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NCT00027560 · REGISTRY CONDITION SEARCH

Melphalan, Fludarabine, and Alemtuzumab Followed by Peripheral Stem Cell Transplant in Treating Patients With Hematologic Cancer

Found through the registry condition index, not selected as a treatment recommendation. This discovery collection was restricted to studies with posted results.

Phase
PHASE2
Status at capture
COMPLETED
Registry last update
2013-01-07

RATIONALE: Giving low doses of chemotherapy, such as melphalan and fludarabine, and a monoclonal antibody, such as alemtuzumab, before a donor bone marrow or peripheral blood stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine after the transplant may stop this from happening. PURPOSE: This phase II trial is studying how well fludarabine, melphalan, alemtuzumab, and peripheral stem cell transplant work in treating patients with hematologic cancer.

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What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

flow

Participant flow

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baseline

Baseline characteristics

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outcome · POSTED

Overall Survival

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outcome · POSTED

Overall Survival

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outcome · POSTED

Acute Graft-versus-Host Disease Matched Related Patients

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outcome · POSTED

Acute Graft-versus-Host Disease Unrelated and Mismatched Related Patients

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outcome · POSTED

Extensive Chronic Graft-versus-Host Disease Matched Related Patients

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outcome · POSTED

Extensive Chronic Graft-versus-Host Disease Unrelated and Mismatched Related Patients

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adverse events

Adverse events

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more info

Limitations, agreements, and source contact

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Who could take part
eligibility Criteria
INCLUSION CRITERIA: * Disease criteria: This trial is primarily designed for: 1) patients with relapsed or primary refractory non-Hodgkin's lymphoma, 2) chemosensitive relapsed or refractory acute and chronic lymphocytic leukemias, 3) relapsed or primary refractory Hodgkin's Disease, or advanced (Durie-Salmon stage II or III) multiple myeloma, advanced Waldenstrom macroglobulinemia, who, by virtue of advanced age, intensity of prior radiation and/or chemotherapy, history of prior toxicity associated with chemo/radiotherapy or existing organ dysfunction, would be at undue risk of regimen associated mortality if transplanted according to protocols involving myeloablative conditioning regimens. * Patients with aggressive NHL histologies must have chemo/radiosensitive disease, or have non-progressive disease, or have stable disease on therapy, and be ineligible for an autologous HSC transplant because of disease in the marrow. * Patients with chronic myeloid leukemia and high risk forms of acute myelogenous leukemia or myelodysplastic syndromes are also eligible in the absence of an alternative active higher priority allogeneic transplant protocol for which they are eligible. * Age criteria: Patients may be up to 70 years of age. There is no lower age threshold. Patients above the age of 70 may also participate, after evaluation and approval by the BMT Service attendings. * Absence of active or uncontrolled bacterial, viral, or fungal infection that would contraindicate the use of myelosuppressive chemotherapy. * Patients must have a healthy HLA-compatible donor, either a matched or single HLA allele disparate related donor or a similarly compatible unrelated donor recruited through the National Marrow Donor Program. Related donors must be willing to participate as research subjects and be willing to receive G-CSF to mobilize PBPC and undergo leukapheresis to donate PBSC. Unrelated donors identified by the NMDP may elect to donate either PBSC after treatment with G-CSF, or bone marrow. These unrelated donors will provide informed consent and their PBSC or bone marrow donations will be obtained at a qualified donor center participating in the NMDP. * Each patient must be willing to participate as a research subject and must sign an informed consent form after discussion of the nature and risks of the study prior to entering the protocol. Parents or legal guardians of patients who are minors will sign the consent form for these patients after discussion of the nature and risks of the study. EXCLUSION CRITERIA: * Female patients who are pregnant or lactating. * Active or uncontrolled viral (including HIV-1), bacterial or fungal infection. * Severe renal insufficiency (creatinine \>2.0 or creatinine clearance \< 30mL/minute) * Severe hepatic dysfunction, as defined by: total bilirubin greater than 2.5 mg/dL and AST and ALT \>3xnl, unless the liver is involved with disease. * Severe cardiac insufficiency, defined as a resting left ventricular ejection of less than 30% as measured by echocardiography or radionuclide cardiac angiography. Patients on cardiac medications for congestive heart failure are eligible, as long as their LVEF is greater than 30% on medication. * Severe pulmonary insufficiency, as defined by an adjusted diffusing capacity of less than 40% of predicted value. * Karnofsky or Lansky score \<40%
healthy Volunteers
false
maximum Age
70 Years
sex
ALL
std Ages
  1. CHILD
  2. ADULT
  3. OLDER_ADULT
Treatment arms and interventions
arm Groups
  1. description
    This is a stratified single-armed phase II study designed to investigate the safety and efficacy of hematopoietic cell allografts administered after nonmyeloablative cytoreduction.
    intervention Names
    1. Biological: alemtuzumab
    2. Drug: cyclosporine
    3. Drug: fludarabine phosphate
    4. Drug: melphalan
    5. Procedure: allogeneic bone marrow transplantation
    6. Procedure: peripheral blood stem cell transplantation
    label
    TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    type
    EXPERIMENTAL
interventions
  1. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    description
    Consenting individuals will receive pretransplant immunosuppressive cytoreduction, which will consist of 4 days of Campath-1H, 5 days of fludarabine, and two days of melphalan. All therapy should be completed approximately 24-36 hours before administration of the primary allograft. Campath-1H (20mg/dose/day) will be administered for each of four days from day -8 to day -5, inclusive. Each dose will be infused intravenously over 8 hours.
    name
    alemtuzumab
    other Names
    1. Campath
    type
    BIOLOGICAL
  2. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    description
    Patients will be treated with Cyclosporine as prophylaxis against GvHD. Cyclosporine will be initiated at least 1 day prior to transplant at a dose of 1.5 mg / kg IV q12h (3 mg / kg / day = total daily dose). Dose will thereafter be adjusted to maintain a trough serum level of 200-300 ng /ml. Cyclosporine will be administered intravenously until the patient tolerates full alimentation, at which time conversion to oral dosing to sustain therapeutic levels will be initiated according to standard BMT service guidelines.
    name
    cyclosporine
    type
    DRUG
  3. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    description
    Fludarabine, 25mg/m2/d will be administered for each of five days from day -8 to day -4, inclusive. Each dose will be infused intravenously over 30 minutes.
    name
    fludarabine phosphate
    type
    DRUG
  4. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    description
    Melphalan will be administered intravenously over 30 minutes on each of two days from day -3 to day -2, inclusive. The dose for recipients of HLA-matched related grafts will be 50 mg/m2/day x 2. The dose for recipients of HLA-matched unrelated and HLA-single allele disparate related or unrelated marrow or PBSC transplants will be 70 mg/m2/day x 2.
    name
    melphalan
    type
    DRUG
  5. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    name
    allogeneic bone marrow transplantation
    type
    PROCEDURE
  6. arm Group Labels
    1. TREATMENT OF LYMPHOHEMATOPOIETIC MALIGNANCIES
    name
    peripheral blood stem cell transplantation
    type
    PROCEDURE
Study design
allocation
NA
intervention Model
SINGLE_GROUP
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
51
type
ACTUAL
Registered outcome plans (not posted results)
primary Outcomes
  1. measure
    Overall Survival
    time Frame
    12 months post transplant
  2. measure
    Overall Survival
    time Frame
    24 months post transplant
  3. description
    Grade III-IV Acute Graft-versus-Host Disease
    measure
    Acute Graft-versus-Host Disease Matched Related Patients
    time Frame
    up to 4 months post transplant
secondary Outcomes
  1. description
    Grade III-IV Acute Graft-versus-Host Disease
    measure
    Acute Graft-versus-Host Disease Unrelated and Mismatched Related Patients
    time Frame
    up to 4 months post transplant
  2. measure
    Extensive Chronic Graft-versus-Host Disease Matched Related Patients
    time Frame
    up to 2 years post transplant
  3. measure
    Extensive Chronic Graft-versus-Host Disease Unrelated and Mismatched Related Patients
    time Frame
    up to 2 years post transplant
Full study description
brief Summary
RATIONALE: Giving low doses of chemotherapy, such as melphalan and fludarabine, and a monoclonal antibody, such as alemtuzumab, before a donor bone marrow or peripheral blood stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine after the transplant may stop this from happening. PURPOSE: This phase II trial is studying how well fludarabine, melphalan, alemtuzumab, and peripheral stem cell transplant work in treating patients with hematologic cancer.
detailed Description
OBJECTIVES: Overall survival-12 months Overall survival-24 months Acute Graft-versus-Host Disease Matched Related patients-up to 4 months post transplant Acute Graft-versus-Host Disease Unrelated and Mismatched related patients- up to 4 months post transplant Chronic Graft-versus-Host Disease Matched Related patients- up to 2 years post transplant Chronic Graft-versus-host disease Unrelated and Mismatched related patients- up to 2 years post transplant * OUTLINE: Patients are stratified according to donor type (HLA-matched related vs HLA-matched unrelated, single HLA-allele disparate related, or unmatched) (HLA-mismatched related or matched unrelated donor stratum closed to accrual as of 1/11/06). Patients receive a nonmyeloablative regimen comprising alemtuzumab IV over 8 hours on days -8 to -5, fludarabine IV over 30 minutes on days -8 to -4, and melphalan IV over 30 minutes on days -3 and -2. Allogeneic peripheral blood stem cells or bone marrow is infused on day 0. Patients receive graft-versus host disease prophylaxis comprising cyclosporine IV every 12 hours beginning on day -1 and continuing orally as tolerated until day 100. Patients are followed every 6 weeks for 6 months, every 3 months for 6 months, every 3-6 months for 1 year, and then annually thereafter or as clinically indicated. PROJECTED ACCRUAL: A maximum of 50 patients (25 HLA-matched related and 25 HLA-mismatched related or matched unrelated) will be accrued for this study within 2 years (HLA-mismatched related or matched unrelated donor stratum closed to accrual as of 1/11/06).
Source references
Source notices and limitations
    Discovery and provenance
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    Preserved source evidence · Not medical advice