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Allogeneic Transplantation for Pediatric Leukemias With Unrelated Donors

Information source: Ann & Robert H Lurie Children's Hospital of Chicago
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Leukemia

Intervention: Busulfan (Drug); Fludarabine (Drug); Thymoglobulin (Drug); Total Body Irradiation (Radiation)

Phase: Phase 1/Phase 2

Status: Recruiting

Sponsored by: Ann & Robert H Lurie Children's Hospital of Chicago

Official(s) and/or principal investigator(s):
Sonali Chaudhury, MD, Principal Investigator, Affiliation: Ann & Robert H Lurie Children's Hospital of Chicago

Overall contact:
Sonali Chaudhury, MD, Phone: 312-227-4863, Email: schaudhury@luriechildrens.org

Summary

The study proposes the use of Fludarabine, Busulfan, Anti Thymocyte Globulin Rabbit (ATG) and Total Body Irradiation as a preparative regimen before hematopoietic stem cell transplant from unrelated donor peripheral blood stem cells (PBSC). The hypothesis states that the 100 day mortality after this type of transplant will be significantly below the accepted standards, which is about 30% for unrelated donors.

Clinical Details

Official title: Allogeneic Transplantation for Pediatric Leukemias With Unrelated Donors Using Fludarabine, Busulfan, 400 cGy Total Body Irradiation, and Thymoglobulin

Study design: Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: To evaluate the toxicity (as measures by 100 day survival) after hematopoietic stem cell transplant from an unrelated donor with a novel preparative regimen.

Secondary outcome:

To evaluate the relapse-free and overall survival after hematopoietic stem cell transplant with Fludarabine/Busulfan/ATG/TBI preparative regimen for pediatric patients with leukemia.

To evaluate the incidence of acute and chronic graft-versus-host disease after hematopoietic stem cell transplant

Detailed description: The primary objective of this study is to evaluate the toxicity (as measured as 100 day survival) after hematopoietic stem cell transplant from an unrelated donor with a novel preparative regimen of Fludarabine, Busulfan, Anti-Thymocyte Globulin, and Total Body Irradiation for pediatric patients with leukemia. The secondary objectives are to evaluate the relapse-free and overall survival after hematopoietic stem cell transplant as well as to evaluate the incidence of acute and chronic graft-versus-host disease after this preparative regimen.

Eligibility

Minimum age: N/A. Maximum age: 21 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Ages 0-21

- AML in one of the following stages:

- Having preceding myelodysplasia (MDS)

- High Risk cytogenetics

- Requiring > 2 cycles chemotherapy to obtain complete remission

- High allelic ratio FLT3/ITD+,

- Standard risk cytogenetics with positive MRD at end of Induction

- Second or greater CR

- First relapse with < 25% blasts in bone marrow

- With therapy-related AML whose prior malignancy has been in remission for at

least 12 months

- ALL in one of the following stages:

- High risk first remission, defined as:

- Ph+ ALL; or,

- MLL rearrangement with slow early response [defined as having M2 (5-25% blasts)

or M3 (>25% blasts on bone marrow examination on Day 14 of induction therapy)]; or,

- Hypodiploidy (< 44 chromosomes or DNA index < 0. 81); or,

- End of induction M3 bone marrow; or,

- End of induction M2 marrow or MRD>1% with M2-3 marrow or MRD>1% at Day 42.

- High-risk infant ALL defined as age <6 months at diagnosis with MLL (11q23)

translocation.

- High risk second remission, defined as:

- Bone marrow relapse < 36 months from induction; or >36 mths if a matched sibling

donor is available

- T-lineage relapse at any time; or,

- Very early isolated CNS relapse (<18 months from diagnosis); or,

- Slow reinduction (M2-3 at Day 28) after relapse at any time. − Any third or

subsequent CR.

- Biphenotypic or undifferentiated leukemia in any CR or if in first relapse must have

< 25% blasts in bone marrow

- MDS at any stage; prior therapies allowed

- CML in chronic or accelerated phase; prior therapies allowed

- Patient also must have the following organ requirements:

- Adequate renal function defined as serum creatinine <2x normal, or creatinine

clearance > 40 ml/min/m^2 or 70 ml/min.

- Adequate liver function as defined by total bilirubin less than or equal to 2

times normal and AST and ALT less than or equal to 4 times normal.

- Adequate cardiac function as defined by: shortening fraction > 24% by

echocardiogram, or ejection fraction > 30% by radionuclide angiogram.

- Adequate pulmonary function as defined by DLCO, FEV1/FVC > 60% by pulmonary

function tests. For children who are uncooperative for PFTs and have no evidence of dyspnea at rest or exercise intolerance, pulse oximetry > 94% on room air is considered acceptable, with a normal chest xray.

- Adequate venous access; a double lumen central vascular access device or its

equivalent and an additional PICC line will be required for all patients.

- Women of childbearing potential and sexually active males should use effective

contraception while on study. Exclusion Criteria:

- Inability to give informed consent or assent

- Inability to obtain a suitable donor

- Patient who is HIV-positive

- Patient who has active Hepatitis B

- Patient who is pregnant

- Patient who is otherwise considered unsuitable for transplant at the discretion of

the principal investigator.

Locations and Contacts

Sonali Chaudhury, MD, Phone: 312-227-4863, Email: schaudhury@luriechildrens.org

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, United States; Recruiting
Sonali Chaudhury, MD, Phone: 312-227-4863, Email: schaudhury@luriechildrens.org
Colleen E Rosen, BS, RN, Phone: 312-227-4870, Email: crosen@luriechildrens.org
Additional Information

Starting date: May 2008
Last updated: January 22, 2014

Page last updated: August 23, 2015

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