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Busulfan/Clofarabine + Allogeneic Stem Cell Transplantation

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01643668
First Posted: July 18, 2012
Last Update Posted: July 13, 2017
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.
Information provided by (Responsible Party):
Yi-Bin A. Chen, MD, Massachusetts General Hospital
June 12, 2012
July 18, 2012
May 15, 2017
July 13, 2017
July 13, 2017
July 2012
August 2016   (Final data collection date for primary outcome measure)
  • Assessment of Donor Stem Cell Engraftment: ANC Count [ Time Frame: 1, 2, 3, and 4 weeks after transplantation ]
    Patients are considered to have achieved donor cell engraftment if they have an absolute neutrophil count (ANC) of at least 500 cells/uL of blood for 3 consecutive measurements and at least 75% of hematopoietic elements are donor-derived as determined by chimerism assays from peripheral blood prior to day +40 after Busulfan/Clofarabine (BuClo) reduced intensity allogeneic stem cell transplantation
  • Donor Stem Cell Engraftment: Platelet Count [ Time Frame: 1, 2, 3, 4, 8, and 14 weeks post transplant ]
    Platelet recovery was defined as having a platelet count of at least 20,000 platelets/uL of blood on 2 consecutive measurements without transfusional support prior to day +100 after BuClo RIC HSCT.
  • Assessment of Donor Stem Cell Engraftment: ANC Count [ Time Frame: 2 years ]
    ANC at least 500/uL and at least 75% of hematopoietic elements are donor-derived as determined by chimerism assays from peripheral blood prior to day +40 after Busulfan/Clofarabine (BuClo) reduced intensity allogeneic stem cell transplantation
  • Assessment of donor stem cell engraftment: Platelet count [ Time Frame: 2 years ]
    Platelets at least 20,000/uL on 3 consecutive measurements without transfusional support prior to day +100 after BuClo RIC HSCT
Complete list of historical versions of study NCT01643668 on ClinicalTrials.gov Archive Site
  • Cumulative Incidence of Non-relapse Mortality [ Time Frame: 100 days, 1 year ]
    The percentage of participants that experienced non-relapse mortality (NRM) at day 100 and 1 year after BuClo RIC SCT. Non-relapse mortality is any mortality that is not associated with or proceeded by disease progression of prior cancers.
  • Progression-Free and Overall Survival [ Time Frame: 1 year, 2 years ]
    The 1-year and 2-year progression-free and overall survival measured from the time of stem cell transplantation. Progression is the recurrence or increase in the number of cancer cells found in the body.
  • Cumulative Incidence and Severity of Acute GVHD Within 100 Days Post Transplant [ Time Frame: 100 days ]
    The percentage of participants who experienced grades 2-4 and grades 3-4 acute graft-versus-host disease (GVHD) by 100 days post transplantation. GVHD is a condition that can occur following an allogenic stem cell transplantation when the donated bone marrow or peripheral stem cells view the recipients body as foreign and the donated cell/marrow attack the body. Acute GVHD is generally observed within the first 100 days post transplant. Acute GVHD is associated with increased treatment related morbidity and mortality. Grade I GVHD is characterized as mild disease, grade II GVHD as moderate, grade III as severe, and grade IV life-threatening. The grade of the GVHD is determined by grading GHVD associated adverse events. Associated adverse events were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 4 which uses the same mild, moderate, severe, life threatening grading system as the overall GHVD assessment.
  • Cumulative Incidence of Chronic GVHD at One Year [ Time Frame: 1 year ]
    The percentage of participants who experienced chronic Graft Versus Host Disease (GVHD) by one year. GVHD is a condition that can occur following an allogenic stem cell transplantation when the donated bone marrow or peripheral stem cells view the recipients body as foreign and the donated cell/marrow attack the body. Chronic GVHD normally occurs after the first 100 days post transplantation. Chronic GVHD can adversely influence long term survival.
  • Incidence of Hepatic Veno-occlusive Disease [ Time Frame: 2 years ]
    The number of participants that experienced hepatic veno-occlusive disease (VOD). VOD is a condition in which some of the small veins in the liver are obstructed.
  • Grade 3 or 4 Toxicities [ Time Frame: 2 years ]
    The number of participants that experienced the specified grade 3 and 4 non-hematological toxicities during treatment and follow-up as assessed by Common Terminology Criteria for Adverse Events version 4(CTAE v 4.0). Grade 3 toxicity is considered to be severe and grade 4 is considered to be life threatening.
  • Infection-related Complications [ Time Frame: 2 years ]
    The number of patients with infection-related complications
  • Assessment of non-relapse mortality [ Time Frame: 2 years ]
    Assessment of non-relapse mortality (NRM) at day 100 and 1 year after BuClo RIC SCT
  • Assessment of progression-free and overall survival [ Time Frame: 2 years ]
    Assess 1-year and 2-year progression-free and overall survival
  • Assess incidence and severity of GVHD [ Time Frame: 2 years ]
    Assess the incidence and severity of grades 2-4 and grades 3-4 acute graft-versus-host disease (GVHD) developing by day 200
  • Assess incidence and severity of chronic GVHD [ Time Frame: 2 years ]
    Assess the incidence and severity of chronic GVHD
  • Assess incidence of hepatic veno-occlusive disease [ Time Frame: 2 years ]
    Assess the incidence of hepatic veno-occlusive disease (VOD)
  • Assess toxicity of BuClo RIC regimen [ Time Frame: 2 years ]
    Assess toxicity of BuClo RIC regimen
  • Assess infection-related complications [ Time Frame: 2 years ]
    Assess infection-related complications
Not Provided
Not Provided
 
Busulfan/Clofarabine + Allogeneic Stem Cell Transplantation
Phase II Study of Reduced Intensity Conditioning With Busulfan/Clofarabine Followed by Allogeneic Stem Cell Transplantation

This research is a phase II clinical trial. Phase II clinical trials test the effectiveness of an investigational intervention to learn whether it works in treating a specific cancer. "Investigational" means that the study intervention is still being studied and that research doctors are trying to find out more about it. It also means that the FDA has not yet approved this study intervention for your type of cancer.

All participants on this study are treated in an identical manner. The investigators are doing this study because there continues to be a significant risk of relapse of disease after reduced intensity transplantation. In studies which have compared transplants using high-doses of chemotherapy and/or radiation versus reduced intensity transplants, patients undergoing reduced intensity transplants appear to have higher rates of relapse, but lower rates of toxicity and complication. This study attempts to utilize clofarabine, a newer chemotherapy agent shown to be quite active in AML, ALL, and MDS, to increase the anti-tumor effects of the conditioning regimen without accumulating unacceptable toxicity.

The reduced intensity allogeneic stem cell transplantation procedure involves giving you chemotherapy in relatively less intense doses to suppress your immune system. This is followed by an infusion of healthy blood stem cells from a matched related donor or a matched unrelated volunteer donor. It is hoped that these donor cells can eventually then attack any cancer cells which remain.

In this research study, the investigators are looking to see how well this new combination of busulfan and clofarabine works in reduced intensity allogeneic stem cell transplantation. By "works" the investigators mean to analyze safety, ability of donor cells to engraft (take hold), as well as measures of complications including toxicity, infections, graft-vs-host disease (GVHD), and relapse.

You will start the conditioning regimen, which is also called the preparative regimen. Conditioning is done to kill more cancer cells which may remain as well as prepare your body for transplant. You will receive the conditioning drugs into a vein. The conditioning regimen consists of the following drugs: Busulfan and Clofarabine.

While you are in the hospital you will have regular physical exams and you will be asked specific questions about any problems that you might be having. You will also have blood tests every day to look at how your bone marrow is recovering, to give possible transfusional support, and how to see how your liver and kidneys are functioning.

You will receive the following drugs before and after the allogeneic stem cell transplant: Neupogen (G-CSF) injections, drugs to prevent infections, Tacrolimus to prevent GVHD and Methotrexate.

You will have routine and regular follow-up in the transplant clinic after discharge from the hospital. The following will be performed at each visit:

Physical exam to monitor your health and check for signs of GVHD, infections and any side effects you may be having; Blood draw for routine blood tests to measure your blood cell count and chemistry; Blood tests to see if the transplanted stem cells are being accepted and are growing in the body (engraftment); Bone marrow biopsy to see the status of the underlying disease (to be done around 100 days after the stem cell transplant).

You will be asked to return to the clinic, at a minimum, for follow-up visits at 6 months, 9 months, 12 months, 18 months and 24 months after your stem cell transplant.

Interventional
Phase 2
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
  • Acute Myeloid Leukemia
  • Acute Lymphoblastic Leukemia
  • Myelodysplastic Syndrome
  • Drug: Busulfan
    Busulfan as part of reduced intensity conditioning prior to allogeneic stem cell transplantation
  • Drug: Clofarabine
    Clofarabine as part of reduced intensity conditioning prior to allogeneic stem cell transplantation
  • Procedure: Allogeneic Stem Cell Infusion
    Allogeneic stem cell transplantation after reduced intensity conditioning with busulfan / clofarabine chemotherapy
Experimental: BuClo RIC + SCT
Busulfan and Clofarabine (BuClo) reduced intensity conditioning (RIC) followed by allogeneic stem cell Transplantation (SCT)
Interventions:
  • Drug: Busulfan
  • Drug: Clofarabine
  • Procedure: Allogeneic Stem Cell Infusion
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
34
August 2016
August 2016   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Must have well-matched adult donor willing to donate peripheral blood stem cells with well-matched defined as 8/8 matched related or unrelated donor
  • Adequate organ functioning

Exclusion Criteria:

  • Pregnant or breastfeeding
  • Psychiatric disease severely impairing the compliance of the patient to participate in the study and/or give informed consent
  • Evidence of prior exposure to HIV or HCV
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01643668
12-128
Yes
Not Provided
Not Provided
Yi-Bin A. Chen, MD, Massachusetts General Hospital
Massachusetts General Hospital
Not Provided
Principal Investigator: Yi-Bin Chen, MD Massachusetts General Hospital
Massachusetts General Hospital
June 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP