Transplantation of Umbilical Cord Blood in Patients With Hematological Malignancies Using a Reduced-intensity Preparative Regimen
PRIMARY OBJECTIVES:
I. Estimate probability of one year survival.
II. Demonstrate equivalent or improved engraftment rates with a non-anti-thymocyte globulin
(ATG) based conditioning regimen. Patients will be considered graft failure/rejections
provided they meet any of the criteria listed below:
- Absence of 3 consecutive days with neutrophils >= 500/ul combined with host CD3
peripheral blood chimerism >= 50% at day 42
- Absence of 3 consecutive days with neutrophils >= 500/ul under any circumstances at day
55
- Death after day 28 with neutrophil count < 100/ul without any evidence of engraftment
(< 5% donor CD3)
- Primary autologous count recovery with < 5% donor CD3 peripheral blood chimerism at
count recovery and without relapse
SECONDARY OBJECTIVES:
I. Six month non-relapse mortality.
II. Overall incidence of graft failure/rejection. Patients will be considered graft
failure/rejections provided they meet any of the criteria listed below:
- Absence of 3 consecutive days with neutrophils >= 500/ul combined with host CD3
peripheral blood chimerism >= 50% at day 42
- Absence of 3 consecutive days with neutrophils >= 500/ul under any circumstances at day
55
- Death after day 28 with neutrophil count < 100/ul without any evidence of engraftment
(< 5% donor CD3)
- Primary autologous count recovery with < 5% donor CD3 peripheral blood chimerism at
count recovery and without relapse.
III. Kinetics of chimeric reconstitution.
IV. Incidence of neutrophil engraftment by day 42.
V. Incidence of platelet engraftment by six months.
VI. Incidence of grade II-IV and III-IV acute graft-versus-host disease (GvHD) for each arm
at day 100.
VII. Incidence of one year chronic GvHD for each arm.
VIII. Incidence of clinically significant infections at 6 months, 1 year, 2 years for each
arm.
IX. Probability of one and two year survival.
X. Incidence of one and two year relapse or disease progression.
XI. Fred Hutchinson Cancer Research Center (FHCRC) patients: Kinetics of immune
reconstitution, with both functional and quantitative assays.
XII. FHCRC patients: Examination of possible immunologic factors leading to emergence of a
dominant unit.
OUTLINE: Patients are assigned to 1 of 2 treatment arms.
ARM I:
CONDITIONING REGIMEN: Patients receive fludarabine phosphate intravenously (IV) on days -6
to -2 and cyclophosphamide IV on day -6. Patients undergo a lower dose of total-body
irradiation (TBI) on day -1.
UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo donor umbilical cord blood infusion on day
0.
IMMUNOSUPRESSIVE THERAPIES: Patients receive cyclosporine IV over 1 hour every 8-12 hours on
days -3 to +180 and mycophenolate mofetil IV or orally (PO) every 8 hours on days -3 to +96.
ARM II:
CONDITIONING REGIMEN: Patients receive fludarabine phosphate and cyclophosphamide as in Arm
I. Patients undergo a higher dose of TBI on day -1.
UMBILICAL CORD BLOOD TRANSPLANT: Patients undergo donor umbilical cord blood infusion as in
Arm I.
IMMUNOSUPRESSIVE THERAPIES: Patients receive cyclosporine and mycophenolate mofetil as in
Arm I.
After completion of study treatment, patients are followed periodically for up to 2 years.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Probability of overall survival
At 1 year
No
Colleen Delaney
Principal Investigator
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
United States: Institutional Review Board
2239.00
NCT00723099
June 2008
Name | Location |
---|---|
LDS Hospital | Salt Lake City, Utah 84143 |
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium | Seattle, Washington 98109 |
VA Puget Sound Health Care System | Seattle, Washington 98101 |
Froedtert and the Medical College of Wisconsin | Milwaukee, Wisconsin 53226 |
University of Colorado Cancer Center - Anschutz Cancer Pavilion | Aurora, Colorado 80045 |
Colorado Blood Cancer Institute | Denver, Colorado 80218 |