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Peripheral Blood Stem Cell Transplantation in Patients With Advanced Malignancies Eligible for Allogeneic Transplantation From Matched Related Donors: A Randomized Study of Cyclosporine/Methotrexate or Cyclosporine/T-Cell Depletion (CD34 Cell Selection) for GVHD Prophylaxis


Phase 3
18 Years
55 Years
Not Enrolling
Both
Graft Versus Host Disease, Leukemia, Lymphoma

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Trial Information

Peripheral Blood Stem Cell Transplantation in Patients With Advanced Malignancies Eligible for Allogeneic Transplantation From Matched Related Donors: A Randomized Study of Cyclosporine/Methotrexate or Cyclosporine/T-Cell Depletion (CD34 Cell Selection) for GVHD Prophylaxis


OBJECTIVES: I. Demonstrate that the graft versus host disease (GVHD) prophylactic regimen
consisting of T-cell depletion and cyclosporine results in less toxicity than the control
regimen of methotrexate and cyclosporine in recipients of peripheral blood stem cell
transplants. II. Monitor safety of the two regimens in order to assure that the treatment
regimen dose not result in any increase in serious or unexpected toxicities, does not
compromise the efficacy of GVHD prophylaxis, and does not compromise the efficacy of the
disease therapy.

OUTLINE: This is a multicenter, controlled, randomized trial. Patients are assigned to high
or low risk groups and randomized to the control or treatment arms. Patients are stratified
by risk group and by site. Mobilization, apheresis, and successful cryopreservation of the
minimum number of CD34 cells for transplant has to be achieved prior to initiating
cytoreductive therapy. Following intensive cytoreductive therapy, patients receive either
unselected peripheral blood stem cells (PBSC) together with the control graft versus host
disease (GVHD) prophylaxis regimen or CD34+ cells isolated from PBSC with cyclosporine. In
the control group, GVHD prophylaxis consists of two drug therapies, cyclosporine and
methotrexate. The cyclosporine is administered first by IV continuous infusion and then
later orally, twice a day, in decreasing increments for 180 days. Methotrexate is
administered by IV on days 1, 3, 6, and 11. Cyclosporine is discontinued after day +180 if
there is no evidence of GVHD. In the treatment group, GVHD prophylaxis consists of T cell
depletion of the transplant product using the Isolex positive selection procedure (Isolex
selected CD34+ cells) and cyclosporine. The cyclosporine is administered at the same doses
and increments as in the control group. In cases where there still is acute or chronic GVHD,
the patient is given the appropriate salvage regimens. Patients are followed monthly for 6
months after transplant, and then for 2 years to monitor relapses.

PROJECTED ACCRUAL: There will be 200 patients accrued (100 in each arm) in this study.

Inclusion Criteria


DISEASE CHARACTERISTICS: - Acute lymphocytic leukemia (ALL) with documented
chemosensitivity (complete response [CR], partial response [PR], or minor response [MR])
in first or second remission, first or second relapse, or high risk ALL with Ph positive
9/22 translocation; OR - Acute myelogenous leukemia (AML) with documented chemosensitivity
(CR, PR, or MR) in first or second remission, or first or second relapse; OR - Chronic
myelogenous leukemia (CML), chronic or accelerated, that is not in blast crisis; OR -
Hodgkin's disease or non-Hodgkin's lymphoma with documented chemosensitivity in first or
second relapse Consenting human lymphocyte antigen (HLA)-identical related donor required
No active central nervous system (CNS) or skin leukemia involvement No disease that
requires additional mediastinal radiation

PATIENT CHARACTERISTICS: Age: 18-55 Performance status: Karnofsky 70-100% Life expectancy:
Greater than 8 weeks Hematopoietic: Not specified Hepatic: Bilirubin less than 1.5 times
normal serum glutamate oxalo-acetate transaminase (SGOT) less than 2 times normal Renal:
Creatinine less than 1.5 times normal Cardiovascular: Left ventricular ejection fraction
at rest at least 40% or within normal range Pulmonary: diffusing capacity of the lung for
carbon monoxide (DLCO) greater than 45% of predicted or within normal range Other: HIV
negative At least 2 weeks since any active infection requiring intravenous treatment with
antifungal, antibacterial or antiviral agents with the exception of coagulase negative
staphylococcal line infection No coexisting medical problems that would significantly
increase the risk of the transplant procedure Not pregnant or nursing

PRIOR CONCURRENT THERAPY: No more that 2 prior therapy regimens Biologic therapy: No prior
autologous or allogeneic bone marrow or peripheral blood stem cell transplant
Chemotherapy: Not specified Endocrine therapy: Not specified Radiotherapy: Prior radiation
therapy subject to dose requirements Surgery: Not specified Other: At least 2 weeks since
intravenous treatment with antifungal, antibacterial or antiviral agents, except for
treatment of coagulase negative staphylococcal infection of an IV or central line

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Primary Purpose: Supportive Care

Principal Investigator

John M. McCarty, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Massey Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

BAXTER-302302

NCT ID:

NCT00003056

Start Date:

April 1997

Completion Date:

June 2003

Related Keywords:

  • Graft Versus Host Disease
  • Leukemia
  • Lymphoma
  • recurrent adult Hodgkin lymphoma
  • recurrent adult acute myeloid leukemia
  • recurrent adult acute lymphoblastic leukemia
  • chronic phase chronic myelogenous leukemia
  • accelerated phase chronic myelogenous leukemia
  • adult acute myeloid leukemia in remission
  • adult acute lymphoblastic leukemia in remission
  • 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
  • graft versus host disease
  • recurrent mantle cell lymphoma
  • 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
  • Graft vs Host Disease
  • Leukemia
  • Lymphoma

Name

Location

Alexandria, Minnesota  56308
Albany, Georgia  31701
Fountain Valley, California  92708
Miami, Florida  33176
Columbia, Missouri  65203
Philadelphia, Pennsylvania  19104
Austin, Texas  78705
McLean, Virginia  22101
Kansas City, Kansas  66160
Hackensack, New Jersey  07601
Indianapolis, Indiana