Tacrolimus and Thymoglobulin, as GvHD Prophylaxis in Patients Undergoing Related Donor HCT
Condition: Hematological Malignancies
MeSH terms: Hematologic Neoplasms
Intervention: Tacrolimus and Thymoglobulin
Intervention description: Intravenous Tacrolimus 0.03 mg/kg/d, beginning day -3, where day 0 is the day of stem cell infusion or "transplant." Intravenous tacrolimus will be discontinued once the participant starts eating, and the drug will then be given orally at a dose of approximately 4 times the intravenous dose. Tacrolimus will be discontinued starting 100 days after transplant unless signs of acute and chronic GVHD develop or if severe toxicity occurs. Thymoglobulin will be given 0.5 mg/kg day-3, Thymoglobulin 1.5 mg/kg day -2, Thymoglobulin 2.5 mg/kg day -1. Thymoglobulin will be given intravenously over 6 hours.
Intervention MeSH terms: Tacrolimus; Thymoglobulin
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 21.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No
Keywords: ● Non-Hodgkin lymphoma,; ● Hodgkin disease,; ● Acute Myelogenous or Acute Lymphocytic Leukemia; ● Myelodysplastic Syndromes,; ● Chronic Myelogenous Leukemia; ● Multiple Myeloma; ● Chronic Lymphocytic Leukemia; ● Myelofibrosis and other myeloproliferative disorders;

Summary:

      The primary goal of the study is to determine the incidence and severity of acute Graft
      versus Host Disease (GVHD) following human leukocyte antigen (HLA) matched related donor
      Hematopoetic Stem Cell(HSC) transplant in patients with blood related cancers who receive the
      combination of tacrolimus and Thymoglobulin as GVHD prophylaxis. The investigators also will
      determine the safety of this combination in the first six months post transplant.

      Secondary goals include determining the time to recovery of white blood cells and platelets
      (engraftment), determining the occurrence of opportunistic infections, defined as infection
      that occurs in people with weakened immune systems and caused by organisms that do not
      normally cause disease (fungal infections, pneumocystis carinii pneumonia (PCP), and viral
      infections), estimating the incidence of chronic GVHD at two years and the overall and
      disease free survival at two years.

      Immune response will be assessed by means of immuno-correlative studies both prior to and at
      various points after transplant.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Suitable related donor as determined by the treating physician

          -  High resolution molecular HLA typing is mandatory for HLA Class I and II

          -  Diagnosis of hematological malignancy

          -  Patients with one of the following hematologic malignancies, and felt to be transplant
             candidates by their treating physician are eligible to enroll on this protocol:

          -  Non-Hodgkin lymphoma, any complete remission (CR)/partial remission (PR)

          -  Hodgkin disease, any CR/PR/stable disease (SD)

          -  Acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) any CR; for non-CR
             AML or ALL, bone marrow blast < 20% within 4 weeks of transplant and peripheral blood
             (PB) absolute blast count < 500/μl on the day of initiation of conditioning

          -  Myelodysplastic syndrome (MDS), treated or untreated

          -  Chronic myelogenous leukemia (CML) in chronic phase or accelerated phase

          -  Chronic myelomonocytic leukemia (CMML)

          -  Multiple myeloma, any CR/PR/SD

          -  Chronic lymphocytic leukemia (CLL) any CR/PR

          -  Myelofibrosis and other myeloproliferative disorders; bone marrow blasts less than 20
             percent within four weeks of transplant and peripheral blood absolute blast counts
             less than 500 per microliter on the day of initiation of conditioning

          -  Age >= 18 and able to cooperate with oral medication intake

          -  Filgrastim (G-CSF) mobilized Peripheral blood stem cells

          -  Agrees to participate, and informed consent signed

          -  Karnofsky performance status (KPS) >= 60, Eastern Cooperative Oncology Group (ECOG)
             performance status =< 2

          -  Creatinine clearance > 60 mL/min

          -  Ejection fraction > 50%

          -  Serum bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) less
             than 3 X upper limit of normal

          -  Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) or
             diffusion capacity of carbon monoxide (DLCO) > 50% predicted

        Exclusion Criteria:

          -  Bone marrow or Ex vivo engineered or processed graft (cluster of differentiation
             [CD]34+ enrichment, T-cell depletion, etc)

          -  Patients with documented uncontrolled central nervous system (CNS) disease

          -  Active donor or recipient serology positive for human immunodeficiency virus (HIV)

          -  Known contraindication to administration of Tacrolimus or Thymoglobulin

          -  Active Hepatitis B or C

          -  Patients with coronary heart disease (recent myocardial infarctions, angina, cardiac
             stent, or bypass surgery in the last 6 months) need to be cleared with a stress
             echocardiogram or nuclear myocardial perfusion stress test, and cardiology consult;
             all other cardiac history will be at the discretion of the Principal Investigator

          -  Oxygen usage at the time of enrollment

          -  Patients with clinical ascites

          -  Women who are pregnant or nursing