NEWS HIGHLIGHTS
Published Studies Related to Myleran (Busulfan)
Clofarabine +/- fludarabine with once daily i.v. busulfan as pretransplant conditioning therapy for advanced myeloid leukemia and MDS. [2011.06]
Although a combination of i.v...
Randomized trial of two different conditioning regimens for bone marrow transplantation in thalassemia--the role of busulfan pharmacokinetics in determining outcome. [2005.11]
In total, 94 patients with homozygous beta thalassemia were randomized to two different conditioning regimens: busulfan 600 mg/m2 + cyclophosphamide 200 mg/kg or busulfan 16 mg/kg + cyclophosphamide 200 mg/kg and antilymphocyte globulin (47 in each group), for bone marrow transplantation, to see whether increased myeloablation or increased immunosuppression would reduce rejection...
Randomized trial of busulfan vs total body irradiation containing conditioning regimens for children with acute lymphoblastic leukemia: a Pediatric Blood and Marrow Transplant Consortium study. [2003.09]
Conditioning regimens for children with ALL have generally included total body irradiation (TBI), which may result in significant sequelae. The primary aim of this study was to evaluate the outcome for children with ALL undergoing allogeneic stem cell transplant (SCT) with either busulfan (Bu) or TBI regimens...
Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. [2001.12.15]
In the early 1990s, 4 randomized studies compared conditioning regimens before transplantation for leukemia with either cyclophosphamide (CY) and total-body irradiation (TBI), or busulfan (Bu) and CY. This study analyzed the long-term outcomes for 316 patients with chronic myeloid leukemia (CML) and 172 patients with acute myeloid leukemia (AML) who participated in these 4 trials, now with a mean follow-up of more than 7 years...
Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Nordic Bone Marrow Transplantation Group. [1999.04.01]
Leukemic patients receiving marrow from HLA-identical sibling donors were randomized to treatment with either busulfan 16 mg/kg (n = 88) or total body irradiation ([TBI] n = 79) in addition to cyclophosphamide 120 mg/kg. The patients were observed for a period of 5 to 9 years... In patients with chronic myeloid leukemia (CML) in first chronic phase, 7-year LFS was 72% and 83% in the two groups, respectively.
Clinical Trials Related to Myleran (Busulfan)
Phase II Trial of a Chemotherapy Alone Regimen of IV Busulfan (Busulfex), Melphalan and Fludarabine as Myeloablative Regimen Followed by an Allogeneic T-Cell Depleted Hematopoietic Stem Cell Transplant From an HLA-Identical, or HLA-Non Identical Related or Unrelated Donor [Active, not recruiting]
The purpose of this research study is:(1) to determine if high doses of chemotherapy without
total body irradiation can allow selected stem cells to take and grow,(2) to determine if
selected stem cells from the blood or marrow can take and not cause a complication called
graft-versus-host disease (GvHD) and (3) to evaluate the side effects of the combination of
chemotherapy drugs used for these transplants. In the last 10 years we have developed
chemotherapy combinations to be used for this T-cell depleted transplant protocol. By using
three chemotherapy drugs (IV busulfan, melphalan and fludarabine), we hope to have a good
chemotherapy combination to kill cancer cells, and to make the graft take, without the side
effects of total body irradiation. The chemotherapy drugs to be tested in this protocol are
busulfan, melphalan and fludarabine, all of which have been used successfully for stem cell
transplantation, but not given together as in this specific regimen. This is what is being
tested in this study.
Our initial trials in the 1980's with T-cell depleted transplants showed less GvHD, but the
overall results of the transplants were not better. The reason for this was that the stem
cells did not take and engraft in 15% of our adult patients. This failure of the stem cells
to take can leave patients without bone marrow or blood cells necessary for life. Most stem
cell transplants were done using bone marrow (BMA) obtained from the donors. However, if we
give a medication called G-CSF by shots to the donor, we can collect peripheral blood stem
cells (PBSC) and use them for transplant. The advantage of this approach is that we can
collect 2-20 times more stem cells than that obtained from the marrow. It has been proven
that a larger number of stem cells in the graft make it more difficult for the patient to
reject the stem cells. Some donors may be too small to provide peripheral blood stem cells or
they may not want to take G-CSF shots. In these cases the donors will have their marrow
collected in the operating room under general anesthesia.
Stem cell transplants can lead to a condition known as acute graft-versus-host disease or
GvHD. This disease is caused by an assault by certain cells in the marrow or blood (T-cells)
of the donor (graft) against your body (the host). These T-cells see your body as foreign and
attack it. The disease causes a skin rash, liver disease, and diarrhea. Methods were
developed at this institution to prevent GvHD. These methods take out most of the T-cells
(responsible for GvHD) from the marrow or blood stem cells before transplant. This is called
"T-cell depletion" or "stem cell selection". In this hospital, we use two types of methods of
T-cell depletion: one method is used with peripheral blood stem cells and one for bone
marrow. Both these techniques have been successful in preventing both acute and chronic GvHD.
You will receive a T-cell depleted stem cell transplant.
Gemcitabine/Clofarabine/Busulfan and Allogeneic Transplantation for Aggressive Lymphomas [Recruiting]
The goal of this clinical research study is to find the highest tolerable dose of
gemcitabine (out of 6 possible doses) that can be given in combination with busulfan and
clofarabine before an allogeneic stem cell transplant. Researchers also want to learn if
this combination can help to control lymphoma. The safety of this treatment will also be
studied.
Busulfan is designed to bind to DNA (the genetic material of cells), which may cause cancer
cells to die. It is commonly used in stem cell transplants.
Clofarabine and gemcitabine are designed to block the growth of cancer cells, which may
cause the cancer cells to die.
Plerixafor and Granulocyte Colony-stimulating Factor (G-CSF) With Busulfan, Fludarabine and Thymoglobulin [Recruiting]
The goal of this clinical research study is to learn about the safety of AMD3100
(plerixafor) and G-CSF (filgrastim) in combination with fludarabine, busulfan, and an
allogeneic blood stem cell transplant. This treatment will be studied in patients with AML,
MDS, or CML.
Objectives:
Primary Objective:
1. To determine the safety of Plerixafor and Filgrastim (G-CSF) in combination with
busulfan, fludarabine and allogeneic hematopoietic transplantation for treatment of
advanced myeloid leukemias.
2. Determine biologic effects of Plerixafor and G-CSF on leukemia cells.
3. To determine if the combination of Plerixafor and G-CSF with busulfan, fludarabine will
improve progression free survival post allogeneic stem cell transplantation from an
HLA-compatible donor compared to historical controls receiving busulfan-fludarabine
alone.
Secondary Objectives:
1. To determine the time to engraftment, the rate and severity of GVHD, and immune
reconstitution.
Targeted, Dose-Escalation Busulfan-Etoposide as Prep Regimen [Recruiting]
Busulfan and etoposide have been used as preparative therapy for autoSCT (stem cell
transplant) in adults with acute myeloid leukemia (AML) at UCSF for the past 10 years. Over
this period and together with collaborative transplant centers, over 200 patients have
received this treatment. By intent-to-treat analysis, and with median follow-up of 7. 0
years, the 5-year DFS is 55%. The current protocol will utilize the combination of IV
Busulfan (BU) and etoposide. The busulfan dose will be escalated amongst 3 targeted dose
levels. All targeted dose levels represent higher busulfan dosing than standard
myeloablative dosing, with the lowest dose being approximately 14% higher than standard.
Busulfan levels will be monitored after the first, fourth and twelfth doses. Dose
adjustments will be made "in real time" based on AUC levels determined from the first and
fourth doses. This strategy of busulfan monitoring and dose adjustment has improved the
therapeutic widow of BU in previous clinical trials.
The current protocol will utilize the combination of intravenous busulfan and etoposide. The
busulfan dose will be escalated amongst 3 targeted dose levels (area under the curve (AUC)
levels at time 6 hours of 1250 uMol*min, 1400 uMol*min and 1550 uMol*min). All targeted
dose levels represent higher busulfan dosing than standard myeloablative dosing with the
lowest dose (1250 uMol*min) being approximately 14% higher than standard. In the absence of
dose-limiting toxicity, cohorts of 4-6 patients will be treated at each dose level and 10
additional patients will be treated at the maximum tolerated dose (MTD) to confirm safety.
The busulfan dosing will begin at 1 mg/kg based on historical plasma levels obtained from
patients receiving BU at a starting dose of 0. 8 mg/kg at UCSF Medical Center.
The highest dose level proposed for this study will exceed the reported toxic level for
busulfan in the alloSCT setting. Patients will be followed closely for toxicity and strict
stopping rules have been included. Eligibility criteria will exclude patients with prior
history of hepatotoxicity or viral hepatitis. Potential hepatotoxic agents will not be
allowed just prior to and during the busulfan dosing period. In addition, patients who
experience hepatotoxicty during pre-transplant mobilization therapy may be excluded from
receiving dose-escalated busulfan therapy. Every attempt will be made to prevent or avoid
hepatotoxicity.
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