Research Study to Determine if an Experimental Agent, LLME Can Decrease the Incidence and Severity of Graft-Versus-Host-Disease (GVHD) Following Blood (Hematopoietic) Stem Cell Transplantation
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| ClinicalTrials.gov Identifier: NCT00429416 |
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Recruitment Status :
Completed
First Posted : January 31, 2007
Results First Posted : December 10, 2013
Last Update Posted : November 29, 2016
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Sponsor:
Sidney Kimmel Cancer Center at Thomas Jefferson University
Information provided by (Responsible Party):
Thomas Jefferson University ( Sidney Kimmel Cancer Center at Thomas Jefferson University )
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Brief Summary:
The purpose of this research study is to determine if an experimental agent, LLME can decrease the incidence and severity of Graft-Versus-Host-Disease (GVHD) following blood (hematopoietic) stem cell transplantation
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Hematologic Malignancies | Drug: L-leucyl-L-leucine Methyl Ester (LLME) Drug: Fludarabine Drug: Cytarabine Drug: Cyclophosphamide Drug: Tacrolimus Drug: Mesna Biological: Granulocyte Macrophage Colony-Stimulating Factor (GM-CSF) Procedure: Hematopoietic stem cell transplantation (HSCT) | Phase 1 Phase 2 |
We believe that the risks of allogeneic transplant can be drastically reduced if the following criteria can be met: (1) consistent engraftment, (2) little or no GVHD with the ability to rapidly withdraw immune suppression, (3) rapid recovery of CD4 counts to levels greater than 200 cells/micro liter. Our prior (ongoing) trial attempts to address how LLME treated T cells given as donor lymphocyte infusion (DLI) can address points 2 and 3 above. The current study addresses how treatment of the CD34- fraction of the graft attempts to address points 1 and 2 (and to a lesser extent point 3) above. We believe that if these points can be consistently achieved that the mortality of allogeneic HSCT may be reduced to levels more akin to those of autologous HSCT. We propose to test the hypothesis that LLME-treated T cells will be safe with regard to reducing GVHD or other infusion related toxicities and that their administration as part of the transplant will facilitate engraftment. We believe that this approach will ultimately be an important step in a variety of transplant settings ranging from matched siblings to haplodisparate donors.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 14 participants |
| Allocation: | N/A |
| Intervention Model: | Single Group Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Phase I/II Study of Llme Treated Non-Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation for Patients With Hematological Malignancies |
| Study Start Date : | March 2004 |
| Actual Primary Completion Date : | December 2008 |
| Actual Study Completion Date : | May 2009 |
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| Arm | Intervention/treatment |
|---|---|
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Experimental: LLME to Decrease GVHD Following HSC T
To determine if an experimental agent, LLME, can decrease the incidence and severity of Graft-Versus-Host-Disease (GVHD) following hematopoietic stem cell transplantation (HSCT).
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Drug: L-leucyl-L-leucine Methyl Ester (LLME)
Infusion of L-leucyl-L-leucine methyl ester (LLME) treated donor white blood cells
Other Name: LLME Drug: Fludarabine Fludarabine 30 mg/m2 prior to HSCT infusion
Other Names:
Drug: Cytarabine Cytarabine 2gm/m2 prior to HSCT infusion
Other Names:
Drug: Cyclophosphamide Cyclophosphamide 1gm/m2 prior to HSCT infusion
Other Names:
Drug: Tacrolimus Tacrolimus given before and after HSCT infusion
Other Names:
Drug: Mesna Mesna 1gm/m2/day given prior to HSCT infusion.
Other Names:
Biological: Granulocyte Macrophage Colony-Stimulating Factor (GM-CSF) GM-CSF given post HSCT infusion
Other Name: GM-CSF Procedure: Hematopoietic stem cell transplantation (HSCT) CD34 selected allogeneic stem cell infusion with 5x104/kg untreated T cells
Other Name: HSCT |
Primary Outcome Measures :
- Safety of CD34+ Stem Cell Infusions Followed by LLME as Measured by 100-Day Mortality [ Time Frame: Through 100 days post-transplant or death ]
Determine the safety of CD34+ stem cell infusions followed by the LLME treated CD34- fraction. This includes monitoring the patients for any side effects associated with the LLME treated cell infusion or any other unexpected adverse events.
This regimen will be gauged as to its safety using 100 day mortality as the measured endpoint. Deaths from all causes will be included.
Secondary Outcome Measures :
- Rate of Engraftment of Non-Myeloablative Transplants [ Time Frame: Through 30 days post-transplant ]Determine the engraftment rate of non-myeloablative transplants using CD34+ stem cells and LLME treated CD34- products.
- Incidence of Grade II-IV Acute Graft-Versus-Host-Disease (GVHD) [ Time Frame: Through 24 months post-treatment ]Determine the incidence of grade II-IV acute GVHD after administration of grafts when combined with Cyclosporine/Mycophenolate Mofetil for GVHD prophylaxis. GVHD assessments occur daily as an in patient and at each out patient visit.
- Rate of Serious Infectious Complications [ Time Frame: Through 3 months post-transplant ]
Determine the rate of serious infectious complications. A serious infection will be defined as any requiring hospitalization or parenteral therapy.
CD4 counts will be measured monthly for the first 3 months after transplant.
- Number of Patients Who Achieve a CD4 Count > 200/Micro-liters [ Time Frame: Through 60 Days Post Transplant ]Determine the number of patients who achieve a CD4 count > 200/micro-liters by 60 days after transplant.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- Patients must be > 18 years of age, with no upper age limit.
- Patients must have an ECOG performance status of 0 or 1.
- Any patient with a hematologic malignancy which is unlikely to be cured by conventional treatment is eligible for this study.
- Patients for whom a disease specific protocol exists will be transplanted on those protocols as discussed in the introduction.
- Patients who have had prior autografts may be treated on this protocol.
- Patients must have adequate physical function as measured by the following criteria:
- Cardiac: Asymptomatic or, if symptomatic, then left ventricular ejection fraction at rest must be >40%.
- Hepatic: Aspartate transaminase (AST) micro 3x the upper limits of normal and total serum bilirubin < 2.5 mg/dL. Patients with a higher bilirubin from "benign conditions" such as Gilbert's disease may still be eligible for the study.
- Renal: Serum creatinine within the normal range or if creatinine outside normal range then creatinine clearance > 60 ml/min/1.73m2. Serum creatinine must be less than or equal to 2.0 mg/dl.
- Pulmonary: Asymptomatic or, if symptomatic, DLCO (diffusion capacity) > 45% of predicted (corrected for hemoglobin)
- The patient or guardian(s) must be able to give informed consent to the study.
- Patient must have a suitable donor who is identical for HLA (human leukocyte antigens) -A, -B, -C, -DR. Single antigen mismatches for HLA-A, -B, -C, -DR are also permitted. Donors obtained through the National Marrow Donor Program (NMDP) will follow NMDP guidelines.
Exclusion Criteria:
- Patients who are eligible for a standard myeloablative transplant and for whom a standard myeloablative transplant is preferable will not be treated on this protocol.
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): NCT00429416
Locations
| United States, Pennsylvania | |
| Thomas Jefferson University' | |
| Philadelphia, Pennsylvania, United States, 19107 | |
Sponsors and Collaborators
Sidney Kimmel Cancer Center at Thomas Jefferson University
Investigators
| Principal Investigator: | John Wagner, MD | Thomas Jefferson University |
Additional Information:
| Responsible Party: | Sidney Kimmel Cancer Center at Thomas Jefferson University |
| ClinicalTrials.gov Identifier: | NCT00429416 |
| Other Study ID Numbers: |
04U.115 2003-68 ( Other Identifier: CCRRC ) |
| First Posted: | January 31, 2007 Key Record Dates |
| Results First Posted: | December 10, 2013 |
| Last Update Posted: | November 29, 2016 |
| Last Verified: | October 2016 |
Keywords provided by Thomas Jefferson University ( Sidney Kimmel Cancer Center at Thomas Jefferson University ):
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Hematologic Malignancies GVHD Graft-Versus-Host-Disease LLME CD34+ stem cell infusions |
CD34- fraction Cyclosporine Mycophenolate Mofetil HSCT Hematopoietic stem cell transplantation |
Additional relevant MeSH terms:
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Neoplasms Hematologic Neoplasms Neoplasms by Site Hematologic Diseases Cytarabine Cyclophosphamide Fludarabine Fludarabine phosphate Molgramostim Tacrolimus Sargramostim Mesna Immunosuppressive Agents Immunologic Factors |
Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists Antimetabolites, Antineoplastic Antimetabolites Antiviral Agents Anti-Infective Agents Calcineurin Inhibitors Enzyme Inhibitors Protective Agents |