Clinical trial NCT00003116: High-Dose Chemotherapy Plus Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer
Official title: Allogeneic Peripheral Blood Progenitor Cell Transplantation Using Histocompatible Sibling-Matched Donor Cells After High-Dose Busulfan/Cyclophosphamide as Therapy for Hematologic Malignancies
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Leukemia
Lymphoma
Multiple Myeloma and Plasma Cell Neoplasm
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Keywords: recurrent childhood acute lymphoblastic leukemia
recurrent adult Hodgkin lymphoma
refractory multiple myeloma
recurrent childhood lymphoblastic lymphoma
recurrent childhood acute myeloid leukemia
recurrent adult acute myeloid leukemia
recurrent adult acute lymphoblastic leukemia
adult acute myeloid leukemia in remission
adult acute lymphoblastic leukemia in remission
childhood acute myeloid leukemia in remission
childhood acute lymphoblastic leukemia in remission
recurrent/refractory childhood Hodgkin lymphoma
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
recurrent adult diffuse small cleaved cell lymphoma
recurrent adult diffuse mixed cell lymphoma
recurrent adult diffuse large cell lymphoma
recurrent adult immunoblastic large cell lymphoma
recurrent adult lymphoblastic lymphoma
recurrent adult Burkitt lymphoma
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
secondary myelodysplastic syndromes
recurrent childhood small noncleaved cell lymphoma
recurrent childhood large cell lymphoma
recurrent mantle cell lymphoma
atypical chronic myeloid leukemia
myelodysplastic/myeloproliferative disease, unclassifiable
recurrent marginal zone lymphoma
recurrent small lymphocytic lymphoma
extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
nodal marginal zone B-cell lymphoma
splenic marginal zone lymphoma
adult acute myeloid leukemia with t(8;21)(q22;q22)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with t(15;17)(q22;q12)
childhood myelodysplastic syndromes
Lead sponsor: Case Comprehensive Cancer Center
Sponsor class: OTHER
Collaborators: name: National Cancer Institute (NCI)
First posted: 2003-01-27
Enrollment: 66
Sex: ALL
Minimum age (years): 4
Maximum age (years): 55
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving busulfan, cyclophosphamide, and filgrastim together with peripheral stem cell transplantation from a sibling donor works in treating patients with hematologic cancer.

Detailed description: OBJECTIVES:

* Determine the safety and feasibility of using allogeneic peripheral blood progenitor cell infusions obtained from normal histocompatible sibling donors for reconstituting bone marrow and immunologic function when given after high-dose busulfan/cyclophosphamide in patients with a hematologic malignancy.
* Determine the efficacy of this treatment in these patients.
* Determine the ability to mobilize hematopoietic progenitor cells from normal donors given filgrastim (G-CSF) by determining the hematopoietic progenitor cell content of allogeneic peripheral blood progenitor cell collections.
* Determine the incidence of engraftment failures in these patients.
* Determine the incidence of severe acute graft-versus-host disease in these patients.

OUTLINE: Patients receive high-dose oral busulfan every 6 hours on days -8 to -5, cyclophosphamide IV twice a day on days -4 and -3, and cyclosporine IV over 6 hours on day -1 and then 10 hours on day 0 for 2 doses (allogeneic only). Allogeneic peripheral blood progenitor cells IV are administered on day 0.

Filgrastim (G-CSF) is administered subcutaneously twice a day beginning 3 hours after completion of cell infusion and continuing until blood counts recover.

Patients are followed every month for 2 months, every 3 months for 6 months, and then every 6 months until disease progression.

PROJECTED ACCRUAL: A total of 40 patients will be accrued over a 15 month period.

Eligibility criteria: DISEASE CHARACTERISTICS:

* Histologically diagnosed:

  * Acute myeloid leukemia in first, second, or third complete remission or first or second early relapse
  * Acute lymphoblastic leukemia in first, second, or third complete remission or first or second early relapse
  * Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory
  * Non-Hodgkin's lymphoma in second or third remission or first, second, or third relapse, or refractory
  * Multiple myeloma and plasma cell leukemia in second or third remission or first, second, or third relapse, or refractory
  * Myelodysplastic syndrome deemed suitable for allogeneic bone marrow transplantation
* No symptoms or signs of CNS involvement and CNS is disease free on lumbar puncture and brain CT scan
* No active meningeal cancer

PATIENT CHARACTERISTICS:

Age:

* 4 to 55 (4 to 60 if donor is identical twin)

Performance status:

* ECOG 0-2

Life expectancy:

* Not specified

Hematopoietic:

* Not specified

Hepatic:

* SGOT/SGPT less than 3 times normal
* Bilirubin less than 2.0 mg/dL

Renal:

* Creatinine less than 2.1 mg/dL
* Creatinine clearance at least 60 mL/min (no greater than 1.5 times normal for children under 40 kg)

Cardiovascular:

* No uncontrolled hypertension
* No uncontrolled congestive heart failure
* No active angina pectoris requiring nitrates
* At least 6 months since prior myocardial infarction
* No major ventricular arrhythmia
* Left ventricular ejection fraction at least 45% on MUGA

Pulmonary:

* No severe or symptomatic restrictive or obstructive lung disease
* FEV_1 greater than 50% of predicted
* DLCO greater than 50% of predicted

Neurologic:

* No severe central or peripheral neurologic abnormality

Other:

* Must have HLA-A,B,C,D/DR identical sibling age 4 to 65, in good health
* No insulin-dependent diabetes mellitus
* No major thyroid or major adrenal dysfunction
* No active infection
* No other active malignancy
* Not pregnant
* HIV negative
* HTLV-I and HTLV-II negative

PRIOR CONCURRENT THERAPY:

Biologic therapy:

* No excessive anthracycline exposure, unless endomyocardial biopsy shows less than grade 2 drug effect and cardiac scan shows at least 50% ejection fraction
* At least 1 year since prior autologous bone marrow or peripheral blood progenitor cell transplant or allogeneic bone marrow transplant

Chemotherapy:

* At least 3 weeks since prior chemotherapy
* No prior excessive carmustine and bleomycin

Endocrine therapy:

* Not specified

Radiotherapy:

* At least 3 weeks since prior radiotherapy

Surgery:

* Not specified

Other:

* No concurrent nitroglycerin for angina pectoris
* No concurrent anti-arrhythmic drugs for major ventricular dysrhythmias

Primary outcomes:
measure: Hematopoietic reconstitution measured daily during transplant
timeFrame: at months 2, 4, 7, and 10, and then every 6 months until disease progression
Secondary outcomes:
Other outcomes:
Locations:
city: Cleveland
country: United States
facility: Ireland Cancer Center at University Hosptials Case Medical Center, Case Comprehensive Cancer Center
state: Ohio
Study officials:
affiliation: Ireland Cancer Center at University Hosptials Case Medical Center, Case Comprehensive Cancer Center
name: Hillard M. Lazarus, MD
role: STUDY_CHAIR
References: