Description:
The study proposes the use of Fludarabine, Busulfan, Anti Thymocyte Globulin Rabbit (ATG) and
Total Body Irradiation as a preparative regimen before hematopoietic stem cell transplant
from unrelated donor peripheral blood stem cells (PBSC). The hypothesis states that the 100
day mortality after this type of transplant will be significantly below the accepted
standards, which is about 30% for unrelated donors.
Title
- Brief Title: Allogeneic Transplantation for Pediatric Leukemias With Unrelated Donors
- Official Title: Allogeneic Transplantation for Pediatric Leukemias With Unrelated Donors Using Fludarabine, Busulfan, 400 cGy Total Body Irradiation, and Thymoglobulin
Clinical Trial IDs
- ORG STUDY ID:
SCT 0208
- NCT ID:
NCT00679536
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Busulfan | IV Busulfex | A |
Fludarabine | Fludara | A |
Thymoglobulin | | A |
Purpose
The study proposes the use of Fludarabine, Busulfan, Anti Thymocyte Globulin Rabbit (ATG) and
Total Body Irradiation as a preparative regimen before hematopoietic stem cell transplant
from unrelated donor peripheral blood stem cells (PBSC). The hypothesis states that the 100
day mortality after this type of transplant will be significantly below the accepted
standards, which is about 30% for unrelated donors.
Detailed Description
The primary objective of this study is to evaluate the toxicity (as measured as 100 day
survival) after hematopoietic stem cell transplant from an unrelated donor with a novel
preparative regimen of Fludarabine, Busulfan, Anti-Thymocyte Globulin, and Total Body
Irradiation for pediatric patients with leukemia. The secondary objectives are to evaluate
the relapse-free and overall survival after hematopoietic stem cell transplant as well as to
evaluate the incidence of acute and chronic graft-versus-host disease after this preparative
regimen.
Trial Arms
Name | Type | Description | Interventions |
---|
A | Experimental | All patients on this trial will receive a conditioning regimen of Busulfan, Fludarabine, Anti-Thymocyte Globulin and Total Body Irradiation (400 cGy) | - Busulfan
- Fludarabine
- Thymoglobulin
|
Eligibility Criteria
Inclusion Criteria:
- Ages 0-21
- AML in one of the following stages:
- Having preceding myelodysplasia (MDS)
- High Risk cytogenetics
- Requiring > 2 cycles chemotherapy to obtain complete remission
- High allelic ratio FLT3/ITD+,
- Standard risk cytogenetics with positive MRD at end of Induction
- Second or greater CR
- First relapse with < 25% blasts in bone marrow
- With therapy-related AML whose prior malignancy has been in remission for at
least 12 months
- ALL in one of the following stages:
- High risk first remission, defined as:
- Ph+ ALL; or,
- MLL rearrangement with slow early response [defined as having M2 (5-25% blasts)
or M3 (>25% blasts on bone marrow examination on Day 14 of induction therapy)];
or,
- Hypodiploidy (< 44 chromosomes or DNA index < 0.81); or,
- End of induction M3 bone marrow; or,
- End of induction M2 marrow or MRD>1% with M2-3 marrow or MRD>1% at Day 42.
- High-risk infant ALL defined as age <6 months at diagnosis with MLL (11q23)
translocation.
- High risk second remission, defined as:
- Bone marrow relapse < 36 months from induction; or >36 mths if a matched sibling
donor is available
- T-lineage relapse at any time; or,
- Very early isolated CNS relapse (<18 months from diagnosis); or,
- Slow reinduction (M2-3 at Day 28) after relapse at any time.
- Any third or subsequent CR.
- Biphenotypic or undifferentiated leukemia in any CR or if in first relapse must have <
25% blasts in bone marrow
- MDS at any stage; prior therapies allowed
- CML in chronic or accelerated phase; prior therapies allowed
- Patient also must have the following organ requirements:
- Adequate renal function defined as serum creatinine <2x normal, or creatinine
clearance > 40 ml/min/m^2 or 70 ml/min.
- Adequate liver function as defined by total bilirubin less than or equal to 2
times normal and AST and ALT less than or equal to 4 times normal.
- Adequate cardiac function as defined by: shortening fraction > 24% by
echocardiogram, or ejection fraction > 30% by radionuclide angiogram.
- Adequate pulmonary function as defined by DLCO, FEV1/FVC > 60% by pulmonary
function tests. For children who are uncooperative for PFTs and have no evidence
of dyspnea at rest or exercise intolerance, pulse oximetry > 94% on room air is
considered acceptable, with a normal chest xray.
- Adequate venous access; a double lumen central vascular access device or its
equivalent and an additional PICC line will be required for all patients.
- Women of childbearing potential and sexually active males should use effective
contraception while on study.
Exclusion Criteria:
- Inability to give informed consent or assent
- Inability to obtain a suitable donor
- Patient who is HIV-positive
- Patient who has active Hepatitis B
- Patient who is pregnant
- Patient who is otherwise considered unsuitable for transplant at the discretion of the
principal investigator.
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To evaluate the toxicity (as measures by 100 day survival) after hematopoietic stem cell transplant from an unrelated donor with a novel preparative regimen. |
Time Frame: | 100 day mortality |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | To evaluate the relapse-free and overall survival after hematopoietic stem cell transplant with Fludarabine/Busulfan/ATG/TBI preparative regimen for pediatric patients with leukemia. |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Measure: | To evaluate the incidence of acute and chronic graft-versus-host disease after hematopoietic stem cell transplant |
Time Frame: | 5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Unknown status |
Lead Sponsor: | Ann & Robert H Lurie Children's Hospital of Chicago |
Trial Keywords
- Reduced Toxicity
- Toxicity
- Event Free Survival
- Graft vs Host Disease
Last Updated
January 23, 2014