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Adult Acute Lymphoblastic Leukemia in RemissionPhase 1NCT02122081

Organ-Sparing Marrow-Targeted Irradiation Before Stem Cell Transplant in Treating Patients With High-Risk Hematologic Malignancies

A Phase 1 study testing radiation therapy, cyclophosphamide and anti-thymocyte globulin in people with Adult Acute Lymphoblastic Leukemia in Remission and Adult Acute Myeloid Leukemia in Remission, run by Sumithira Vasu 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

This pilot clinical trial aims to assess feasibility and tolerability of using an LINAC based "organ-sparing marrow-targeted irradiation" to condition patients with high-risk hematological malignancies who are otherwise ineligible to undergo myeloablative Total body irradiation (TBI)-based conditioning prior to… Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
radiation therapy, cyclophosphamide and anti-thymocyte globulin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
33 participants
Where
1 siteUnited States
Study dates
27 Jul 2015to 6 Sep 2022
Phase
Phase 1

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 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with a diagnosis of acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS) with fewer than 10% myeloblasts or lymphoblasts in the bone marrow and no blasts in the peripheral blood on morphologic analysis performed within 30 days of start of the conditioning regimen; if remission bone marrow is available beyond 30 days a new bone marrow evaluation is required to assess remission status
  • The diagnosis of AML, ALL, or MDS will be based on World Health Organization (WHO) criteria
  • Pre-transplant bone marrow sample must be evaluable for assessment of remission status (i.e. aspirate smear containing particles and/or evaluable bone marrow core biopsy)
  • Patients with leukemia infiltration in the central nervous system (CNS) are eligible if cerebrospinal fluid (CSF) cytospin is negative for myeloblasts or lymphoblasts at time of enrollment
  • If the patient has an intra-abdominal chloroma on presentation, and has a partial response or complete response to treatment (size reduction of chloroma and marrow blast < 10%), the patient is eligible; however the chloroma must be included as part of the treatment target
  • For patients receiving treatment of their AML, MDS or ALL prior to transplantation:
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  • Interval between the start of a cycle of conventional cytotoxic chemotherapy and the start of conditioning regimen must be at least 30 days
  • Interval between completing treatment with a hypomethylating agent or other non-cytotoxic chemotherapy and the start of conditioning regimen must be at least 10 days
  • Hematopoietic Cell Transplantation-Specific Comorbidity Index score (HCT-CI) =< 4 for patients in Cohort 1 and > 4 for Cohort 2
  • Patient must be able to lie still in full body cast for 45 minutes
  • Must have a suitable donor defined as a sibling matched at 5/6 or 6/6 antigens (human leukocyte antigen [HLA]-A, B, and DRB1) or an unrelated volunteer matched at 7/8 or 8/8 HLA alleles (HLA-A, B, C, and DRB1)
  • Signed informed consent
  • DONOR: "High resolution" typing at HLA-A, B, C and DRB1 alleles
  • Single antigen mismatch for siblings and single allele mismatch for volunteer unrelated donors is acceptable
  • Donors must be >= 17 years of age

Who cannot join

  • Circulating peripheral blood myeloblasts or lymphoblasts on morphologic analysis from time of last treatment to time of enrollment
  • Prior allograft or prior autograft
  • Active CNS disease as identified by positive CSF cytospin at time of enrollment
  • Karnofsky performance score < 70
  • Symptomatic uncontrolled coronary artery disease or ejection fraction < 40%
  • Total bilirubin >= 2 x the upper limit of normal
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  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >= 3 x the upper limit of normal
  • Diffusion capacity of the lung for carbon monoxide (DLCO) < 40%
  • Forced expiratory volume in one second (FEV1) < 50% (corrected for hemoglobin)
  • Receiving supplementary continuous oxygen
  • Creatinine clearance < 50 mL/min/1.73m^2
  • Patients with active uncontrolled bacterial, viral or fungal infections (undergoing appropriate treatment and with progression of clinical symptoms)
  • Patients seropositive for the human immunodeficiency virus (HIV)
  • Females who are pregnant or breastfeeding
  • Fertile men and women unwilling to use contraceptive techniques during and for 12 months following treatment
  • Patients who had prior radiation to more than 20% bone marrow containing areas or to any areas exceeding 2000 cGy
  • DONOR:
  • Donors will be excluded if they are an identical twin of the recipient
  • Females who are pregnant (positive serum beta human chorionic gonadotropin beta [β HCG]) or uninterruptible breastfeeding
  • HIV seropositive
  • Donors receiving experimental therapy or investigational agents unless approved by the protocol chair

Trial locations and contacts

1 site in 1 country.

United States1 site

  • Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center

    Columbus, Ohio, 43210

Other trials in United States

About this study

Official title: A Feasibility Study of Organ-Sparing Marrow-Targeted Irradiation (OSMI) to Condition Patients With High-Risk Hematologic Malignancies Prior to Allogeneic Hematopoietic Stem Cell Transplantation

This pilot clinical trial aims to assess feasibility and tolerability of using an LINAC based "organ-sparing marrow-targeted irradiation" to condition patients with high-risk hematological malignancies who are otherwise ineligible to undergo myeloablative Total body irradiation (TBI)-based conditioning prior to allogeneic stem cell transplant. The target patient populations are those with ALL, AML, MDS who are either elderly (>50 years of age) but healthy, or younger patients with worse medical comorbidities (HCT-Specific Comorbidity Index Score (HCT-CI) > 4). The goal is to have the patients benefit from potentially more efficacious myeloablative radiation based conditioning approach without the side effects associated with TBI.

Read the detailed description

PRIMARY OBJECTIVES:

  1. To assess feasibility and tolerability of OSMI based hematopoietic stem cell transplant (HSCT) as defined by transplant-related mortality (TRM) at day 30 as well as rate of grade II/III organ toxicity (defined by Bearman Regimen-Related Toxicities Scale) attributable to conditioning occurring within 30 days.

SECONDARY OBJECTIVES:

  1. Day 100 transplant-related mortality (TRM). II. Donor chimerism assessment at day 100 (to assess failure of engraftment rate).

III. Incidence of acute graft-versus-host disease (aGVHD) by day 100. IV. Incidence of chronic GVHD at one year. V. Cumulative incidence of grade II organ toxicity through day 100. VI. Rate and kinetics of hematopoietic recovery. VII. Incidence of graft failure (primary and secondary). VIII. Rate of infectious complications. IX. Cumulative incidence of relapse, overall survival, and progression-free survival at 1 year.

OUTLINE:

CONDITIONING REGIMEN: Patients undergo organ-sparing marrow irradiation twice daily (BID) on days -6 to -4 and receive cyclophosphamide intravenously (IV) over 1-2 hours every 24 hours on days -3 to -2. Patients with an unrelated donor also receive anti-thymocyte globulin every 24 hours on days -4 to -2.

GVHD PROPHYLAXIS: Patients receive tacrolimus IV or orally (PO) beginning on day -1 and continuing for at least 6 months and methotrexate IV on days 1, 3, 6, and 11.

TRANSPLANT: Patients undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0.

After completion of study treatment, patients are followed up weekly for 12 weeks, at day 100, and then at 6 and 12 months.

Being tested
radiation therapy, cyclophosphamide, anti-thymocyte globulin, tacrolimus, methotrexate
Medical subject headings
Congenital Abnormalities, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Myeloid, Acute

What participants receive

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

  • radiation therapyRadiation

    Also called irradiation, radiotherapy, therapy, radiation

    Undergo organ-sparing marrow irradiation BID on days -6 to -4

  • cyclophosphamideDrug

    Also called CPM, CTX, Cytoxan, Endoxan

    Given IV over 1-2 hours every 24 hours on days -3 to -2.

  • anti-thymocyte globulinBiological

    Also called ATG, ATGAM, lymphocyte immune globulin, Thymoglobulin

  • tacrolimusDrug

    Also called FK 506, Prograf

    Given IV or PO

  • methotrexateDrug

    Also called amethopterin, Folex, methylaminopterin, Mexate

    Given IV

  • allogeneic bone marrow transplantationProcedure or surgery

    Also called bone marrow therapy, allogeneic, bone marrow therapy, allogenic, transplantation, allogeneic bone marrow, transplantation, allogenic bone marrow

    Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0

  • allogeneic hematopoietic stem cell transplantationProcedure or surgery

    Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant

  • peripheral blood stem cell transplantationProcedure or surgery

    Also called PBPC transplantation, PBSC transplantation, peripheral blood progenitor cell transplantation, transplantation, peripheral blood stem cell

    Undergo allogeneic peripheral blood progenitor cell or bone marrow transplant

  • laboratory biomarker analysisOther

    Correlative studies

Study groups in NCT02122081
Study groupRoleWhat they receive
Treatment (OSMI, allogeneic transplant)ExperimentalCONDITIONING REGIMEN: Patients undergo organ-sparing marrow irradiation BID on days -6 to -4 and receive cyclophosphamide IV over 1-2 hours every 24 hours on days -3 to -2. Patients with an unrelated donor also receive anti-thymocyte globulin every 24 hours on days -4 to -2. GVHD PROPHYLAXIS: Patients receive tacrolimus IV or PO beginning on day -1 and continuing for at least 6 months and methotrexate IV on days 1, 3, 6, and 11. TRANSPLANT: Patients undergo allogeneic peripheral blood progenitor cell or bone marrow transplant on day 0.
Receives: Radiation: radiation therapy; Drug: cyclophosphamide; Biological: anti-thymocyte globulin; Drug: tacrolimus; Drug: methotrexate; Procedure: allogeneic bone marrow transplantation; Procedure: allogeneic hematopoietic stem cell transplantation; Procedure: peripheral blood stem cell transplantation; Other: laboratory biomarker analysis

What is being measured

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

  1. TRM, defined as death occurring in a patient from causes other than disease relapse

    Proportions will be derived for incidence of TRM divided by all evaluable patients along with corresponding 95% binomial confidence intervals.

    Measured: At day 30 post-transplant

  2. Rate of grade II/III organ toxicity, defined by the Bearman Regimen-Related Toxicities Scale

    Toxicities will be tabulated by grade for each cohort, by type of toxicity, as well as the maximum grade overall. Toxicity frequencies will be described for the day +30, day +100, and one year time intervals as well as cumulative over time. Proportions will be derived for incidence of grade II/III organ toxicity divided by all evaluable patients along with corresponding 95% binomial confidence intervals.

    Measured: Up to 30 days

Secondary outcomes (12)

  1. TRM

    Proportions will be derived for incidence of toxicity divided by all evaluable patients along with corresponding 95% binomial confidence intervals.

    Measured: Day 100 post-transplant

  2. Donor chimerism

    Donor chimerism is used to assess failure of engraftment rate.

    Measured: Day 100

  3. Incidence of aGVHD, graded according to Ohio State University Bone Marrow Transplant (OSU BMT) Program policy

    The first day of aGVHD onset at a certain grade will be used to calculate cumulative incidence curves for that GVHD grade.

    Measured: Up to day 100

  4. Incidence of chronic GVHD, scored according to the OSU BMT Program policy

    The first day of chronic GVHD onset will be used to calculate cumulative incidence curves. Rates and severity of chronic GHVD will be calculated.

    Measured: At 1 year

  5. Cumulative incidence of grade II organ toxicity

    Toxicity will be tabulated by grade for each cohort, by type of toxicity as well as the maximum grade overall.

    Measured: Up to day 100

  6. Incidence of hematopoietic recovery

    The rate and kinetics of hematopoietic recovery will be assessed. The kinetics of post-transplant recovery of both neutrophil and platelet engraftment will be assessed.

    Measured: Up to day 100

  7. Incidence of graft failure

    Primary graft failure (defined by the lack of neutrophil engraftment by 28 days) and secondary graft failure (defined by initial neutrophil engraftment followed by subsequent decline in neutrophil counts < 500/uL unresponsive to growth factor therapy) will be assessed on days 30 and 100 and at 1 year post-transplant.

    Measured: Up to 1 year post-transplant

  8. Rate of infectious complications

    The number of infections and the number of patients experiencing infections will be tabulated by type of infection, severity, and time period after transplant. The cumulative incidence of severe, life-threatening, or fatal infections will be tabulated.

    Measured: Up to 12 months

  9. Incidence of relapse

    Measured: Time from start of conditioning to relapse, assessed at 1 year

  10. Overall survival

    Measured: Time from start of conditioning to death, loss to follow up, or end of study, whichever comes first, assessed at 1 year

  11. Progression-free survival

    Patients are considered a failure of this endpoint if they die or suffer from disease relapse or progression.

    Measured: Time from start of conditioning to relapse, progression, death, initiation of non-protocol therapy, loss to follow up or end of study, whichever comes first, assessed at 1 year

  12. Immune reconstitution

    Quantitative assessments of peripheral blood CD3, CD4, CD8, CD19, and CD56 positive lymphocytes will be done throw flow cytometric analysis at baseline, 100 days, and 12 months post transplantation.

    Measured: Up to 12 months 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 posted24 Apr 2014 (estimated)
  2. Study start27 Jul 2015
  3. Primary completion6 Sep 2022
  4. Study completion6 Sep 2022

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
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
33 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02122081
Sponsor's protocol ID
OSU-13219
Other IDs
NCI-2014-00763
Status last verified
Sep 2023
First submitted
22 Apr 2014
Last updated
21 Sep 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

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