Conditions: Hematological Malignancies Myelodysplastic Syndrome Leukemia Lymphoma
Keywords: Hematological Malignancies Myelodysplastic Syndrome Graft Versus Host Disease GVHD Allogeneic Hematopoietic Stem Cell Transplantation AHSCT Leukemia Lymphoma T-Cells Thymoglobulin ATG rATG Rabbit Antithymocyte Globulin Rapamune Sirolimus Mycophenolate Mofetil Cellcept MMF
Allocation: NA | Intervention model: SINGLE_GROUP
Enrollment: 13
Healthy volunteers: no

Brief summary:
The goal of this clinical research study is to learn if the combination of rabbit anti-thymocyte globulin (Thymoglobulin®), sirolimus (Rapamune®), and mycophenolate mofetil (Cellcept®) can help to prevent graft versus host disease (GVHD). The safety of this drug combination will also be studied.

Primary Objective: To determine efficacy and toxicity of a regimen of thymoglobulin, sirolimus and mycophenolate mofetil for prevention of acute GVHD after allogeneic stem cell transplantation from human leukocyte antigen (HLA) identical related or unrelated donors.

Secondary Objective: To assess engraftment, chronic GVHD, relapse and survival.

Detailed description:
Rabbit anti-thymocyte globulin (rATG), sirolimus, and mycophenolate mofetil (MMF) are all designed to prevent GVHD.

If you are found to be eligible to take part in this study, you will receive rATG through a needle in your vein over 3-4 hours on each of the 4 days before the stem cell transplant.

Beginning 2 days before the transplant, you will take sirolimus by mouth once per day. You will continue to receive sirolimus until 90 days after the transplant. Beginning on Day 60, you will start taking increasingly lower doses of the study drug. This is done so you can taper down slowly, and be off of the drug on Day 90.

Beginning on the day of the transplant, you will take MMF by mouth 2 times a day. You will continue to take MMF until 27 days after the transplant.

Every week (for the first 90-100 days after the transplant) you will have study visits. At this visit, you will have a physical exam. Blood (about 1-2 tablespoons) will be drawn for routine tests.

You will remain on study for up to 90 days after transplantation. You will be taken off study if intolerable side effects occur.

Starting on Day 90 after the transplant, you will continue to follow up with your transplant doctor at least every 3 months through 1 year after the transplant. During these visits you will have physical exams. Blood (about 1-2 tablespoons) will be drawn for routine tests. Your doctor may request additional testing.

This is an investigational study. RATG, sirolimus, and MMF are all FDA approved for their use in the transplantation of solid organs (like kidney and liver). All 3 drugs are commercially available. This particular combination and dose schedule is considered investigational. Up to 30 patients will take part in this study. All will be enrolled at M.D. Anderson.

Arms:
arm 1: Thymoglobulin 1.5 mg/kg intravenous (IV) days -4, -3, -2, -1 before Stem Cell Transplant (Day 0); Sirolimus 6 mg IV on day -2 followed by 2 mg daily to maintain therapeutic levels and Mycophenolate Mofetil (MMF) 15 mg/kg IV or orally every 12 hours starting on day 0 until day+27.

Interventions: intervention 1: Mycophenolate Mofetil (MMF) intervention 2: Thymoglobulin intervention 3: Sirolimus intervention 4: Stem Cell Transplant
Intervention descriptions: intervention 1: 15 mg/kg by vein or by mouth every 12 hours. intervention 2: 1.5 mg/kg by vein daily for 4 days intervention 3: 6 mg daily by mouth for 1 day, followed by 2 mg daily for 1 day. intervention 4: Stem cell infusion on Day 0.

Protocol document: