Description:
This phase II trial studies how well donor umbilical cord blood transplant with ex-vivo
expanded cord blood progenitor cells (NLA101) 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.
Title
- Brief Title: 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
- Official Title: Pilot Study: Infusion of Off the Shelf Ex Vivo Expanded Cryopreserved Progenitor Cells (NLA101) in the Setting of Single Cord Blood Transplantation for Patients With Hematologic Malignancies
Clinical Trial IDs
- ORG STUDY ID:
9910
- SECONDARY ID:
NCI-2017-02205
- SECONDARY ID:
9910
- SECONDARY ID:
P30CA015704
- SECONDARY ID:
P50HL110787
- SECONDARY ID:
RG9218003
- NCT ID:
NCT03399773
Conditions
- Acute Biphenotypic Leukemia
- Acute Lymphoblastic Leukemia
- Chronic Myelogenous Leukemia, BCR-ABL1 Positive
- Hematopoietic and Lymphoid Cell Neoplasm
- Myelodysplastic Syndrome
- Myelodysplastic Syndrome With Excess Blasts
Interventions
Drug | Synonyms | Arms |
---|
Omidubicel | Ex Vivo-expanded Umbilical Cord Blood-derived Hematopoietic CD34-positive Progenitor Cells, UCB-derived CD34+ HPCs | Treatment (chemotherapy, TBI, NLA101) |
Cyclophosphamide | Carloxan, Cicloxal, Mitoxan, Neosar, Revimmune | Treatment (chemotherapy, TBI, NLA101) |
Fludarabine | fluoroadenine, Fluradosa | Treatment (chemotherapy, TBI, NLA101) |
Thiotepa | Oncotiotepa, STEPA, Tepadina, TESPA, Tespamine, Thiofosfamide, Thiofozil, Thiophosphoramide, Thiotef, Triethylene Thiophosphoramide | Treatment (chemotherapy, TBI, NLA101) |
Purpose
This phase II trial studies how well donor umbilical cord blood transplant with ex-vivo
expanded cord blood progenitor cells (NLA101) 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.
Detailed Description
OUTLINE:
Patients receive either regimen A or regimen B.
REGIMEN A: Patients (18 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 NLA101 IV within the next 24 hours on day 0.
REGIMEN B: Patients (18 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 receive unmanipulated cord blood unit IV
followed by NLA101 IV within the next 24 hours on day 0.
After completion of study treatment, patients are followed up at 180 days, 1 year, and 2
years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (chemotherapy, TBI, NLA101) | Experimental | Patients receive either regimen A or regimen B.
REGIMEN A: Patients (18 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 NLA101 IV within the next 24 hours on day 0.
REGIMEN B: Patients (18 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 receive unmanipulated cord blood unit IV followed by NLA101 IV within the next 24 hours on day 0. | - Omidubicel
- Cyclophosphamide
- Fludarabine
- Thiotepa
|
Eligibility Criteria
Inclusion Criteria:
- 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., RAEB, 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: 18 to =< 45 years
- Intermediate intensity regimen: 18 =< 65 years
- Patients 18 to =< 45 years: Karnofsky (>= 18 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
- Calculated creatinine clearance must be > 60 mL and serum creatinine =< 2 mg/dL
- 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)
- Left ventricular ejection fraction >= 50% OR
- Shortening fraction > 26%
- Ability 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 domestic backup unit, meeting the same HLA and cell dose requirements, 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
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
innovation and development (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
Maximum Eligible Age: | 65 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of graft failure |
Time Frame: | Up to day 45 post-transplant |
Safety Issue: | |
Description: | Primary graft failure/rejection as defined by no neutrophil recovery (regardless of donor chimerism) or autologous recovery (neutrophil recovery but < 10% donor chimerism in blood and bone marrow [BM]). |
Secondary Outcome Measures
Measure: | Time to neutrophil engraftment |
Time Frame: | Up to day 45 post-transplant |
Safety Issue: | |
Description: | The day of neutrophil recovery will be the 1st day of 2 consecutive days of absolute neutrophil count at or above 500 after the 1st post-cord blood transplant nadir. |
Measure: | Time to platelet engraftment |
Time Frame: | Up to day 100 post-transplant |
Safety Issue: | |
Description: | Measured by the number of participants with a platelet count > 20,000/ul without subsequent transfusions for 7 days |
Measure: | Incidence of adverse events |
Time Frame: | Up to day 100 post-transplant |
Safety Issue: | |
Description: | Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. |
Measure: | Incidence of non-relapse mortality |
Time Frame: | At day 100 post-transplant |
Safety Issue: | |
Description: | |
Measure: | Incidence of non-relapse mortality |
Time Frame: | At 1 year post-transplant |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Not yet recruiting |
Lead Sponsor: | Fred Hutchinson Cancer Research Center |
Last Updated
August 4, 2021