remission with imatinib mesylate-based treatment.
Exclusion Criteria:
- Zubrod Performance Scale (PS) >=2, uncontrolled infection, Creatinine > 2.0 mg/dl; Ejection fraction < 40%; Carbon Monoxide Diffusing Capacity (DLCO) < 45% of predicted; Serum bilirubin > 2 gm/dl; GPT (Glutamic-pyruvic transaminase) or GOT (glutamic-oxaloacetic transaminase)> 3 times normal values. Patients should not be human immunodeficiency virus (HIV) seropositive or pregnant.
- Patients should not have progressed to accelerated phase or blast crisis while receiving imatinib mesylate containing therapy.
Contacts and Locations
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): NCT00499889
| United States, Texas | |
| UT MD Anderson Cancer Center | |
| Houston, Texas, United States, 77030 | |
| Principal Investigator: | Richard E. Champlin, MD | M.D. Anderson Cancer Center |
More Information
Additional Information:
| Responsible Party: | M.D. Anderson Cancer Center |
| ClinicalTrials.gov Identifier: | NCT00499889 History of Changes |
| Other Study ID Numbers: |
ID02-901 |
| First Submitted: | July 10, 2007 |
| First Posted: | July 12, 2007 |
| Results First Submitted: | September 30, 2011 |
| Results First Posted: | November 7, 2011 |
| Last Update Posted: | April 23, 2012 |
| Last Verified: | April 2012 |
Keywords provided by M.D. Anderson Cancer Center:
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Chronic Myelogenous Leukemia Allogeneic Stem Cell Transplantation Leukemia Imatinib Mesylate Gleevec Busulfan Busulfex |
Myleran Fludarabine ATG STI571 Antithymocyte Globulin Thymoglobulin |
Additional relevant MeSH terms:
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Leukemia Leukemia, Myelogenous, Chronic, BCR-ABL Positive Neoplasms by Histologic Type Neoplasms Leukemia, Myeloid Myeloproliferative Disorders Bone Marrow Diseases Hematologic Diseases Methotrexate Fludarabine phosphate Tacrolimus Imatinib Mesylate Busulfan Thymoglobulin Antilymphocyte Serum |
Vidarabine Fludarabine Abortifacient Agents, Nonsteroidal Abortifacient Agents Reproductive Control Agents Physiological Effects of Drugs Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Dermatologic Agents Enzyme Inhibitors Folic Acid Antagonists Immunosuppressive Agents Immunologic Factors |