Busulfan, Melphalan, Fludarabine and T-Cell Depleted Allogeneic Hematopoietic Stem Cell Transplantation Followed by Post Transplantation Donor Lymphocyte Infusions
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Blood Cancer, Hematology |
| Therapuetic Areas: | Hematology, Oncology |
| Healthy: | No |
| Age Range: | 21 - 72 |
| Updated: | 6/2/2018 |
| Start Date: | May 2010 |
| End Date: | May 2019 |
A Trial of Busulfan, Melphalan, Fludarabine and T-Cell Depleted Allogeneic Hematopoietic Stem Cell Transplantation Followed by Post Transplantation Donor Lymphocyte Infusions for Patients With Relapsed or High-Risk Multiple Myeloma
The patients are being offered a stem cell transplant. Stem cells are very early blood cells.
They have not yet matured to become red or white blood cells or platelets. They have already
received the standard treatment of chemotherapy and an autologous stem cell transplant. An
autologous stem cell transplant is when the patient receives their infusion of their own
cells. Thi will give the patient a better chance of curing the disease, this protocol
includes an infusion of stem cells from the blood (or the bone marrow) of another person.
This is called an allogeneic stem cell transplant. The stem cells will begin to grow in the
bone marrow and produce new blood cells.
Allogeneic stem cell transplants can cause a condition called graft-versus-host disease or
GVHD. In GVHD, a kind of white blood cell from the donor (graft) begins to attack the body
(host). That blood cell is called a T-cell. It is a cell that normally helps to protects
against things like bacteria and viruses. In this case, the donor's T-cells see the body as
foreign in the same way they would see bacteria as foreign. GVHD can be fatal. In order to
lower the chance that the patient will get GVHD this protocol treatment will remove the
T-cells from the donor's cells. This is called T-cell depletion. The T cells are removed by a
system called "Clinimacs". This method is still being evaluated through clinical trials and
not been approved by the Federal Drug Administration (FDA) at this time.
Before the transplant, the physician will treat the bone marrow to get rid of the cancer. The
physician uses three chemotherapy drugs plus ATG. The chemotherapy drugs (Busulfan, Melphalan
and Fludarabine) kills the cancer. ATG gets rid of any of the patients T cells that survive
the chemotherapy. This ensures that the donor stem cells are not rejected. The patient will
also receive additional white blood cells called lymphocytes from the donor. This is called a
donor lymphocyte infusion or DLI. These additional infusions will help cause a
graft-versus-myeloma effect and can help the donor stem cells grow.
They have not yet matured to become red or white blood cells or platelets. They have already
received the standard treatment of chemotherapy and an autologous stem cell transplant. An
autologous stem cell transplant is when the patient receives their infusion of their own
cells. Thi will give the patient a better chance of curing the disease, this protocol
includes an infusion of stem cells from the blood (or the bone marrow) of another person.
This is called an allogeneic stem cell transplant. The stem cells will begin to grow in the
bone marrow and produce new blood cells.
Allogeneic stem cell transplants can cause a condition called graft-versus-host disease or
GVHD. In GVHD, a kind of white blood cell from the donor (graft) begins to attack the body
(host). That blood cell is called a T-cell. It is a cell that normally helps to protects
against things like bacteria and viruses. In this case, the donor's T-cells see the body as
foreign in the same way they would see bacteria as foreign. GVHD can be fatal. In order to
lower the chance that the patient will get GVHD this protocol treatment will remove the
T-cells from the donor's cells. This is called T-cell depletion. The T cells are removed by a
system called "Clinimacs". This method is still being evaluated through clinical trials and
not been approved by the Federal Drug Administration (FDA) at this time.
Before the transplant, the physician will treat the bone marrow to get rid of the cancer. The
physician uses three chemotherapy drugs plus ATG. The chemotherapy drugs (Busulfan, Melphalan
and Fludarabine) kills the cancer. ATG gets rid of any of the patients T cells that survive
the chemotherapy. This ensures that the donor stem cells are not rejected. The patient will
also receive additional white blood cells called lymphocytes from the donor. This is called a
donor lymphocyte infusion or DLI. These additional infusions will help cause a
graft-versus-myeloma effect and can help the donor stem cells grow.
Inclusion Criteria:
- Patient must have multiple myeloma that has either relapsed or has high risk
cytogenetics.
- Patients with relapsed multiple myeloma following autologous stem cell transplantation
must have achieved at least partial response following additional chemotherapy (cohort
1):
- Patients are eligible if relapse occurs with complex/high-risk cytogenetics or occurs
with normal cytogenetics but within 15 months following the autologous transplant.
- Patients with high risk cytogenetics at diagnosis must have achieved at least very
good partial response following autologous stem cell transplantation (cohort 2):
- Patients must have complex karyotype, 1q25, del17p, t4;14 and/or t14;16 by FISH
and/or del13 by karyotyping.
DONOR: Patients must have a healthy HLA matched or mismatched related or unrelated donor
who is willing to receive G-CSF injections and undergo apheresis for PBSC collection, or
undergo a marrow harvesting procedure.
1. HLA-matched related and unrelated donors Patients who have an HLA-matched related or
unrelated donor are eligible for entry on this protocol. This will include a healthy
donor who is genotypically matched at all A, B, C, DRB1 and DQB1 locus, loci, as
tested by DNA analysis.
2. HLA- mismatched related and unrelated donors Patients who do not have an HLA-matched
donor but have a related or unrelated donor who have one antigen or one allele
mismatch at the HLA A, B, C, DRB1 or DQB1 loci; or who have two mismatches, at
HLA-DQB1 and at one other locus, will be eligible for entry on this protocol.
The following inclusion criteria are also required:
- Patients should be ≥ 21, < 73 years old.
- Patients may be of either gender or any ethnic background.
- Patients must have a Karnofsky (adult) or Performance Status ≥ 70%
- Patients must have adequate organ function measured by:
Cardiac: asymptomatic or if symptomatic then LVEF at rest must be ≥ 50% and must improve
with exercise. Hepatic: < 3x ULN ALT and ≤ 1.5 total serum bilirubin, unless there is
congenital benign hyperbilirubinemia.
Renal: serum creatinine <1.2 mg/dl or if serum creatinine is outside the normal range, then
CrCl > 40 ml/min (measured or calculated/estimated) with dose adjustment of Fludarabine for
<70ml/min.
Pulmonary: asymptomatic or if symptomatic, DLCO > 50% of predicted (corrected for
hemoglobin)
- Each patient must be willing to participate as a research subject and must sign an
informed consent form.
Exclusion Criteria:
- Patients achieving < Partial Response following preceding chemotherapy (cohort 1) or <
Very Good Partial Response following autologous stem cell transplantation (cohort 2).
- Patients with Plasma Cell Leukemia.
- Female patients who are pregnant or breast-feeding
- Active viral, bacterial or fungal infection
- Patient seropositive for HIV-I/II; HTLV -I/II
- Patients who have undergone prior allogeneic hematopoietic stem cell transplantation.
- Patients who have had a previous malignancy that is not in remission.
- Patients with known hypersensitivity to mouse proteins (murine antibodies in ISOLEX)
if receiving SBA-E- bone marrow, or chicken egg products.
We found this trial at
1
site
1275 York Ave
New York, New York 10021
New York, New York 10021
(212) 639-2000
Phone: 212-639-8599
Memorial Sloan Kettering Cancer Center Memorial Sloan Kettering Cancer Center — the world's oldest and...
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