Allogeneic Bone Marrow Transplantation With Matched Unrelated Donors for Patients With Hematologic Malignancies

NCT ID: NCT00208923

Last Updated: 2012-04-06

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 55 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 1998-07-31
• Study Completion Date: 2007-10-31

Brief Summary

Patients who have cancer of the bone marrow (leukemia) or lymph gland (lymphomas) are being asked to take part in this study. This study uses a new chemotherapy regimen and matched volunteer stem cell transplant to treat patients with cancers of this kind.

Detailed Description

Patients who have cancer of the bone marrow (leukemia) or lymph gland (lymphomas) are being asked to take part in this study. This study uses a new chemotherapy regimen and matched volunteer stem cell transplant to treat patients with cancers of this kind.

High dose chemotherapy, followed by a transplant of stem cells collected from either bone marrow (BMT) or peripheral blood of an HLA (tissue type) matched unrelated donor, offers a potential cure for several serious blood diseases including acute and chronic leukemia, myelodysplastic syndrome and lymphoma.

However, the success of allogeneic (unrelated volunteer matched donor) transplant is limited by treatment related illness, death, and relapse in patients with refractory (resistant) disease and/or advanced age (older than 40 years).

Patients being sought for this study do not have an HLA-matched relative to donate stem cell; however, through The National Marrow Donor Program or International Registries, an HLA-matched unrelated donor has been found to donate stem cells. Preliminary data shows that the outcome is comparable between bone marrow and peripheral blood stem cell transplantations, and donor preference will determine which type of cells the patient receives.

To carry out an unrelated transplant, a normal person with similar HLA type must be available to donate cells. The patient must be prepared to accept the donor cells by decreasing the body's immune systems. In addition, the malignant (cancerous) cells must be destroyed to allow growth and repopulation of healthy donor cells. This is usually done by giving total body irradiation and chemotherapy, which is associated with severe side effects in patients over age 40.

In other studies, it has been found that treating the patient with two anticancer drugs, Busulfan and Cyclophosphamide, without total body irradiation, is safe and sufficiently immunosuppressive. High dose Busulfan and Cyclophosphamide are frequently used in combination prior to matched related bone marrow transplant in case of acute leukemia, myelodysplastic syndrome (MDS), Hodgkin's disease (HD), and chronic myeloid leukemia (CML). Fludarabine (another anticancer drug) suppresses the immune system and has strong anticancer effect against chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL). Researchers are studying a new chemotherapy regimen that includes fludarabine, along with busulfan and cyclophosphamide, to provide more immunosuppression and anti-cancer effect without increasing the chemotherapy related toxicity in patients with CML, acute leukemia and MDS, CLL, NHL, and HD.

The purposes of this study are: 1) to decrease the side effects due to the chemotherapy used to treat the bone marrow; and 2) to increase the number of tumor cells killed. There will be up to 55 patients enrolled in this study at Emory University. The expected duration of each subject's participation in this study will be for two years.

Conditions

Hematologic Malignancies

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

1

Chemotherapy-only conditioning regimen comprising busulfan (Bu), cyclophosphamide (Cy) and fludarabine (FLUDARA) followed by an allogeneic stem cell transplant.

Group Type: ACTIVE_COMPARATOR

Busulfan, Cyclophosphamide and Fludarabine

Intervention Type: DRUG

• Bulsufan 1mg/kg/dose P.O. every 6 hours for 4 days. If intravenous, busulfan dose will be 0.8 mg/kg every 6 hours for 16 doses.
• Fludarabine 40 mg/m2 a day for 5 days via IV over 2 hours, dose based on weight.
• Cyclophosphamide given via IV over 1 hour at dose of 60 mg/kg/day for 2 consecutive days.

Interventions

Busulfan, Cyclophosphamide and Fludarabine

• Bulsufan 1mg/kg/dose P.O. every 6 hours for 4 days. If intravenous, busulfan dose will be 0.8 mg/kg every 6 hours for 16 doses.
• Fludarabine 40 mg/m2 a day for 5 days via IV over 2 hours, dose based on weight.
• Cyclophosphamide given via IV over 1 hour at dose of 60 mg/kg/day for 2 consecutive days.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patients eligible to participate in this study must have CML in the first chronic phase, AML in the first complete remission, AML in second remission, ALL or hybrid leukemia in the first complete remission, ALL in second remission, or advanced MDS. Final eligibility for this study will be determined by the health professionals conducting the trial.

Exclusion Criteria

• Patients with active CNS malignant disease, or an invasive/systemic fungal infection are not eligible to participate in this study. Patients who are lactating, or who have an HLA identical or 1 antigen mismatched relative who is eligible and willing to donate bone marrow will also be excluded from the study. Final eligibility for this study will be determined by the health professionals conducting the trial.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Emory University

OTHER

Sponsor Role: lead

Responsible Party

Amelia A Langston

MD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Amelia Langston, MD

Role: PRINCIPAL_INVESTIGATOR

Emory University Winship Cancer Institute

Locations

Emory Universtiy Winship Cancer Institute

Atlanta, Georgia, United States

Countries

United States

Other Identifiers

0709-1997

Identifier Type: -

Identifier Source: org_study_id