Allogeneic Transplant in HIV Patients (BMT CTN 0903)

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2015 by Medical College of Wisconsin
Sponsor:
Collaborators:
Blood and Marrow Transplant Clinical Trials Network
Information provided by (Responsible Party):
Medical College of Wisconsin
ClinicalTrials.gov Identifier:
NCT01410344
First received: August 3, 2011
Last updated: March 2, 2015
Last verified: March 2015
  Purpose

The rationale for this trial is to demonstrate the feasibility and safety of allogeneic HCT for patients with chemotherapy-sensitive hematological malignancies and coincident HIV-infection. In particular, the trial will focus on the 100-day non-relapse mortality as an indicator of the safety of transplant in this patient population. Correlative assays will focus upon the incidence of infectious complications in this patient population, the evolution of HIV infection and immunological reconstitution. Where feasible (and when this can be accomplished without compromise of either the donor quality or the timeliness of transplantation), an attempt will be made to identify donors who are homozygotes for the delta32 mutation for CCR5.


Condition Intervention Phase
Leukemia
Lymphoma
HIV
Drug: Fludarabine and Busulfan
Drug: Fludarabine and Melphalan
Drug: Busulfan and Fludarabine
Drug: Cyclophosphamide and Total Body Irradiation
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Allogeneic Hematopoietic Cell Transplant for Hematological Cancers and Myelodysplastic Syndromes in HIV-Infected Individuals (BMT CTN #0903)

Resource links provided by NLM:


Further study details as provided by Medical College of Wisconsin:

Primary Outcome Measures:
  • Non-Relapse Mortality [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
    The events for non-relapse mortality are death due to any cause other than relapse of the underlying malignancy


Secondary Outcome Measures:
  • Disease Status Following Transplant [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
    Patients will be assessed for disease status at Day 100 post-HCT: complete remission, partial remission (HL, NHL), stable disease (HL, NHL), relapse.

  • Chimerism [ Time Frame: 4 weeks, 100 days and 6 months ] [ Designated as safety issue: Yes ]
    Blood samples will be evaluated for T cell and myeloid chimerism at 4 weeks, 100 days and 6 months post-transplant.

  • Incidence of Infections [ Time Frame: Date of transplant through one year post-transplant ] [ Designated as safety issue: Yes ]
    Microbiologically documented infections will be reported by site of disease, date of onset, severity, and resolution, if any.

  • Six Month Overall Survival [ Time Frame: Six months post transplant ] [ Designated as safety issue: Yes ]
    Overall survival is defined as time from transplant to death or last follow-up.

  • Acute Graft-versus-Host Disease (GVHD) [ Time Frame: 100 Days ] [ Designated as safety issue: Yes ]
    Acute GVHD will be graded according to the BMT CTN Manual of Procedures. The time to onset of acute grades II-IV GVHD and grades III-IV GVHD will be recorded, as well as the maximum grade achieved.

  • Chronic Graft-versus-Host Disease (GVHD) [ Time Frame: 100 days, 6 months, 2 years ] [ Designated as safety issue: Yes ]
    Chronic GVHD will be scored according to the BMT CTN Manual of Procedures. The time to onset of limited and extensive chronic GVHD will be recorded.

  • Immunologic Reconstitution [ Time Frame: 8 Weeks; 6, 12 and 24 Months ] [ Designated as safety issue: Yes ]
    This will be measured in all patients at 8 weeks, 6 months, 12 months and 24 months post-transplant. Tests to be performed on peripheral blood at those time points include CD2, CD3, CD4, CD8, CD19, CD3+/CD25+, CD45 RA/RO, CD56+/CD3-, and quantitative immunoglobulins (IgM, IgG and IgA).

  • Impact of Therapy on the HIV Reservoir [ Time Frame: Day 100, 6 Months, 12 Months, and 24 Months ] [ Designated as safety issue: Yes ]
    HIV-1 RNA in plasma will be measured by standard real-time reverse transcription polymerase chain reaction (RT-PCR) (detection limit 40 copies/ml) and by the investigational single copy assay (SCA, detection limit 0.38 copy/ml). HIV-1 DNA in peripheral blood mononuclear cells (PBMCs) and other cells will be quantified using the same primers and probes used for SCA but without a reverse transcription step. HIV-1 RNA levels will be measured in plasma prior to the initiation of ablative chemotherapy, and at Day +100, 1 and 2 years post-transplant.

  • Hematologic Function [ Time Frame: Day 100, 6 months ] [ Designated as safety issue: Yes ]
    Hematologic function will be defined by absolute neutrophil count (ANC) greater than 1500, Hemoglobin greater than 10g/dL without transfusion support, and platelets greater than 100,000 and measured at Day 100 and 6 months. Use of growth factors will be noted.


Estimated Enrollment: 15
Study Start Date: September 2011
Estimated Study Completion Date: November 2015
Estimated Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Allogeneic Transplant
One regimen from either reduced-intensity conditioning (RIC) (Fludarabine and Busulfan; or Fludarabine and Melphalan) or myeloablative conditioning (MAC) (Busulfan and Fludarabine; or Cyclophosphamide and Total Body Irradiation) will be administered prior to allogeneic hematopoietic cell transplantation (HCT).
Drug: Fludarabine and Busulfan

RIC Regimen (Flu/Bu): Fludarabine total dose: 120-180 mg/m^2, Busulfan: ≤ 8 mg/kg PO or 6.4 mg/kg IV). Recommended regimen:

  • Days -6 to -2: Flu (30 mg/m^2/day, total dose of 150 mg/m^2)
  • Days -5 to -4: Busulfan (4mg/kg/day PO or 3.2 mg/kg IV, 130 mg/m^2/day, total dose of 8 mg/kg PO or 6.4 mg/kg IV, or 260 mg/m^2 IV, respectively)

Patients with a creatinine clearance of 40-70 ml/min (measured or calculated) should have a 20 percent dose reduction in Fludarabine dosage.

Busulfan will be dosed according to the recipient's ideal body weight (IBW), unless the patient weighs more than 125 percent of IBW, in which case the drug will be dosed according to the adjusted IBW.

Other Name: Fludara and Busulfex
Drug: Fludarabine and Melphalan

RIC Regimen (Flu/Mel): Fludarabine total dose: 120-180 mg/m^2, Melphalan total dose: less than or equal to 150 mg/m^2. Recommended regimen:

  • Days -5 to -2: Flu (30mg/m^2/day, total dose of 120 mg/m^2)
  • Day -1: Mel (140mg/m^2)

Patients with a creatinine clearance of 40-70 ml/min (measured or calculated) should have a 20 percent dose reduction in Fludarabine dosage.

Other Name: Fludara and Alkeran
Drug: Busulfan and Fludarabine

MAC Regimen (Bu/Flu): Fludarabine total dose: 120-180mg/m^2 Busulfan total dose less than or equal to 16mg/kg PO or 12.8 mg/kg IV. Recommended regimen:

  • Days -5 to -2: Busulfan (4 mg/kg/day PO with Bu Css 900 plus/equal to 100 ng/mL (or per institutional standard), 3.2 mg/kg/day IV or 130 mg/m^2/day IV; total dose of 16 mg/kg, 12.8 mg/kg or 520 mg/m^2, respectively)
  • Days -5 to -2: Flu (30 mg/m^2/day, total dose of 120 mg/m^2)

Patients with a creatinine clearance of 40-70 ml/min (measured or calculated) should have a 20 percent dose reduction in Fludarabine dosage.

Busulfan will be dosed according to the recipient's ideal body weight (IBW), unless the patient weighs more than 125 percent of IBW, in which case the drug will be dosed according to the adjusted IBW.

Other Name: Busulfex and Fludara
Drug: Cyclophosphamide and Total Body Irradiation

MAC Regimen (Cy/TBI): Cyclophosphamide total dose: 120 mg/kg, Fractionated TBI total dose: 1200-1420 cGy Recommended regimen:

  • Days -7 to -4: TBI (total dose of 1200-1420 cGy)
  • Days -3 to -2: Cy (60 mg/kg/day, total dose of 120 mg/kg)

Cyclophosphamide will be dosed according to the recipient's ideal body weight (IBW), unless the patient weighs less than IBW, in which case the drug will be dosed according to the actual body weight.

Other Name: Cytoxan® and radiation

Detailed Description:

The study is designed to evaluate the feasibility and safety of reduced-intensity and fully-ablative allogeneic hematopoietic cell transplantation (HCT) for patients with hematological malignancies or myelodysplastic syndromes (MDS) who have HIV infection. The goal of the study is to assess the 100 day Non-relapse Mortality as well as immunological reconstitution in this patient population. Where feasible, an attempt will be made to identify human leukocyte antigen (HLA)-compatible hematopoietic stem cell donors who are homozygotes for the delta32 mutation of the chemokine receptor 5 (CCR5delta32). Patients will undergo a treatment plan review prior to registration on the trial. All patients will undergo allogeneic HCT from a matched sibling or unrelated donor.

  Eligibility

Ages Eligible for Study:   15 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV-1 infection, as documented by a rapid HIV test or any FDA-Approved HIV-1 Enzyme or Chemiluminescence Immunoassay (E/CIA) test kit and confirmed by Western Blot at any time prior to study entry. HIV antigen, plasma HIV-1 RNA, or a secondary antibody test by a method other than rapid HIV and E/CIA is acceptable as an alternative test. Alternatively, if a rapid HIV test or any FDA-Approved HIV-1 Enzyme or Chemiluminescence Immunoassay (E/CIA) test is not available, two HIV-1 RNA values greater than or equal to 2000 copies/mL at least 24 hours apart performed by any laboratory that has Clinical Laboratory Improvement Amendments (CLIA) certification, or its equivalent, may be used to document infection.
  • Patients must be willing to comply with effective Antiretroviral Therapy.
  • Patients must be greater than or equal to 15 years of age.
  • Hematological malignancy associated with a poor prognosis with medical therapy alone. Diagnoses to be included: a)Patients with the diagnosis of Acute Myeloid or Lymphocytic Leukemia (AML or ALL) in first or second complete remission; b)Patients with advanced myelodysplastic syndromes (MDS), including those with International Prognostic Scoring System (IPSS) Int-2 and high-risk disease with less than 10 percent marrow blasts and no circulating myeloblasts after most recent therapy. Patients with acute leukemia that develops from a pre-existing MDS must meet the inclusion criteria for patients with AML detailed above; c)Hodgkin Lymphoma beyond first remission achieving at least a partial response to most recent therapy with no evidence of progression prior to transplant; d)Non-Hodgkin Lymphoma beyond first remission achieving at least a partial response to most recent therapy with no evidence of progression prior to transplant.
  • Donor/recipient HLA matching: a) Related donor: must be an 8/8 match at HLA-A, -B, -C, (serologic typing or higher resolution) and -DRB1 (at high resolution using DNA based typing). A 7/8 related donor match is permitted only if an 8/8 unrelated donor cannot be identified; b) Unrelated donor: must be a 7/8 or 8/8 match at HLA-A, -B, -C, and -DRB1 (at high resolution using DNA based typing).
  • Patients with adequate organ function as measured by: a)Cardiac -Left ventricular ejection fraction at rest greater than or equal to 40 percent demonstrated by Multi Gated Acquisition Scan (MUGA) or echocardiogram. Patients with known heart disease must have a functional status no worse than American Heart Association Class I defined as patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain; bi)Hepatic - Total Bilirubin less than 2.0 mg/dL (except for isolated hyperbilirubinemia attributed to Gilbert syndrome or antiretroviral therapy as specified in the protocol Appendix E) and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than 5x the upper limit of normal; bii)Concomitant Hepatitis - Patients with chronic hepatitis B or C may be enrolled on the trial providing the above bilirubin and transaminase criteria are met. In addition, there must be no clinical or pathologic evidence of irreversible chronic liver disease, and there must be no active viral replication as evidenced by an undetectable hepatitis viral load by a PCR-based assay; c)Renal-Creatinine clearance (calculated creatinine clearance is permitted) greater than 40 mL/min; d)Pulmonary: Diffusing capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in one second (FEV1), or forced vital capacity (FVC) greater than or equal to 45 percent of predicted (corrected for hemoglobin).
  • Signed Informed Consent

Exclusion Criteria:

  • Karnofsky/Lansky performance score less than 70 percent.
  • Active central nervous system (CNS) malignancy; however, patients with a history of positive Cerebrospinal fluid (CSF) cytology that has become negative with intrathecal chemotherapy are eligible.
  • Uncontrolled bacterial, viral or fungal infection (currently taking medication and with progression or no clinical improvement).
  • Active Cytomegalovirus (CMV) retinitis or other CMV-related organ dysfunction.
  • AIDS related syndromes or symptoms that pose a perceived excessive risk for transplantation-related morbidity as determined by the principal investigator.
  • Untreatable HIV infection due to multidrug antiretroviral resistance. Patients with a detectable viral load greater than 750 copies/ml should be evaluated with an HIV drug resistance test (HIV-1 genotype). The results should be included as part of the Antiretroviral Review. This Review Committee will make the final determination as to whether HIV viremia could potentially be suppressed with alternate antiretroviral therapy.
  • Pregnant (positive β-HCG) or breastfeeding.
  • Fertile men or women unwilling to use contraceptive techniques from the time of initiation of mobilization until six-months post-transplant.
  • Prior allogeneic HCT.
  • Patients with psychosocial conditions that would prevent study compliance and follow-up, as determined by the principal investigator.
  • T-cell depletion (including anti-thymocyte globulin (ATG) or alemtuzumab) is not allowed.
  • Use of cord blood as the source of hematopoietic cells is not allowed.
  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: NCT01410344

Contacts
Contact: Heather Wittsack 301-251-1161 hwittsack@emmes.com
Contact: Adam Mendizabal, PhD 301-251-1161 amendizabal@emmes.com

Locations
United States, Arizona
Mayo Clinic - Phoenix Recruiting
Phoenix, Arizona, United States, 85054
Contact: Lisa Sproat, MD    480-301-8335    Sproat.Lisa@mayo.edu   
United States, California
City of Hope National Medical Center Recruiting
Duarte, California, United States, 91010
University of California Los Angeles Withdrawn
Los Angeles, California, United States, 90035
University of CA, SF Recruiting
San Francisco, California, United States, 94143-0324
Contact: Lawrence Kaplan, MD    415-353-2661    lkaplan@medicine.ucsf.edu   
United States, Florida
University of Florida College of Medicine (Shands) Recruiting
Gainesville, Florida, United States, 32610-0277
Contact: John R Wingard, MD    352-273-7760    wingajr@medicine.ufl.edu   
H. Lee Moffitt Cancer Center Recruiting
Tampa, Florida, United States, 33624
Contact: Ernesto Ayala, MD    813-745-1554    ernesto.ayala@moffitt.org   
United States, Georgia
Blood & Marrow Transplant Program at Northside Hospital Recruiting
Atlanta, Georgia, United States, 30342
Contact: Kent Holland, MD       bmtga@aol.com   
United States, Maryland
Johns Hopkins Recruiting
Baltimore, Maryland, United States, 21231
Contact: Richard Ambinder, MD    410-955-8839    rambind1@jhmi.edu   
United States, Minnesota
Mayo Clinic - Rochester Recruiting
Rochester, Minnesota, United States, 55905
Contact: Shahrukh Hashmi, MD       Hashmi.Shahrukh@mayo.edu   
United States, New Jersey
Hackensack University Medical Center Recruiting
Hackensack, New Jersey, United States, 07601
Contact: Scott Rowley, MD    201-996-5828    srowley@humed.com   
Contact: Melissa Baker, MD       mbaker@humed.com   
United States, New York
Memorial Sloan-Kettering Cancer Center Recruiting
New York, New York, United States, 10174
Contact: Ariel Noya, MD       noya@mskcc.org   
United States, Ohio
Ohio State/Arthur G. James Cancer Hospital Recruiting
Columbus, Ohio, United States, 43210
Contact: Sumithira Vasu, MD    614-293-8196    Sumithira.Vasu@osumc.edu   
United States, Pennsylvania
University of Pennsylvania Cancer Center Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Kim Hummel    215-349-5786    kim.hummel@uphs.upenn.edu   
United States, Texas
University of Texas/MD Anderson CRC Recruiting
Houston, Texas, United States, 77030
Contact: Uday Popat, MD    713-745-3055    upopat@mdanderson.org   
Texas Transplant Institute Recruiting
San Antonio, Texas, United States, 78229
Contact: Paul Shaughnessy, MD    210-575-6907    Paul.Shaughnessy@MHShealth.com   
United States, Utah
University of Utah Withdrawn
Salt Lake City, Utah, United States, 84132
United States, Wisconsin
Medical College of Wisconsin Recruiting
Milwaukee, Wisconsin, United States, 53211
Contact: Carlos Arce-Lara    414-805-6800    carcelara@mcw.edu   
Sponsors and Collaborators
Medical College of Wisconsin
Blood and Marrow Transplant Clinical Trials Network
Investigators
Study Director: Mary Horowitz, MD Center for International Blood and Marrow Transplant Research
  More Information

Additional Information:
No publications provided

Responsible Party: Medical College of Wisconsin
ClinicalTrials.gov Identifier: NCT01410344     History of Changes
Other Study ID Numbers: BMTCTN0903, U01HL069294, BMT CTN 0903
Study First Received: August 3, 2011
Last Updated: March 2, 2015
Health Authority: United States: Federal Government
United States: Food and Drug Administration

Keywords provided by Medical College of Wisconsin:
HIV
ALL
AML
MDS
Non-Hodgkin Lymphoma

Additional relevant MeSH terms:
Busulfan
Cyclophosphamide
Fludarabine
Fludarabine phosphate
Vidarabine
Alkylating Agents
Anti-Infective Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Antiviral Agents
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on March 31, 2015