Pilot Study of Non-Myeloablative, HLA-Matched Allogeneic Stem Cell Transplantation for Pediatric Hematopoietic Malignancies
- Allogeneic blood and marrow stem cell transplantation (BMT) plays an important role in the curative treatment of a number of pediatric malignancies. Unfortunately, the success of conventional allogeneic BMT is limited in part by the multiple toxicities associated with myeloablative preparative regimens.
- Non-myeloablative pre-transplant regimens are associated with less toxic side effects than standard BMT. Recently, a novel immunosuppressive, non-myeloablative pre-transplant chemotherapy regimen has been shown to facilitate complete donor engraftment in an adult trial at the NCI.
The primary objective of this protocol is to evaluate the efficacy and safety of this treatment approach in pediatric patients with hematopoietic malignancies
Age: Patient must be greater than or equal to 5 years and less than 22 years of age.
- Hodgkin s and Non-Hodgkin s Lymphoma: Refractory disease or relapse after salvage regimen.
- Acute Myelogenous Leukemia: History of bone marrow relapse in remission (CR) #2 or greater.
- Acute Lymphocytic Leukemia: History of bone marrow relapse in CR #2 or greater (CR#1 with Philadelphia chromosome positive or prior induction failure).
- Acute Hybrid Leukemia including mixed lineage, biphenotypic and undifferentiated: History of bone marrow relapse in CR #2 or greater (CR#1 with Philadelphia chromosome positive or prior induction failure).
- Myelodysplastic Syndrome: RAEB or RAEB-t with less than 10% blasts in marrow and blood.
- Chronic Myelogenous Leukemia: Chronic phase or accelerated phase with less than 10% blasts in marrow and blood.
- Juvenile Myelomonocytic Leukemia: less than 10% blasts in marrow and blood.
Prior Therapy: Chemotherapy to achieve above criteria allowed. Prior BMT allowed as long as at least day 100+ post-prior BMT, no evidence of GVHD, and no detectable residual donor chimerism.
Donor: First degree related donors, who are HLA matched (single HLA-A or B locus mismatch allowed), weight greater than or equal to 15 kilograms, and who meet standard donation criteria will be considered. The same donor from a prior BMT is allowed.
ECOG Performance Status: 0, 1, or 2. and life expectancy: greater than 3 months.
Liver Function: Serum direct bilirubin less than 2.0 mg/dL and serum ALT and AST values less than or equal to 2.5x upper limit of normal. (Values above these levels may be accepted if due to malignancy.)
Renal Function: Age adjusted normal serum creatinine or Cr clearance greater than or equal to 60 mL/min/1.73 m(2).
Pulmonary Function: DLCO greater than or equal to 50%.
Cardiac Function: LVEF greater than or equal to 45% by MUGA or LVSF greater than or equal to 28% by ECHO
- Active CNS malignancy: Tumor mass on CT or leptomeningeal disease. (Patients with a history of CNS involvement and no current evidence of CNS disease are allowed.)
- HIV infection, active hepatitis B or C infection: HbSAg or HCV seropositive and elevated liver transaminases.
- Fanconi Anemia.
- Lactating or pregnant females.
- Initial evaluation: Patient and donor will be screened for eligibility. G-CSF primed bone marrow derived stem cells will be collected from the donor.
- Induction/Consolidation chemotherapy: 1 to 3 cycles will be given every 22 days depending on disease response, CD4 count, and toxicities.
- Lymphoma: fludarabine, etoposide, doxorubicin, vincristine, cyclophohamide, prednisone, and filgrastim (EPOCH-fludarabine).
- Leukemia and MDS: Fludarabine, cytarabine, and filgrastim (FLAG).
- Transplantation: Fludarabine and cyclophosphamide will be administered over 4 days followed by bone marrow transplant. Patients will remain hospitalized until bone marrow recovery. Patients will be monitored closely at the NIH for at least 100 days post-BMT.
- Post-transplant CNS prophylaxis for ALL: Standard post-transplant CNS prophylaxis will be employed with intrathecal methotrexate to decrease the risk of CNS relapse for all patients with ALL.
- Total number of recipient and donors to be accrued is 56.
Mixed Cell Leukemia
Non Hodgkin's Lymphoma
Procedure: Stem cell transplantation
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Pilot Study of Non-Myeloablative, HLA-Matched Allogeneic Stem Cell Transplantation for Pediatric Hematopoietic Malignancies|
- To determine the efficacy and safety of this chemotherapy regimen in facilitating donor engraftment after allogeneic bone marrow transplantation (BMT).
- Safety/Efficacy [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
- Toxicity of regimen [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
- To determine the toxicity of this non-myelablative allogeneic BMT regimen.
- fludarabine-based induction reducing T-cells [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- immune suppression [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- IL-7 levels [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- cytokine profiles [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- response rates and DFS [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- incidence and severity of GVHD [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- response rates, DFS rates, and incidence and severity ofGVHD following withdrawal of immunosuppression and donorlymphocyte infusions (DLI) for patients who developprogressive disease after day +28 post-transplant [ Time Frame: 5 years ] [ Designated as safety issue: No ]
|Study Start Date:||March 2001|
|Study Completion Date:||May 2015|
|Primary Completion Date:||March 2008 (Final data collection date for primary outcome measure)|
Transplant with Induction Therapy
Procedure: Stem cell transplantation
>3 x 106/kg CD34+ stem cells by IV infusion
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT00013533
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike|
|Bethesda, Maryland, United States, 20892|
|Principal Investigator:||Terry J Fry, M.D.||National Cancer Institute (NCI)|