Allogeneic Hematopoietic Cell Transplantation for Adult Acute Lymphoblastic Leukemia (2015)

Study Overview
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Brief Summary
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This study is a prospective multicenter observational study to evaluate the feasibility and the efficacy of the conditioning regimens which are modified by the donor differences and the age of recipients among patients who will receive allogeneic hematopoietic stem cell transplantation in their 1st or 2nd hematologic complete remission (CR).

Detailed Description
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Allogeneic hematopoietic cell transplantation (AlloHCT) is recommended as a post-remission therapy for patients with adult ALL, and reduced intensity conditioning has been tried to decrease treatment-related mortality (TRM) rate. Recent results showed that reduced intensity conditioning can be safely and effectively used for alloHCT of adult patients with ALL. However, the reduced intensity conditioning (RIC) can increase the possibilities of hematologic relapse, especially due to the reduced anti-leukemic effect. Another challenge in performing alloHCT for ALL is the donor availability - the limited availability of matched sibling donor (MSD) and well-matched unrelated donor (WMUD) forces us to find the feasibility of alternative donors such as partially-matched unrelated donor (PMUD) or haploidentical familial donor (familial mismatched donor, FMD). The previous study (NCT0137764) which the investigators performed showed that the use of RIC and alternative donor was feasible. However, the incidence of relapse was slightly higher among patients who received RIC when the investigators analyzed the interim analysis results. Especially, the graft-versus-host disease (GVHD) incidence was relatively higher among patients who received alloHCT from MSD, and the investigators think that the addition of antithymocyte globulin will reduce the incidence of GVHD for these patients. In this study, the dose of busulfan will be increased when the recipients are below 55 years old, irrespective of donor type. The investigators will also define the partially matched donor exactly and find the feasibility of PMUD and FMD again. Another endpoint for this study is to find out whether the addition of antithymocyte globulin may be helpful in preventing the GVHD incidence for patients who received alloHCT from MSD without increasing the chance of hematologic relapse.

Official Title
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A Prospective Study Evaluating the Efficacy of the Allogeneic Hematopoietic Cell Transplantation With Antithymocyte Globulin (ATG)-Based Conditioning of Adult Acute Lymphoblastic Leukemia in First / Second Complete Hematologic Remission

Conditions
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Precursor Cell Lymphoblastic Leukemia-Lymphoma

Intervention / Treatment
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* Procedure: AlloHCT for Young/MSD
* Procedure: AlloHCT for Young/MUD&FMD
* Procedure: AlloHCT for Old/MSD
* Procedure: AlloHCT for Old/MUD&FMD


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who has been previously diagnosed as one of the following disease; Acute lymphoblastic leukemia Biphenotypic acute leukemia with Philadelphia-positive chromosome or gene translocation Patients whose disease status is one of the following; First hematologic complete remission (HCR1) Second hematologic complete remission (HCR2) 15 years of age and over. With a suitable donor (matched sibling, well-matched unrelated, partially-matched unrelated, and haploidentical familial donor) Adequate cardiac function (EF>45% via cardiac scan or EchoCG) European Clinical Oncology Group (ECOG) performance status ≥grade 2 or Karnofsky scale >60% at the time of screening All patients give written informed consent according to guidelines at institution's committee on human research. Exclusion Criteria: Acute lymphoblastic leukemia L3 type (Burkitt leukemia/lymphoma) Biphenotypic acute leukemia without BCR-ABL1 translocation Lymphoblastic lymphoma (bone marrow blast count is below 20% of mononuclear cells of bone marrow aspirate) Patients with psychiatric disorder or mental deficiency severe as to make compliance with the treatment unlike, and making informed consent impossible Nursing women, pregnant women, women of childbearing potential who do not want adequate contraception Male patient who reject the methods of avoiding pregnancy via methods such as abstinence, barrier method (condom etc). Patients with a diagnosis of prior malignancy (including hematologic malignancies such as acute leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome, etc) unless disease-free for at least 5 years following therapy with curative intent (except curatively treated nonmelanoma skin cancer, in situ carcinoma, or cervical intraepithelial neoplasia)

Ages Eligible for Study
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Minimum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Young/MSD<br>Patients who are <55 years old, and will receive alloHCT for Young/MSD | Procedure: AlloHCT for Young/MSD<br>* Allogeneic hematopoietic cell transplantation with conditioning as follows; Busulfan 3.2 mg/kg (D-7 to D-4) Cyclophosphamide 60 mg/kg (D-3 to D-2) Thymoglobulin 1.5 mg/kg (D-3 to D-1)<br>|
| Young/MUD&FMD<br>Patients who are <55 years old, and will receive alloHCT for Young/MUD&FMD | Procedure: AlloHCT for Young/MUD&FMD<br>* Allogeneic hematopoietic cell transplantation with conditioning as follows; Busulfan 3.2 mg/kg (D-7 to D-4) Fludarabine 30 mg/m2 (D-7 to D-2) Thymoglobulin 3.0 mg/kg (D-3 to D-1)<br>|
| Old/MSD<br>Patients who are >=55 years old, and will receive alloHCT for Old/MSD | Procedure: AlloHCT for Old/MSD<br>* Allogeneic hematopoietic cell transplantation with conditioning as follows; Busulfan 3.2 mg/kg (D-7 to D-6) Fludarabine 30 mg/m2 (D-7 to D-2) Thymoglobulin 1.5 mg/kg (D-3 to D-1)<br>|
| Old/MUD&FMD<br>Patients who are >=55 years old, and will receive alloHCT for Old/MUD&FMD | Procedure: AlloHCT for Old/MUD&FMD<br>* Allogeneic hematopoietic cell transplantation with conditioning as follows; Busulfan 3.2 mg/kg (D-7 to D-6) Fludarabine 30 mg/m2 (D-7 to D-2) Thymoglobulin 3.0 mg/kg (D-3 to D-1)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| relapse-free survival (RFS) rate | time from achieving hematologic CR to hematologic relapse / time from the enrollment of this trial to hematologic relapse | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| relapse-free survival (RFS) rate | time from achieving hematologic CR to hematologic relapse / time from the enrollment of this trial to hematologic relapse | 5 years | 
| overall survival (OS) rate | time from the diagnosis of disease to death/ time from the enrollment of this trial to death | 2 years | 
| overall survival (OS) rate | time from the diagnosis of disease to death/ time from the enrollment of this trial to death | 5 years | 
| cumulative incidence of relapse | from achieving hematologic CR to hematologic relapse / time from the enrollment of this trial to hematologic relapse | 2 years | 
| cumulative incidence of relapse | from achieving hematologic CR to hematologic relapse / time from the enrollment of this trial to hematologic relapse | 5 years | 
| treatment-related mortality rate | after enrollment of this trial | 100 days | 
| treatment-related mortality rate | after enrollment of this trial | 1 year | 
| treatment-related mortality rate | after enrollment of this trial | 2 years | 
| treatment-related mortality rate | after enrollment of this trial | 5 years | 
| cumulative incidence of acute graft-versus-host disease | after enrollment of this trial | 100 days | 
| cumulative incidence of acute graft-versus-host disease | after enrollment of this trial | 1 year | 
| cumulative incidence of acute graft-versus-host disease | after enrollment of this trial | 2 years | 
| cumulative incidence of acute graft-versus-host disease | after enrollment of this trial | 5 years | 
| cumulative incidence of chronic graft-versus-host disease | after enrollment of this trial | 100 days | 
| cumulative incidence of chronic graft-versus-host disease | after enrollment of this trial | 1 year | 
| cumulative incidence of chronic graft-versus-host disease | after enrollment of this trial | 2 years | 
| cumulative incidence of chronic graft-versus-host disease | after enrollment of this trial | 5 years | 
| molecular relapse-free survival | after enrollment of this trial / after achieving molecular CR (for Ph-positive ALL) | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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allogeneic hematopoietic stem cell transplantation, acute lymphoblastic leukemia, alternative hematopoietic stem cell donor, busulfan, antithymocyte globulin