Antithymocyte Globulin and Cyclosporine in Preventing Graft-Versus-Host Disease in Patients Undergoing Chemotherapy With or Without Radiation Therapy Followed By Donor Stem Cell Transplant for Acute Lymphoblastic Leukemia or Acute Myeloid Leukemia

Study Overview
=================
Brief Summary
-----------------
RATIONALE: Giving chemotherapy and total-body irradiation before a donor bone marrow transplant or peripheral blood stem cell transplant helps stop the growth of cancer cells. It also helps stop 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. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving antithymocyte globulin before transplant and cyclosporine after transplant may stop this from happening. PURPOSE: This randomized clinical trial is studying how well giving antithymocyte globulin together with cyclosporine works in preventing graft-versus-host disease in patients who are undergoing chemotherapy with or without radiation therapy followed by donor stem cell transplant for acute lymphoblastic leukemia or acute myeloid leukemia.

Detailed Description
-----------------
OBJECTIVES: Primary Compare the incidence of acute graft-vs-host disease (GVHD) within the first 100 days after transplantation in patients with acute lymphoblastic leukemia or acute myeloid leukemia treated with a myeloablative conditioning regimen comprising cyclophosphamide (with or without radiotherapy) and low- vs high-dose anti-thymocyte globulin followed by allogeneic HLA-matched related stem cell transplantation and cyclosporine. Compare the incidence of serious adverse events within the first 100 days after transplantation in patients treated with these regimens. Secondary Compare 100-day and 6-month survival in patients treated with these regimens. Compare the severity of acute GVHD in patients treated with these regimens. Compare the incidence of culture-proven infections at 100 days and 6 months after transplantation in patients treated with these regimens. Compare the incidence of mucositis, in terms of presence, severity, and duration, in patients treated with these regimens. Compare the number of days on opiate drugs within the first 30 days after transplantation in patients treated with these regimens. Compare the time to engraftment in patients treated with these regimens. Compare the incidence of hospitalization within the first 6 months after transplantation, in terms of length of initial stay, cumulative total days, and number of hospitalizations, in patients treated with these regimens. Compare the relapse rate and time to relapse in patients treated with these regimens. Compare the incidence and severity of chronic GVHD between 100 days and 6 months after transplantation in patients treated with these regimens. OUTLINE: This is a pilot, randomized, open-label, multicenter study. Conditioning: All patients receive a standard myeloablative-conditioning regimen that contains cyclophosphamide IV over 2 hours per center regimen, typically on days -6 to -3. Patients also undergo total body irradiation OR receive busulfan. Graft-versus-host disease (GVHD) prophylaxis (as part of conditioning): Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive low-dose anti-thymocyte globulin IV over 4-8 hours on days -3 to -1. Arm II: Patients receive high-dose anti-thymocyte globulin IV over 4-8 hours on days -5 to -1. Allogeneic hematopoietic stem cell transplantation: Patients in both arms undergo allogeneic peripheral blood stem cell or bone marrow transplantation on day 0. Post-transplantation GVHD prophylaxis: Patients in both arms receive cyclosporine IV over 1-4 hours or orally twice daily beginning on day -1 and continuing until approximately day 60 followed by tapering doses until day 180 in the absence of GVHD. Patients are followed at 7, 14, 21, 30, 100, and 180 days. PROJECTED ACCRUAL: A total of 30-60 patients (15-30 per treatment arm) will be accrued for this study.

Official Title
-----------------
Pilot Trial of Two Dose Levels of Thymoglobulin® as Part of a Myeloablative-Conditioning for a HLA Identical Matched Related Donor (MRD) Stem Cell Transplant With Cyclosporine (CsA) as Posttransplant Graft vs Host Disease (GvHD) Prophylaxis

Conditions
-----------------
Graft Versus Host Disease, Leukemia

Intervention / Treatment
-----------------
* Biological: anti-thymocyte globulin
* Drug: busulfan
* Drug: cyclophosphamide
* Drug: cyclosporine
* Procedure: allogeneic bone marrow transplantation
* Procedure: peripheral blood stem cell transplantation
* Radiation: radiation therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
DISEASE CHARACTERISTICS: Confirmed diagnosis of acute myeloid leukemia (AML) or acute lymphoblastic leukemia In first complete remission or second complete remission Secondary AML allowed HLA-A, -B, and -DRB1 identical related donor available AND must be fully matched at Class II by high-resolution molecular HLA typing (at least 4 digits) Currently receiving a myeloablative conditioning regimen that includes cyclophosphamide All patients from a center should receive the same conditioning regimen throughout the study No fludarabine or other purine analogues (e.g. cladribine or pentostatin) as part of conditioning regimen No uncontrolled CNS disease PATIENT CHARACTERISTICS: Age 18 to 55 Performance status ECOG 0-3 Life expectancy Not specified Hematopoietic Not specified Hepatic Bilirubin < 2 mg/dL ALT and/or AST ≤ 3 times normal Renal Creatinine < 2.0 mg/dL OR Creatinine clearance > 50 mL/min Cardiovascular Ejection fraction > 40% No severe cardiac disease Other Negative pregnancy test Fertile patients must use effective contraception No known contraindication to administration of rabbit anti-thymocyte globulin No current drug or alcohol abuse No significant medical or psychosocial problem or unstable disease state (including, but not limited to, morbid obesity) that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy No prior or concurrent bone marrow transplantation from a donor who has positive serology for HIV, hepatitis B virus, hepatitis C virus, or syphilis No IV immunoglobulin prior to engraftment No concurrent ex vivo engineered or processed graft (CD34+ enrichment or T-cell depletion) Chemotherapy See Disease Characteristics No prior or concurrent methotrexate for graft-vs-host disease prophylaxis Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other More than 30 days since prior experimental agents No other concurrent investigational agents Enrollment in investigational studies (i.e., anti-microbial agents) allowed only for life threatening events or after exhausting other treatment modalities

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Biological: anti-thymocyte globulin|nan|
|Drug: busulfan|nan|
|Drug: cyclophosphamide|nan|
|Drug: cyclosporine|nan|
|Procedure: allogeneic bone marrow transplantation|nan|
|Procedure: peripheral blood stem cell transplantation|nan|
|Radiation: radiation therapy|nan|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
graft versus host disease, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, 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), secondary acute myeloid leukemia, adult acute lymphoblastic leukemia in remission, adult acute myeloid leukemia in remission