Reduced Intensity Total Body Irradiation + Thymoglobulin Followed by Allogeneic PBSCT

NCT ID: NCT00709592

Last Updated: 2018-11-09

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

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-07-21

Study Completion Date

2017-06-28

Brief Summary

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One of two different doses of thymoglobulin will allow bone marrow engraftment with minimal Graft-versus-Host Disease and allow adequate immune response to allow the transplanted stem cells to replace the tumor cells.

Detailed Description

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This randomized phase II trial studies how well giving low dose total-body irradiation (TBI) with anti-thymocyte globulin followed by donor peripheral blood stem cell transplant (PBSCT) works in treating patients with hematologic malignancies. Giving reduced intensity total-body irradiation and anti-thymocyte globulin before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem 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 total-body irradiation together with antithymocyte globulin before transplant may stop this from happening.

Conditions

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Non-Hodgkin's Lymphoma Leukemia Multiple Myeloma Acute Myeloid Leukemia Hodgkin Lymphoma Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia Myelodysplastic Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ATG 1.7 mg/kg, TBI, transplant

(Rabbit-ATG;Thymoglobulin,Genzyme) ATG 5.1 mg/kg in three divided doses (1.7 mg/kg/d) given over three days (day -9 to -7) followed by 450 cGy TBI and tacrolimus plus MMF GVHD prophylaxis. Patients receive lower dose anti-thymocyte globulin IV on days -9 to -7. Patients undergo total-body radiation (TBI) twice daily (BID) on day -1 and once daily (QD) on day 0. Patients then undergo peripheral blood stem cells or bone marrow transplant on day 0. GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS: patients receive tacrolimus orally (PO) on days -2 to 90-120 with taper for 2 months, and mycophenolate mofetil (MMF) PO BID on days 0-30.

Group Type EXPERIMENTAL

Thymoglobulin

Intervention Type BIOLOGICAL

Patients eligible for participation in this study will be randomized between receiving rabbit ATG for 3 days. Thymoglobulin will be administered according to VCU BMT standard of care starting day -9 and continued daily through day -7.

Total-Body Irradiation

Intervention Type RADIATION

Undergo TBI

Allogeneic PBSCT or BMT

Intervention Type PROCEDURE

Undergo allogeneic PBSCT or BMT

Tacrolimus

Intervention Type DRUG

Given PO

Mycophenolate Mofetil

Intervention Type DRUG

Given PO

ATG 2.5 mg/kg/d, TBI, transplant

(Rabbit-ATG;Thymoglobulin,Genzyme) ATG 7.5 mg/kg in three divided doses (2.5 mg/kg/d) given over three days (day -9 to -7) followed by 450 cGy TBI and tacrolimus plus MMF GVHD prophylaxis. Patients receive higher dose anti-thymocyte globulin intravenously (IV) on days -9 to -7. Patients undergo total-body radiation (TBI) twice daily (BID) on day -1 and once daily (QD) on day 0. Patients then undergo peripheral blood stem cells or bone marrow transplant on day 0. GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS: patients receive tacrolimus orally (PO) on days -2 to 90-120 with taper for 2 months, and mycophenolate mofetil (MMF) PO BID on days 0-30.

Group Type EXPERIMENTAL

Thymoglobulin

Intervention Type BIOLOGICAL

Patients eligible for participation in this study will be randomized between receiving rabbit ATG for 3 days. Thymoglobulin will be administered according to VCU BMT standard of care starting day -9 and continued daily through day -7.

Total-Body Irradiation

Intervention Type RADIATION

Undergo TBI

Allogeneic PBSCT or BMT

Intervention Type PROCEDURE

Undergo allogeneic PBSCT or BMT

Tacrolimus

Intervention Type DRUG

Given PO

Mycophenolate Mofetil

Intervention Type DRUG

Given PO

Interventions

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Thymoglobulin

Patients eligible for participation in this study will be randomized between receiving rabbit ATG for 3 days. Thymoglobulin will be administered according to VCU BMT standard of care starting day -9 and continued daily through day -7.

Intervention Type BIOLOGICAL

Total-Body Irradiation

Undergo TBI

Intervention Type RADIATION

Allogeneic PBSCT or BMT

Undergo allogeneic PBSCT or BMT

Intervention Type PROCEDURE

Tacrolimus

Given PO

Intervention Type DRUG

Mycophenolate Mofetil

Given PO

Intervention Type DRUG

Other Intervention Names

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anti-thymocyte globulin (rabbit) ATG Genzyme anti-thymocyte globulin Rabbit Rabbit-ATG Whole-Body Irradiation Total Body Irradiation [TBI] PBPC transplantation Peripheral Blood Progenitor Cell Transplantation Peripheral Blood Stem Cell Transplantation [Allogenic PBSCT] Allogeneic Bone Marrow Transplantation [BMT] Allogeneic BMT Allogeneic Hematopoietic Stem Cell Transplantation HSCT Fujimycin Hecoria Prograf Protopic CellCept MMF

Eligibility Criteria

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Inclusion Criteria

* Patients with hematological malignancies for which allogeneic stem cell transplantation indicated including non-Hodgkin lymphoma (NHL), multiple myeloma (MM), acute myeloid leukemia (AML), Hodgkin lymphoma (HD), chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS)
* Patients with HLA compatible related or unrelated stem cell donor, willing and able to serve as an allogenic HSC donor. Unrelated donors have to be matched at HLA-A, B, C and DRB1 loci. A single locus mismatch will be tolerated in the event a more closely matched donor is not available.
* Patients age \>/=40 to \</=70 with an ECOG performance status \< 2
* Patients between 18 and 40 years of age will be eligible only if they have co-morbidities precluding conventional allogeneic transplantation with full intensity myeloablative conditioning
* Adequate cardiac, pulmonary, renal and hepatic function for transplant
* Negative serology for HIV
* Negative serum pregnancy test
* Patients who have received therapeutic radiation to a localized field will be eligible, provided critical structure tolerance doses have not been exceeded
* Patients who have had prior myeloablative autologous transplant will be eligible

Exclusion Criteria

* Evidence of uncontrolled viral, fungal, bacterial infection
* Evidence of active meningeal or CNS disease
* Prior therapy with rabbit ATG, prior treatment with equine ATG is allowed if more than 3 months ago
* Breast feeding mothers are excluded
Minimum Eligible Age

40 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Genzyme, a Sanofi Company

INDUSTRY

Sponsor Role collaborator

Virginia Commonwealth University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amir Toor, MD

Role: PRINCIPAL_INVESTIGATOR

Massey Cancer Center

Locations

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Virginia Commonwealth University/Massey Cancer Center

Richmond, Virginia, United States

Site Status

Countries

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United States

Related Links

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http://www.massey.vcu.edu/

VCU Massey Cancer Center

Other Identifiers

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NCI-2011-01698

Identifier Type: OTHER

Identifier Source: secondary_id

MCC-11561

Identifier Type: -

Identifier Source: org_study_id

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