Randomized Study: Standard of Care With or Without Atorvastatin for Prevention of GVHD for Matched Unrelated Donor BMT
| Status: | Recruiting |
|---|---|
| Conditions: | Cancer, Blood Cancer, Blood Cancer, Blood Cancer, Blood Cancer, Hematology, Hematology |
| Therapuetic Areas: | Hematology, Oncology |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 3/13/2019 |
| Start Date: | December 10, 2019 |
| End Date: | February 28, 2021 |
| Contact: | Patrick Stiff, MD |
| Email: | pstiff@lumc.edu |
| Phone: | 708-327-3148 |
Randomized Study of Atorvastatin Prophylaxis as a Supplement to Standard of Care Prophylaxis to Prevent Chronic Graft Versus Host Disease Allogeneic Stem Cell Transplantation From Matched Unrelated Donors
Chronic Graft Versus Host Disease (GVHD) is one of the most challenging complications in long
term survivors of allogeneic stem cell transplantation. As the number of allogeneic stem cell
transplantations rises annually, the incidence of chronic GVHD rates have also increased due
to a variety of factors including but not limited to increasing use of peripheral blood stem
cell (PBSC) grafts, increasing age of both donors and recipients, and increased use of
matched unrelated donors. One study showed much lower than traditional acute GHVD rate and
chronic GHVD which is similar with historical rates when atorvastatin was administered
prophylactically to both the donors as well as recipients of matched related allogeneic stem
cell transplantation, lead to the interest in further examining the role of Atorvastatin in
relation to the development of GVHD. The investigator hypothesize that the administration of
atorvastatin in recipients of matched unrelated allogeneic stem cell transplantation, a group
with known higher incidence of chronic GHVD, would be a safe and effective method to reduce
the incidence of chronic GVHD. Matched related allogeneic stem cell transplantation
recipients will not be included in this study due to their significantly lower GVHD rates.
The definition and monitoring of our primary endpoint of GVHD is well established in clinical
trials in allogeneic stem cell transplantations and the investiagor will utilize the National
Institutes of Health (NIH) Staging System for the diagnosis and severity assessment of
chronic GVHD as well the recommendations from the NIH Consensus Conference for the conduct of
clinical trials in chronic GVHD.
Several secondary endpoints will be examined as defined below and include standard
complementary data in the examination of clinical trials in chronic GVHD again as laid out by
the NIH Consensus Conference for conduct of clinical trials in chronic GHVD.
term survivors of allogeneic stem cell transplantation. As the number of allogeneic stem cell
transplantations rises annually, the incidence of chronic GVHD rates have also increased due
to a variety of factors including but not limited to increasing use of peripheral blood stem
cell (PBSC) grafts, increasing age of both donors and recipients, and increased use of
matched unrelated donors. One study showed much lower than traditional acute GHVD rate and
chronic GHVD which is similar with historical rates when atorvastatin was administered
prophylactically to both the donors as well as recipients of matched related allogeneic stem
cell transplantation, lead to the interest in further examining the role of Atorvastatin in
relation to the development of GVHD. The investigator hypothesize that the administration of
atorvastatin in recipients of matched unrelated allogeneic stem cell transplantation, a group
with known higher incidence of chronic GHVD, would be a safe and effective method to reduce
the incidence of chronic GVHD. Matched related allogeneic stem cell transplantation
recipients will not be included in this study due to their significantly lower GVHD rates.
The definition and monitoring of our primary endpoint of GVHD is well established in clinical
trials in allogeneic stem cell transplantations and the investiagor will utilize the National
Institutes of Health (NIH) Staging System for the diagnosis and severity assessment of
chronic GVHD as well the recommendations from the NIH Consensus Conference for the conduct of
clinical trials in chronic GVHD.
Several secondary endpoints will be examined as defined below and include standard
complementary data in the examination of clinical trials in chronic GVHD again as laid out by
the NIH Consensus Conference for conduct of clinical trials in chronic GHVD.
This is a randomized, open label phase III trial in patients with Acute Myeloid Leukemia,
Acute Lymphocytic Leukemia, and Myelodysplastic Syndrome undergoing matched unrelated donor
transplant.
Patients randomized to the treatment arm (atorvastatin):
The prophylaxis atorvastatin treatment (taken by mouth) for GVHD will start at 14 days prior
to transplant and continue until 365 days post-transplant or until development of significant
adverse events or desire of the primary treating physician to stop the administration.
The patients will also receive our institution's standard graft versus host disease
prophylactic regimen which consists of two drugs. It has been shown that immunosuppression
with two drugs is better than a single agent thus our institution utilizes a combination of
Methotrexate and Tacrolimus. For all matched unrelated donor allogeneic transplantation
patients, the following schedule of Methotrexate will be administered intravenously (IV)
post-transplant on Days 1, 3 and 6. Tacrolimus will be administered 2 days prior to
transplant and continue approximately 180 days post-transplant. Tacrolimus will be
administered IV until patient can take it by mouth.
Patients randomized to standard of care:
Patients will receive our institution's standard graft versus host disease prophylactic
regimen which consists of two drugs. It has been shown that immunosuppression with two drugs
is better than a single agent thus our institution utilizes a combination of Methotrexate and
Tacrolimus. For all matched unrelated donor allogeneic transplantation patients, the
following schedule of Methotrexate will be administered intravenously (IV) post-transplant on
Days 1, 3 and 6. Tacrolimus will be administered 2 days prior to transplant and continue
approximately 180 days post-transplant. Tacrolimus will be administered IV until patient can
take it by mouth.
Acute Lymphocytic Leukemia, and Myelodysplastic Syndrome undergoing matched unrelated donor
transplant.
Patients randomized to the treatment arm (atorvastatin):
The prophylaxis atorvastatin treatment (taken by mouth) for GVHD will start at 14 days prior
to transplant and continue until 365 days post-transplant or until development of significant
adverse events or desire of the primary treating physician to stop the administration.
The patients will also receive our institution's standard graft versus host disease
prophylactic regimen which consists of two drugs. It has been shown that immunosuppression
with two drugs is better than a single agent thus our institution utilizes a combination of
Methotrexate and Tacrolimus. For all matched unrelated donor allogeneic transplantation
patients, the following schedule of Methotrexate will be administered intravenously (IV)
post-transplant on Days 1, 3 and 6. Tacrolimus will be administered 2 days prior to
transplant and continue approximately 180 days post-transplant. Tacrolimus will be
administered IV until patient can take it by mouth.
Patients randomized to standard of care:
Patients will receive our institution's standard graft versus host disease prophylactic
regimen which consists of two drugs. It has been shown that immunosuppression with two drugs
is better than a single agent thus our institution utilizes a combination of Methotrexate and
Tacrolimus. For all matched unrelated donor allogeneic transplantation patients, the
following schedule of Methotrexate will be administered intravenously (IV) post-transplant on
Days 1, 3 and 6. Tacrolimus will be administered 2 days prior to transplant and continue
approximately 180 days post-transplant. Tacrolimus will be administered IV until patient can
take it by mouth.
Inclusion Criteria
- Men or women between 18-65 years of age
- Patients designated to undergo allogeneic peripheral blood or bone marrow stem cell
transplantation from matched unrelated donor following the diagnosis of one of the
following primary diseases in early or intermediate disease status:
- AML at the following stages at time of screening: 1st remission, 2nd remission,
and 3rd or subsequent remission
- ALL at the following stages at time of screening: 1st remission, 2nd remission,
and 3rd or subsequent remission
- MDS
- Patients must have Performance Score (PS) greater than 70 percent
Exclusion Criteria
- Cardiac: ejection fraction less than 40 percent or other significant cardiac disease
- Pulmonary: FEV1 or DLCO less than 45 percent
- Renal: creatinine greater than the upper limit of normal
- Hepatic: bilirubin greater than 2.0 times the upper limit of normal
- CNS: documented active CNS disease
- Patients who are known to be positive for Hepatitis B surface antigen or Hepatitis C
antibody, or who have tested positive for HIV
We found this trial at
1
site
2160 South 1st Avenue
Maywood, Illinois 60153
Maywood, Illinois 60153
(888) 584-7888
Phone: 708-327-3148
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