Test Extracorporeal Photopheresis (ECP) Treatment Before/After Allogeneic Bone Marrow Transplant (BMT) or Peripheral Blood Stem Cell (PBSC) Transplant to Prevent Graft Versus Host Disease

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: NCT01174940
Recruitment Status : Completed
First Posted : August 4, 2010
Last Update Posted : January 9, 2017
Information provided by (Responsible Party):
University of Kansas Medical Center

Brief Summary:
To study the effect of ECP with Uvadex® in conjunction with a standard myeloablative conditioning regimen on the incidence of acute and chronic GvHD in patients undergoing an allogeneic related or unrelated BMT or PBSC transplant, for treatment of hematologic or lymphoproliferative malignancies.

Condition or disease Intervention/treatment Phase
Stem Cell Leukemia of Unclear Lineage Graft Versus Host Disease Drug: extracorporeal photopheresis Early Phase 1

Detailed Description:

This study is to test the concept that using ECP treatment prior to and after an allogeneic bone marrow transplant (BMT) or peripheral blood stem cell (PBSC) transplant will prevent the development of GvHD. This study is not designed to detect a specific treatment effect. However, some statements about the outcome of the study are possible. A sample size of n = 21 patients could detect a statistically significant difference between the expected rate of GvHD in an untreated population, 60%, and our hypothesized rate, 30%, for the matched-unrelated recipients. This calculation is based on a one-sample, two-sided chi-square test at the 5% level of significance with 80% power.

Patients will receive ECP from day -10 and day -8 before transplant and then from day of engraftment absolute neutrophil count (ANC>500) until day 90 after transplant. Patients who enter the study will receive a BMT or PBSC transplant from a donor who is matched unrelated (8/10 to 10/10 match). Rates of acute GvHD and chronic GvHD that occur in patients are 50-70% for the matched-unrelated donor transplant.

The choice of sample size is 21 patients. The analysis will determine if there are favorable trends for a treatment effect. Comparison on survival, and rates of acute and chronic GvHD will be made with historical controls who have undergone similar myeloablative transplant from an unrelated donor.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 22 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Study of Extracorporeal Photopheresis With UVADEX® in the Setting of a Standard Myeloablative Conditioning Regimen in Related or Unrelated Donor Hematopoietic Stem Cell Transplantation for the Prevention of Graft Versus Host Disease
Study Start Date : June 2010
Actual Primary Completion Date : August 2014
Actual Study Completion Date : August 2015

Arm Intervention/treatment
Experimental: Extracorporeal Photopheresis
Patients will receive 2 ECP treatments on day -10 and day -8 and then for two consecutive days every two weeks starting from post engraftment (ANC > 500) up to day 90 (total of 10 treatments). This may be given as an outpatient procedure.
Drug: extracorporeal photopheresis

Patients will receive 2 ECP treatments prior to the commencement of the high dose chemotherapy and then for two consecutive days every two weeks starting from post engraftment (ANC > 500) up to day 90 (total of 10 treatments). This may be given as an outpatient procedure.

The dose of UVADEX® used to inoculate these cells will be calculated based on the treatment volume collected during the plasma/buffy coat collection process, using the following formula:

Treatment Volume in mL X 0.017 of UVADEX® (20 mcg/ml) required for administration into the recirculation bag = Amount of UVADEX® (in mLs) required for administration into the recirculation bag.

After the cells are inoculated with UVADEX®, the buffy coat/plasma suspension is irradiated with ultraviolet-A light and then re-infused back into the patient.

Other Names:
  • UVAR

Primary Outcome Measures :
  1. Presence/absence of grade II-IV acute Graft versus Host Disease (aGVHD) [ Time Frame: 100 days after transplant ]
    The primary efficacy variable is the presence/absence of grade II-IV acute GvHD within the first 100 days after transplantation

Secondary Outcome Measures :
  1. proportion of patients who develop chronic Graft versus Host Disease (cGVHD) and experience relapse of primary disease. [ Time Frame: 365 days after transplantation ]

    These secondary efficacy variables for a patient are dichotomous:

    • the development of cGvHD during 365 days after transplantation (and which body sites are involved)
    • the relapse of primary disease (hematologic or lymphoproliferative malignancy)
    • the grade of aGvHD
    • the involved sites of cGvHD

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients are eligible if they have a diagnosis of one of the following hematologic or lymphoproliferative malignancies for which a treatment option would be an allogeneic BMT or PBSC transplant:

    • acute myelogenous leukemia
    • chronic myelogenous leukemia
    • acute lymphocytic/blastic leukemia
    • chronic lymphocytic leukemia
    • myelodysplastic syndrome
    • non-Hodgkin's lymphoma (expected survival > 60 days)
    • Hodgkin's disease (expected survival > 60 days)
  • Patients who are candidates for a standard allogeneic BMT or patients who are candidates for a standard allogeneic PBSC transplant.
  • Patients must have a suitable HLA- molecular matched (8/10 or more) related or unrelated donor.
  • Patients must be physically and psychologically capable of undergoing a BMT or PBSC transplant and the attendant period of strict isolation.
  • Patients must test negative for human immunodeficiency virus (HIV).
  • Patients must present no evidence of active ongoing infection.
  • Patients must have adequate renal, hepatic, pulmonary, and cardiac function to enable the patient to tolerate the extracorporeal volume shifts associated with ECP, as determined by the physician's clinical judgment.
  • Platelets ≥ 20,000/cmm.
  • Patients ≥ 18 years of age.
  • Weight ≥ 40 kg (88 lb).
  • Systolic Blood Pressure ≥ 90 mm Hg after the patient has been in a sitting position for five minutes.
  • Women of childbearing potential must agree to use a reliable method of birth control for the duration of the study.
  • Patients must be willing to comply with all study procedures.
  • Signed and dated informed consent must be obtained prior to conducting any study procedures. The parent or legal guardian of a minor must also provide written informed consent.

Exclusion Criteria

  • Patients who have received a prior allogeneic BMT or PBSC transplant.
  • Hypersensitivity or allergy to psoralen (methoxsalen).
  • Contraindication to radiation, cyclophosphamide, CSA, Busulphan or MTX.
  • Hypersensitivity or allergy to both heparin and citrate products. (If hypersensitive or allergic to only one of these two products, exclusion does not apply if the other product is strictly used for the patient.)
  • Patients whose treatment requires donor lymphocyte infusion up to day 100 post-transplant.
  • Participation in another clinical trial for prevention of GvHD within 7 days prior to patient enrollment or concurrent participation in any other clinical study.
  • Active gastrointestinal bleeding.
  • Females who are pregnant or lactating.
  • Previous treatment with ECP.

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): NCT01174940

United States, Kansas
University of Kansas Medical Center
Kansas City, Kansas, United States, 66160
Sponsors and Collaborators
University of Kansas Medical Center
Principal Investigator: Sunil Abhyankar, MD University of Kansas Medical Center

Responsible Party: University of Kansas Medical Center Identifier: NCT01174940     History of Changes
Other Study ID Numbers: 12047
First Posted: August 4, 2010    Key Record Dates
Last Update Posted: January 9, 2017
Last Verified: January 2017

Keywords provided by University of Kansas Medical Center:
myelogenous leukemia
lymphocytic leukemia
lymphoblastic leukemia
myelodysplastic syndrome
non-Hodgkin's lymphoma
Hodgkin's disease

Additional relevant MeSH terms:
Graft vs Host Disease
Neoplasms by Histologic Type
Immune System Diseases