Thymoglobulin, Sirolimus and Mycophenolate Mofetil for Prevention of Acute Graft-Versus-Host Disease (GVHD)

NCT ID: NCT00506948

Last Updated: 2020-09-24

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

13 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-09-30

Study Completion Date

2010-10-31

Brief Summary

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The goal of this clinical research study is to learn if the combination of rabbit anti-thymocyte globulin (Thymoglobulin®), sirolimus (Rapamune®), and mycophenolate mofetil (Cellcept®) can help to prevent graft versus host disease (GVHD). The safety of this drug combination will also be studied.

Primary Objective: To determine efficacy and toxicity of a regimen of thymoglobulin, sirolimus and mycophenolate mofetil for prevention of acute GVHD after allogeneic stem cell transplantation from human leukocyte antigen (HLA) identical related or unrelated donors.

Secondary Objective: To assess engraftment, chronic GVHD, relapse and survival.

Detailed Description

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Rabbit anti-thymocyte globulin (rATG), sirolimus, and mycophenolate mofetil (MMF) are all designed to prevent GVHD.

If you are found to be eligible to take part in this study, you will receive rATG through a needle in your vein over 3-4 hours on each of the 4 days before the stem cell transplant.

Beginning 2 days before the transplant, you will take sirolimus by mouth once per day. You will continue to receive sirolimus until 90 days after the transplant. Beginning on Day 60, you will start taking increasingly lower doses of the study drug. This is done so you can taper down slowly, and be off of the drug on Day 90.

Beginning on the day of the transplant, you will take MMF by mouth 2 times a day. You will continue to take MMF until 27 days after the transplant.

Every week (for the first 90-100 days after the transplant) you will have study visits. At this visit, you will have a physical exam. Blood (about 1-2 tablespoons) will be drawn for routine tests.

You will remain on study for up to 90 days after transplantation. You will be taken off study if intolerable side effects occur.

Starting on Day 90 after the transplant, you will continue to follow up with your transplant doctor at least every 3 months through 1 year after the transplant. During these visits you will have physical exams. Blood (about 1-2 tablespoons) will be drawn for routine tests. Your doctor may request additional testing.

This is an investigational study. RATG, sirolimus, and MMF are all FDA approved for their use in the transplantation of solid organs (like kidney and liver). All 3 drugs are commercially available. This particular combination and dose schedule is considered investigational. Up to 30 patients will take part in this study. All will be enrolled at M.D. Anderson.

Conditions

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Hematological Malignancies Myelodysplastic Syndrome Leukemia Lymphoma

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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Thymoglobulin + Sirolimus + MMF

Thymoglobulin 1.5 mg/kg intravenous (IV) days -4, -3, -2, -1 before Stem Cell Transplant (Day 0); Sirolimus 6 mg IV on day -2 followed by 2 mg daily to maintain therapeutic levels and Mycophenolate Mofetil (MMF) 15 mg/kg IV or orally every 12 hours starting on day 0 until day+27.

Group Type EXPERIMENTAL

Mycophenolate Mofetil (MMF)

Intervention Type DRUG

15 mg/kg by vein or by mouth every 12 hours.

Thymoglobulin

Intervention Type DRUG

1.5 mg/kg by vein daily for 4 days

Sirolimus

Intervention Type DRUG

6 mg daily by mouth for 1 day, followed by 2 mg daily for 1 day.

Stem Cell Transplant

Intervention Type PROCEDURE

Stem cell infusion on Day 0.

Interventions

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Mycophenolate Mofetil (MMF)

15 mg/kg by vein or by mouth every 12 hours.

Intervention Type DRUG

Thymoglobulin

1.5 mg/kg by vein daily for 4 days

Intervention Type DRUG

Sirolimus

6 mg daily by mouth for 1 day, followed by 2 mg daily for 1 day.

Intervention Type DRUG

Stem Cell Transplant

Stem cell infusion on Day 0.

Intervention Type PROCEDURE

Other Intervention Names

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CellCept MMF Antithymocyte Globulin rATG ATG Rapamune hematopoietic stem cell transplantation HSCT transplantation

Eligibility Criteria

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Inclusion Criteria

1. Patients with high risk hematological malignancies, including those with induction failure and after treated or untreated relapse. High risk hematological malignancies include: Acute myelogenous or lymphocytic leukemia with induction failure of after relapse, myelodysplastic syndrome of intermediate and high risk according to Greenberg criteria, chronic myelogenous leukemia in accelerated phase or blast crisis, non-Hodgkin's and Hodgkin's lymphoma with induction failure or relapse after chemotherapy and refractory or relapsed chronic lymphocytic leukemia.
2. HLA-identical sibling or matched unrelated donor transplants not eligible for protocols of higher priority.
3. Age 18-75 years.
4. Bilirubin \</=1.5 mg/dl, serum glutamic-pyruvic transaminase (SGPT) \</= 200 IU/ml.
5. Creatinine \</=1.6 mg/dl.

Exclusion Criteria

1. Regimens including rituximab or alemtuzumab in the preparative regimen.
2. Patients can not have received prior treatment with gemtuzumab.
3. Planned conditioning chemotherapy for transplant can not include gemtuzumab.
4. Planned conditioning chemotherapy for transplant can not include the busulfan and cyclophosphamide regimen.
5. HIV seropositivity
6. Uncontrolled infection, not responding to adequate antimicrobial therapy after 7 days of treatment. The protocol PI is the final arbiter of eligibility.
7. Pregnancy
8. Inability to sign consent.
9. Patients who are past recipients of allogeneic or autologous stem cell transplants from any source.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Genzyme, a Sanofi Company

INDUSTRY

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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Amin Alousi, MD

Role: PRINCIPAL_INVESTIGATOR

M.D. Anderson Cancer Center

Locations

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UT 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

University of Texas (UT) MD Anderson Cancer Center Official Website

Other Identifiers

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2006-0435

Identifier Type: -

Identifier Source: org_study_id

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