T-Reg Cell Kinetics for Patients Receiving Stem Cell Transplant

Status:	Completed
Conditions:	Blood Cancer, Lymphoma, Hematology, Leukemia
Therapuetic Areas:	Hematology, Oncology
Healthy:	No
Age Range:	Any - 64
Updated:	3/30/2013
Start Date:	October 2007
End Date:	December 2015

T-Regulatory Cell Kinetics for Patients Receiving Alemtuzamb and Undergoing Stem Cell Transplantation From HLA Mismatched-Related, or HLA Matched, or One Antigen Mismatched-Unrelated Donors

Patients have a type of blood cell disorder that is very hard to cure. We are now suggesting
a treatment that might help patients live longer without disease than other treatment plans
would. This treatment is known as a stem cell transplant. We believe this may help patients
as it allows us to give much stronger doses of drugs and radiation to kill the diseased
cells than we could give without the transplant. We also think that the healthy cells may
help fight any diseased cells left after the transplant.

Stem Cells are special "mother" cells that are found in the bone marrow (the spongy tissue
inside bones), although some are also found in the bloodstream (peripheral blood). As they
grow, they become either white blood cells which fight infection, red blood cells which
carry oxygen and remove waste products from the organs and tissues or platelets, which
enable the blood to clot. For the transplant to take place, we will collect these stem cells
from a "donor" (a person who agrees to donate these cells) and give them to recipient.
Patients do not have a sibling that is a perfect match, so the stem cells will come from a
donor who is the best match available. This person may be a close relative or an unrelated
person whose stem cells best "matches" the patients, and who agrees to donate stem cells.
Before the transplant, two very strong drugs plus total body irradiation will be given to
the patient (pre-conditioning). This treatment will kill most of the blood-forming cells in
the bone marrow. We will then give the patient the healthy stem cells. Once these healthy
stem cells are in the bloodstream they will move to the bone marrow (graft) and begin
producing blood cells that will eventually mature into healthy red blood cells, white blood
cells and platelets.

This research study will also use CAMPATH-1H as a pre-treatment. CAMPATH-1H is an antibody
against certain types of blood cells. CAMPATH-1H is important because it stays active in the
body for a long time after infusion, which means it may work longer at preventing GvHD
symptoms.

The stem cell transplant described above is considered to be "standard" treatment. We would
like to collect additional blood as described below in order to evaluate how the immune
system is recovering.

We are asking permission to draw blood from the patient so that we can measure the number of
certain blood cells called T regulatory cells. T regulatory cells are special immune cells
that can control or regulate the body's immune response. We want to determine whether T
regulatory cells are important participants in graft versus host disease (GVHD), infection
and relapse. In GVHD, certain cells from the donated marrow or blood (the graft) attack the
body of the transplant patient (the host). GVHD can affect many different parts of the body.
The skin, eyes, stomach and intestines are affected most often. GVHD can range from mild to
life-threatening. We do not know whether T regulatory cells can modify these conditions. We
want to measure these T regulatory cells and learn if these cells do influence these
conditions. If we learn that T regulatory cells do affect these conditions, then it may be
possible to modify these cells for the benefit of transplant patients.

To participate in this transplant, the patient will need to have a central line.

Before the transplant we will test the blood for viruses which can cause problems after the
transplant. These viruses include Hepatitis B, cytomegalovirus and HIV. If the patient is
positive for the AIDS virus, they will not be able to undertake the transplant.

Standard therapy: The patient will be given 6 doses of chemotherapy with a drug called Ara C
in high doses (every 12 hours) which will begin 8 days before the stem cell transplant.
Then, another chemotherapy drug called cyclophosphamide will be given in high doses by vein
for two days on the 7th and 6th days before the transplant. A drug called MESNA will be
given with cyclophosphamide. MESNA is used to decrease the side effects caused by
cyclophosphamide. The patient will also receive an antibody called Campath (each day for 4
days before the transplant) to help destroy the immune system so that there is less host
resistance to the growth of the donor cells. Radiation treatment will be given to the entire
body on each day for 4 days before transplant. This will be given 2 times a day for 4 days.
The chemotherapy and radiation treatment will last 8 days. If the patient has a diagnosis of
T-cell Lymphoma, they will not be given the Ara-C.

Extra bone marrow tests may be recommended by the physician to check on the patients
condition, especially if the marrow is slow to grow.

The day after the radiation treatment is completed; the patient will receive the healthy
stem cells by vein. Once in the bloodstream, these stem cells will go to the bone marrow and
should begin to grow.

In prevention of GvHD, the patient will also receive medicine called FK506 as well as low
dose methotrexate. The FK506 will be given intravenously initially starting 2 days before
the transplant and later by mouth (when they are able to take oral medications). This drug
will be given each day for several weeks. Four doses of low dose methotrexate will be given
intravenously. The methotrexate will be given on the day after the transplant, 3, 6 and 11
days after the transplant. If the GVHD cannot be controlled with FK506, other medicines may
need to be given. The doctor will describe these medicines at that time.

Blood samples for research: To study how these cells are working in the patients system,
blood samples will be taken each month for six months, at nine months, at one year, 2 years
and 3 years following transplant. Approximately 6-8 teaspoons of blood will be collected
each time. The total blood drawn for this study over three years should not exceed 1 and 3/4
cups. This amount is considered safe in adults. The amount of blood collected will be
decreased in children and/or in patients where this amount of blood collection would not be
appropriate.

INCLUSION CRITERIA:

- Patients with acute or chronic leukemia or advanced Hodgkin or non Hodgkin lymphoma
or myelodysplastic/myeloproliferative disease who are unlikely to be cured by
standard chemotherapy treatments. This includes patients who have relapsed after
standard chemotherapy treatments and patients in first remission with unfavorable
prognostic features.

- Using the standard 6 HLA antigen profile (HLA class I, A and B, and HLA class II,
DRB1) a patient must have either a one HLA antigen mismatched related donor or an HLA
matched or one antigen mismatched unrelated donor.

EXCLUSION CRITERIA:

- Patients with a life expectancy (less than or equal to 6 weeks) limited by disease
other than leukemia.

- Patients with symptomatic cardiac failure unrelieved by medical therapy or evidence
of significant cardiac dysfunction by echocardiogram (shortening fraction <20%).

- Patients with severe renal disease (i.e., creatinine greater than 3 times normal for
age).

- Patients with pre-existing severe restrictive pulmonary disease (FVC less than 40% of
predicted).

- Patients with severe hepatic disease (direct bilirubin greater than 3 mg/dl or AST
greater than 500 IU/L).

- Patients with severe personality disorder or mental illness.

- Patients with severe infection that in the estimation of the principal investigator
prohibits the use of ablative chemotherapy.

- Patients who are documented HIV positive.

- Patients with a Karnofsky performance score <70% or Lansky score <50%.

NOTE: Patients who would be excluded from treatment on this protocol strictly for
laboratory abnormalities can be included at the principal investigator's discretion after
consultation with the members of the SCT Policy and Procedures Committee.

We found this trial at

sites

Texas Children's Hospital

6621 Fannin St
Houston, Texas 77030

(832) 824-1000