Mismatched Family Member Donor Transplantation for Children and Young Adults With High Risk Hematological Malignancies
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cancer, Blood Cancer, Lymphoma, Hematology |
| Therapuetic Areas: | Hematology, Oncology |
| Healthy: | No |
| Age Range: | Any - 21 |
| Updated: | 5/13/2018 |
| Start Date: | December 2007 |
| End Date: | December 2018 |
A Reduced Intensity Conditioning Regimen With CD3-Depleted Hematopoietic Stem Cells to Improve Survival for Patients With Hematologic Malignancies Undergoing Haploidentical Stem Cell Transplantation
Blood and marrow stem cell transplant has improved the outcome for patients with high-risk
hematologic malignancies. However, most patients do not have an appropriate HLA (immune type)
matched sibling donor available and/or are unable to identify an acceptable unrelated HLA
matched donor through the registries in a timely manner. Another option is haploidentical
transplant using a partially matched family member donor.
Although haploidentical transplant has proven curative in many patients, this procedure has
been hindered by significant complications, primarily regimen-related toxicity including GVHD
and infection due to delayed immune reconstitution. These can, in part, be due to certain
white blood cells in the graft called T cells. GVHD happens when the donor T cells recognize
the body tissues of the patient (the host) are different and attack these cells. Although too
many T cells increase the possibility of GVHD, too few may cause the recipient's immune
system to reconstitute slowly or the graft to fail to grow, leaving the patient at high-risk
for significant infection.
For these reasons, a primary focus for researchers is to engineer the graft to provide a T
cell dose that will reduce the risk for GVHD, yet provide a sufficient number of cells to
facilitate immune reconstitution and graft integrity. Building on prior institutional trials,
this study will provide patients with a haploidentical (HAPLO) graft engineered to specific T
cell target values using the CliniMACS system. A reduced intensity, preparative regimen will
be used in an effort to reduce regimen-related toxicity and mortality.
The primary aim of the study is to help improve overall survival with haploidentical stem
cell transplant in this high risk patient population by 1) limiting the complication of graft
versus host disease (GVHD), 2) enhancing post-transplant immune reconstitution, and 3)
reducing non-relapse mortality.
hematologic malignancies. However, most patients do not have an appropriate HLA (immune type)
matched sibling donor available and/or are unable to identify an acceptable unrelated HLA
matched donor through the registries in a timely manner. Another option is haploidentical
transplant using a partially matched family member donor.
Although haploidentical transplant has proven curative in many patients, this procedure has
been hindered by significant complications, primarily regimen-related toxicity including GVHD
and infection due to delayed immune reconstitution. These can, in part, be due to certain
white blood cells in the graft called T cells. GVHD happens when the donor T cells recognize
the body tissues of the patient (the host) are different and attack these cells. Although too
many T cells increase the possibility of GVHD, too few may cause the recipient's immune
system to reconstitute slowly or the graft to fail to grow, leaving the patient at high-risk
for significant infection.
For these reasons, a primary focus for researchers is to engineer the graft to provide a T
cell dose that will reduce the risk for GVHD, yet provide a sufficient number of cells to
facilitate immune reconstitution and graft integrity. Building on prior institutional trials,
this study will provide patients with a haploidentical (HAPLO) graft engineered to specific T
cell target values using the CliniMACS system. A reduced intensity, preparative regimen will
be used in an effort to reduce regimen-related toxicity and mortality.
The primary aim of the study is to help improve overall survival with haploidentical stem
cell transplant in this high risk patient population by 1) limiting the complication of graft
versus host disease (GVHD), 2) enhancing post-transplant immune reconstitution, and 3)
reducing non-relapse mortality.
This study will explore the following objectives:
1. To assess if the event-free survival at one-year post-transplant for research
participants with high-risk hematologic malignancies can be improved following HAPLO
hematopoietic stem cell transplant (HSCT) using a graft depleted of CD3+ cells ex vivo
and a reduced intensity-conditioning regimen.
Secondary objectives:
1. To estimate the one-year overall survival (OS) and disease-free survival (DFS) for
research participants who receive this study treatment.
2. To estimate the cumulative incidence of relapse for research participants who receive
this study treatment.
3. To estimate the rate of overall grade III-IV acute GVHD, and the rate and severity of
chronic GVHD in research participants.
4. To estimate the incidence of non-hematologic regimen-related toxicity and
regimen-related mortality in the first 100 days post-transplant.
Exploratory objectives:
1. To explore the biologic significance of soluble interleukin-2 receptor and immunologic
state [quantitative lymphocyte studies, V beta spectratyping, T-cell receptor excision
circles (TREC) assay] to predict the development of acute and chronic GVHD in these
research participants.
2. To measure the pharmacokinetics of Campath-1H in pediatric HAPLO HSCT recipients
NOTE: This protocol originally used muromonab (OKT3) in the conditioning regimen to prepare
participants for haploidentical HCT. After muromonab became unavailable from the manufacturer
in 2010, muromonab was replaced by alemtuzumab (Campath-1H) for use in subsequent
participants.
1. To assess if the event-free survival at one-year post-transplant for research
participants with high-risk hematologic malignancies can be improved following HAPLO
hematopoietic stem cell transplant (HSCT) using a graft depleted of CD3+ cells ex vivo
and a reduced intensity-conditioning regimen.
Secondary objectives:
1. To estimate the one-year overall survival (OS) and disease-free survival (DFS) for
research participants who receive this study treatment.
2. To estimate the cumulative incidence of relapse for research participants who receive
this study treatment.
3. To estimate the rate of overall grade III-IV acute GVHD, and the rate and severity of
chronic GVHD in research participants.
4. To estimate the incidence of non-hematologic regimen-related toxicity and
regimen-related mortality in the first 100 days post-transplant.
Exploratory objectives:
1. To explore the biologic significance of soluble interleukin-2 receptor and immunologic
state [quantitative lymphocyte studies, V beta spectratyping, T-cell receptor excision
circles (TREC) assay] to predict the development of acute and chronic GVHD in these
research participants.
2. To measure the pharmacokinetics of Campath-1H in pediatric HAPLO HSCT recipients
NOTE: This protocol originally used muromonab (OKT3) in the conditioning regimen to prepare
participants for haploidentical HCT. After muromonab became unavailable from the manufacturer
in 2010, muromonab was replaced by alemtuzumab (Campath-1H) for use in subsequent
participants.
Inclusion Criteria:(transplant recipient)
- Patients less than or equal to 21 years of age; may be greater than 21 years old if a
current St. Jude patient or previously treated St. Jude patient within 3 years of
completion of prior treatment.
- Must have one of the following diagnosis:
- ALL high risk in second remission. Examples include relapse on therapy, first
remission duration of less than or equal to 30 months, or relapse within 12
months of completing therapy.
- ALL in third or subsequent remission.
- ALL high risk in first remission. Examples include: induction failure, minimal
residual disease greater than or equal to 1% marrow blasts by morphology after
induction, persistent or recurrent cytogenetic or molecular evidence of disease
during therapy requiring additional therapy after induction to achieve remission.
- High-risk AML in first remission. Examples include monosomy 7, M6, M7, t(6;9),
FLT3-ITD, or patients who have greater than or equal to 25% blasts by morphology
after induction or who do not achieve CR after 2 courses of therapy (includes
myeloid sarcoma).
- Relapsed or persistent AML (less than or equal to 25% blasts in marrow by
morphology).
- AML in second or subsequent morphologic remission (includes myeloid sarcoma).
- CML in first chronic phase with detectable molecular or cytogenetic evidence of
disease despite medical therapy; or CML with a history of accelerated or blast
crisis, now in chronic phase; or unable to tolerate tyrosine kinase inhibitor
therapy.
- Juvenile myelomonocytic leukemia (JMML).
- Myelodysplastic syndrome (MDS).
- Therapy related (secondary) AML, ALL, or MDS.
- Hodgkin lymphoma after failure of prior autologous HSCT or unsuitable for
autologous HSCT.
- Non-Hodgkin lymphoma (NHL) in second complete remission (CR2) or subsequent.
- Has not received a prior allogeneic hematopoietic stem cell transplant.
- Does not have a suitable HLA-matched sibling donor available for stem cell donation.
- Does not have a suitable cord blood product or volunteer matched unrelated donor (MUD)
available in the necessary time for stem cell donation.
- Has a suitable HLA partially matched family member available for stem cell donation.
- Cardiac shortening fraction greater than or equal to 25%.
- Creatinine clearance or glomerular filtration rate (GFR) greater than or equal to 40
ml/min/1.73 m^2.
- Forced vital capacity (FVC) greater than or equal to 40% of predicted value or a pulse
oximetry value of greater than or equal to 92% on room air.
- Direct bilirubin less than or equal to 3 mg/dl.
- Age-dependent performance score of greater than or equal to 50.
- Serum glutamic pyruvic transaminase (SGPT) less than 3 times the upper limit of normal
for age.
- Karnofsky or Lansky (age-dependent) performance score of greater than or equal to 50.
- No known allergy to murine products or human anti-mouse antibody (HAMA) results within
normal limits.
- Not pregnant (confirmed by negative serum or urine pregnancy test within 14 days prior
to enrollment).
- Not breast feeding.
Inclusion criteria (stem cell donor):
- Partially HLA matched family member.
- At least 18 years of age.
- Human immunodeficiency virus (HIV) negative.
- Not pregnant (confirmed by negative serum or urine pregnancy test within 7 days prior
to enrollment).
- Not breast feeding.
Inclusion criteria (transplant recipient - stem cell boost)
Has experienced one of the following disorders post-transplant:
- graft failure
- graft rejection
- delayed hematopoietic and/or immune reconstitution.
We found this trial at
1
site
St. Jude Children's Research Hospital St. Jude is unlike any other pediatric treatment and research...
Click here to add this to my saved trials
