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Fludarabine Phosphate, Cyclophosphamide, Total Body Irradiation, and Donor Stem Cell Transplant in Treating Patients With Blood Cancer

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ClinicalTrials.gov Identifier: NCT03333486
Recruitment Status : Recruiting
First Posted : November 7, 2017
Last Update Posted : June 15, 2018
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Roswell Park Cancer Institute

Brief Summary:
This phase II trial studies how well fludarabine phosphate, cyclophosphamide, total body irradiation, and donor stem cell transplant work in treating patients with blood cancer. Drugs used in chemotherapy, such as fludarabine phosphate and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. Giving chemotherapy and total-body irradiation before a donor peripheral blood stem cell transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. The donated stem cells may also replace the patient?s immune cells and help destroy any remaining cancer cells.

Condition or disease Intervention/treatment Phase
Accelerated Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive Acute Leukemia in Remission Acute Lymphoblastic Leukemia Acute Myeloid Leukemia Acute Myeloid Leukemia With FLT3/ITD Mutation Acute Myeloid Leukemia With Gene Mutations Aplastic Anemia B-Cell Non-Hodgkin Lymphoma CD40 Ligand Deficiency Chronic Granulomatous Disease Chronic Leukemia in Remission Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia, BCR-ABL1 Positive Chronic Myelomonocytic Leukemia Chronic Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive Congenital Amegakaryocytic Thrombocytopenia Congenital Neutropenia Congenital Pure Red Cell Aplasia Glanzmann Thrombasthenia Immunodeficiency Syndrome Myelodysplastic Syndrome Myelofibrosis Myeloproliferative Neoplasm Paroxysmal Nocturnal Hemoglobinuria Plasma Cell Myeloma Polycythemia Vera Recurrent Non-Hodgkin Lymphoma Refractory Non-Hodgkin Lymphoma Secondary Acute Myeloid Leukemia Secondary Myelodysplastic Syndrome Severe Aplastic Anemia Shwachman-Diamond Syndrome Sickle Cell Disease T-Cell Non-Hodgkin Lymphoma Thalassemia Waldenstrom Macroglobulinemia Wiskott-Aldrich Syndrome Drug: Cyclophosphamide Drug: Fludarabine Phosphate Other: Laboratory Biomarker Analysis Procedure: Peripheral Blood Stem Cell Transplantation Radiation: Total-Body Irradiation Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To evaluate the rate of relapse, defined as recurrence of underlying disease or progression of underlying disease, at 1 year in patients who receive haploidentical peripheral blood stem cells (PBSCs) after reduced intensity conditioning and post-transplant cyclophosphamide.

SECONDARY OBJECTIVES:

I. To evaluate safety including development of acute graft versus host disease (GVHD) and death at 100 days post-transplant, as well as other treatment related toxicities including chronic GVHD, engraftment rate, non-relapse mortality, progression free survival (PFS) at one year, and overall survival (OS) at one year, as compared with historical controls.

TERTIARY OBJECTIVES:

I. Correlative studies will include chimerism analysis by molecular analysis and evaluation of immune reconstitution by cytomegalovirus (CMV) dextramer analysis using flow cytometry.

OUTLINE:

Patients receive fludarabine phosphate intravenously (IV) over 30 minutes on days -6 to -2 and cyclophosphamide IV over 2 hours on days -6 and -5. Patients undergo total body irradiation (TBI) on days -1 and peripheral blood stem cell transplantation (PBSCT) on day 0.

After completion of study treatment, patients are followed up at 30 and 100 days.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 58 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Trial of Haploidentical Allogeneic Stem Cell Transplantation Utilizing Mobilized Peripheral Blood Stem Cells
Actual Study Start Date : December 7, 2017
Estimated Primary Completion Date : September 6, 2021
Estimated Study Completion Date : September 6, 2022


Arm Intervention/treatment
Experimental: Treatment (fludarabine, cyclophosphamide, TBI, PBSCT)
Patients receive fludarabine phosphate IV over 30 minutes on days -6 to -2 and cyclophosphamide IV over 2 hours on days -6 and -5. Patients undergo TBI on days -1 and PBSCT on day 0.
Drug: Cyclophosphamide
Given IV
Other Names:
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
  • Carloxan
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafen
  • Claphene
  • CP monohydrate
  • CTX
  • CYCLO-cell
  • Cycloblastin
  • Cycloblastine
  • Cyclophospham
  • Cyclophosphamid monohydrate
  • Cyclophosphamidum
  • Cyclophosphan
  • Cyclophosphane
  • Cyclophosphanum
  • Cyclostin
  • Cyclostine
  • Cytophosphan
  • Cytophosphane
  • Cytoxan
  • Fosfaseron
  • Genoxal
  • Genuxal
  • Ledoxina
  • Mitoxan
  • Neosar
  • Revimmune
  • Syklofosfamid
  • WR- 138719

Drug: Fludarabine Phosphate
Given IV
Other Names:
  • 2-F-ara-AMP
  • 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-
  • Beneflur
  • Fludara
  • SH T 586

Other: Laboratory Biomarker Analysis
Correlative studies

Procedure: Peripheral Blood Stem Cell Transplantation
Undergo PBSCT
Other Names:
  • PBPC transplantation
  • PBSCT
  • Peripheral Blood Progenitor Cell Transplantation
  • peripheral stem cell support
  • Peripheral Stem Cell Transplant
  • peripheral stem cell transplantation

Radiation: Total-Body Irradiation
Undergo TBI
Other Names:
  • TOTAL BODY IRRADIATION
  • Whole-Body Irradiation




Primary Outcome Measures :
  1. Relapse rate [ Time Frame: At 1 year ]

Secondary Outcome Measures :
  1. Engraftment rate [ Time Frame: At 1 year post-transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson.

  2. Incidence of acute graft versus host disease (GVHD) [ Time Frame: At 100 days post-transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson.

  3. Incidence of chronic GVHD [ Time Frame: At 1 year post-transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson.

  4. Overall survival [ Time Frame: At 1 year post-transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson. Will be obtained using the product-limit based Kaplan-Meier method.

  5. Progression free survival [ Time Frame: At 1 year from time of transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson. Will be obtained using the product-limit based Kaplan-Meier method.

  6. Transplant related mortality [ Time Frame: At 1 year post-transplant ]
    Will be computed with corresponding exact 95% confidence intervals based on the methodology of Clopper and Pearson.


Other Outcome Measures:
  1. Immune reconstitution [ Time Frame: Up to 1 year ]
    Will be assessed by bone marrow transplantation SOC immunophenotyping panel and by analysis of cytomegalovirus-specific immunity.

  2. Myeloid and lymphoid chimerism expressed as a percentage of donor cells [ Time Frame: At 30 days ]
  3. Myeloid and lymphoid chimerism expressed as a percentage of donor cells [ Time Frame: At 100 days ]


Information from the National Library of Medicine

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:   1 Year to 75 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The patient must have a diagnosis of one of the following (one must be yes):

    • Bone marrow failure disorders:

      • Acquired bone marrow failure disorders include aplastic anemia, paroxysmal nocturnal hemoglobinuria (PNH):

        • SAA must have failed at least one cycle of standard immunosuppressive therapy with calcineurin inhibitor plus anti-thymocyte globulin (ATG) if a fully-matched donor is not available
        • PNH must have failed treatment or not tolerated treatment with eculizumab or progressed during or after treatment with eculizumab)
      • Hereditary bone marrow failure disorders include Diamond-Blackfan anemia, Shwachman-Diamond syndrome, Kostmann syndrome, and congenital amegakaryocytic thrombocytopenia
    • Other non-malignant hematologic or immunologic disorders that require transplantation:

      • Quantitative or qualitative congenital platelet disorders (including but not limited to congenital amegakaryocytopenia, absent-radii syndrome, Glanzmann's thrombasthenia)
      • Quantitative or qualitative congenital neutrophil disorders (including but not limited to chronic granulomatous disease, congenital neutropenia)
      • Congenital primary immunodeficiencies (including but not limited to severe combined immunodeficiency syndrome, Wiskott-Aldrich syndrome, CD40 ligand deficiency, T-cell deficiencies)
      • Hemoglobinopathies (including sickle cell disease and thalassemia
    • Acute leukemias:

      • Acute myeloid leukemia (AML) - antecedent myelodysplastic syndrome, secondary AML, high risk cytogenetic abnormalities or normal cytogenetics with high-risk molecular mutations (including but not limiting to Flt3-ITD mutation)
      • Acute lymphoblastic leukemia (ALL) B cell or T cell
    • Chronic myelocytic leukemia (CML):

      • Chronic phase (intolerant or unresponsive to imatinib and/or tyrosine kinase inhibitors)
      • Second chronic phase or accelerated phase who are ineligible for conventional myeloablative transplantation
    • Myeloproliferative and myelodysplasia syndromes:

      • Myelofibrosis (with/without splenectomy) with intermediate to high risk features
      • Advanced polycythemia vera not responding to therapy
      • Myelodysplastic syndrome (MDS) with an International Prognostic Scoring System (IPSS) score of intermediate or higher
      • Secondary MDS with any IPSS score
      • Chronic myelomonocytic leukemia (CMML)
    • Lymphoproliferative disease:

      • Chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin lymphoma (NHL) (recurrent or persistent) cytotoxic therapy refractory or with less than 6 months duration of complete response (CR) between courses of conventional therapy
      • Multiple myeloma (MM) progressive disease after auto bone marrow transplantation (BMT), tandem allo after prior auto
      • Waldenstrom?s macroglobulinemia (failed one standard regimen)
      • T or B cell lymphoma with poor risk features
      • Hodgkin disease:

        • Received and failed frontline therapy
        • Failed or not eligible for autologous transplantation
  • Suitable related haploidentical donor identified:

    • Must be matched at least at 5 of 10 HLA antigens (A, B, C,DRB1, DQ)
    • Must not be matched at more than 7 of 10 HLA antigens
    • Recipient should not have HLA antibodies to potential donor; if the recipient does have HLA antibodies to the potential donor, an alternative donor is preferred; however, if there are no suitable alternative donors, the donor to whom the patient has HLA antibodies can be utilized as long as the antibody titer is less than 2000 median fluorescence intensity (MFI); if the titer is > or = to 2000 MFI, the recipient must undergo successful antibody desensitization prior to enrollment on this study; any patients who have demonstrated donor specific antibodies will not be evaluated for the end points measured in this study but will be followed for treatment related toxicities
    • Haploidentical donors that are ABO compatible with the recipient are preferred. Minor ABO incompatibility is preferred to major ABO incompatibility. Major ABO incompatibility between recipient and donor is the least preferred but still acceptable for this study.
    • It is preferred that the haploidentical donor must be available to donate on day -1 and day 0, so that fresh product can be processed by the Stem Cell lab and administered to the patient on day 0.. While less preferable, cryopreserved product may be utilized with this product.
  • Diffusing capacity of the lung for carbon monoxide (DLCO) > 40% predicted, corrected for hemoglobin and/or alveolar ventilation
  • Left ventricular ejection fraction > 40%
  • Bilirubin, liver alkaline phosphatase, serum glutamic-oxaloacetic transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) =< 3 x upper limit of normal
  • Calculated creatinine clearance > 40 cc/min by the modified Cockcroft-Gault formula for adults or the Schwartz formula for pediatrics
  • Have a Karnofsky (adult) or Lansky (for =< 16 years) performance status >= 60%
  • Patient must be able to pass radiation evaluation (i.e.: able to receive 200 cGy)
  • Patients who have failed a prior autologous transplant are eligible; however, at least 90 days must have elapsed between the start of this reduced intensity conditioning regimen and the last transplant if patient had a prior autologous BMT
  • Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
  • Participant or legal representative must understand the investigational nature of this study and sign an independent ethics committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure
  • Patient in CR or has a bone marrow failure disorder or non-malignant hematologic or immune disorder : does NOT have a sibling donor or 12/12 HLA matched unrelated donor available OR treating clinician considers haploidentical transplant referable (despite sibling donor availability or 12/12 HLA matched donor availability) due to patient's clinical status.
  • Exclusion Criteria:
  • Participants who have had chemotherapy, radiation treatment and/or surgery 2 weeks prior to entering the study or, as per discretion of the treating physician, those who have not recovered sufficiently from adverse events due to agents administered more than 2 weeks earlier
  • Uncontrolled central nervous system (CNS) disease (for hematologic malignancies)
  • Child-Pugh class B and C liver failure
  • Concomitant active malignancy that would be expected to require chemotherapy within 3 years of transplant (other than non-melanoma skin cancer)
  • Patients who have received maximally allowed doses (given in 2 Gy fractionations, or equivalent) of previous radiation therapy to various organs; patients who previously have received a higher than allowed dose of radiation to a small lung, liver and brain volume, will be evaluated by the radiation oncologist to determine if the patient is eligible for study
  • Uncontrolled diabetes mellitus, cardiovascular disease, active serious infection or other condition which, in the opinion of treating physician, would make this protocol unreasonably hazardous for the patient
  • Known human immunodeficiency virus (HIV) positive
  • Pregnant or nursing female participants
  • Patients who in the opinion of the treating physician are unlikely to comply with the restrictions of allogeneic stem cell transplantation based on formal psychosocial screening
  • Patients with donor specific HLA antibodies with a titer greater than 2000 MFI (whether or not they have undergone a desensitization protocol)
  • Patients who have undergone a prior allogeneic hematopoietic or (other organ) transplant
  • Treating physician considers the potential HLA haploidentical donor to be ineligible to receive G-CSF, and/or concern on the part of the treating physician for risk of harm to the potential donor with administration of G-CSF, and/or refusal by the potential donor (or donor?s guardian) to receive G-CSF
  • Any condition which in the investigator?s opinion deems the participant an unsuitable candidate to receive study drug
  • Received an investigational agent within 30 days prior to enrollment

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): NCT03333486


Contacts
Contact: ASK RPCI 877-275-7724 askrpci@roswellpark.org

Locations
United States, New York
Roswell Park Cancer Institute Recruiting
Buffalo, New York, United States, 14263
Contact: Sophia R. Balderman    716-845-6972    Sophia.Balderman@roswellpark.org   
Principal Investigator: Sophia R. Balderman         
Sponsors and Collaborators
Roswell Park Cancer Institute
National Cancer Institute (NCI)
Investigators
Principal Investigator: Sophia Balderman Roswell Park Cancer Institute

Responsible Party: Roswell Park Cancer Institute
ClinicalTrials.gov Identifier: NCT03333486     History of Changes
Other Study ID Numbers: I 40916
NCI-2017-01949 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
I 40916 ( Other Identifier: Roswell Park Cancer Institute )
P30CA016056 ( U.S. NIH Grant/Contract )
First Posted: November 7, 2017    Key Record Dates
Last Update Posted: June 15, 2018
Last Verified: June 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphocytic, Chronic, B-Cell
Anemia, Sickle Cell
Lymphoma, T-Cell
Lymphoma, B-Cell
Neoplasms, Plasma Cell
Red-Cell Aplasia, Pure
Pathologic Processes
Neoplastic Processes
Leukemia, B-Cell
Lymphoma
Syndrome
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Anemia
Myelodysplastic Syndromes
Preleukemia
Lymphoma, Non-Hodgkin
Leukemia, Lymphoid
Neoplasm Metastasis
Immunologic Deficiency Syndromes
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Primary Myelofibrosis
Thrombocytopenia
Neutropenia
Thalassemia
Waldenstrom Macroglobulinemia
Anemia, Aplastic
Leukemia, Myelomonocytic, Chronic