Giving Chemotherapy for a Shortened Amount of Time Before a Stem Cell Transplantation
Ключови думи
Резюме
Дати
Последна проверка: | 05/31/2020 |
Първо изпратено: | 09/18/2019 |
Очаквано записване подадено: | 09/18/2019 |
Първо публикувано: | 09/22/2019 |
Изпратена последна актуализация: | 06/04/2020 |
Последна актуализация публикувана: | 06/08/2020 |
Действителна начална дата на проучването: | 09/17/2019 |
Приблизителна дата на първично завършване: | 08/31/2021 |
Очаквана дата на завършване на проучването: | 08/31/2021 |
Състояние или заболяване
Интервенция / лечение
Drug: patients hematologic malignancies other than multiple myeloma
Drug: Fludarabine
Drug: Melphalan
Drug: Antithymocyte globulin (ATG)
Drug: patients with multiple myeloma
Procedure: Allogeneic hematopoietic cell transplantation (Allo-HCT)
Фаза
Групи за ръце
Arm | Интервенция / лечение |
---|---|
Experimental: patients hematologic malignancies other than multiple myeloma A. Busulfan 3.2 mg/kg/day, with dose adjustments made according to pharmacokinetic (PK) levels. B. Melphalan (70mg/m2/day) administered on days -6 and -5. C. Fludarabine (25mg/m2/ day) administered on days -6, -5, -4, -3, and -2. All patients receiving matched related or unrelated donor allografts receive anti-thymocyte globulin (ATG) 2.5 mg/kg/day on days -3 and -2 to deplete chemotherapy resistant host T-cells that could hinder engraftment, and it may provide additional GVHD prophylaxis. | Drug: patients hematologic malignancies other than multiple myeloma Busulfan 3.2 mg/kg/day, with dose adjustments made according to pharmacokinetic (PK) levels. |
Experimental: patients with multiple myeloma A. Busulfan 0.8 mg/kg every 6 hours x 10 doses, with dose adjustments made according to PK levels. B. Melphalan (70 mg/m2/day) administered on days -6 and -5. C. Fludarabine (25 mg/m2/day) administered on days -6, -5, -4, -3, -2. All patients receiving matched related or unrelated donor allografts receive anti-thymocyte globulin (ATG) 2.5 mg/kg/day on days -3 and -2 to deplete chemotherapy resistant host T-cells that could hinder engraftment, and it may provide additional GVHD prophylaxis. | Drug: patients with multiple myeloma Busulfan 0.8 mg/kg every 6 hours x 10 doses, with dose adjustments made according to PK levels. |
Критерии за допустимост
Възрасти, отговарящи на условията за проучване | 18 Years Да се 18 Years |
Полове, допустими за проучване | All |
Приема здрави доброволци | Да |
Критерии | Inclusion Criteria: - Patients aged ≥ 18 years old. - Patients with any of the following hematologic malignancies for which allo-HCT is indicated, including: - Acute myeloid leukemia (AML) with intermediate or high-risk features in CR1. - Relapsed AML in ≥ CR2. - Acute leukemias of ambiguous lineage in ≥ CR1. - Acute lymphoid leukemia (ALL) in CR1 with clinical, flow cytometric, or molecular features indicating a high risk for relapse, or ALL in ≥ CR2. - CML meeting one of the following criteria: - Failed response to or intolerant to BCR-ABL tyrosine kinase inhibitors (TKIs). - CML with BCR-ABL mutation consistent with poor response to TKIs (e.g., T315I mutation) - CML in accelerated phase or blast crisis with <10% blasts after therapy, or in second chronic phase. - Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN), or MDS/MPN overlap syndromes with least one of the following: - Revised International Prognostic Scoring System risk score of intermediate or higher at the time of transplant evaluation. - Life-threatening cytopenias. - Karyotype or genomic changes that indicate high risk for progression to acute myelogenous leukemia, including abnormalities of chromosome 7 or 3, mutations of TP53, or complex or monosomal karyotype. - Therapy related disease or disease evolving from other malignant processes. - Chronic myelomonocytic leukemia (CMML-1 or CMML-2). - Severe aplastic anemia. - Relapsed Hodgkin lymphoma meeting both of the following criteria: - Responding to therapy prior to enrollment. - Relapse after autologous HCT or are ineligible for autologous HCT. - Relapsed non-Hodgkin lymphoma meeting both of the following criteria: - Responding to therapy prior to enrollment. - Relapse after prior autologous HCT or are ineligible for autologous HCT. - High-risk multiple myeloma following autologous HCT or relapsed multiple myeloma following autologous HCT with chemosensitive disease. - Adequate organ function is required, defined as follows: - Serum bilirubin ≤ 2 mg/dL, unless benign congenital hyperbilirubinemia. Patients with hyperbilirubinemia related to paroxysmal nocturnal hemoglobinuria or other hemolytic disorders are eligible with PI approval. - AST, ALT, and alkaline phosphatase < 3 times the upper limit of normal unless thought to be disease-related. - Creatinine clearance ≥ 50 ml/min (calculated by Cockcroft Gault) - LVEF ≥ 45% by MUGA or resting echocardiogram. - Pulmonary function (FEV1 and corrected DLCO) ≥ 50% predicted. - Adequate performance status of ECOG ≤ 2. - Each patient must be willing to participate as a research subject and must sign an informed consent form. Exclusion Criteria: - Patients with active extramedullary disease. - Patients with active central nervous system malignancy. - Active and/or uncontrolled infection at the time of allo-HCT. - Patients who have undergone previous allo-HCT. - Patients who have undergone previous autologous HCT within the last 6 months, with the exclusion of high-risk multiple myeloma patients. - Patient seropositivity for HIV I/II and/or HTLV I/II. - Females who are pregnant or breastfeeding. - Patients unwilling to use contraception during the study period. - Patient or guardian unable to give informed consent or unable to comply with the treatment protocol. Donor Inclusion and Exclusion Criteria: - Must be a 10/10 HLA genotypically matched related or unrelated donor at A, B, C, DRB1, and DQB1 loci, as tested by DNA analysis. - Able to provide informed consent for the donation process per institutional standards. - Meet standard criteria for donor collection as defined by the National Marrow Donor Program Guidelines. |
Резултат
Първични изходни мерки
1. the number of grade 4 toxicities [in the first 30 days post-HCT]