Alemtuzumab Plus Fludarabine and Melphalan With or Without Cyclosporine, Mycophenolate Mofetil, and Low-Dose Total-Body Irradiation
Therapy Followed by Donor Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer
This study is not yet open for patient recruitment.
Sponsored by: |
Cancer and Leukemia Group B
|
Information provided by: |
National Cancer Institute (NCI) |
Purpose
RATIONALE: Monoclonal antibodies such as alemtuzumab can locate cancer cells and either kill them or deliver cancer-killing
substances to them without harming normal cells. Donor stem cell transplantation may be able to replace immune cells that
were destroyed by chemotherapy and radiation therapy. Sometimes the transplanted cells from a donor are rejected by the body’s
normal cells. Giving alemtuzumab, fludarabine, and melphalan with or without cyclosporine, mycophenolate mofetil, and low-dose
total-body irradiation before transplantation may prevent this from happening.
PURPOSE: Phase I/II trial to study the effectiveness of giving alemtuzumab, fludarabine, and melphalan with or without cyclosporine,
mycophenolate mofetil, and total-body irradiation before donor peripheral stem cell transplantation in treating patients who
have relapsed or refractory hematologic cancer.
Condition
|
Treatment or Intervention |
Phase |
acute leukemia atypical chronic myeloid leukemia chronic leukemia myelodysplastic and myeloproliferative disease Non-Hodgkin's Lymphoma plasma cell neoplasm
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Drug: alemtuzumab Drug: allogeneic lymphocytes Drug: cyclosporine Drug: fludarabine Drug: melphalan Drug: mycophenolate mofetil Drug: sargramostim Procedure: antibody therapy Procedure: biological response modifier therapy Procedure: bone marrow ablation with stem cell support Procedure: chemotherapy Procedure: colony-stimulating factor therapy Procedure: cytokine therapy Procedure: graft versus host disease prophylaxis/therapy Procedure: graft versus tumor induction Procedure: monoclonal antibody therapy Procedure: peripheral blood stem cell transplantation Procedure: radiation therapy Procedure: supportive care/therapy
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Phase I Phase II
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MedlinePlus related topics: Leukemia, Adult Acute; Leukemia, Adult Chronic; Leukemia, Childhood; Lymphoma
Study Type: Interventional
Study Design: Treatment
Official Title: Phase I/II Pilot Study of a Reduced-Intensity Conditioning Regimen Comprising Alemtuzumab, Fludarabine, and Melphalan With
or Without Cyclosporine, Mycophenolate Mofetil, and Low-Dose Total Body Radiotherapy Followed By Haplotype-Mismatched, KIR
Class I Epitope-Mismatched CD34-Positive Allogeneic Peripheral Blood Stem Cell Transplantation in Patients With Relapsed,
Refractory, or Poor-Risk Hematological Malignancies
Further Study Details:
OBJECTIVES:
- Determine the ability of a reduced-intensity conditioning regimen comprising alemtuzumab, fludarabine, and melphalan with
or without cyclosporine, mycophenolate mofetil, and low-dose total body radiotherapy followed by haplotype-mismatched, KIR
class I epitope-mismatched CD34-positive allogeneic peripheral blood stem cell transplantation to facilitate engraftment by
day 35 post-transplantation in at least 85% of patients with relapsed, refractory, or poor-risk hematological malignancies.
- Determine the risk of graft-versus-host-disease in patients treated with these regimens.
- Determine, preliminarily, the efficacy of these regimens, in terms of progression-free survival, in these patients.
- Correlate outcomes, engraftment, and progression-free survival with the number of detectable alloreactive natural killer cell
clones before transplantation and after engraftment in patients treated with these regimens.
- Determine immune reconstitution in patients treated with these regimens.
OUTLINE: This is a multicenter, pilot study. Patients are initially treated with conditioning regimen A. If adequate donor
engraftment is not achieved, subsequent patients are treated with conditioning regimen B.
- Conditioning regimen A: Patients receive alemtuzumab IV over 2 hours on days -14 to -12; fludarabine IV over 30 minutes on
days -7 to -3; and melphalan IV over 20-30 minutes on day -2.
- Conditioning regimen B: Patients receive oral or IV cyclosporine twice daily and oral or IV mycophenolate mofetil twice daily
on days -15 to 0. Patients also receive alemtuzumab, fludarabine, and melphalan as in conditioning regimen A. Patients undergo
low-dose total body irradiation twice daily on days -2 and -1. All patients undergo allogeneic, T-cell-depleted, CD34-positive
peripheral blood stem cell transplantation on day 0. Patients receive sargramostim (GM-CSF) subcutaneously beginning on day
1 and continuing until blood counts recover.
Patients are followed every 3 months for 1 year and then every 6 months for 5 years.
PROJECTED ACCRUAL: A total of 14-56 patients (14-28 per regimen) will be accrued for this study.
Eligibility
Ages Eligible for Study:
18 Years
-
60 Years,
Genders Eligible for Study:
Both
DISEASE CHARACTERISTICS:
- Histologically confirmed hematological malignancy of 1 of the following types:
- Acute myeloid leukemia meeting at least 1 of the following criteria:
- Poor-risk cytogenetics, including -5, 5q-, -7, 7q-, 11q23, and Philadelphia (Ph) chromosome-positive in first or subsequent
complete remission (CR)
- Relapsed or primary refractory disease with ≤ 10% blasts in the peripheral blood and ≤ 20% blasts in the bone marrow
- Standard-risk cytogenetics in second CR AND autologous transplantation is not feasible
- Standard-risk cytogenetics in third or subsequent CR
- Acute lymphoblastic leukemia meeting 1 of the following criteria:
- Second or subsequent CR
- High-risk cytogenetics, including Ph chromosome-positive and t(4:11) in first CR
- Relapsed or primarily refractory disease with ≤ 10% blasts in the peripheral blood and ≤ 20% blasts in the bone marrow
- High-risk myelodysplasia
- International Prognostic Scoring System Score ≥ 2.5
- Chronic myeloid leukemia (CML)* meeting 1 of the following criteria:
- Second or subsequent chronic phase
- Accelerated phase NOTE: *Patients with CML in blast crisis (> 30% promyelocytes and myeloblasts in the bone marrow) are not
eligible
- Non-Hodgkin's lymphoma meeting 1 of the following criteria:
- Primarily refractory disease or in refractory relapse
- Relapsed disease after autologous stem cell transplantation
- Chemosensitive relapsed disease without CR to standard salvage therapy AND no option for autologous stem cell transplantation
due to blood or marrow involvement or failure to harvest sufficient autologous stem cells
- Chronic lymphocytic leukemia meeting both of the following criteria:
- Stage III or IV disease
- Refractory to fludarabine
- Multiple myeloma meeting 1 of the following criteria:
- Primarily refractory disease or in refractory relapse
- Relapsed disease after autologous stem cell transplantation
- No relapsed disease < 6 months after autologous stem cell transplantation
- No available eligible HLA-matched (i.e., 5 of 6 or 6 of 6 antigen match for HLA-A, -B, and -DR loci) family donor by serological
or molecular typing
- Available suitable family donor meeting the following criteria:
- Parent, sibling, or child of the recipient
- ≥ 16 years of age
- Identical for only one HLA haplotype (i.e., haploidentical) AND incompatible at the HLA-A, -B, -C, and -DR loci of the unshared
haplotype by serological or molecular typing
- Mismatched with respect to KIR class I epitopes graft-vs-host directional activity
- Mismatching that predicts both graft-vs-host and host-vs-graft bi-directional activity eligible
- No mismatching that predicts only host-vs-graft directional activity
PATIENT CHARACTERISTICS: Age
Performance status
Life expectancy
Hematopoietic
Hepatic
- Bilirubin < 2 times upper limit of normal (ULN)
- AST and ALT < 2 times ULN
Renal
Cardiovascular
Pulmonary
Other
- No active infection requiring oral or IV antibiotics
- HIV negative
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY: Biologic therapy
- See Disease Characteristics
Chemotherapy
- See Disease Characteristics
Endocrine therapy
- Concurrent corticosteroids allowed for adrenal failure, treatment of graft-vs-host disease, or as premedication during study
- No concurrent corticosteroids for antiemesis
Radiotherapy
Surgery
Location
Information
Study chairs or principal investigators
Sherif S. Farag, MD, PhD, Study Chair, Arthur G. James Cancer Hospital & Richard J. Solove Research Institute
Koen Van Besien, MD, University of Chicago Cancer Research Center
More Information
Clinical trial summary from the National Cancer Institute's PDQ® database
Study ID Numbers:
CDR0000370797; CALGB-100102
Record last reviewed:
May 2004
Record first received:
June 10, 2004
ClinicalTrials.gov Identifier:
NCT00085449Health Authority: Unspecified
ClinicalTrials.gov processed this record on 2004-10-20