A Randomized Trial of Sirolimus-Based Graft Versus Host Disease Prophylaxis After Hematopoietic Stem Cell Transplantation in Relapsed Acute Lymphoblastic Leukemia
PRIMARY OBJECTIVES:
I. Compare the post-transplant 2-year event-free survival of pediatric patients with
intermediate-risk or high-risk acute lymphoblastic leukemia (ALL) in second complete
remission undergoing allogeneic hematopoietic stem cell transplantation treated with
graft-versus-host disease (GVHD) prophylaxis comprising tacrolimus and methotrexate with or
without sirolimus.
SECONDARY OBJECTIVES:
I. Compare rates of relapses, transplant-related mortality, and acute and chronic GVHD in
these patients.
II. Evaluate the relative contribution of resistance by ALL blasts to cytolytic therapy
(e.g., chemotherapy/irradiation) as a cause of relapse post-transplantation by correlating
ALL in vivo blast resistance with in vivo sirolimus, inhibition levels of the mTOR pathway
in patients treated with sirolimus, and altered resistance pathways in ALL blasts measured
by microarray analysis.
III. Evaluate the relative contribution of resistance by ALL blasts to the donor immune
response as a cause of relapse post-transplantation by correlating the development of donor
anti-ALL T-cell response, the development of acute and/or chronic GVHD, and the detection of
altered ALL blast immunogenicity after transplant with increased minimal residual disease,
persistent recipient chimerism, and relapse.
OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified
according to risk (intermediate CR2 vs high CR2 vs very high CR1), donor type (matched
sibling vs unrelated or mismatched vs mismatched related), and stem cell source (filgrastim
[G-CSF]-primed bone marrow vs unprimed bone marrow vs bone marrow vs peripheral blood vs
umbilical cord blood).
PREPARATIVE REGIMEN: Patients undergo total-body irradiation twice daily on days -8 to -6
and receive thiotepa IV on days -5 and -4 and cyclophosphamide IV on days -3 and -2.
ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: Patients undergo allogeneic
hematopoietic stem cell transplantation on day 0.
GRAFT-VERSUS-HOST DISEASE (GVHD) PROPHYLAXIS: Patients are randomized to 1 of 2 treatment
arms.
ARM I: (experimental) Patients receive tacrolimus IV continuously or orally (when able)
daily beginning on day -2 followed by a taper beginning on day 42 and continuing until day
98 (for patients undergoing matched sibling donor transplantation) OR tacrolimus IV
continuously or orally daily beginning on day -2 followed by a taper beginning on day 100
and continuing until day 180 (for patients undergoing related, unrelated, or cord blood
donor transplantation) in the absence of GVHD. Patients also receive methotrexate IV on days
1, 3, and 6 (for patients with matched sibling and umbilical cord blood donors) OR days 1,
3, 6, and 11 (for patients with unrelated bone marrow and peripheral blood stem cell donors)
and oral sirolimus daily beginning on day 0 followed by a taper beginning on day 180 and
continuing until day 207.
ARM II: (control) Patients receive tacrolimus and methotrexate as in arm I.
After completion of study treatment, patients are followed periodically for approximately 10
years.
Interventional
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Event-free survival after transplantation as measured by the O'Brien-Fleming spending function
Up to 2 years
No
Michael Pulsipher
Principal Investigator
Children's Oncology Group
United States: Institutional Review Board
ASCT0431
NCT00382109
March 2007
Name | Location |
---|---|
Johns Hopkins University | Baltimore, Maryland 21205 |
Cleveland Clinic Foundation | Cleveland, Ohio 44195 |
Roswell Park Cancer Institute | Buffalo, New York 14263 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
University of Iowa Hospitals and Clinics | Iowa City, Iowa 52242 |
Washington University School of Medicine | Saint Louis, Missouri 63110 |
Medical University of South Carolina | Charleston, South Carolina 29425-0721 |
Midwest Children's Cancer Center | Milwaukee, Wisconsin 53226 |
Vanderbilt-Ingram Cancer Center | Nashville, Tennessee 37232-6838 |
New York Medical College | Valhalla, New York 10595 |
Hackensack University Medical Center | Hackensack, New Jersey 07601 |
Children's National Medical Center | Washington, District of Columbia 20010-2970 |
All Children's Hospital | St. Petersburg, Florida 33701 |
Kosair Children's Hospital | Louisville, Kentucky 40202-3830 |
University of Wisconsin Hospital and Clinics | Madison, Wisconsin 53792-0001 |
Cincinnati Children's Hospital Medical Center | Cincinnati, Ohio 45229-3039 |
Methodist Children's Hospital of South Texas | San Antonio, Texas 78229-3993 |
Primary Children's Medical Center | Salt Lake City, Utah 84113-1100 |
Rady Children's Hospital - San Diego | San Diego, California 92123-4282 |
Nationwide Children's Hospital | Columbus, Ohio 43205-2696 |
Children's Hospital of Pittsburgh of UPMC | Pittsburgh, Pennsylvania 15213 |
Children's Hospital and Research Center at Oakland | Oakland, California 94609-1809 |
City of Hope Medical Center | Duarte, California 91010 |
University of North Carolina | Chapel Hill, North Carolina 27599 |
University of Rochester | Rochester, New York 14642 |
Wayne State University | Detroit, Michigan 48202 |
Indiana University Medical Center | Indianapolis, Indiana 46202 |
University of Texas Southwestern Medical Center | Dallas, Texas |
Oregon Health and Science University | Portland, Oregon 97201 |
Virginia Commonwealth University | Richmond, Virginia |
Seattle Children's Hospital | Seattle, Washington 98105 |
Childrens Memorial Hospital | Chicago, Illinois 60614 |
Columbia University Medical Center | New York, New York 10032 |
Cook Children's Medical Center | Fort Worth, Texas 76104 |
C S Mott Children's Hospital | Ann Arbor, Michigan 48109 |
Phoenix Childrens Hospital | Phoenix, Arizona 85016 |
Childrens Hospital of Orange County | Orange, California 92868-3874 |
Children's Healthcare of Atlanta - Egleston | Atlanta, Georgia 30322 |
The Childrens Mercy Hospital | Kansas City, Missouri 64108 |
Rainbow Babies and Childrens Hospital | Cleveland, Ohio 44106 |
Penn State Hershey Children's Hospital | Hershey, Pennsylvania 17033 |
Children's Hospital Colorado | Aurora, Colorado 80045 |
University of California San Francisco Medical Center-Parnassus | San Francisco, California 94143 |
Children's Hospital-Main Campus | New Orleans, Louisiana 70118 |