Donor Umbilical Cord Blood Transplant in Treating Patients With Advanced Hematologic Cancer

NCT ID: NCT00304018

Last Updated: 2013-08-14

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

PHASE1

Total Enrollment

5 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-10-31

Study Completion Date

2009-03-31

Brief Summary

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RATIONALE: Giving chemotherapy, such as fludarabine, busulfan, and etoposide, before a donor umbilical cord blood stem cell transplant helps stop the growth of cancer cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving antithymocyte globulin before transplant and tacrolimus and prednisone after transplant may stop this from happening.

PURPOSE: This phase I trial is studying how well donor umbilical cord blood transplant works in treating patients with advanced hematologic cancer.

Detailed Description

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OBJECTIVES:

Primary

* Determine the safety and feasibility of performing donor umbilical cord blood transplantation (UCBT) in patients with advanced hematologic malignancies, in terms of \> 80% engraftment rate at day 100 post-transplant and ≤ 50% transplant-related mortality.

Secondary

* Determine the toxicity of a myeloablative preparative regimen comprising busulfan, fludarabine, and etoposide prior to UCBT in these patients.
* Determine the neutrophil and platelet recovery in patients treated with this regimen.
* Determine the event-free and overall survival of patients treated with this regimen.
* Evaluate lineage-specific chimerism after UCBT and assess the contribution of each individual cord blood unit to post-transplantation hematopoiesis in these patients.
* Determine the incidence, severity, and timing of acute and chronic graft-vs-host disease in patients treated with this regimen.

OUTLINE: This is a pilot study.

* Preparative regimen: Patients receive fludarabine IV over 30 minutes on days -7 to -3, busulfan IV over 2 hours 4 times daily on days -7 and -4, etoposide IV over 4 hours on day -3, and anti-thymocyte globulin IV over 6 hours on days -2 and -1.
* Donor umbilical cord blood transplantation (UCBT): Patients undergo donor UCBT on day 0. Beginning on day 7, patients receive sargramostim (GM-CSF) IV or subcutaneously once daily until blood counts recover.
* Graft-vs-host disease prophylaxis: Patients receive tacrolimus IV continuously over 24 hours or orally twice daily beginning on day -2 and continuing until day 180 followed by a taper. Patients also receive oral prednisone twice daily on days 13-50 and then once daily on days 50-60, followed by a rapid taper.

After completion of study treatment, patients are followed periodically for approximately 2 years.

PROJECTED ACCRUAL: A total of 10 patients will be accrued for this study.

Conditions

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Leukemia Lymphoma Multiple Myeloma and Plasma Cell Neoplasm Myelodysplastic Syndromes

Keywords

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adult acute myeloid leukemia with 11q23 (MLL) abnormalities recurrent adult acute myeloid leukemia secondary acute myeloid leukemia adult acute myeloid leukemia in remission adult acute erythroid leukemia (M6) adult acute megakaryoblastic leukemia (M7) adult acute monoblastic leukemia (M5a) adult acute monocytic leukemia (M5b) refractory multiple myeloma adult acute lymphoblastic leukemia in remission accelerated phase chronic myelogenous leukemia blastic phase chronic myelogenous leukemia relapsing chronic myelogenous leukemia chronic phase chronic myelogenous leukemia stage II multiple myeloma stage III multiple myeloma recurrent adult acute lymphoblastic leukemia recurrent adult diffuse large cell lymphoma stage III adult diffuse large cell lymphoma recurrent mantle cell lymphoma stage III mantle cell lymphoma recurrent adult Hodgkin lymphoma stage III adult Hodgkin lymphoma adult acute myeloid leukemia with inv(16)(p13;q22) adult acute myeloid leukemia with t(15;17)(q22;q12) adult acute myeloid leukemia with t(16;16)(p13;q22) adult acute myeloid leukemia with t(8;21)(q22;q22) de novo myelodysplastic syndromes previously treated myelodysplastic syndromes secondary myelodysplastic syndromes recurrent adult T-cell leukemia/lymphoma stage IV adult diffuse large cell lymphoma stage IV adult Hodgkin lymphoma stage IV adult T-cell leukemia/lymphoma stage IV mantle cell lymphoma stage III adult T-cell leukemia/lymphoma stage I multiple myeloma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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cord blood transplant

Group Type EXPERIMENTAL

anti-thymocyte globulin

Intervention Type BIOLOGICAL

sargramostim

Intervention Type BIOLOGICAL

busulfan

Intervention Type DRUG

etoposide

Intervention Type DRUG

fludarabine phosphate

Intervention Type DRUG

prednisone

Intervention Type DRUG

tacrolimus

Intervention Type DRUG

allogeneic hematopoietic stem cell transplantation

Intervention Type PROCEDURE

umbilical cord blood transplantation

Intervention Type PROCEDURE

Interventions

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anti-thymocyte globulin

Intervention Type BIOLOGICAL

sargramostim

Intervention Type BIOLOGICAL

busulfan

Intervention Type DRUG

etoposide

Intervention Type DRUG

fludarabine phosphate

Intervention Type DRUG

prednisone

Intervention Type DRUG

tacrolimus

Intervention Type DRUG

allogeneic hematopoietic stem cell transplantation

Intervention Type PROCEDURE

umbilical cord blood transplantation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* No rapid progression of malignant disease
* Not eligible for autologous stem cell transplantation
* Available umbilical cord blood (1-3 units) donor matching at ≥ 4 of 6 HLA antigens (A, B, and DR)

* Patients with an HLA-identical or 1 antigen-mismatched related donor OR a potential HLA-matched unrelated donor matching at \> 6/8 (A, B, C, DR) alleles are not eligible

PATIENT CHARACTERISTICS:

* ECOG performance status 0-2
* Creatinine \< 2.0 mg/dL
* Creatinine clearance \> 40 mL/min
* Bilirubin \< 2.0 mg/dL
* AST and alkaline phosphatase \< 3 times upper limit of normal
* Hepatitis C and active hepatitis B allowed if patient has ≤ grade 2 inflammation or fibrosis by liver biopsy
* Ejection fraction \> 40% by echocardiogram or MUGA
* DLCO \> 40% of predicted
* Not pregnant or nursing
* Negative pregnancy test
* No known HIV infection
* No active infection requiring ongoing antibiotic treatment

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Thomas G. Martin, MD

Role: STUDY_CHAIR

University of California, San Francisco

Locations

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UCSF Helen Diller Family Comprehensive Cancer Center

San Francisco, California, United States

Site Status

Countries

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United States

Other Identifiers

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UCSF-02253

Identifier Type: -

Identifier Source: secondary_id

UCSF-H24045-21269-04

Identifier Type: -

Identifier Source: secondary_id

UCSF-2207

Identifier Type: -

Identifier Source: secondary_id

CDR0000463370

Identifier Type: -

Identifier Source: org_study_id