Trial of Allogeneic Stem Cell Transplants From HLA Compatible, Related and Unrelated Donors After a Myeloablative Preparative Regimen With Hyperfractionated TBI, Thiotepa and Fludarabine For Adult Patients With Lymphohematopoietic Disorders
Condition: Allogeneic Stem Cell Transplant; Leukemia; Non-Hodgkins; Lymphoblastic Lymphoma; Myelodysplastic Syndrome; Paroxysmal Nocturnal Hemoglobinuria (PNH)
MeSH terms: Preleukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Hemoglobinuria; Myelodysplastic Syndromes; Hemoglobinuria, Paroxysmal
Study type: Interventional
Phase: Phase 2

Summary: 
      This is a phase II, single-center study to evaluate the efficacy of a novel cytoreductive
      regimen followed by CD34+E- selected T cell depleted allogeneic stem cell (or soybean
      agglutinated and E-rosetted BM) transplant as treatment for patients with acute and chronic
      leukemias, lymphoma and myelodysplstic syndrome/PNH. The impact of the change in conditioning
      regimen and use of CD34-selected T cell depleted PBSCs on transplanted related morbidity and
      mortality and disease free survival will be assessed.
    

Detailed description: 
      The purpose of this study is: (1) to try to kill any cancer or precancer cells that are in
      your body, and to reduce the side effects of a transplant, which we have seen in our previous
      studies, (2) to see if this treatment with a new recipe of radiation and chemotherapy can
      suppress your immune system enough for the stem cells to 'take' and grow, (3) to see if the
      specially prepared stem cells can grow in you without a problem called graft-versus-host
      disease (GvHD) occurring.

      One of the major side effects of any stem cell transplant is a condition known as graft vs.
      host disease or GVHD. GVHD is an immune reaction caused by certain cells from the
      transplanted stem cells called T-lymphocytes (or T-cells). The T-cells from your donor may
      see your organs as foreign and attack them. New ways to remove the T-cells from the stem
      cells before the transplant are being used to try and prevent GVHD. In some studies, the
      removal of T-cells from the stem cells has been successful for many patients in preventing
      both short-term (acute) and long-term (chronic) forms of GVHD. However, the removal of
      T-cells may increase the chance that the new bone marrow developing from the stem cells will
      be rejected or will not function well. Rejection of the transplant means that some of your
      own cells have survived the chemo and radiation therapy, and are attacking the new bone
      marrow cells. This condition can be lifethreatening because of an increased risk of
      infections and bleeding and would require your getting more treatment and additional stem
      cells. Studies like this one are designed to find better ways to avoid GVHD without
      increasing the risk of other problems such as graft rejection.
    

Intervention name(s): cytoreductive regimen followed by a CD34+E- selected allogeneic stem cell transplant
Intervention type(s): Drug
Intervention description(s): Myeloablative and will consist of hyperfractionated TBI - 1375 cGy administered in 11 doses of 125 cGy each over a total of four days, with three doses on three days and two doses on the last day, fludarabine 25 mg/m2 IV x 5 days, and thiotepa 5mg/kg IV x 2 days. Recipients of HLA identical related transplants will not receive ATG to promote engraftment. Recipients of HLA mismatched related or unrelated stem cells will receive ATG for two days prior to the transplant. G-CSF mobilized CD34+E- PBSCs obtained from the HLA compatible donor will be infused on day 0. Post transplantation G-CSF will be administered only if clinically indicated and should begin on or after d+7.
Patients will be clinically evaluated at each clinic visit for incidence and severity of acute and chronic GVHD and transplant associated morbidity. Sequential evaluation of functional reconstitution of hematopoiesis and immunity will be made as per the BMT Service guidelines.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: leukemia; non-Hodgkins; lymphoblastic lymphoma; myelodysplastic syndrome; paroxysmal nocturnal hemoglobinuria (PNH); cytoreductive regimen; allogeneic stem cell transplant