Fludarabine and Busulfan Followed by Allogeneic Stem Cell Transplant in Treating Older Patients With Acute Myeloid Leukemia in First Complete Remission
Condition: Adult Acute Myeloid Leukemia in Remission; Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Myelodysplastic Syndromes
Study type: Interventional
Phase: Phase 2

Summary: 
      This phase II trial studies how well fludarabine and busulfan followed by a donor
      (allogeneic) stem cell transplant work in treating older patients with acute myeloid leukemia
      that is in first complete remission. Giving low doses of chemotherapy, such as fludarabine
      and busulfan, before a donor peripheral blood stem cell transplant helps stop the growth of
      cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer cells.
      It may also stops 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 replace the patient's immune system and help destroy any remaining cancer cells.
      Sometimes the transplanted cells from a donor can make an immune response against the body's
      normal cells (called graft-versus-host disease). Giving tacrolimus, methotrexate, and rabbit
      antithymocyte globulin before or after the transplant may stop this from happening.
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. Determine if allogeneic transplantation from a matched sibling or unrelated donor using a
      non-myeloablative preparative regimen results in a 2-year disease-free survival (DFS) that is
      better than historical results using standard chemotherapy.

      SECONDARY OBJECTIVES:

      I. Determine 2-year actuarial risks of transplant-related mortality, acute and chronic
      graft-versus-host (GVHD) disease and relapse among patients with acute myeloid leukemia (AML)
      in first complete remission (CR1) following a non-myeloablative preparative regimen.

      II. To examine recovery of T and B cell number and function following non-myeloablative stem
      cell transplant.

      III. To examine the time course of T, B and myeloid progenitor chimerism following this
      preparative regimen.

      IV. To characterize the pharmacokinetics of intravenous busulfan used in a non-myeloablative
      preparation regimen in AML patients age >= 60 years.

      OUTLINE:

      PREPARATIVE REGIMEN: Patients receive fludarabine intravenously (IV) over 30 minutes on days
      -7 to -3 and busulfan IV over 2 hours 4 times per day (every 6 hours) on days -4 and -3.

      GRAFT-VERSUS-HOST DISEASE (GVHD) PROPHYLAXIS: Patients receive tacrolimus orally (PO) or IV
      twice daily (BID) on days -2 with taper between days 90-120, and stopping by days 150-180.
      Patients also receive methotrexate IV on days 1, 3, 6, and 11 and rabbit antithymocyte
      globulin IV over 4-6 hours on days -4 through -2.

      ALLOGENEIC PERIPHERAL BLOOD STEM CELL TRASNPLANTATION (PBSC): Patients undergo allogeneic
      PBSC transplant on day 0. Patients then receive filgrastim subcutaneously (SC) daily
      beginning on day 12 and continuing until blood counts recover.

      Patients are followed monthly for 1 year, every 3 months for 1 year, and then every 6 months
      for 3 years.
    

Intervention name(s): filgrastim; Anti-Thymocyte Globulin; busulfan; fludarabine phosphate; methotrexate; tacrolimus; Allogeneic Hematopoietic Stem Cell Transplantation
Intervention type(s): Biological; Biological; Drug; Drug; Drug; Drug; Procedure
Intervention description(s): Given SC; Given IV; Given IV; Given IV; Given IV; Given PO or IV; Undergo allogeneic PBSC transplantation
Other intervention name(s): HSC, HSCT
Intervention MeSH terms: Methotrexate; Fludarabine phosphate; Fludarabine; Busulfan; Tacrolimus; Antilymphocyte Serum
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: adult acute myeloid leukemia in remission; secondary acute myeloid leukemia; adult acute monocytic leukemia (M5b); adult acute erythroid leukemia (M6); adult acute megakaryoblastic leukemia (M7); adult acute minimally differentiated myeloid leukemia (M0); adult acute myeloblastic leukemia with maturation (M2); adult acute myeloblastic leukemia without maturation (M1); adult acute myelomonocytic leukemia (M4); adult acute monoblastic leukemia (M5a); adult acute myeloid leukemia with t(8;21)(q22;q22); adult acute myeloid leukemia with t(16;16)(p13;q22); adult acute myeloid leukemia with inv(16)(p13;q22); adult acute myeloid leukemia with 11q23 (MLL) abnormalities