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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
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Trial Contact Information Registry Information
Alternate Title
Alemtuzumab Plus Fludarabine and Melphalan With or Without Cyclosporine, Mycophenolate Mofetil, and Low-Dose Total-Body Irradiation Therapy Followed by Donor Peripheral Stem Cell Transplant in Treating Patients With Hematologic Cancer
Basic Trial Information
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Protocol IDs
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Phase II, Phase I
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Treatment
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Completed
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18 to 60
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NCI
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CALGB-100102 NCT00085449
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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.
Entry Criteria Disease Characteristics:
- Histologically confirmed hematological malignancy of 1 of the following types:
- 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
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 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
Expected Enrollment 56A total of 14-56 patients (14-28 per regimen) will be accrued for this study. Outcomes Primary Outcome(s)Engraftment rate Risk of graft-vs-host disease Progression-free survival (PFS) Correlation of outcomes, engraftment, and PFS with number of detectable alloreactive natural killer cell clones Performance assessment
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.
Trial Contact Information
Trial Lead Organizations Cancer and Leukemia Group B | | | Sherif Farag, MD, PhD, Protocol chair | | | | Koen Van Besien, MD, Protocol co-chair | | Ph: 773-702-6696; 888-824-0200 |
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Registry Information | | Official Title | | A Trial of Reduced Intensity Conditioning and Transplantation of Haplotype Mismatched and KIR Class I Epitope-Mismatched Highly Purified CD34 Cells | | Trial Start Date | | 2006-05-15 | | Registered in ClinicalTrials.gov | | NCT00085449 | | Date Submitted to PDQ | | 2004-05-05 | | Information Last Verified | | 2007-04-05 | | NCI Grant/Contract Number | | CA31946 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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