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Myelodysplastic and Myeloproliferative DisordersPhase 1/2NCT00579111

Reduced Intensity Preparative Regimen Followed by Stem Cell Transplant (FAB)

A Phase 1/2 study testing Campath, Busulfan and Fludarabine in people with Myelodysplastic and Myeloproliferative Disorders and Acute Myelogenous Leukemia, run by Baylor College of Medicine at 2 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Blood disorders such as leukemia or lymphoma or hemoglobinopathies can benefit from receiving an allogeneic (meaning that the cells are from a donor) stem cell transplant. Stem cells are created in the bone marrow. Read more about this study

Who is it for?
Ages Up to 70 years
What is being tested?
Campath, Busulfan and Fludarabine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
4 participants
Where
2 sitesUnited States
Study dates
Jun 2007to Oct 2010
Phase
Phase 1/2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 70 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Diagnosis of myelodysplastic and myeloproliferative disorders, acute myelogenous leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, multiple myeloma, plasma cell dyscrasia, lymphoproliferative disorders (non-Hodgkin lymphoma, hairy cell leukemia, chronic lymphocytic leukemia, and Hodgkin's disease) and non malignant hematologic diseases considered treatable with an allogeneic transplant including but not limited to bone marrow failure syndrome, hemoglobinopathy and severe immunodeficiency states.
  • Performance status 0-2 on Zubrod scale
  • Ejection fraction > 30%
  • AST/ALT and bilirubin not > 4 times normal
  • FEV1 greater than 1.0 and diffusion capacity > 40%
  • Age birth to 70 years of age
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  • Conditions that increase treatment related mortality (need more than one to be eligible):
  • Age > 35 years
  • EF of less than 45%
  • DLCO less than 50% or FEV1 50-75% of predicted value
  • Diabetes mellitus
  • Renal insufficiency, defined by increase in serum creatinine level of 1.5 times ULN or decrease in GFR by 25%
  • Prior recent history of systemic fungal infection
  • 3rd or greater remission of AML or ALL
  • More than 1 year of diagnosis (CML or myeloma patients only)
  • Multiple types of treatment regimens (equal to or more than 3)
  • Prior autologous or allogeneic stem cell transplantation
  • Significant Grade III or IV neurologic or hepatic toxicity as defined by NCI CTC toxicity from previous treatment
  • No matched sibling donor
  • Available healthy donor without any contraindications for donation
  • 5/6 or 6/6 related
  • 5/6 or 6/6 unrelated (molecular typing for DRB1)
  • Patient and/or responsible person able to understand and sign consent
  • For women of childbearing potential, negative pregnancy test

Who cannot join

  • Pregnant and lactating women or women unwilling to use contraception.
  • HIV positive patient.
  • Uncontrolled intercurrent infection.
  • Refractory AML or ALL.
  • Untreated blast crisis for CML.
  • Uncontrolled high-grade lymphoproliferative disease/lymphoma.
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  • Unstable angina and uncompensated congestive heart failure (Zubrod of 3 or greater).
  • Severe chronic pulmonary disease requiring oxygen (Zubrod of 3 or greater).
  • Hemodialysis dependent.
  • Active Hepatitis or cirrhosis with total bilirubin, SGOT, and SGPT greater than 3 x normal.
  • Serum creatinine >2x ULN.
  • Unstable cerebral vascular disease and recent hemorrhagic stroke (less than 6 months).
  • Active CNS disease from hematological disorder.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Texas Children's Hospital

    Houston, Texas, 77030

  • The Methodist Hospital

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: Reduced-Intensity Preparative Regiment With Fludarabine, Busulfan, And Alemtuzumab (Campath 1H) Followed By Allogeneic Hematopoietic Stem Cell Transplant For Malignant And Non-Malignant Hematological Diseases

Blood disorders such as leukemia or lymphoma or hemoglobinopathies can benefit from receiving an allogeneic (meaning that the cells are from a donor) stem cell transplant. Stem cells are created in the bone marrow. They grow into different types of blood cells that the body needs, including red blood cells, white blood cells, and platelets. In a transplant, the body's stem cells would be killed and then replaced by stem cells from the donor. Usually, patients are given very high doses of chemotherapy (drugs which kill cancer cells) prior to receiving a stem cell transplant. However, patients that are older, have received several prior treatments, or have other organ diseases are at a high risk of getting life-threatening treatment-related side effects from high doses of chemotherapy. Over the past several years, some doctors have begun to use lower doses of chemotherapy for preparing patients for a stem cell transplant.

A condition that can occur after a stem cell transplant from a donor is Graft Versus Host Disease (GVHD). It is a rare but serious disorder that can strike persons whose immune system is suppressed and have received either a blood transfusion or a bone marrow transplant. Symptoms may include skin rash, intestinal problems similar to inflammation of the bowel and liver dysfunction.

Read more

This research study uses a combination of lower-dose chemotherapy agents that is slightly different from those that have been used before.

The medicines that will be used in this study are Fludarabine, Busulfan, both chemotherapy medicines, and Campath. Campath is a monoclonal antibody (a type of substance produced in the laboratory that binds to cancer cells). It helps the immune system see the cancer cell as something that needs to be destroyed.

This research study will help us learn if using Fludarabine, Busulfan and Campath prior to an allogeneic stem cell transplant can provide treatment for blood disorders while decreasing the incidence of side effects.

Read the detailed description

Allogeneic stem cell transplantation with high-dose chemotherapy affords a better chance of cure of malignant and non-malignant hematological diseases compared to autologous transplantation, because of the lack of stem cell contamination and the immune mediated graft vs. leukemia effect. Unfortunately, high-dose chemotherapy and allogeneic stem cell transplantation has a substantial treatment related mortality, that is particularly high in older patients (greater than 50 yrs of age), or in those with co-morbidities such as congestive heart disease and pulmonary disease. Patients who have pre-existing infections or who have had multiple relapses with prior chemotherapy are also at high risk. In all these groups, treatment related mortality may exceed 50%, making them ineligible for high-dose chemotherapy and allogeneic stem cell transplantation.

Recently interest has increased in using less toxic chemotherapy protocols that are termed submyeloablative. The intent is to allow partial engraftment of a donor immune and hemopoietic systems with subsequent progressive replacement of the host's own hemopoiesis and immunity. As the donor immune system becomes established, patients may develop full donor chimerism, without passing through the period of prolonged aplasia associated with conventional conditioning regimens, and with less of the associated toxicity. Preliminary results in high-risk patients have shown treatment related mortality (TRM) of 15-20%, versus 50% expected, with an overall survival rate of 70-80% at 1-2 years post transplant.

As might be anticipated, the major problem with sub-ablative conditioning is that the graft failure rate is increased, with published figures of 5-30% versus 1-5% predicted in fully ablated patients. The incorporation of lymphodepleting antibodies in the preliminary conditioning regimen may allow these rejection rates to be diminished. Moreover, a highly efficient lymphodepleting MAb or MAb combination might be successfully substituted in part or in whole for cytotoxic and immunosuppressive drugs, further increasing the safety and efficacy of the subablative approach to stem cell transplantation. Our own data using the crude polyclonal mixture of antibodies in ATG as a component of pre-transplant conditioning revealed an improvement in engraftment during matched unrelated donor transplantation.The lymphodepleting monoclonal antibody Campath IH has many of the properties desired for this application, and we propose to incorporate it in our conditioning regimen. Since CAMPATH1H persists after infusion, we would expect it to have additional anti-GvHD effector function, further reducing treatment related mortality (TRM).

The following preparative regimen will be delivered to all patients:

  1. Busulfan 3.2 mg/kg/day IV daily for 2 days, infused over 3 hours, on Day -5 and Day -4
  2. Fludarabine 30mg/m2/day IV daily for 4 days on Day -5 to D -2
  3. Campath 10 mg/day IV daily for 3 days on days -6 to D-4.

Because CAMPATH-1H infusions will provide a persisting level of antibody over the transplant period, it will contribute to anti-GvHD activity. Additional Graft vs. host disease prophylaxis will consist of FK506 administered from Day-2.

The stem cells will be infused on day 0.

Being tested
Campath, Busulfan, Fludarabine, Hematopoietic stem cell infusion, FK-506
Keywords
Myelodysplastic and Myeloproliferative Disorders, Acute Myelogenous Leukemia, Acute Lymphoblastic Leukemia, Chronic Myelogenous Leukemia, Multiple Myeloma, Plasma Cell dyscrasia, Lymphoproliferative disorders, Hematologic Diseases, Fludarabine, Busulfan, Campath, Alemtuzumab, allogeneic stem cell transplant
Medical subject headings
Myeloproliferative Disorders, Leukemia, Myeloid, Acute, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Multiple Myeloma, Paraproteinemias, Lymphoproliferative Disorders, Hematologic Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CampathDrug

    Also called Alemtuzumab

    10 mg/day IV daily for 3 days on days -6 to D-4. Campath may be omitted from the conditioning regimen for patients with malignant diseases and matched related donor transplants

  • BusulfanDrug

    3.2 mg/kg/day IV daily for 2 days, infused over 3 hours, on Day -5 and Day -4

  • FludarabineDrug

    30mg/m2/day IV daily for 4 days on Day -5 to D -2

  • Hematopoietic stem cell infusionProcedure or surgery

    Peripheral blood stem cells when possible. Bone marrow cells will be used if peripheral blood cells are insufficient or unavailable.

  • FK-506Drug

    Also called Tacrolimus

    FK-506 at a dose of 0.03 mg/kd/day will be administered via continuous infusion over 24 hours from 4pm on Day -2 until engraftment or when the patient is able to take PO, then 0.03 mg/kg PO every 12 hours.

Study groups in NCT00579111
Study groupRoleWhat they receive
HLA-identical sibling transplantExperimentalRecipients of HLA identical sibling stem cell transplants
Receives: Drug: Campath; Drug: Busulfan; Drug: Fludarabine; Procedure: Hematopoietic stem cell infusion; Drug: FK-506
Unrelated Matched or Single Antigen Mismatched transplantExperimentalRecipients of unrelated matched or single antigen mismatched donor stem cell transplant or single antigen mismatched family donor stem cell transplants
Receives: Drug: Campath; Drug: Busulfan; Drug: Fludarabine; Procedure: Hematopoietic stem cell infusion; Drug: FK-506

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Patients With Successful Donor Engraftment

    Each patient will be classified as a success or failure. A success will be defined as engraftment of at least 35% of cells 100 days after transplant.

    Measured: 100 days

Secondary outcomes (1)
  1. Number of Patients With Treatment Related Grade III or IV Non-hematological Toxicity

    Measured: 100 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Dec 2007 (estimated)
  2. Study startJun 2007
  3. Primary completionFeb 2009
  4. Study completionOct 2010

Why it stopped: slow accrual

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
4 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00579111
Sponsor's protocol ID
19386
Other IDs
FAB
Status last verified
Mar 2016
First submitted
19 Dec 2007
Last updated
4 May 2016
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Campath, Busulfan and Fludarabine in people with Myelodysplastic and Myeloproliferative Disorders and Acute Myelogenous Leukemia, run by Baylor College of Medicine at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 24 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 4 May 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 9 Aug 2012). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Patients With Successful Donor Engraftment (time frame: 100 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 May 2016.

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