Comparing Cyclophosphamide and Abatacept With Standard of Care Treatment Following Stem Cell Transplantation

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

43 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-26

Study Completion Date

2023-06-15

Brief Summary

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The purpose of this study is to investigate whether the combination of cyclophosphamide and abatacept versus the treatment used in standard of care will reduce the incidence of moderate and severe chronic graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation. GVHD occurs when the cells from your donor (the graft) see your body's cells (the host) as different and attack them.

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Detailed Description

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The experimental GVHD prophylaxis arm consists of cyclophosphamide and abatacept. Cyclophosphamide induces apoptosis of activated T cells and abatacept (CTLA4Ig) blocks activation of T cells by inhibiting the co-stimulatory signal.

Compared to the standard-of-care control arm, the experimental arm is much more convenient and expected to be associated with fewer toxicities.

In addition there is a great theoretical potential for immunological synergy between cyclophosphamide and abatacept for inducing post-transplant immunologic tolerance that clinically might translate into less GVHD without increase in relapse Patients will be randomized 1:1 to the experimental vs the standard of care arm. Randomization will be done prior to the use of any conditional therapy.

The two arms will be stratified by disease (acute leukemia vs others) and donor type (MRD vs MUD/MUD vs Haplo) in an effort to keep them balanced.

The conditioning regimen for both arms will be mainly Busulfan/Fludarabine (A Total Body Irradiation based conditioning regimen will be allowed for diseases such as ALL)

The GVHD prophylaxis regimen on the experimental arm will consist of high dose Cyclophosphamide on Days +3 and +4 followed by abatacept for 6 months.

The GVHD prophylaxis regimen on the standard of care arm will consist of methotrexate on Days +1,+3, +6 and +11 and tacrolimus for patients with a 10/10 matched related or unrelated donor and of high dose cyclophosphamide on Days +3 and +4 followed by tacrolimus and mycophenolate for patients with a haploidentical donor.

Conditions

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GVHD Hematologic Neoplasms

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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Cyclophosphamide and abatacept

The GVHD prophylaxis regimen on the experimental arm will consist of high dose Cyclophosphamide on Days +3 and +4 followed by abatacept for 6 months. Abatacept at a dose of 10mg/kg will be administered on days +5, +14 and +28, +56, +84, +112, +140, +168

Group Type EXPERIMENTAL

Cyclophosphamide

Intervention Type DRUG

Day 3 and day 4 following transplant. Dosing will be based on patients' actual weight up to 120% of ideal body weight, above which it will be based on adjusted ideal body weight (ideal weight plus 50% of the difference between ideal and actual weight).

abatacept

Intervention Type DRUG

Abatacept at a dose of 10mg/kg will be administered on days +5, +14 and +28, +56, +84, +112, +140, +168

methotrexate and tacrolimus

The GVHD prophylaxis regimen on the standard of care arm will consist of methotrexate on Days +1,+3, +6 and +11 and tacrolimus

Group Type ACTIVE_COMPARATOR

Methotrexate

Intervention Type DRUG

standard of care Methotrexate 5 mg/m2 on Days 1, 3, 6 and 11

Tacrolimus

Intervention Type DRUG

Tacrolimus per institutional guidelines

Interventions

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Cyclophosphamide

Day 3 and day 4 following transplant. Dosing will be based on patients' actual weight up to 120% of ideal body weight, above which it will be based on adjusted ideal body weight (ideal weight plus 50% of the difference between ideal and actual weight).

Intervention Type DRUG

abatacept

Abatacept at a dose of 10mg/kg will be administered on days +5, +14 and +28, +56, +84, +112, +140, +168

Intervention Type DRUG

Methotrexate

standard of care Methotrexate 5 mg/m2 on Days 1, 3, 6 and 11

Intervention Type DRUG

Tacrolimus

Tacrolimus per institutional guidelines

Intervention Type DRUG

Other Intervention Names

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cytophosphane Cytoxan Neosar ORENCIA Trexall Prograf Astagraf XL Envarsus XR

Eligibility Criteria

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Inclusion Criteria

* High risk hematologic malignancy justifying the need for an allogeneic hematopoetic stem cell transplantation: AML, ALL, CML in accelerated or blast phase, MDS/MPN, NHL, Hodgkin lymphoma, and multiple myeloma
* Creatinine clearance \> 40
* Adequate hepatic function
* Normal cardiac function (EF \> 50%)

Exclusion Criteria

* Patients with hematologic malignancies for which transplant is not the only curative option, such as AML with good or intermediate cytogenetics or molecular markers in CR1 or CML in chronic phase
* Inability to identify an 10/10 HLA-Matched Donor (related or unrelated) or a haploidentical donor
* Active malignant disease relapse
* Active, uncontrolled infection, uncontrolled cardiac angina, symptomatic congestive heart failure
* Life expectancy \<3 months
* Pregnancy or lactation
* Patients may not be receiving any other investigational agents in the last 28 days
* Patients with chronic myeloid leukemia in first chronic phase

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No