Infusion of Expanded Cord Blood Cells in Addition to Single Cord Blood Transplant in Treating Patients With Acute Leukemia, Chronic Myeloid Leukemia, or Myelodysplastic Syndromes

NCT ID: NCT03399773

Last Updated: 2025-08-26

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

31 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-10

Study Completion Date

2027-04-02

Brief Summary

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This phase II trial studies how well donor umbilical cord blood transplant with ex-vivo expanded cord blood progenitor cells (dilanubicel) works in treating patients with blood cancer. Before the transplant, patients will receive chemotherapy (fludarabine, cyclophosphamide and in some cases thiotepa) and radiation therapy. Giving chemotherapy and total-body irradiation before a donor umbilical cord blood transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and 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. The donated stem cells may also replace the patient's immune cells and help destroy any remaining cancer cells.

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Detailed Description

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OUTLINE:

Patients receive either regimen A or regimen B.

REGIMEN A: Patients (10 through 45 years old) receive fludarabine intravenously (IV) over 30 minutes on days -8 to -6 and cyclophosphamide IV on days -7 and -6. Patients undergo total body irradiation (TBI) twice daily (BID) on days -4 to -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.

REGIMEN B: Patients (10 through 65 years old) receive fludarabine IV over 30-60 minutes on days -6 to -3 and IV over 30 minutes on day -2, cyclophosphamide IV on day -6, and thiotepa IV over 2-4 hours on days -5 and -4. Patients undergo TBI once daily (QD) on days -2 and -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.

All patients undergo bone marrow aspirate and biopsy as clinically indicated during screening and on study. Patients undergo multigated acquisition scan (MUGA) or echocardiography (ECHO), and computed tomography (CT) during screening. Patients also undergo blood sample collection on study.

After completion of study treatment, patients are followed up at 180 days, 1 year, and 2 years.

Conditions

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Acute Biphenotypic Leukemia Acute Lymphoblastic Leukemia Chronic Myelogenous Leukemia, BCR-ABL1 Positive Hematopoietic and Lymphoid Cell Neoplasm Myelodysplastic Syndrome Myelodysplastic Syndrome With Excess Blasts

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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Treatment (chemotherapy, TBI, NLA101)

Patients receive either regimen A or regimen B.

REGIMEN A: Patients (10 through 45 years old) receive fludarabine IV over 30 minutes on days -8 to -6 and cyclophosphamide IV on days -7 and -6. Patients undergo TBI BID on days -4 to -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.

REGIMEN B: Patients (10 through 65 years old) receive fludarabine IV over 30-60 minutes on days -6 to -3 and IV over 30 minutes on day -2, cyclophosphamide IV on day -6, and thiotepa IV over 2-4 hours on days -5 and -4. Patients undergo TBI QD on days -2 and -1. Patients receive unmanipulated cord blood unit IV followed by dilanubicel IV within the next 24 hours on day 0.

All patients undergo bone marrow aspirate and biopsy as clinically indicated during screening and on study. Patients undergo MUGA or ECHO, and CT during screening. Patients also undergo blood sample collection on study.

Group Type EXPERIMENTAL

Dilanubicel

Intervention Type BIOLOGICAL

Given IV

Cyclophosphamide

Intervention Type DRUG

Given IV

Fludarabine

Intervention Type DRUG

Given IV

Thiotepa

Intervention Type DRUG

Given IV

Total-Body Irradiation

Intervention Type RADIATION

Undergo TBI

Umbilical Cord Blood Transplantation

Intervention Type PROCEDURE

Given IV

Laboratory Biomarker Analysis

Intervention Type OTHER

Correlative studies

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Bone Marrow Aspirate

Intervention Type PROCEDURE

Undergo bone marrow aspirate and biopsy

Bone Marrow Biopsy

Intervention Type PROCEDURE

Undergo bone marrow aspirate and biopsy

Multigated Acquisition Scan

Intervention Type PROCEDURE

Undergo MUGA

Electrocardiography

Intervention Type PROCEDURE

Undergo ECHO

Computed Tomography

Intervention Type PROCEDURE

Undergo CT

Interventions

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Dilanubicel

Given IV

Intervention Type BIOLOGICAL

Cyclophosphamide

Given IV

Intervention Type DRUG

Fludarabine

Given IV

Intervention Type DRUG

Thiotepa

Given IV

Intervention Type DRUG

Total-Body Irradiation

Undergo TBI

Intervention Type RADIATION

Umbilical Cord Blood Transplantation

Given IV

Intervention Type PROCEDURE

Laboratory Biomarker Analysis

Correlative studies

Intervention Type OTHER

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Bone Marrow Aspirate

Undergo bone marrow aspirate and biopsy

Intervention Type PROCEDURE

Bone Marrow Biopsy

Undergo bone marrow aspirate and biopsy

Intervention Type PROCEDURE

Multigated Acquisition Scan

Undergo MUGA

Intervention Type PROCEDURE

Electrocardiography

Undergo ECHO

Intervention Type PROCEDURE

Computed Tomography

Undergo CT

Intervention Type PROCEDURE

Other Intervention Names

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Allogeneic UCB-derived Hematopoietic Stem and Progenitor Cells NLA101 NLA101 Allogeneic Umbilical Cord Blood-derived HSPCs NLA101 Carloxan Cicloxal Mitoxan Neosar Revimmune fluoroadenine Fluradosa Oncotiotepa STEPA Tepadina TESPA Tespamine Thiofosfamide Thiofozil Thiophosphoramide Thiotef Triethylene Thiophosphoramide SCT_TBI Total Body Irradiation Whole Body Irradiation Whole-Body Irradiation Cord Blood Transplantation UCB transplantation Biological Sample Collection Human Bone Marrow Aspirate Blood Pool Scan Equilibrium Radionuclide Angiography Gated Blood Pool Imaging MUGA Scan Multi-Gated Acquisition Scan Radionuclide ventriculography ECG EKG CAT Scan

Eligibility Criteria

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Inclusion Criteria

* Patients 10 to 65 years old with a hematologic malignancy in need of hematopoietic cell transplant who are \> 30 kg and without a suitable related donor
* Patient must have hematologic malignancy that meets institutional eligibility requirements for cord blood transplant
* Malignancies included are:

* Acute leukemia, including acute myeloid leukemia (AML), biphenotypic acute leukemia or mixed-lineage leukemia, acute lymphoblastic leukemia (ALL); all patients must be in complete response (CR) as defined by \< 5% blasts by morphology/flow cytometry in a representative bone marrow sample with adequate cellularity to assess remission status
* Myelodysplasia (MDS) International Prognostic Scoring System (IPSS) intermediate (Int)-2 or high risk (i.e., refractory anemia with excess blasts \[RAEB\], refractory anemia with excess blasts in transformation \[RAEBt\]) or refractory anemia with severe pancytopenia or high risk cytogenetics; blasts must be \< 10% in a representative bone marrow aspirate
* Chronic myeloid leukemia excluding refractory blast crisis; to be eligible in first chronic phase (CP1) patient must have failed or be intolerant to tyrosine kinase inhibitor therapy
* High dose TBI regimen: 10 to =\< 45 years
* Intermediate intensity regimen: 10 to =\< 65 years
* Patients 10 to =\< 45 years: Lansky (\< 16 years old) or Karnofsky (\>= 16 years old) \>= 70 or Eastern Cooperative Oncology Group (ECOG) 0-1
* Patients \> 45 to =\< 65 years: Karnofsky \>= 70 or ECOG 0-1 and non-age adjusted comorbidity index =\< 5
* Adults: Calculated creatinine clearance must be \> 60 mL and serum creatinine =\< 2 mg/dL
* Children (\< 18 years old): Calculated creatinine clearance must be \> 60 mL/min
* Total serum bilirubin must be \< 3 mg/dL unless the elevation is thought to be due to Gilbert's disease or hemolysis
* Transaminases must be \< 3 x the upper limit of normal per reference values of treating institution
* Carbon monoxide diffusing capability (DLCO) corrected \>= 60% normal (may not be on supplemental oxygen)
* For pediatric patients unable to perform pulmonary function tests, O2 saturation \> 92% on room air
* Left ventricular ejection fraction \>= 50% OR
* Shortening fraction \> 26%
* Ability of participant or legally authorized representative to understand and the willingness to sign a written informed consent form
* DONOR: Minimum requirement: The cord blood (CB) unit must be matched at a minimum at 4/6 HLA-A, B antigens and DRB1 allele with the recipient; therefore, 0-2 mismatches at the A or B or DRB1 loci based on intermediate resolution at HLA-A, B and high resolution allele level typing at HLA- DRB1 are allowed
* DONOR: Institutional guidelines for HLA-match may be followed as long as the minimum criteria for HLA-matching as above are met
* DONOR: The CB unit selected for transplant must have a MINIMUM of 2.5 x 10\^7 TNC/kg
* DONOR: The minimum recommended CD34/kg cell dose is 1.7 x 10\^5 CD34/kg
* DONOR: A backup unit must be identified and reserved prior to the start of the treatment plan for possible infusion in the unlikely event of poor post-thaw viability of the primary CB unit. A suitable back up unit will be considered, as follows:

* Must be matched at a minimum at 4/6 HLA-A, B, DRBl loci with the recipient. Therefore 0-2 mismatches at the A or B or DRBl loci based on intermediate resolution A, B antigen and DRBl allele typing for determination of HLA-match is allowed (Fred Hutch Protocol 2010).
* Must contain a MINIMUM of 1.5 x 10\^7 TNC/kg to ensure the same requirement we use for a standard double CBT per CB selection guideline (Fred Hutch Protocol 2010).

Exclusion Criteria

* Uncontrolled viral or bacterial infection at the time of study enrollment
* Active or recent (prior 6 month) invasive fungal infection unless cleared by infectious disease (ID) consult
* History of human immunodeficiency virus (HIV) infection
* Pregnant or breastfeeding
* Prior allogeneic transplant
* Central nervous system (CNS) leukemic involvement not clearing with intrathecal chemotherapy; diagnostic lumbar puncture is to be performed
* \< 30 kg
Minimum Eligible Age

10 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nohla Therapeutics, Inc.

INDUSTRY

Sponsor Role collaborator

National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Fred Hutchinson Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Filippo Milano

Role: PRINCIPAL_INVESTIGATOR

Fred Hutch/University of Washington Cancer Consortium

Locations

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Fred Hutch/University of Washington Cancer Consortium

Seattle, Washington, United States

Site Status

Countries

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United States

Other Identifiers

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NCI-2017-02205

Identifier Type: REGISTRY

Identifier Source: secondary_id

9910

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA015704

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P50HL110787

Identifier Type: NIH

Identifier Source: secondary_id

View Link

RG9218003

Identifier Type: OTHER

Identifier Source: secondary_id

9910

Identifier Type: -

Identifier Source: org_study_id

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