Clofarabine, Cytarabine, and Filgrastim Followed by Infusion of Non-HLA Matched Ex Vivo Expanded Cord Blood Progenitors in Treating Patients With Acute Myeloid Leukemia
Condition: Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Acute Promyelocytic Leukemia (M3); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Recurrent Adult Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Leukemia, Monocytic, Acute; Leukemia, Myelomonocytic, Acute; Leukemia, Megakaryoblastic, Acute; Leukemia, Erythroblastic, Acute
Study type: Interventional
Phase: Phase 1

Summary: 
      This phase I trial is studying the safety and potential efficacy of infusing non-human
      leukocyte antigen (HLA) matched ex vivo expanded cord blood progenitors following treatment
      with clofarabine and cytarabine for patients with acute myeloid leukemia (AML). The
      combination of clofarabine, cytarabine (Ara-C) and granulocyte colony-stimulating factor
      (G-CSF) has been tested in earlier studies for the treatment of acute myeloid leukemia. In
      these previous clinical trials, this combination of drugs has been shown to have an
      anti-leukemia effect. However, the combination of clofarabine and Ara-C is profoundly
      myelosuppressive and immunosuppressive causing periods of neutropenia potentially lasting
      more than three weeks. During this period, patients are at increased risk of infections that
      can result in an increased risk of death. G-CSF is a growth factor that is used to help the
      white blood cells recover more quickly, but even with G-CSF, the use of clofarabine and Ara-C
      is often limited by the need to take long breaks between treatments to allow blood counts to
      recover. In our lab we have developed a method of growing or "expanding" blood stem cells
      (cells that give rise to the blood system) from umbilical cord blood. We are doing this study
      to find out if giving these expanded cells after chemotherapy is safe, helps the blood system
      recover more quickly from chemotherapy to allow shorter breaks between treatments, and
      decreases the risk of infection
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. Assess the safety of infusing off-the-shelf non-HLA matched expanded cord blood cells
      following administration of cytarabine hydrochloride (GCLAC) for patients with AML.

      SECONDARY OBJECTIVES:

      I. Assess the ability of the product to provide temporary myeloid engraftment.

      II. Assess the kinetics/persistence of potential engraftment.

      III. Assess the kinetics of autologous recovery when compared to historical cohorts.

      IV. Assess the development of alloimmunization.

      OUTLINE:

      INDUCTION THERAPY: Patients receive clofarabine intravenously (IV) over 1 hour and cytarabine
      hydrochloride IV over 2 hours on days 1-5. Patients receive an infusion of non-HLA matched ex
      vivo expanded cord blood progenitors on day 6. Filgrastim (G-CSF) is administered
      subcutaneously (SC) on days 0-5 and from day 7 until blood counts recover. Treatment
      modifications may apply according to response.

      CONSOLIDATION THERAPY: Patients receive clofarabine IV over 1 hour and cytarabine
      hydrochloride IV over 2 hours on days 1-5. Patients also receive G-CSF SC beginning on day 0
      and continuing until blood counts recover.

      Patients may receive treatment for 1-4 courses in the absence of disease progression or
      unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3-6 months for 2 years
      and then annually for 3 years.
    

Intervention name(s): cytarabine; clofarabine; filgrastim; Ex-vivo expanded cord blood progenitor cell infusion; laboratory biomarker analysis
Intervention type(s): Drug; Drug; Drug; Biological; Other
Intervention description(s): Given IV; Given IV; Given SC; Undergo ex vivo-expanded cord blood progenitor cell infusion; Correlative studies
Other intervention name(s): ARA-C; arabinofuranosylcytosine; arabinosylcytosine; Cytosar-U; cytosine arabinoside; CAFdA; Clofarex; Clolar; G-CSF; Neupogen; Dilanubicel; NLA101
Intervention MeSH terms: Cytarabine; Clofarabine
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment