Hematopoietic Cell Transplantation for Patients With Hematologic Malignancies Using Related, HLA-Haploidentical Donors

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine if engraftment can be achieved safely in patients with high-risk hematologic malignancies who undergo non-myeloablative transplant with peripheral stem cells from Human Leukocyte Antigen (HLA) haploidentical donors with pre and post-transplant cyclophosphamide as immunosuppression.

Detailed Description
-----------------
It is important to extend the option of nonmyeloablative, hematopoietic stem cell transplantation (HSCT) for potential therapy of hematologic malignancies to patients who do not have an HLA-matched donor. Almost all patients would have a related donor identical for one HLA haplotype (haploidentical) and mismatched at HLA-A, B or DR of the unshared haplotype. Thus far, nonmyeloablative HSCT from HLA-mismatched donors has been associated with a high rate of graft failure and graft-versus-host disease (GVHD). In this protocol, we will use a combination of immunosuppressive agents including cyclophosphamide administered before and after HSCT to facilitate engraftment and to delete highly alloreactive T-cell clones presumably involved in GVHD.

Official Title
-----------------
Nonmyeloablative Hematopoietic Stem Cell Transplantation (SCT) for High-Risk Hematologic Malignancies With Related, HLA-Haploidentical Donors: A Phase II Trial of Immunosuppression With Cyclophosphamide Administered Before and After SCT

Conditions
-----------------
Hematologic Neoplasms

Intervention / Treatment
-----------------
* Drug: Cyclophosphamide
* Other: Hematopoietic Stem Cell Transplantation,


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients ≤70 years old Eligible diagnoses: CML in AP AML with high-risk cytogenetics [del(5q)/-5, del(7q)/-7, abnormal 3q, 9q, 11q, 20q, 21q, 17p, t(6:9), t(9;22), complex karyotypes (≥3 abnormalities)] in CR1 AML ≥ CR2; patients should have <5% marrow blasts at the time of transplant High-risk ALL defined as: CR1 with high-risk cytogenetics t(9;22), t(8;14), t(4;11), t(1;19) for adult patients >4 wk to achieve CR1 ≥ CR2 Patients should have <5% marrow blasts at the time of transplant MDS (>int-1 per IPSS) after ≥ 1 prior cycle of induction chemotherapy; should have<5% marrow blasts at the time of transplant MM Stage II or III patients who have progressed after an initial response to chemotherapy or autologous HSCT or MM patients with refractory disease who may benefit from tandem autologous-nonmyeloablative allogeneic transplant CLL, NHL or HD who are ineligible for autologous HSCT or who have resistant/refractory disease and who may benefit from tandem autologous nonmyeloablative allogeneic transplant. Patients who have received a prior allogeneic HSCT and who have either rejected their grafts or who have become tolerant of their grafts with no active GvHD requiring immunosuppressive therapy could be enrolled Exclusion Criteria: Patients with suitably matched related or unrelated donors Patients with conventional transplant options (a conventional transplant should be the priority for eligible patients ≤ 50 yr of age who have a related donor mismatched for a single HLA-A, -B or DRB1 antigen) CNS involvement with disease refractory to intrathecal chemotherapy Presence of active, serious infection (e.g., mucormycosis, uncontrolled aspergillosis, tuberculosis) Karnofsky Performance Status < 60% for adult patients (Appendix A) Patients with the following organ dysfunction: Left ventricular ejection fraction <35% DLCO <35% and/or receiving supplemental continuous oxygen Liver abnormalities: fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin >3 mg/dL or symptomatic biliary disease. HIV-positive patients Women of childbearing potential who are pregnant (β-HCG+) or breast feeding Fertile men and women unwilling to use contraceptives during and for 12 months post transplant Life expectancy severely limited by diseases other than malignancy Patients on any other investigational drug at time of enrolment

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 70 Years

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

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

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

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stem Cell Transplant+Cyclophosphamide<br>patients with high-risk hematologic malignancies will receive hematopoietic stem cell transplantation from haploidentical donors after treatment with cyclophosphamide | Drug: Cyclophosphamide<br>* 14.5 mg/kg, IV qd on day -6 and -5 and 50 mg/kg, IV on day +3 and +4<br>* Other names: Endoxan;Other: Hematopoietic Stem Cell Transplantation,<br>* Hematopoietic Stem Cell Transplantation,<br>* Other names: Stem cell transplantation;|

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Donor engraftment | percentage of donor engraftment after 84 from baseline | Day +84 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence and severity of graft versus host disease | Incidence and severity of graft versus host disease after 200 days from the baseline | up to 200 days after the baseline | 
| Non-relapse-related mortality | incidence of non-relapse-related mortality after 200 days from the baseline | Incidence and severity of graft versus host disease after 200 days from the baseline | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Hematopoietic Stem Cell Transplantation, High-Risk Hematologic Neoplasms, Haploidentical Donors, Cyclophosphamide