Description:
The Investigators would like to study the incidence of complete remission (CR) at day +30
after Clofarabine followed by haploidentical transplant. The conditioning regimen used is
Fludarabine, Busulfan (2 doses) and Total Body Irradiation (TBI) with post transplant
cyclophosphamide for patients with Acute Myeloid Leukemia (AML) who are not in remission
prior to considering allogeneic transplant with haploidentical donors.
Title
- Brief Title: Clofarabine Pre-allogeneic Stem Cell Transplant for Non-remission AML
- Official Title: Clofarabine Followed by Hematopoietic Stem Cell Transplant Using Fludarabine, Busulfan, and Total-Body Irradiation With Post-Transplant Cyclophosphamide for Non-remission Acute Myeloid Leukemia
Clinical Trial IDs
- ORG STUDY ID:
18-011
- NCT ID:
NCT04002115
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Clofarabine | Clolar | Clofarabine 30 mg/m^2 |
Fludarabine | Fludara | Clofarabine 30 mg/m^2 |
Busulfan | Busulfex | Clofarabine 30 mg/m^2 |
Cyclophosphamide | Cytoxan | Clofarabine 30 mg/m^2 |
Granulocyte Colony-Stimulating Factor | Filgrastim G-CSF | Clofarabine 30 mg/m^2 |
Tacrolimus | Prograf | Clofarabine 30 mg/m^2 |
Cellcept | Mycophenolate Mofetil (MMF) | Clofarabine 30 mg/m^2 |
Purpose
The Investigators would like to study the incidence of complete remission (CR) at day +30
after Clofarabine followed by haploidentical transplant. The conditioning regimen used is
Fludarabine, Busulfan (2 doses) and Total Body Irradiation (TBI) with post transplant
cyclophosphamide for patients with Acute Myeloid Leukemia (AML) who are not in remission
prior to considering allogeneic transplant with haploidentical donors.
Detailed Description
Approximately 30-40% of patients with acute myeloid leukemia (AML) experience induction
failures. In these patients who do not achieve remission with two cycles of standard
induction therapies, the probability of achieving remission with subsequent inductions is
limited. Hematopoietic stem cell transplantation (HSCT) is the only curative option for these
patients, but high relapse rate and transplant-related mortality often preclude them to
proceed to transplant. Thus, AML not in remission at time of HSCT remains a huge unmet need
in current HSCT practice, particularly if the patient does not have a Human Leukocyte Antigen
(HLA)-matched donor identified by the time of two induction failures.
Salvage chemotherapy with clofarabine appears to be another promising option in relapsed and
refractory AML. Clofarabine is a second-generation purine nucleoside analog with substantial
single-agent activity in adult patients with AML. It is an effective immunosuppressive agent
and several trials have shown the feasibility of conditioning with clofarabine-based regimen.
In the past, a conditioning regimen of clofarabine with busulfan (4 doses) has been
successfully used prior to allogeneic stem cell transplantation for non-remission AML with
day +30 complete remission rates were 90-100%. However, these patients were transplanted with
HLA matched donors. This study will examine those patients undergoing haploidentical
transplantation.
Achieving a long-term remission is clearly the goal of AML treatment. For this clinical
trial, the Investigators propose to examine the use of clofarabine pre- haploidentical
(related) stem cell transplantation for patients who have experienced two induction failures.
Even in previous Clofarabine/Busulfan4 studies, the Investigators observed a relapse rate of
about 45% after achieving the first complete remission. With further development of
molecularly targeted maintenance therapies, reliable protocols to bring these patients into
the early complete remission will be essential.
Trial Arms
Name | Type | Description | Interventions |
---|
Clofarabine 30 mg/m^2 | Experimental | Clofarabine 30 mg/m^2 IV once a day for 5 days prior to the initiation of the standard conditioning regimen for the stem cell transplant infusion (Day 0). In the event of excessive toxicities related to the clofarabine, a dose de-escalation to 20 mg/m^2 will occur for the next cohort of subjects.
Day -14 through Day -10 Clofarabine 30 mg/m^2, Day - 9 Day of rest (no scheduled conditioning medications), Day - 8 Day of rest, Day - 7 Day of rest, Day - 6 Fludarabine 40 mg/m^2 IV and Busulfan 3.2 mg/kg IV, Day - 5 Fludarabine 40 mg/m^2 IV and Busulfan 3.2 mg/kg IV, Day - 4 Fludarabine 40 mg/m^2 IV, Day - 3 Fludarabine 40 mg/m^2 IV, Day - 2 Day of Rest, Day -1 Total Body Irradiation 200 cGys, Day 0 stem cell transplant infusion, Day +3 Cyclophosphamide 50 mg/kg IV, Day +4 Cyclophosphamide 50 mg/kg IV, Day +5 Start G-CSF, Tacrolimus, and MMF | - Clofarabine
- Fludarabine
- Busulfan
- Cyclophosphamide
- Granulocyte Colony-Stimulating Factor
- Tacrolimus
- Cellcept
|
Eligibility Criteria
Inclusion Criteria:
- Diagnostic criteria of AML, without having achieved remission after at least 2
attempts at induction chemotherapy, no attempt of induction if relapsed within 6
months of induction or no attempt of induction if relapsed after 6 months post
induction therapy.
- Age 18 to 55 years of age.
- Planned or scheduled to receive an allogeneic hematopoietic stem cell transplant
(HSCT) using peripheral blood (PB) or bone marrow (BM) stem cells. Cord blood donor
cells are not allowed.
- Planned or scheduled to receive a standard conditioning regimen consisting of
Busulfan, Fludarabine, and TBI.
- Performance status: Karnofsky ≥ 70% within 28 days of study registration
- LVEF ≥ 50% by MUGA or echocardiogram within 28 days of study registration.
- FEV1 and FVC ≥ 50% predicted, DLCO (corrected for hemoglobin) ≥ 50% of predicted
within 28 days of study registration.
- Creatinine clearance 60 mL/min/1.73 m^2 within 28 days of study registration
- Serum bilirubin less than or equal to 1.5 times upper limit of normal (ULN);
- AST/ALT less than or equal to 2.5 times ULN;
- Alkaline phosphatase less than or equal to 2.5 times ULN
Exclusion Criteria:
- Known history of non-compliance with medication, scheduled clinic visits, or
self-care.
- In the opinion of the investigator, no appropriate caregivers identified.
- HIV1 (Human Immunodeficiency Virus-1) or HIV2 positive
- Active infection including Hepatitis B and Hepatitis C.
- In the opinion of the physician investigator, uncontrolled medical or psychiatric
disorders.
- In the opinion of the physician investigator, uncontrolled infections, defined as
positive blood cultures within 72 hours of study entry or evidence of progressive
infection by imaging studies such as chest CT scan within 14 days of registration.
- Active central nervous system (CNS) leukemia.
- Prior allogeneic HSCT.
- Pregnant or breastfeeding. Women of child bearing potential (WCBP) are required to
have a negative serum or urine pregnancy test within 7 days of initiation of
conditioning regimen.
Maximum Eligible Age: | 55 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of complete remission (CR) |
Time Frame: | 30 days |
Safety Issue: | |
Description: | Determine the incidence of CR at 30 days (Day +30) post stem cell transplant infusion |
Secondary Outcome Measures
Measure: | Non-relapse related mortality |
Time Frame: | 100 days |
Safety Issue: | |
Description: | Determine the rate of non-relapse related mortality at 100 days post transplant (Day +100) |
Measure: | Neutrophil engraftment |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Rates of engraftment, defined as the first day of Absolute Neutrophil Count (ANC) greater than 500 for the first of three consecutive days |
Measure: | Incidence of Acute graft-versus-host disease (GVHD) |
Time Frame: | 100 days |
Safety Issue: | |
Description: | The incidence of any grade (1-4) of acute GvHD as measured from day of transplantation to Day +100 using the Glucksberg criteria. |
Measure: | Severity of Acute graft-versus-host disease (GVHD) |
Time Frame: | 100 days |
Safety Issue: | |
Description: | The highest grade (1-4) of acute GvHD experienced by participants as measured from day of transplantation to Day +100 using the Glucksberg criteria |
Measure: | Incidence of Chronic GVHD |
Time Frame: | 1 year |
Safety Issue: | |
Description: | The incidence of any grade (1-4) of acute GvHD as measured from Day +100 to Year 1 post-transplantation using the Glucksberg criteria. |
Measure: | Severity of Chronic GVHD |
Time Frame: | 1 year |
Safety Issue: | |
Description: | The highest overall grade (1-4) of chronic GvHD experienced by participants as measured from Day +100 to Year 1 post-transplantation using the Glucksberg criteria |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Milton S. Hershey Medical Center |
Trial Keywords
- Clofarabine
- Haploidentical stem cell transplantation
- Non-remission AML
Last Updated
November 2, 2020