HLA-Mismatched Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation for Hematological Malignancies
N/A
N/A
Both
Graft vs Host Disease, Hematologic Neoplasms, Lymphoma, Myelodysplastic Syndromes, Myeloid Leukemia
Trial Information
HLA-Mismatched Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation for Hematological Malignancies
Many patients with hematological malignancies potentially curable by bone marrow
transplantation are not considered for transplantation because an HLA identical family or
unrelated donor is unavailable. For these patients the only curative option is a transplant
from a partially matched family donor. Such transplants are feasible but are less
successful than matched sibling donor transplants. The main problems with mismatched
transplants are graft rejection, graft-vs-host disease, and regimen-related mortality. This
restricts the use of mismatched transplants to patients less than 45 years at high risk of
dying from the hematological malignancy.
This protocol evaluates a new preparative regimen designed to ensure stem cell engraftment
by increased immunosuppression, followed by a G-CSF mobilized T cell depleted, stem cell
rich, peripheral blood progenitor cell (PBPC) transplant from a mismatched related donor in
patients with high risk hematological malignancies.
This phase I study evaluates engraftment and GVHD following T cell depleted, HLA-mismatched
PBPC transplants. Stopping rules will be used to make modifications to the protocol in the
event of graft failure.
The end points of the study are graft take, acute and chronic GVHD, leukemic relapse,
transplant-related mortality, death and leukemia-free survival. Patients will be followed
up for 5 years. It is planned to treat up to 35 patients aged between 10 and 45 years.
Inclusion Criteria
Patient:
Ages 10-45 years.
Chronic myelogenous leukemia, any of these categories: accelerated phase or blast
transformation.
Acute lymphoblastic leukemia, any of these categories: Adults (greater than 18 years) in
any remission with high-risk features (presenting leukocyte count greater than 100,000/cu
mm, Karyotypes t9; 22, t4, t19, t11, biphenotypic leukemia). All second remissions,
primary induction failure including partial remission, partially responding or untreated
relapse.
Acute myelogenous leukemia (AML): All AML in second or subsequent remission, primary
induction failure or partial remission and resistant relapse.
Myelodysplastic syndromes, any of these categories: refractory anemia with excess of
blasts, transformation to acute leukemia, chronic myelomonocytic leukemia.
Myeloproliferative disorders undergoing transformation to terminal stages.
Chronic lymphocytic leukemia (CLL) in Richter transformation.
High-grade lymphoma, refractory to standard treatment approaches, mantle cell lymphoma.
No major organ dysfunction precluding transplantation.
DLCO greater than 65% predicted.
Left ventricular ejection fraction: greater than 40% predicted.
ECOG performance status of 0 or 1.
Informed consent given. Informed consent from parents for minors.
Women of childbearing age with a negative pregnancy test may participate.
Donor:
Partially HLA matched family donor (3-5/6 matches).
Fit to receive G-CSF and give peripheral blood stem cells (normal blood count,
normotensive, and no history of stroke).
Informed consent given.
Patients or donors must not be pregnant or nursing.
Must not have ECOG performance status of 2 or more.
No severe psychiatric illness in patient or donor: Mental deficiency sufficiently severe
as to make compliance with the BMT treatment unlikely and making informed consent
impossible.
No major anticipated illness or organ failure incompatible with survival from BMT.
DLCO must not be less than 65% predicted.
No left ventricular ejection fraction: less than 40% predicted.
Must not have serum creatinine greater than 3 mg/dl.
Must not have serum bilirubin greater than 4 mg/dl, Transaminases greater than 3 times the
upper limit of normal.
Donor or patient must not be HIV positive.
Must not have history of other malignancies except basal cell or squamous carcinoma of the
skin, positive PAP smear and subsequent negative follow up.
Donor must be fit to receive G-CSF and undergo apheresis.
Must not fail to mobilize adequate numbers of CD34+ cells after two cycles of G-CSF.
Type of Study:
Interventional
Study Design:
Endpoint Classification: Safety Study, Primary Purpose: Treatment
Authority:
United States: Federal Government
Study ID:
980122
NCT ID:
NCT00001748
Start Date:
June 1998
Completion Date:
May 2000
Related Keywords:
- Graft Vs Host Disease
- Hematologic Neoplasms
- Lymphoma
- Myelodysplastic Syndromes
- Myeloid Leukemia
- Cyclophosphamide
- Donor Apheresis
- Graft vs. Host Disease
- Graft-Versus-Leukemia
- Leukemic Relapse
- Myeloma
- Peripheral Blood Stem Cells
- Whole Body Irradiation
- Acute Lymphoblastic Leukemia (ALL)
- Chronic Lymphocytic Leukemia (CLL)
- Chronic Myelogenous Leukemia (CML)
- Hematological Malignancies
- Myelodysplastic Syndrome
- Myeloproliferative Disorders
- Neoplasms
- Graft vs Host Disease
- Leukemia
- Leukemia, Myeloid
- Lymphoma
- Myelodysplastic Syndromes
- Preleukemia
- Hematologic Neoplasms
Name | Location |
|---|---|
| National Heart, Lung and Blood Institute (NHLBI) | Bethesda, Maryland 20892 |
