211At-BC8-B10 Followed by Donor Stem Cell Transplant in Treating Patients With Relapsed or Refractory High-Risk Acute Leukemia or Myelodysplastic Syndrome

NCT ID: NCT03670966

Last Updated: 2025-10-16

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

RECRUITING

Clinical Phase

PHASE1/PHASE2

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-10

Study Completion Date

2029-03-20

Brief Summary

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This phase I/II trial studies the side effects and best dose of a radioactive agent linked to an antibody (211At-BC8-B10) followed by donor stem cell transplant in treating patients with high-risk acute leukemia or myelodysplastic syndrome that has come back (recurrent) or isn't responding to treatment (refractory). 211At-BC8-B10 is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Giving chemotherapy and total body irradiation before a stem cell transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and 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 attack the body's normal cells, called graft versus host disease. Giving cyclophosphamide, mycophenolate mofetil, and tacrolimus after a transplant may stop this from happening.

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Detailed Description

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OUTLINE: This is a dose-escalation study of astatine At 211 anti-CD45 monoclonal antibody BC8-B10.

PREPARATIVE REGIMEN: Patients receive astatine At 211 anti-CD45 monoclonal antibody BC8-B10 infusion over 6-8 hours on day -8, fludarabine intravenously (IV) over 30 minutes on days -6 to -2, and cyclophosphamide IV over 1 hour on days -6 and -5. Patients also undergo TBI on day -1.

TRANSPLANT: Patients undergo peripheral blood stem cell (PBSC) or bone marrow transplant on day 0.

GVHD PROPHYLAXIS: Patients receive cyclophosphamide IV over 1-2 hours on days 3-4, mycophenolate mofetil IV or PO three times daily (TID) on days 5-35, and tacrolimus IV over 1-2 hours (changed to PO once tolerated) on days 5-180 with taper beginning on day 84 per physician discretion. Patients also begin granulocyte colony-stimulating factor (G-CSF) IV or subcutaneously (SC) on day 5 to continue until absolute neutrophil count (ANC) \> 1000/mm\^3 x 3 days.

Patients undergo bone marrow biopsy and aspiration and blood sample collection throughout the study.

After completion of study treatment, patients are followed up at day 100, and at 6, 9, 12, 18, and 24 months.

Conditions

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Acute Lymphoblastic Leukemia in Remission Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome Acute Myeloid Leukemia in Remission Chronic Myelomonocytic Leukemia Myelodysplastic Syndrome With Excess Blasts Recurrent Acute Lymphoblastic Leukemia Recurrent Acute Myeloid Leukemia Refractory Acute Lymphoblastic Leukemia Refractory Acute Myeloid Leukemia Recurrent Mixed Phenotype Acute Leukemia Refractory Mixed Phenotype Acute Leukemia Hematopoietic and Lymphoid Cell Neoplasm

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 (211At-BC8-B10, chemotherapy, TBI, MMF, G-CSF)

PREPARATIVE REGIMEN: Patients receive astatine At 211 anti-CD45 monoclonal antibody BC8-B10 infusion over 6-8 hours on day -8, fludarabine IV over 30 minutes on days -6 to -2, and cyclophosphamide IV over 1 hour on days -6 and -5. Patients also undergo TBI on day -1.

TRANSPLANT: Patients undergo PBSC or bone marrow transplant on day 0.

GVHD PROPHYLAXIS: Patients receive cyclophosphamide IV over 1-2 hours on days 3-4, mycophenolate mofetil IV or PO TID on days 5-35, and tacrolimus IV over 1-2 hours (changed to PO once tolerated) on days 5-180 with taper beginning on day 84 per physician discretion. Patients also begin G-CSF IV or SC on day 5 to continue until ANC \> 1000/mm\^3 x 3 days.

Patients undergo bone marrow biopsy and aspiration and blood sample collection throughout the study.

Group Type EXPERIMENTAL

Astatine At 211 Anti-CD45 Monoclonal Antibody BC8-B10

Intervention Type BIOLOGICAL

Given via infusion

Cyclophosphamide

Intervention Type DRUG

Given IV

Total-Body Irradiation

Intervention Type RADIATION

Undergo TBI

Peripheral Blood Stem Cell Transplantation

Intervention Type PROCEDURE

Undergo PBSC transplantation

Bone Marrow Transplantation

Intervention Type PROCEDURE

Undergo bone marrow transplant

Mycophenolate Mofetil

Intervention Type DRUG

Given IV or PO

Recombinant Granulocyte Colony-Stimulating Factor

Intervention Type BIOLOGICAL

Given IV or SC

Fludarabine Phosphate

Intervention Type DRUG

Given IV

Tacrolimus

Intervention Type DRUG

Given IV or PO

Bone Marrow Aspiration and Biopsy

Intervention Type PROCEDURE

Undergo bone marrow biopsy and aspiration

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Interventions

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Astatine At 211 Anti-CD45 Monoclonal Antibody BC8-B10

Given via infusion

Intervention Type BIOLOGICAL

Cyclophosphamide

Given IV

Intervention Type DRUG

Total-Body Irradiation

Undergo TBI

Intervention Type RADIATION

Peripheral Blood Stem Cell Transplantation

Undergo PBSC transplantation

Intervention Type PROCEDURE

Bone Marrow Transplantation

Undergo bone marrow transplant

Intervention Type PROCEDURE

Mycophenolate Mofetil

Given IV or PO

Intervention Type DRUG

Recombinant Granulocyte Colony-Stimulating Factor

Given IV or SC

Intervention Type BIOLOGICAL

Fludarabine Phosphate

Given IV

Intervention Type DRUG

Tacrolimus

Given IV or PO

Intervention Type DRUG

Bone Marrow Aspiration and Biopsy

Undergo bone marrow biopsy and aspiration

Intervention Type PROCEDURE

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Other Intervention Names

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At 211 MAb BC8-B10 APAMISTAMAB-B10-ASTATINE AT-211 (-)-Cyclophosphamide Asta B 518 B-518 WR-138719 Total Body Irradiation SCT_TBI Whole Body Irradiation Whole-Body Irradiation TBI PBPC transplantation Bone Marrow Grafting BMT 115007-34-6 MMF Cellcept 143011-72-7 Recombinant Colony-Stimulating Factor 3 rhG-CSF 2-F-ara-AMP Beneflur Fludara Fludarabine-5''-Monophosphate SH T 586 Prograf Protopic FK 506 FK-506 Tacforius Biological Sample Collection

Eligibility Criteria

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Inclusion Criteria

* Patients must have AML, ALL, high-risk MDS, or MPAL (also known as biphenotypic) meeting one of the following descriptions:

* AML, ALL, or MPAL in first remission with evidence of measurable residual disease (MRD) by flow cytometry;
* AML, ALL, or MPAL beyond first remission (i.e., having relapsed at least one time after achieving remission in response to a treatment regimen);
* AML, ALL, or MPAL representing primary refractory disease (i.e., having failed to achieve remission at any time following one or more prior treatment regimens);
* AML evolved from myelodysplastic or myeloproliferative syndromes;
* MDS expressed as refractory anemia with excess blasts (RAEB)
* Chronic myelomonocytic leukemia (CMML) by French-American-British (FAB) criteria.
* Patients not in remission must have CD45-expressing leukemic blasts. Patients in remission do not require phenotyping and may have leukemia previously documented to be CD45 negative (because in remission patients, virtually all antibody binding is to non-malignant cells which make up \>= 95% of nucleated cells in the marrow).
* Patients must be \>= 18 and =\< 75 years of age.
* Patients should have a circulating blast count of less than 10,000/mm\^3 (control with hydroxyurea or similar agent is allowed).
* Patients must have an estimated creatinine clearance greater than 50/ml per minute by the following formula (Cockcroft-Gault). Serum creatinine value must be within 28 days prior to registration.
* Bilirubin \< 2 times the upper limit of normal.
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 2 times the upper limit of normal.
* Eastern Cooperative Oncology Group (ECOG) \< 2 or Karnofsky \>= 70.
* Patients must be free of uncontrolled infection.
* Patients with prior non-myeloablative or reduced-intensity conditioning allogeneic-HCT must have no evidence of ongoing GVHD and be off all immunosuppression for at least 6 weeks at time of enrollment.
* Patients must have normal elastography.
* If ferritin is elevated, patient must have less than 7 mg/g liver iron concentration on liver T2 magnetic resonance imaging (MRI).
* Patients should have an official gastrointestinal (GI) consult prior to the transplant for full evaluation.
* Patients must have a related donor who is identical for one HLA haplotype and mismatched at the HLA-A, -B or DRB1 loci of the unshared haplotype with the exception of single HLA-A, -B or DRB1 mismatches.
* DONOR: Donors must meet HLA matching criteria as well as standard Seattle Cancer Care Alliance (SCCA) criteria for PBSC or bone marrow donation. Preference should be given to donors who are mismatched at the HLA-A, -B and -DRB1 loci.

Exclusion Criteria

* Patients may not have symptomatic coronary artery disease and may not be on cardiac medications for anti-arrhythmic or inotropic effects.
* Left ventricular ejection fraction \< 45%.
* Corrected diffusion capacity of the lung for carbon monoxide (DLCO) \< 35% or receiving supplemental continuous oxygen. When pulmonary function tests (PFTs) cannot be obtained, the 6-minute walk test (6MWT, also known as exercise oximetry) will be used: Any patient with oxygen saturation on room air of \< 89% during a 6MWT will be excluded
* Liver abnormalities: fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis, or symptomatic biliary disease.
* Patients who are known to be seropositive for human immunodeficiency virus (HIV).
* Perceived inability to tolerate diagnostic or therapeutic procedures.
* Active central nervous system (CNS) leukemia at time of treatment.
* Patients with prior myeloablative allogeneic-HCT.
* Women of childbearing potential who are pregnant (beta human chorionic gonadotropin \[B-HCG\]+) or breast feeding.
* Fertile men and women unwilling to use contraceptives during and for 12 months post-transplant.
* Inability to understand or give an informed consent.
* Allergy to murine-based monoclonal antibodies.
* Known contraindications to radiotherapy.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

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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Phuong Vo

Role: PRINCIPAL_INVESTIGATOR

Fred Hutchinson Cancer Center

Locations

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Fred Hutch/University of Washington Cancer Consortium

Seattle, Washington, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Phuong Vo

Role: CONTACT

206-667-2749

Facility Contacts

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Phuong Vo

Role: primary

206-667-2749

Other Identifiers

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10060

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA015704

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2018-01788

Identifier Type: REGISTRY

Identifier Source: secondary_id

P01CA078902

Identifier Type: NIH

Identifier Source: secondary_id

View Link

RG1003349

Identifier Type: -

Identifier Source: org_study_id

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