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Acute Lymphoblastic LeukemiaPhase 2NCT01621477

T-Cell Replete Haploidentical Donor Hematopoietic Stem Cell Plus Natural Killer (NK) Cell Transplantation in Patients With Hematologic Malignancies Relapsed or Refractory Despite Previous Allogeneic Transplant

A Phase 2 study testing clofarabine, cytarabine and busulfan in people with Acute Lymphoblastic Leukemia and Acute Myelocytic Leukemia, run by St. Jude Children's Research Hospital at 1 site 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

The primary aim of this protocol is to evaluate if the one-year survival is significantly improved in the group of patients who receive a T-cell replete haploidentical donor hematopoietic cell transplant (HCT) with a novel reduced intensity conditioning regimen. Read more about this study

Who is it for?
Ages Up to 21 years
What is being tested?
clofarabine, cytarabine and busulfan
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
1 siteUnited States
Study dates
Aug 2012to Dec 2015
Phase
Phase 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 21 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Age less than 21 years.
  • One of the following hematologic malignancies that has relapsed or remains refractory after prior allogeneic HCT:
  • Acute lymphoblastic leukemia (ALL)
  • Acute myeloid leukemia (AML) (including myeloid sarcoma)
  • Chronic myelogenous leukemia (CML), juvenile myelomonocytic leukemia (JMML), myelodysplastic syndrome (MDS), Hodgkin or non-Hodgkin lymphoma (NHL)
  • Has a suitable single haplotype matched (≥ 3 of 6) family member donor.
Show all 27Show fewer
  • Does not have any other active malignancy other than the one for which this transplant is indicated.
  • If prior central nervous system (CNS) leukemia, it must be treated and have no evidence of CNS disease
  • Does not have current uncontrolled bacterial, fungal, or viral infection per the judgment of the principal investigator.
  • Patient must fulfill pre-transplant evaluation:
  • Left ventricular ejection fraction greater than 40%, or shortening fraction greater than or equal to 25%.
  • Creatinine clearance or Glomerular Filtration Rate of ≥70 ml/min/1.73m^2.
  • Forced vital capacity (FVC) ≥ 40% of predicted value; or pulse oximetry ≥ 92% on room air if patient is unable to perform pulmonary function testing.
  • Karnofsky or Lansky (age-dependent) performance score ≥ 50.
  • Total bilirubin ≤ 1.5 times the upper limit of normal for age.
  • Alanine aminotransferase (ALT) ≤ 3 times the upper limit of normal for age.
  • Not pregnant. If female with child bearing potential, must be confirmed by negative serum or urine pregnancy test within 14 days prior to enrollment.
  • Not breast feeding.
  • Does not have active acute bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia.
  • At least single haplotype matched (≥ 3 of 6) family member,
  • At least 18 years of age.
  • Human immunodeficiency virus (HIV) negative.
  • Not pregnant as confirmed by negative serum or urine pregnancy test within 14 days prior to enrollment (if female).
  • Not breast feeding.
  • A suitable donor is identified as either:
  • Has completed the process of donor eligibility determination as outlined in 21 CFR 1271 and agency guidance; OR
  • Does not meet 21 CFR 1271 eligibility requirements, but has a declaration of urgent medical need completed by the principal investigator or physician sub-investigator per 21 CFR 1271.

Who cannot join

  • Does not meet above inclusion criteria.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • St. Jude Children's Research Hospital

    Memphis, Tennessee, 38105

Other trials in United States

About this study

The primary aim of this protocol is to evaluate if the one-year survival is significantly improved in the group of patients who receive a T-cell replete haploidentical donor hematopoietic cell transplant (HCT) with a novel reduced intensity conditioning regimen. Study population will consist of patients (21 years or under) with hematologic malignancies that have relapsed or are refractory after prior allogeneic transplant. Toxicity will be evaluated by the rate of transplant related mortality and the rates of moderate and severe graft-versus-host disease (GvHD) at day 100. The investigators will describe event-free, and disease-free survival at one year, as well as the rates of hematopoietic recovery and donor engraftment and study comprehensively immune reconstitution following T-cell replete haploidentical transplantation.

Read the detailed description

Patients with refractory hematologic malignancies, including those who develop recurrent disease after allogeneic hematopoietic cell transplantation, have a dismal prognosis. Historically, both regimen-related mortality and disease recurrence have been significant causes of treatment failure in this heavily pre-treated patient population. Our institution has utilized mismatched family member (haploidentical) donors for these patients for a number of years for the following reasons: (1) Only 30% of patients have matched related donors available; (2) transplantation can be performed more rapidly since the time to unrelated donor transplantation averages 3 to 4 months; (3) no other curative treatment options are available. These therapeutic interventions have been largely successful given the dismal prognosis in this patient group; however disease recurrence remains the most significant cause of treatment failure. To provide maximum benefit for this challenging population, the goals of a therapeutic transplant protocol should include: (1) a conditioning regimen that is well tolerated, even in a heavily pre-treated population; but it should also provide substantial antileukemia effects, and (2) should establish rapid immune recovery such that the patient may benefit from graft versus leukemia effect and early protection from life threatening infections while also limiting dangerous and counter-productive graft versus host disease.

The primary aim of this protocol will be to evaluate if the one-year survival is significantly improved in the group of patients receiving T-cell replete haploidentical donor HCT with a novel clofarabine, cytarabine, busulfan, plerixafor, cyclophosphamide, and ATG based reduced intensity conditioning regimen whose hematologic malignancy has relapsed or is refractory after prior allogeneic transplant. Toxicity will be evaluated by the rate of transplant related mortality and the rates of moderate and severe graft versus host disease at day 100. The investigators will also describe event-free, and disease-free survival at one year, as well as the rates of hematopoietic recovery and donor engraftment. Additionally, the investigators will study comprehensively immune reconstitution following T-cell replete haploidentical transplantation.

PRIMARY OBJECTIVE:

  • Evaluate if the one-year survival is significantly improved in a group of children receiving a therapeutic regimen for high-risk hematologic malignancy that is relapsed or refractory despite previous allogeneic hematopoietic cell transplantation (HCT) using a novel reduced intensity conditioning and T-cell replete haploidentical donor hematopoietic stem cell plus NK cell transplantation.

SECONDARY OBJECTIVES:

  • Estimate the incidence of malignant relapse, event-free survival, and disease free survival (DFS) at one-year post-transplantation.
  • Estimate incidence and severity of acute and chronic (GVHD).
  • Estimate the rate of transplant related mortality (TRM) in the first 100 days after transplantation.
Being tested
clofarabine, cytarabine, busulfan, Plerixafor, cyclophosphamide
Keywords
Hematologic malignancy, Hematopoietic cell transplant
Medical subject headings
Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Myeloid, Acute, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Leukemia, Myelomonocytic, Juvenile, Myelodysplastic Syndromes, Lymphoma, Non-Hodgkin, Sarcoma, Myeloid, Hematologic Neoplasms

What participants receive

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

  • clofarabineDrug

    Also called Cl-F-Ara-A, CAFdA, Clofarex, Clolar(TM)

    Given on Day -9 and Day -8 (Day 0 is first stem cell infusion). Drug class: antineoplastic agent

  • cytarabineDrug

    Also called Ara-C

    Given on Day -9 and Day -8 (Day 0 is first stem cell infusion). Drug class: antineoplastic agent

  • busulfanDrug

    Also called Myleran(R), Busulfex

    Given on Day -7 and Day -6 (Day 0 is first stem cell infusion). Drug class: antineoplastic agent

  • PlerixaforDrug

    Also called AMD3100, Mozobil(R)

    Given on Day -7 and Day -6 (Day 0 is first stem cell infusion). Drug class: Hematopoietic Stem Cell Mobilizer

  • cyclophosphamideDrug

    Also called Cytoxan

    Given on Day -5 and Day +4 (Day 0 is first stem cell infusion). Drug class: antineoplastic agent; immunosuppressive agent.

  • antithymocyte globulin (rabbit)Drug

    Also called Rabbit ATG, Rabbit Thymoglobulin(R)

    Given on Day -4, Day -3, Day -2, and Day -1 (Day 0 is first stem cell infusion). Drug class: immunosuppressive agent.

  • stem cellsBiological

    Also called HSC infusion

    Patients undergo T cell replete Hematopoietic stem cell infusion on Day 0 and Day +1. Patients undergo natural killer (NK) cell transplantation on day +6 (Day 0 is first stem cell infusion).

  • TacrolimusDrug

    Also called FK506, Prograf(R), Protonic(R)

    Given on Day +11 (Day 0 is first stem cell infusion). Drug class: immunosuppressive agent.

  • mycophenolate mofetilDrug

    Also called MMF, CellCept(R)

    Given on Day +11 (Day 0 is first stem cell infusion). Drug class: immunosuppressive agent.

Study groups in NCT01621477
Study groupRoleWhat they receive
TreatmentExperimentalAll study participants. Interventions: clofarabine, cytarabine, busulfan, plerixafor, cyclophosphamide, antithymocyte globulin (rabbit), stem cells, tacrolimus, mycophenolate mofetil
Receives: Drug: clofarabine; Drug: cytarabine; Drug: busulfan; Drug: Plerixafor; Drug: cyclophosphamide; Drug: antithymocyte globulin (rabbit); Biological: stem cells; Drug: Tacrolimus; Drug: mycophenolate mofetil

What is being measured

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

  1. One-year Survival (OS)

    Evaluate the number of participants alive at 1 year. The number of participants surviving to one-year post-transplantation is given.

    Measured: One year post transplant

Secondary outcomes (6)
  1. Incidence of Malignant Relapse

    Estimate the incidence of malignant relapse at one year post-transplant. The number of participants with malignant relapse or progressive disease is given. Relapse was evaluated using standard WHO criteria for each disease.

    Measured: One year post transplantation.

  2. Event-Free Survival (EFS)

    Estimate the EFS at one-year post-transplantation. The event is defined as relapse or death due to any cause. The number of participants who were alive without relapse at one year post-transplant is reported.

    Measured: one year post transplant

  3. Disease-Free Survival (DFS)

    Estimate the DFS at one-year post-transplantation. The event is defined as relapse or death due to relapse. The number of participants who did not relapse up to one year post transplant is reported.

    Measured: one year post transplant

  4. Incidence and Severity of Acute Graft Versus Host Disease (GVHD)

    The number of participants with acute GVHD is given, organized by grade. Participants are graded on a scale from 1 to 4, with 1 being mild and 4 being severe.

    Measured: 100 days post transplant

  5. Incidence and Severity of Chronic Graft Versus Host Disease (GVHD)

    The severity of chronic GVHD will be described. Chronic GVHD was evaluated using NIH Consensus Global Severity Scoring. The number of participants with chronic GVHD is given, organized by severity.

    Measured: 100 days post transplant

  6. Number of Participants With Transplant Related Mortality (TRM)

    The number of participants who died due to TRM in the first 100 days post-transplant is given.

    Measured: 100 days post transplant

Timeline

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

  1. First posted18 Jun 2012 (estimated)
  2. Study startAug 2012
  3. Primary completionDec 2015
  4. Study completionDec 2015

Why it stopped: Study was terminated in August 2016 due to replacement by a new study.

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 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01621477
Sponsor's protocol ID
HAP3R
Other IDs
NCI-2012-00554
Status last verified
Dec 2016
First submitted
8 Jun 2012
Last updated
20 Feb 2017
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing clofarabine, cytarabine and busulfan in people with Acute Lymphoblastic Leukemia and Acute Myelocytic Leukemia, run by St. Jude Children's Research Hospital 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 27 inclusion and 1 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 20 Feb 2017. 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.

What does this phase mean?

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 20 Feb 2017). 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?

One-year Survival (OS) (time frame: One year post transplant). 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 20 Feb 2017.

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