Peripheral Stem Cell Transplantation Plus Filgrastim in Treating Patients With Acute or Chronic Myelogenous Leukemia

NCT ID: NCT00002833

Last Updated: 2012-07-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

53 participants

Study Classification

INTERVENTIONAL

Study Start Date

1994-10-31

Study Completion Date

2002-04-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more cancer cells. Colony stimulating factors such as filgrastim may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy.

PURPOSE: Phase II trial to study the effectiveness of peripheral stem cell transplantation plus filgrastim in treating patients who have acute or chronic myelogenous leukemia.

Detailed Description

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OBJECTIVES: I. Determine the toxic effects and feasibility of using filgrastim in promoting hematopoietic recovery and leukemia control after intensive but nonmyeloablative salvage chemotherapy. II. Determine the engraftment kinetics and degree of chimerism achievable.

OUTLINE: The trial will have 2 patient groups. Patients not in remission are assigned to group 1, while patients in remission are assigned to group 2. Then, groups are divided into 2 treatment arms. Patients failing fludarabine therapy receive cytarabine (Ara-C) IV over 2 hours on days -7, -6, -5, -4 and -3. Beginning 4 hours before the first dose of Ara-C, patients receive cladribine (2-chlorodeoxyadenosine; 2-CdA) by continuous infusion for 5 days. Patients without prior fludarabine therapy receive fludarabine IV over 30 minutes daily on days -6, -5, -4 and -3. Ara-C IV begins 4 hours after the beginning of the fludarabine infusion and continues for 4 hours. Idarubicin IV is given on days -6, -5 and -4. Donors receive filgrastim SC every 12 hours for 2 days prior to stem cell collection. Cells are infused on day 0. For GVHD prophylaxis, all patients receive cyclosporine via continuous IV infusion. Oral cyclosporine is administered once patients tolerate oral feeding and continued for 6 months postinfusion. Then, the dose of cyclosporine is tapered 10% weekly until discontinued. Methylprednisolone begins 5 days after infusion and is gradually tapered.

PROJECTED ACCRUAL: A maximum of 15 patients per arm are likely to be entered in 24 to 36 months.

Conditions

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Graft Versus Host Disease Leukemia Myelodysplastic Syndromes

Keywords

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recurrent adult acute myeloid leukemia relapsing chronic myelogenous leukemia chronic phase chronic myelogenous leukemia accelerated phase chronic myelogenous leukemia blastic phase chronic myelogenous leukemia adult acute myeloid leukemia in remission Philadelphia chromosome positive chronic myelogenous leukemia refractory anemia with excess blasts refractory anemia with excess blasts in transformation chronic myelomonocytic leukemia graft versus host disease

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1A

Group 1A - With or Without Remission + Failing Fludarabine therapy:

Ara-C IV over 2 hours on days -7, -6, -5, -4 and -3 with Cladribine continuous infusion for 5 days, beginning 4 hours before Ara-C first dose. Idarubicin IV Days -6, -5 and -4. Cells infused on day 0. Cyclosporine via continuous IV infusion, oral cyclosporine administered for 6 months postinfusion (tapered 10% weekly until discontinued). Methylprednisolone begins 5 days after infusion then gradually tapered.

Group Type EXPERIMENTAL

Filgrastim

Intervention Type BIOLOGICAL

Donors receive Filgrastim SC (Subcutaneously) every 12 hours for 2 days prior to stem cell collection.

Cladribine

Intervention Type DRUG

Continuous infusion for 5 days, beginning 4 hours before Ara-C first dose.

Cyclosporine

Intervention Type DRUG

For GVHD prophylaxis, cyclosporine via continuous IV infusion. Oral cyclosporine administered once tolerating oral feeding and continued for 6 months postinfusion. Then dose tapered 10% weekly until discontinued.

Cytarabine (Ara-C)

Intervention Type DRUG

Group 1A: Ara-C IV over 2 hours on days -7, -6, -5, -4 and -3; Group 1B: Ara-C IV begins 4 hours after fludarabine infusion, continues for 4 hours.

Idarubicin

Intervention Type DRUG

IV Days -6, -5 and -4.

Methylprednisolone

Intervention Type DRUG

Begins 5 days after infusion and is gradually tapered.

Peripheral Blood Stem Cell Transplantation

Intervention Type PROCEDURE

Cell infusion Day 0.

Group 1B

Group 1B: With or Without Remission, No previous Fludara Therapy

Fludarabine IV over 30 minutes daily on days -6, -5, -4 and -3. Ara-C IV begins 4 hours after fludarabine infusion, continues for 4 hours. Idarubicin IV Days -6, -5 and -4. Cells infused on day 0. Cyclosporine via continuous IV infusion, oral cyclosporine administered for 6 months postinfusion (tapered 10% weekly until discontinued). Methylprednisolone begins 5 days after infusion then gradually tapered.

Group Type EXPERIMENTAL

Filgrastim

Intervention Type BIOLOGICAL

Donors receive Filgrastim SC (Subcutaneously) every 12 hours for 2 days prior to stem cell collection.

Cyclosporine

Intervention Type DRUG

For GVHD prophylaxis, cyclosporine via continuous IV infusion. Oral cyclosporine administered once tolerating oral feeding and continued for 6 months postinfusion. Then dose tapered 10% weekly until discontinued.

Cytarabine (Ara-C)

Intervention Type DRUG

Group 1A: Ara-C IV over 2 hours on days -7, -6, -5, -4 and -3; Group 1B: Ara-C IV begins 4 hours after fludarabine infusion, continues for 4 hours.

Fludarabine Phosphate

Intervention Type DRUG

IV over 30 minutes daily on days -6, -5, -4 and -3.

Idarubicin

Intervention Type DRUG

IV Days -6, -5 and -4.

Methylprednisolone

Intervention Type DRUG

Begins 5 days after infusion and is gradually tapered.

Peripheral Blood Stem Cell Transplantation

Intervention Type PROCEDURE

Cell infusion Day 0.

Interventions

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Filgrastim

Donors receive Filgrastim SC (Subcutaneously) every 12 hours for 2 days prior to stem cell collection.

Intervention Type BIOLOGICAL

Cladribine

Continuous infusion for 5 days, beginning 4 hours before Ara-C first dose.

Intervention Type DRUG

Cyclosporine

For GVHD prophylaxis, cyclosporine via continuous IV infusion. Oral cyclosporine administered once tolerating oral feeding and continued for 6 months postinfusion. Then dose tapered 10% weekly until discontinued.

Intervention Type DRUG

Cytarabine (Ara-C)

Group 1A: Ara-C IV over 2 hours on days -7, -6, -5, -4 and -3; Group 1B: Ara-C IV begins 4 hours after fludarabine infusion, continues for 4 hours.

Intervention Type DRUG

Fludarabine Phosphate

IV over 30 minutes daily on days -6, -5, -4 and -3.

Intervention Type DRUG

Idarubicin

IV Days -6, -5 and -4.

Intervention Type DRUG

Methylprednisolone

Begins 5 days after infusion and is gradually tapered.

Intervention Type DRUG

Peripheral Blood Stem Cell Transplantation

Cell infusion Day 0.

Intervention Type PROCEDURE

Other Intervention Names

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G-CSF Neupogen Leustatin 2-CdA Sandimmune CYA Cyclosporin A Ara-C Cytosar DepoCyt Cytosine Arabinosine Hydrochloride Fludara Fludarabine Idamycin Depo-Medrol Medrol Solu-Medrol PBSCT Stem Cell Transplant

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS: Acute leukemia with poor risk cytogenetic features (-5,-7, +8) in first complete remission Poor risk myelodysplasia Refractory anemia with excess blasts (RAEB) RAEB in transformation (RAEB-T) Chronic myelomonocytic leukemia (CMML) Chronic myelogenous leukemia (CML) in late chronic phase Acute leukemia with greater than first complete remission or transformed CML or CMML

PATIENT CHARACTERISTICS: Age: 55 to 65 65 to 70 (at the discretion of study chairperson on basis of performance status) 55 and under (if declined for conventional high dose chemotherapy due to concurrent medical conditions (i.e. ejection fraction less than 50, FEV1, FVC, or DLCO less than 50%, abnormal LFTs) Performance status: Zubrod less than 2 Life expectancy: Not specified Hematopoietic: Not specified Hepatic: Bilirubin less than 3 mg/dL Renal: Serum creatinine less than 2 mg/dL Cardiovascular: Ejection fraction greater than 40% per MUGA scan Pulmonary: Not specified Other: No active uncontrolled infection HLA compatible donor capable of donating stem cells via apheresis

PRIOR CONCURRENT THERAPY: Not specified
Minimum Eligible Age

55 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

M.D. Anderson Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sergio Giralt, MD

Role: STUDY_CHAIR

M.D. Anderson Cancer Center

Locations

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University of Texas - MD Anderson Cancer Center

Houston, Texas, United States

Site Status

Countries

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United States

Related Links

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http://www.mdanderson.org

UT MD Anderson Cancer Center

Other Identifiers

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P30CA016672

Identifier Type: NIH

Identifier Source: secondary_id

View Link

MDA-DM-94078

Identifier Type: OTHER

Identifier Source: secondary_id

NCI-G96-1001

Identifier Type: -

Identifier Source: secondary_id

CDR0000065035

Identifier Type: REGISTRY

Identifier Source: secondary_id

DM94-078

Identifier Type: -

Identifier Source: org_study_id