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Myeloid Hematological MalignanciesUCAMLNCT01247701

Umbilical Cord Blood Transplant for Children With Myeloid Hematological Malignancies

A study testing Busulfan, Cyclophosphamide and Fludarabine in people with Myeloid Hematological Malignancies, run by Baylor College of Medicine at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In this study, the investigators will use busulfan and cyclophosphamide (BuCy) backbone with the addition of fludarabine as the preparative Stem Cell Transplant (SCT) regimen. As an attempt to improve engraftment rate and reduce infections, the investigators are going to incorporate fludarabine in the conditioning… Read more about this study

Who is it for?
Ages Up to 17 years
Conditions the study is for
Myeloid Hematological Malignancies
What is being tested?
Busulfan, Cyclophosphamide and Fludarabine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
1 siteUnited States
Study dates
Nov 2010to Oct 2019
Phase
Interventional
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 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Patients with a myeloid hematologic malignancy (acute myelogenous leukemia, secondary myelogenous leukemia or myelodysplastic syndrome) unlikely to be cure by standard chemotherapy. This includes patients who have relapsed after standard chemotherapy treatments and patients in first remission with unfavorable prognostics features.
  • Related or Unrelated Umbilical Cord Blood Unit with 0-1 antigen mismatch at HLA-A and B (at low resolution) and DRB1 (at high resolution), with a total nucleated cell dose of ≥ 4 x 10^7/kg.
  • Lansky/Karnofsky scores at least 60.
  • Written informed consent and/or signed assent line from patient, parent or guardian.
  • Negative pregnancy test, if applicable.

Who cannot join

  • Patients with uncontrolled infections. For bacterial infections, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to enrollment. For fungal infections, patients must be receiving definitive systemic antifungal therapy and have no signs of progressing infection for 1 week prior to enrollment. Progressing infection is defined as hemodynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
  • Severe renal disease (Creatinine > 3X normal for age).
  • Severe hepatic disease (direct bilirubin > 3 mg/dL or SGOT > 500).
  • Patient has DLCO < 50% predicted or FEV1 < 50% of predicted, if applicable.
  • Patients with symptomatic cardiac failure unrelieved by medical therapy or evidence of significant cardiac dysfunction by echocardiogram (shortening fraction < 20%).
  • HIV positive.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Texas Children's Hospital

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: Umbilical Cord Blood Transplant for Children With Myeloid Hematological Malignancies (UCAML)

In this study, the investigators will use busulfan and cyclophosphamide (BuCy) backbone with the addition of fludarabine as the preparative Stem Cell Transplant (SCT) regimen. As an attempt to improve engraftment rate and reduce infections, the investigators are going to incorporate fludarabine in the conditioning regimen. The use of a BuCy backbone has been widely used and comparable to total body irradiation and cyclophosphamide (Cy/TBI) regimen.

Encouraging data on adding fludarabine to the SCT regimen have been reported. A fludarabine-based, conditioning regimen, with adequate immunosuppressive activity could conceivably allow engraftment of stem cells from alternative donors in hematologic malignancies patients with acceptable engraftment rates and low transplant-related mortality. Regimen-related toxicity is believed to be a major contributing factor to GVHD. Therefore this approach may also lead to reduced GVHD, as some investigators have suggested.

In an attempt to decrease the rate of viral infection and reactivation, the investigators will avoid ATG (Thymoglobulin) / Campath (anti-CD52), and instead administer Mycophenolate Mofetil (MMF). The addition of fludarabine should compensate any increase risk of graft failure with the removal of the ATG/Campath. The investigators anticipate that the removal of ATG/Campath will facilitate immune reconstitution more efficiently after receiving a UCBT.

Read the detailed description

The following will be given as the conditioning regimen for the transplant:

BUSULFAN: Busulfan (intravenous BUSULFEX) dosing will be as follows: patients <12 kg: 1.1 mg/kg/dose IV every 6 hours for 16 doses total; patients >12 kg: 0.8 mg/kg/dose IV every 6 hours for 16 doses. Administration and pharmacokinetic monitoring will be performed as per standard practice. Anticonvulsants will be given in accordance with standard Blood and Marrow Transplant Program recommendations.

CYCLOPHOSPHAMIDE: Cyclophosphamide (50 mg/kg/dose) will be given IV on Days -5, - 4, -3, and -2 over 1 hour. The total dose to be given over 4 days is 200 mg/kg. Mesna will be given in accordance with standard Blood and Marrow Transplant.

FLUDARABINE: Fludarabine will be given IV daily over 1 hour for 3 days. Dosing will be as follows: for patients ≤ 10 kg: 1.3 mg/kg; for patients > 10 kg: 40 mg/m2. Preparation, administration and monitoring will be according to standard practice procedure

POST-TRANSPLANT IMMUNOSUPPRESSION:

  • CSA will begin on Day -3. For children < 40 kg, the initial dose will be 2.5 mg/kg IV over 2 hours every 12 hours. Dose adjustments will be made to maintain levels above 200 ng/mL. Levels will be done on Day 0 and then as clinical indicated. CSA will be tapered per institutional SOP. Once the patient can tolerate oral medications and has a normal gastrointestinal transit time, CSA will be converted to an oral form.
  • MMF will begin on Day 0 at a dose of 15 mg/Kg IV or orally TID, and will be discontinued on Day +45 unless GVHD is present.

CNS Disease: Patients with CNS relapse or primary CNS disease that is symptomatic or associated to radiological changes will receive additional irradiation to the craniospinal axis.

SUPPORTIVE CARE:

  • Supportive care will be provided as per standard practice of the Blood and Marrow Stem Cell Transplant program at the Texas Children's Hospital, including all prophylactic and therapeutic clinical care issues. These practices may be modified if necessary for any individual patient in order to provide optimum care for that particular patient.
  • IVIG: Intravenous immunoglobulin (500 mg/kg per dose) will be given monthly until discontinuation of GVHD therapy and documentation of antibody production.
  • CB-CTLs: Patients enrolled in this protocol may also be eligible for infusion of CB-derived multivirus-specific CTL to provide virus-specific immune reconstitution and treatment of viral infections after CBT.

EVALUATIONS DURING THE STUDY:

Screening Procedures; Pre-HCT:

  • Physical examination
  • Pregnancy test
  • Complete blood count and chemistries
  • Electrocardiogram
  • Echocardiograph
  • PT/PTT/Fibrinogen/Anti-Thrombin III/von Willebrand Factor
  • Viral tests
  • Bone marrow aspirate and biopsy/Lumbar puncture
  • Renal Function (GFR)
  • Lumbar puncture will be performed
  • Pulmonary Function test

EVALUATIONS BETWEEN DAY 0 AND DAY 100:

  • Physical examination
  • Complete blood count and chemistries
  • Lytes/BUN/Cr
  • Peripheral blood for STRs or FISH analysis for molecular diagnostics
  • Lymphocyte phenotype testing and lymphoproliferative responses
  • Bone marrow aspirate and biopsy for assessment of leukemia status and UCB engraftment
  • Lumbar puncture
  • Immunoglobulins

EVALUATIONS AFTER DAY 100:

  • Physical examination
  • Complete blood count and chemistries
  • Lytes/BUN/Cr
  • Serum chemistries
  • Peripheral blood with assessment of engraftment by STRs or FISH analysis and enzyme levels
  • Echocardiograph with LVEF
  • Bone marrow aspirate and biopsy assessment of leukemia status and UCB engraftment
  • Lymphocyte phenotype testing (CD3, CD4, CD8, CD19 and CD56) and lymphoproliferative responses
  • Immunoglobulins

FOLLOW-UP INTERVAL:

Patients will be seen in the hospital everyday until discharge. After discharge from the hospital, the patient will be following on the BMT clinics on a regular basis as recommended by the primary physician.

Being tested
Busulfan, Cyclophosphamide, Fludarabine, Cord Blood Stem Cell Infusion
Keywords
UCB, Umbilical Cord Blood, Transplant, Umbilical Cord Blood Transplant, Cord Blood Stem Cell Transplantation, Pediatric, Myeloid Hematological Malignancies, Busulfan, Cytoxan, Cyclophosphamide, Fludarabine

What participants receive

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

  • BusulfanDrug

    Also called Busulfex

    Busulfan dosing will be as follows: Patients < 12 kg: 1.1 mg/kg/dose IV every 6 hours for 16 doses total; patients > 12 kg: 0.8 mg/kg/dose IV every 6 hours for 16 doses. It will be given on Days -9, -8, -7 and -6.

  • CyclophosphamideDrug

    Also called CTX, Cytoxan

    Cyclophosphamide (50 mg/kg/dose) will be given IV on Days -5, - 4, -3, and -2 over 1 hour. The total dose to be given over 4 days is 200 mg/kg.

  • FludarabineDrug

    Also called Fludera

    Fludarabine will be given IV daily over 1 hour for 3 days. Dosing will be as follows: for patients ≤ 10 kg: 1.3 mg/kg; for patients > 10 kg: 40 mg/m^2.

  • Cord Blood Stem Cell InfusionProcedure or surgery

    The cord blood stem cells will be infused on Day 0.

Study groups in NCT01247701
Study groupRoleWhat they receive
Umbilical Cord Blood TransplantExperimentalBusulfan,Cyclophosphamide, Fludarabine, Cord Blood Stem Cell Infusion
Receives: Drug: Busulfan; Drug: Cyclophosphamide; Drug: Fludarabine; Procedure: Cord Blood Stem Cell Infusion

What is being measured

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

  1. Overall Survival at 100 Days, 1 Year, and 3 Years After Umbilical Cord Blood Transplant in Pediatric Patients.

    To determine the overall survival rate at 1 year after umbilical cord blood transplant in pediatric patients with myeloid hematological malignancies.

    Measured: 100 days, 1 year, and 3 years

Secondary outcomes (6)
  1. Number of Participants With Severe Acute GVHD Grade III-IV

    Number of participants with acute GVHD graded by the method of Przepiorka et al, which evaluates skin involvement, lower and upper GI, and liver function (bilirubin), each being graded in stages from 0 to 4, where 0 means no acute GVHD, and 4 is the highest stage of acute GVHD.

    Measured: Day 100

  2. Number of Participants With Chronic GvHD

    Number of participants with chronic GVHD graded by the method of Przepiorka et al, which evaluates skin, joints, oral, ocular, hepatic, esophagus, GI, respiratory, platelet, and musculoskeletal involvement, in stages from 0 to 3.

    Measured: 1 year

  3. Number of Participants With Relapse Rate After Transplant

    To assess relapse rate at 1 and 3 years after transplant. Cumulative incidence of relapse was calculated from the date of umbilical cord blood transplant using the competing risk method as described in Gray(1988) with death prior to relapse as the competing risk. Participants still alive without a date of relapse were censored at the time of the last follow-up.

    Measured: 1 and 3 years

  4. Number of Participants With Donor Engraftment After Transplant.

    To evaluate donor engraftment at 100 days, 6, 9, 12, 24, and 36 months after transplant.

    Measured: 100 days, 6, 9, 12, 24 and 36 months

  5. Number of Participants With Platelet Engraftment

    Achievement of untransfused platelet count > 20 x 10^9/L on three consecutive days

    Measured: Day 180

  6. Number of Participants With Neutrophil Engraftment

    Achievement of absolute neutrophil count > 0.5 x 10^9/L on three consecutive days

    Measured: Day 42

Timeline

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

  1. First posted24 Nov 2010 (estimated)
  2. Study startNov 2010
  3. Primary completionOct 2019
  4. Study completionOct 2019

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 N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01247701
Sponsor's protocol ID
26558-UCAML
Acronym
UCAML
Status last verified
May 2022
First submitted
22 Nov 2010
Last updated
8 Jun 2022
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Busulfan, Cyclophosphamide and Fludarabine in people with Myeloid Hematological Malignancies, run by Baylor College of Medicine at 1 site 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 5 inclusion and 6 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: finished, as of the sponsor's last update on 8 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 8 Jun 2022). 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?

Overall Survival at 100 Days, 1 Year, and 3 Years After Umbilical Cord Blood Transplant in Pediatric Patients. (time frame: 100 days, 1 year, and 3 years). 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 8 Jun 2022.

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