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Bone Marrow Transplant

Clofarabine and Low-Dose Total-Body Irradiation For AML Patients Undergoing Donor Peripheral Blood Stem Cell Transplant (FHCRC-2430)
A Phase II Study of Optimally Dosed Clofarabine in Combination with Low-Dose TBI to Decrease Relapse Rates after Related or Unrelated Donor Hematopoietic Cell Transplantation in Patients with AML
Status Conditions Phase Study ID
Recruiting Acute Myeloid Leukemia (AML) Phase II FHCRC-2430
NCT01252667
Summary

 Giving chemotherapy and total-body irradiation before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. PURPOSE: This phase II trial is studying the side effects and how well giving clofarabine together with low-dose total-body irradiation works in treating patients with acute myeloid leukemia undergoing donor peripheral blood stem cell transplant.


Investigator
Boglarka Gyurkocza, MD
Location    
Seattle Cancer Care Alliance 800-804-8824  
Eligibility Criteria (must meet the following to participate in this study)

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Patients with AML OR patients age < 55 years with AML, who also through pre-existing medical conditions or prior therapy are considered to be at high risk for serious toxicities associated with a conventional, high-dose preparative regimen
  • Patients must have < 5% marrow blasts at the time of transplant
  • Only patients with Relapse Risk Score > 0 ("high risk") will be enrolled during Part 1; patients with all Relapse Risk Scores will be enrolled during Part 2
  • HLA-identical related or HLA-matched unrelated donor available
  • A signed informed consent form or minor assent form
  • DONOR: FHCRC matching allowed will be Grade 1.0 to 2.1: unrelated donors who are prospectively: matched for HLA-A, B, C, DRB1 and DQB1 by high resolution typing; only a single allele disparity will be allowed for HLA-A, B, or C as defined by high resolution typing
  • DONOR: a positive anti-donor cytotoxic crossmatch is an absolute donor exclusion; donors are excluded when preexisting immunoreactivity is identified that would jeopardize donor hematopoietic cell engraftment; this determination is based on the standard practice of the individual institution; the recommended procedure for patients with 10 of 10 HLA allele level (phenotypic) match is to obtain a panel reactive antibody (PRA) screens to class I and class II antigens for all patients before HCT; if the PRA shows > 10% activity, then flow cytometric or B and T cell cytotoxic cross matches should be obtained; the donor should be excluded if any of the cytotoxic cross match assays are positive; for those patients with an HLA Class I allele mismatch, flow cytometric or B and T cell cytotoxic cross matches should be obtained regardless of the PRA results
  • DONOR: patient and donor pairs homozygous at a mismatched allele are considered a two-allele mismatch, i.e., the patient is A*0101 and the donor is A*0102, and this type of mismatch is not allowed
  • DONOR: peripheral blood stem cells (PBSC) only will be permitted as a HSC source on this protocol
Exclusions (conditions that would prevent participation in this study)

Exclusion Criteria:

  • AML FAB M3 in CR1
  • Active AML involvement of the central nervous system (CNS) with disease refractory to intrathecal chemotherapy
  • Presence of circulating leukemic blasts in the peripheral blood detected by standard morphology
  • Patients who are HIV+ (HIV+ patients registered at FHCRC should be offered treatment on Protocol 1410)
  • Fertile men and women unwilling to use contraceptive techniques during and for 12 months following treatment
  • Left ventricular ejection fraction < 35%; ejection fraction is required if age > 50 years or there is a history of anthracycline exposure or history of cardiac disease
  • DLCO < 40% (corrected), TLC < 40%, FEV1 < 40% and/or receiving supplementary continuous oxygen
  • The FHCRC PI of the study must approve enrollment of all patients with pulmonary nodules
  • Patients with clinical or laboratory evidence of liver disease will be evaluated for the cause of liver disease, its clinical severity in terms of liver function, and the degree of portal hypertension; patients will be excluded if they are found to have fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bridging fibrosis, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin > 3mg/dL, or symptomatic biliary disease
  • Serum creatinine has to be =< 1.0 mg/dL; if not measured creatinine clearance should be equal or more than the lower limit of normal
  • Karnofsky score < 60 or Lansky Score < 50
  • Patients with poorly controlled hypertension and on multiple antihypertensives
  • Females who are pregnant or breastfeeding
  • Patients with active non-hematologic malignancies (except non-melanoma skin cancers) or those with non-hematologic malignancies (except non-melanoma skin cancers) who have been rendered with no evidence of disease, but have a greater than 20% chance of having disease recurrence within five years
  • Patients with systemic, uncontrolled infection
  • The addition of cytotoxic agents for "cytoreduction" with the exception of tyrosine kinase inhibitors (such as imatinib mesylate), cytokine therapy, hydroxyurea, low dose cytarabine, chlorambucil, or rituxan will not be allowed within three weeks of the initiation of conditioning
  • Fungal infections with radiological progression after receipt of amphotorecin B or active triazole for greater than 1 month
  • Patients with active bacterial or fungal infections unresponsive to medical therapy
  • DONOR: marrow donors
  • DONOR: donors who are HIV-positive and/or medical conditions that would result in increased risk to the donor G-CSF mobilization and PBSC collections
  • DONOR: identical twin
  • DONOR: any contraindication to the administration of subcutaneous G-CSF at a dose of 16 mg/kg/day for 5 consecutive days
  • DONOR: serious medical or psychological illness
  • DONOR: pregnant or lactating females
  • DONOR: prior malignancy within the preceding 5 years, with the exception of non-melanoma skin cancers
  • DONOR: children < 12 years old
Last Updated
October 25, 2011
See this trial at ClinicalTrials.gov
Access protocol and consent forms at Fred Hutchinson Cancer Research Center
Disclaimer: We update this information regularly. However, what you read today may not be completely up to date.

Please remember:
  • Talk to your health care providers first before making decisions about your health care.
  • Whether you are eligible for a research study depends on many things. There are specific requirements to be in research studies. These requirements are different for each study.