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Sequential Autologous HCT / Nonmyeloablative Allogeneic HCT Using Related, HLA-Haploidentical Donors for Patients With High-Risk Lymphoma, Multiple Myeloma, or Chronic Lymphocytic Leukemia


Phase 2
N/A
75 Years
Open (Enrolling)
Both
Adult Nasal Type Extranodal NK/T-cell Lymphoma, Anaplastic Large Cell Lymphoma, Angioimmunoblastic T-cell Lymphoma, B-cell Chronic Lymphocytic Leukemia, Childhood Burkitt Lymphoma, Childhood Diffuse Large Cell Lymphoma, Childhood Immunoblastic Large Cell Lymphoma, Childhood Nasal Type Extranodal NK/T-cell Lymphoma, Cutaneous B-cell Non-Hodgkin Lymphoma, Peripheral T-cell Lymphoma, Recurrent Adult Burkitt Lymphoma, Recurrent Adult Diffuse Large Cell Lymphoma, Recurrent Adult Diffuse Mixed Cell Lymphoma, Recurrent Adult Diffuse Small Cleaved Cell Lymphoma, Recurrent Adult Grade III Lymphomatoid Granulomatosis, Recurrent Adult Hodgkin Lymphoma, Recurrent Adult Immunoblastic Large Cell Lymphoma, Recurrent Adult Lymphoblastic Lymphoma, Recurrent Childhood Anaplastic Large Cell Lymphoma, Recurrent Childhood Grade III Lymphomatoid Granulomatosis, Recurrent Childhood Large Cell Lymphoma, Recurrent Childhood Lymphoblastic Lymphoma, Recurrent Childhood Small Noncleaved Cell Lymphoma, Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma, Recurrent Grade 1 Follicular Lymphoma, Recurrent Grade 2 Follicular Lymphoma, Recurrent Grade 3 Follicular Lymphoma, Recurrent Mantle Cell Lymphoma, Recurrent Marginal Zone Lymphoma, Recurrent Mycosis Fungoides/Sezary Syndrome, Recurrent Small Lymphocytic Lymphoma, Recurrent/Refractory Childhood Hodgkin Lymphoma, Refractory Chronic Lymphocytic Leukemia, Refractory Multiple Myeloma, Splenic Marginal Zone Lymphoma, Waldenström Macroglobulinemia

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Trial Information

Sequential Autologous HCT / Nonmyeloablative Allogeneic HCT Using Related, HLA-Haploidentical Donors for Patients With High-Risk Lymphoma, Multiple Myeloma, or Chronic Lymphocytic Leukemia


PRIMARY OBJECTIVES:

I. Event-free survival (EFS) at 1-year after autograft.

SECONDARY OBJECTIVES:

I. Relapse rates at 1-year after autograft.

II. Overall survival (OS) at 1-year after autograft.

III. Incidence of grades II-IV acute GVHD and chronic extensive GVHD.

IV. Non-relapse mortality (NRM) at 200 days and 1 year after allograft.

V. Donor engraftment at day +84.

VI. Incidence of infections.

OUTLINE:

CONDITIONING REGIMEN 1 (lymphoma, Waldenstrom Macroglobulinemia, or chronic lymphocytic
leukemia [CLL] with no dose limiting radiation or significant comorbidities: Patients
receive cyclophosphamide intravenously (IV) on days -6 and -5. Patients undergo high-dose
TBI twice daily (BID) on days -3 to -1.

CONDITIONING REGIMEN 2 (lymphoma, Waldenstrom Macroglobulinemia, CLL, with prior
dose-limiting radiation, or significant comorbidities): Patients receive carmustine IV on
day -7, etoposide IV BID on days -6 to -3, cytarabine IV BID on days -6 to -3, and melphalan
IV on day -2.

CONDITIONING REGIMEN 3 (multiple myeloma or plasma cell leukemia, with no significant renal
insufficiency or other significant comorbidities): Patients receive high-dose melphalan IV
on day -2.

CONDITIONING REGIMEN 4 (multiple myeloma or plasma cell leukemia, with significant renal
insufficiency or other significant comorbidities): Patients receive lessened dose of
melphalan IV on day -2.

PBSC TRANSPLANTATION: All patients undergo autologous PBSC transplantation on day 0.

WAITING INTERVAL: Between 40 and 120 days.

NONMYELOABLATIVE CONDITIONING REGIMEN: Patients receive fludarabine phosphate IV once daily
(QD) on days -6 to -2 and cyclophosphamide IV QD on days -6 to -5 and day 3. Patients
infused with donor's peripheral blood stem cells will additionally receive cyclophosphamide
IV on day 4. Patients undergo low-dose TBI on day -1.

ALLOGENEIC BONE MARROW TRANSPLANTATION: Patients undergo donor bone marrow transplantation
on day 0.

- GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS: Beginning on day 4, patients receive tacrolimus
orally (PO) or IV and taper beginning on day 86 if no graft-versus-host disease.
Patients also receive mycophenolate mofetil PO thrice daily (TID) on days 4 - 35.

- PERIPHERAL BLOOD COUNT SUPPORT: Patients receive filgrastim (G-CSF) IV or
subcutaneously (SC) beginning from day 4 and continue till blood counts recover.

ALLOGENEIC PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMC) TRANSPLANTATION: Patients undergo donor
PBMC transplantation on day 0.

- GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS: Beginning on day 5, patients receive tacrolimus
orally (PO) or IV and taper beginning on day 86 if no graft-versus-host disease.
Patients also receive mycophenolate mofetil PO thrice daily (TID) on days 5 - 35.

- PERIPHERAL BLOOD COUNT SUPPORT: Patients receive filgrastim (G-CSF) IV or
subcutaneously (SC) beginning from day 5 and continue till blood counts recover.

After completion of study treatment, patients are followed periodically for 5 years.


Inclusion Criteria:



- Must have the capacity to give informed consent

- Detectable tumor prior to mobilization regimen

- Patients for whom human leukocyte antigens (HLA)-matched unrelated donor search could
not be initiated or completed due to insurance reasons, concerns of rapidly
progressive disease, and/or discretion of attending physician are eligible for this
protocol

- Patients with stored autologous stem cells will be allowed

- Stem cells from an identical donor could be used for autologous hematopoietic cell
transplant (HCT)

- Marrow is the preferred source of stem cells from the HLA-haploidentical donor,
however, peripheral blood mononuclear cells (PBMC) could be used as stem cell source,
after clearance with the Fred Hutchinson Cancer Research Center (FHCRC) principal
investigator (PI), in the case of difficulties or contraindications to bone marrow
harvest from the donor

- Cross-over to other tandem autologous-allogeneic research protocol (#1409) will be
allowed if a suitable HLA-matched related or unrelated donor is identified before
receiving the allogeneic transplantation and if the patient meets the eligibility
criteria of the subsequent study

- Cross-over from other tandem autologous-allogeneic research protocol (#1409) will be
allowed if the patient loses the suitable HLA-matched related or unrelated donor but
has an available HLA-haploidentical donor before receiving the allogeneic
transplantation and if the patient meets the eligibility criteria of the subsequent
study

- Lymphoma: Patients with

- Diagnosis of non-Hodgkin lymphoma (NHL) or Hodgkin's lymphoma (HL), of any
histological grade,

- Refractory or relapsed disease after standard chemotherapy,

- High risk of early relapse following autograft alone

- Waldenstrom's Macroglobulinemia: must have failed 2 courses of therapy

- CLL:

- Patients with either a:

- Diagnosis of T-cell CLL or T-cell prolymphocytic leukemia (PLL) who have
failed initial chemotherapy, patients with T cell CLL or PLL or

- Diagnosis of B-cell CLL, B-cell small lymphocytic lymphoma, or B-cell CLL
that progressed to PLL who either:

1. Failed to meet National Cancer Institute (NCI) Working Group criteria
for complete or partial response after therapy with a regimen
containing fludarabine (or another nucleoside analog, e.g.
2-chlorodeoxyadenosine [CDA], pentostatin) or experience disease
relapse within 12 months after completing therapy with a regimen
containing fludarabine (or another nucleoside analog)

2. Failed any aggressive chemotherapy regimen, such as fludarabine,
cyclophosphamide and rituximab (FCR), at any time point

3. Have "17p deletion" cytogenetic abnormality and relapsed at any time
point after initial chemotherapy

- Harvesting criteria for autologous HCT:

- Previously collected PBMC may be used

- Circulating CLL cells < 5000

- Marrow involvement with CLL cells < 50%

- Multiple myeloma (MM): Patients who

- Have received induction therapy for a minimum of 4 cycles

- In addition, patients must meet at least one of the following criteria I-IX
(I-VII at time of diagnosis or pre-autograft):

- Any abnormal karyotype by metaphase analysis except for isolated t(11,14),

- Fluorescent in situ hybridization (FISH) translocation 4:14,

- FISH translocation 14:16,

- FISH deletion 17p,

- Beta2-microglobulin > 5.5 mg/ml,

- Cytogenetic hypodiploidy

- Plasmablastic morphology (>= 2%),

- Recurrent or non-responsive (less than partial remission [PR]) MM after at
least two different lines of conventional chemotherapy,

- Progressive MM after a previous autograft (provided stored autologous CD34
cells are available)

- Plasma cell leukemia: after induction chemotherapy

- DONOR: Related donors who are genotypically identical for one HLA haplotype and who
may be mismatched at the HLA-A, -B, -C or DRB1 loci of the unshared haplotype with
the exception of single HLA-A, -B or -C allele mismatches

- DONOR: Marrow is the preferred source of stem cells from the HLA-haploidentical
donor, however PBMC could be used as stem cell source, after clearance with the FHCRC
principal investigator, in the case of difficulties or contraindications to bone
marrow harvest from the donor

- DONOR: In the case that PBMC will be used as stem cell source, ability of donors < 18
years of age to undergo apheresis without use of a vascular access device; vein check
must be performed and verified by an apheresis nurse prior to arrival at the Seattle
Cancer Care Alliance (SCCA)

- DONOR: Age >= 12 years of age

Exclusion Criteria:

- Life expectancy severely limited by disease other than malignancy

- Seropositive for the human immunodeficiency virus (HIV)

- Female patients who are pregnant or breastfeeding

- Fertile men or women unwilling to use contraceptive techniques during and for 12
months following treatment

- Patients with available HLA matched related donors

- Central nervous system (CNS) involvement with disease refractory to intrathecal
chemotherapy

- Patients with active non-hematological malignancies (except non-melanoma skin
cancers) or those with non-hematological malignancies (except non-melanoma skin
cancers) who have been rendered with no evidence of disease, but have a greater than
20% chance of having disease recurrence within 5 years

- This exclusion does not apply to patients with non-hematologic malignancies that do
not require therapy

- Patients with fungal infection and radiological progression after receipt of
amphotericin B or active triazole for greater than 1 month

- Symptomatic coronary artery disease or ejection fraction < 40% or other cardiac
failure requiring therapy (or, if unable to obtain ejection fraction, shortening
fraction of < 26%); ejection fraction is required if the patient has a history of
anthracyclines or history of cardiac disease; patients with a shortening fraction <
26% may be enrolled if approved by a cardiologist

- Corrected diffusion capacity of carbon monoxide (DLCO) < 50% of predicted, forced
expiratory volume in one second (FEV1) < 50% of predicted, and/or receiving
supplementary continuous oxygen; the FHCRC PI of the study must approve of enrollment
of all patients with pulmonary nodules

- Patient with clinical or laboratory evidence of liver disease will be evaluated for
the cause of liver disease, its clinical severity in terms of liver function,
bridging fibrosis, and the degree of portal hypertension; the patient will be
excluded if he/she is found to have fulminant liver failure, cirrhosis of the liver
with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a
history of bleeding esophageal varices, hepatic encephalopathy; the patient will be
excluded if he/she is found to have uncorrectable hepatic synthetic dysfunction
evinced by prolongation of the prothrombin time, ascites related to portal
hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral
hepatitis with total serum bilirubin > 3mg/dL, and symptomatic biliary disease

- Karnofsky score < 50% for adult patients

- Lansky Play-Performance score < 40 for pediatric patients

- Patient with poorly controlled hypertension despite multiple antihypertensives

- DONOR: Donor-recipient pairs in which the HLA-mismatch is only in the
host-versus-graft (HVG) direction

- DONOR: Infection with HIV

- DONOR: Weight < 20 kg

- DONOR: A positive anti-donor cytotoxic crossmatch

Type of Study:

Interventional

Study Design:

Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Progression-free survival (PFS)

Outcome Description:

An observed 1-year PFS of >= 50% would be considered efficacious and worthy of further study.

Outcome Time Frame:

Calculated for all patients from the date of autologous transplant until the time of death, assessed up to 1 year

Safety Issue:

No

Principal Investigator

Mohamed Sorror

Investigator Role:

Principal Investigator

Investigator Affiliation:

Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium

Authority:

United States: Institutional Review Board

Study ID:

2241.00

NCT ID:

NCT01008462

Start Date:

March 2010

Completion Date:

Related Keywords:

  • Adult Nasal Type Extranodal NK/T-cell Lymphoma
  • Anaplastic Large Cell Lymphoma
  • Angioimmunoblastic T-cell Lymphoma
  • B-cell Chronic Lymphocytic Leukemia
  • Childhood Burkitt Lymphoma
  • Childhood Diffuse Large Cell Lymphoma
  • Childhood Immunoblastic Large Cell Lymphoma
  • Childhood Nasal Type Extranodal NK/T-cell Lymphoma
  • Cutaneous B-cell Non-Hodgkin Lymphoma
  • Peripheral T-cell Lymphoma
  • Recurrent Adult Burkitt Lymphoma
  • Recurrent Adult Diffuse Large Cell Lymphoma
  • Recurrent Adult Diffuse Mixed Cell Lymphoma
  • Recurrent Adult Diffuse Small Cleaved Cell Lymphoma
  • Recurrent Adult Grade III Lymphomatoid Granulomatosis
  • Recurrent Adult Hodgkin Lymphoma
  • Recurrent Adult Immunoblastic Large Cell Lymphoma
  • Recurrent Adult Lymphoblastic Lymphoma
  • Recurrent Childhood Anaplastic Large Cell Lymphoma
  • Recurrent Childhood Grade III Lymphomatoid Granulomatosis
  • Recurrent Childhood Large Cell Lymphoma
  • Recurrent Childhood Lymphoblastic Lymphoma
  • Recurrent Childhood Small Noncleaved Cell Lymphoma
  • Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma
  • Recurrent Grade 1 Follicular Lymphoma
  • Recurrent Grade 2 Follicular Lymphoma
  • Recurrent Grade 3 Follicular Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Recurrent Marginal Zone Lymphoma
  • Recurrent Mycosis Fungoides/Sezary Syndrome
  • Recurrent Small Lymphocytic Lymphoma
  • Recurrent/Refractory Childhood Hodgkin Lymphoma
  • Refractory Chronic Lymphocytic Leukemia
  • Refractory Multiple Myeloma
  • Splenic Marginal Zone Lymphoma
  • Waldenström Macroglobulinemia
  • Burkitt Lymphoma
  • Hodgkin Disease
  • Immunoblastic Lymphadenopathy
  • Leukemia
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Leukemia, Lymphoid
  • Lymphoma
  • Lymphoma, Follicular
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Lymphomatoid Granulomatosis
  • Waldenstrom Macroglobulinemia
  • Multiple Myeloma
  • Neoplasms, Plasma Cell
  • Mycoses
  • Mycosis Fungoides
  • Sezary Syndrome
  • Lymphoma, B-Cell
  • Lymphoma, Large-Cell, Immunoblastic
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Lymphoma, T-Cell
  • Lymphoma, T-Cell, Cutaneous
  • Lymphoma, T-Cell, Peripheral
  • Lymphoma, Large-Cell, Anaplastic
  • Lymphoma, B-Cell, Marginal Zone
  • Lymphoma, Extranodal NK-T-Cell
  • Lymphoma, Mantle-Cell

Name

Location

Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Seattle, Washington  98109
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226