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NCT03192397 · REGISTRY CONDITION SEARCH

Chemotherapy, Total Body Irradiation, and Post-Transplant Cyclophosphamide in Reducing Rates of Graft Versus Host Disease in Patients With Hematologic Malignancies Undergoing Donor Stem Cell Transplant

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

Phase
PHASE1, PHASE2
Status at capture
ACTIVE NOT RECRUITING
Registry last update
2026-04-14

This phase Ib/2 trial studies how well chemotherapy, total body irradiation, and post-transplant cyclophosphamide work in reducing rates of graft versus host disease in patients with hematologic malignancies undergoing a donor stem cell transplant. Drugs used in the chemotherapy, such as fludarabine phosphate and melphalan hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy and total-body irradiation before a donor stem cell transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer 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. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells (called graft versus host disease). Giving cyclophosphamide after the transplant may stop this from happening.

Open the original ClinicalTrials.gov record → · Download preserved record

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

Extensive Chronic Graft Versus Host Disease (GVHD)

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outcome · POSTED

Clinical Response Assessed as Per Bone Marrow Transplant (BMT) Standard of Care

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outcome · POSTED

Cumulative Incidence of Grade III-IV Acute Graft Versus Host Disease (GVHD)

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outcome · POSTED

Cumulative Incidence of Relapse

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outcome · POSTED

Engraftment Rate Assessed as Per Bone Marrow Transplant (BMT) Standard of Care

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outcome · POSTED

Overall Survival Assessed as Per Bone Marrow Transplant (BMT) Standard of Care

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outcome · POSTED

1-Year Progression Free Survival (PFS) Rate Assessed as Per Bone Marrow Transplant (BMT) Standard of Care

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outcome · POSTED

Treatment-related Mortality Rates

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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: * The patient must have a diagnosis of one of the following (one must be yes): * Acute myeloid leukemia (AML) * Acute lymphoblastic leukemia (ALL) * Chronic lymphoblastic leukemia (CLL) * Chronic myelogenous leukemia (CML) (chronic phase intolerant or unresponsive to tyrosine kinase inhibitors, accelerated phase, history of blast crisis) * Myelodysplastic syndrome (MDS) * Non-Hodgkin lymphoma (NHL) * Hodgkin lymphoma (HL) (received and failed frontline therapy or failed autologous transplantation or inability to collect enough peripheral blood stem cells \[PBSC\] for autologous hematopoietic cell transplant \[auto-HCT\]) * Multiple myeloma (MM) * Severe aplastic anemia * Histocompatible donor identified: * Related donor matched 5/6 or better (A, B, DRB1) * Unrelated donor matched 7/8 or better (A, B, C and DRB1) * Patients with severe aplastic anemia do not have disease requirements; however, if the patient has a mismatched donor, the patient must have had prior therapy with ATG. The following are eligible for study inclusion: * Patients with MDS/MPN only require \<5% myeloblast on bone marrow evaluation. * Patients with AML, ALL or CLL may be in CRi, patients with MM may be in VGPR * Patients with NHL/HL must be in CR * Have a Karnofsky performance status score of \> 50% * Diffusing capacity of the lung for carbon monoxide (DLCO) \> 40% predicted, corrected for hemoglobin and/or alveolar ventilation * Left ventricular ejection fraction \> 40% * Bilirubin =\< 3 x upper limit of normal * Liver alkaline phosphatase =\< 3 x upper limit of normal * Serum glutamic-oxaloacetic transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) =\< 3 x upper limit of normal * Calculated creatinine clearance \> 40 cc/min by the modified Cockroft-Gault formula * Patient must be cleared pre-transplant by Radiation Oncology to be able to receive 400 cGy * Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately * Patients who have failed a prior autologous or allogeneic transplant are eligible; however, at least 6 months must have elapsed between the start of this reduced intensity conditioning regimen and the last transplant if patient had a prior autologous or myeloablative allogeneic bone marrow transplant (BMT) * At least 2 weeks since prior radiation treatment and/or surgery. Appropriate washout of prior chemotherapy per BMT standard of care. If medication is not on the list, go by physician discretion * Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure Exclusion Criteria: * Moderate to severe myelofibrosis within 60 days prior to transplant * Presence of human leukocyte antigen (HLA) antibodies to the donor within 60 days prior to transplant * Patients who in the opinion of the treating physician are unlikely to comply with the restrictions of allogeneic stem cell transplantation based on formal psychosocial screening. (i.e., serious, uncontrolled psychiatric illness/social situations that would limit compliance with study requirements) * Uncontrolled diabetes mellitus, cardiovascular disease, active serious infection or other condition which, in the opinion of treating physician, would make this protocol unreasonably hazardous for the patient * Known human immunodeficiency virus (HIV) positive * Pregnant or nursing female participants * Unwilling or unable to follow protocol requirements * Any condition which in the Investigator's opinion deems the participant an unsuitable candidate to receive study intervention
healthy Volunteers
false
minimum Age
18 Years
sex
ALL
std Ages
  1. ADULT
  2. OLDER_ADULT
Treatment arms and interventions
arm Groups
  1. description
    CONDITIONING REGIMEN: Patients receive fludarabine phosphate IV over 30 minutes on days -5 to -2 and 50mg/m2 melphalan hydrochloride IV over 30 minutes on day -2. Patients undergo TBI on day -1. STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and sirolimus IV and then PO once tolerated on days 5-180 with a taper beginning on day 100.
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Drug: Cyclophosphamide
    3. Drug: Fludarabine Phosphate
    4. Other: Laboratory Biomarker Analysis
    5. Drug: Melphalan Hydrochloride
    6. Drug: Mycophenolate Mofetil
    7. Drug: Sirolimus
    8. Radiation: Total-Body Irradiation
    label
    <=50 years of age Cohort A
    type
    EXPERIMENTAL
  2. description
    Patients receive fludarabine phosphate IV over 30 minutes on days -5 to -2 and melphalan hydrochloride IV over 30 minutes on day -2. Patients undergo TBI on day -1. Patients recieve 75 mg/m2 Melphalan STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and sirolimus IV and then PO once tolerated on days 5-180 with a taper beginning on day 100.
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Drug: Cyclophosphamide
    3. Drug: Fludarabine Phosphate
    4. Other: Laboratory Biomarker Analysis
    5. Drug: Melphalan Hydrochloride
    6. Drug: Mycophenolate Mofetil
    7. Drug: Sirolimus
    8. Radiation: Total-Body Irradiation
    label
    <=50 years of age Cohort B
    type
    EXPERIMENTAL
  3. description
    Following the administration of Fludarabine 40 mg/m2/day on Days -5 to -2.75 mg/m2 Patients receive 25 mg/m2 Melphalan STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and sirolimus IV and then PO once tolerated on days 5-180 with a taper beginning on day 100.
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Drug: Cyclophosphamide
    3. Drug: Fludarabine Phosphate
    4. Other: Laboratory Biomarker Analysis
    5. Drug: Melphalan Hydrochloride
    6. Drug: Mycophenolate Mofetil
    7. Drug: Sirolimus
    8. Radiation: Total-Body Irradiation
    label
    >50 years of age Cohort A -25 mg/m2 Melphalan
    type
    EXPERIMENTAL
  4. description
    Following the administration of Fludarabine 40 mg/m2/day on Days -5 to -2, Patients receive 50 mg/m2 Melphalan STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and sirolimus IV and then PO once tolerated on days 5-180 with a taper beginning on day 100.
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Drug: Cyclophosphamide
    3. Drug: Fludarabine Phosphate
    4. Other: Laboratory Biomarker Analysis
    5. Drug: Melphalan Hydrochloride
    6. Drug: Mycophenolate Mofetil
    7. Drug: Sirolimus
    8. Radiation: Total-Body Irradiation
    label
    >50 years of age Cohort B 50 mg/m2 Melphalan
    type
    EXPERIMENTAL
  5. description
    Following the administration of Fludarabine 40 mg/m2/day on Days -5 to -2, patients receive 75 mg/m2 Melphalan STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and sirolimus IV and then PO once tolerated on days 5-180 with a taper beginning on day 100.
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Drug: Cyclophosphamide
    3. Drug: Fludarabine Phosphate
    4. Other: Laboratory Biomarker Analysis
    5. Drug: Melphalan Hydrochloride
    6. Drug: Mycophenolate Mofetil
    7. Drug: Sirolimus
    8. Radiation: Total-Body Irradiation
    label
    >50 years of age Cohort C .75 mg/m2 Melphalan
    type
    EXPERIMENTAL
interventions
  1. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Undergo allogeneic hematopoietic stem cell transplant
    name
    Allogeneic Hematopoietic Stem Cell Transplantation
    other Names
    1. allogeneic stem cell transplantation
    2. HSC
    3. HSCT
    type
    PROCEDURE
  2. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Given IV
    name
    Cyclophosphamide
    other Names
    1. (-)-Cyclophosphamide
    2. 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
    3. Carloxan
    4. Ciclofosfamida
    5. Ciclofosfamide
    6. Cicloxal
    7. Clafen
    8. Claphene
    9. CP monohydrate
    10. CTX
    11. CYCLO-cell
    12. Cycloblastin
    type
    DRUG
  3. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Given IV
    name
    Fludarabine Phosphate
    other Names
    1. 2-F-ara-AMP
    2. 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-
    3. Beneflur
    4. Fludara
    5. SH T 586
    type
    DRUG
  4. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Correlative studies
    name
    Laboratory Biomarker Analysis
    type
    OTHER
  5. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Given IV
    name
    Melphalan Hydrochloride
    other Names
    1. Alkeran
    2. Alkerana
    3. Evomela
    type
    DRUG
  6. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Given IV
    name
    Mycophenolate Mofetil
    other Names
    1. Cellcept
    2. MMF
    type
    DRUG
  7. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Given IV and PO
    name
    Sirolimus
    other Names
    1. Rapamune
    type
    DRUG
  8. arm Group Labels
    1. <=50 years of age Cohort A
    2. <=50 years of age Cohort B
    3. >50 years of age Cohort A -25 mg/m2 Melphalan
    4. >50 years of age Cohort B 50 mg/m2 Melphalan
    5. >50 years of age Cohort C .75 mg/m2 Melphalan
    description
    Undergo TBI
    name
    Total-Body Irradiation
    other Names
    1. TOTAL BODY IRRADIATION
    2. Whole-Body Irradiation
    type
    RADIATION
Study design
allocation
NON_RANDOMIZED
intervention Model
SINGLE_GROUP
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
35
type
ACTUAL
Registered outcome plans (not posted results)
primary Outcomes
  1. description
    Percentage of chronic GVHD of response by human leukocyte antigen (HLA) matching by cohort
    measure
    Extensive Chronic Graft Versus Host Disease (GVHD)
    time Frame
    Up to 365 days
secondary Outcomes
  1. description
    Patients who achieved a clinical response will be summarized descriptively using frequency counts
    measure
    Clinical Response Assessed as Per Bone Marrow Transplant (BMT) Standard of Care
    time Frame
    Up to 4 years
  2. description
    Will be analyzed in a descriptive fashion with means +/- standard deviations or frequency counts. Will examine in a post-hoc analysis potential chronic GVHD rates of response by human leukocyte antigen (HLA) matching status.
    measure
    Cumulative Incidence of Grade III-IV Acute Graft Versus Host Disease (GVHD)
    time Frame
    Up to 4 years
  3. description
    Will be analyzed in a descriptive fashion with frequency counts.
    measure
    Cumulative Incidence of Relapse
    time Frame
    Up to 4 years
  4. description
    Will be analyzed in a descriptive fashion with frequency counts.
    measure
    Engraftment Rate Assessed as Per Bone Marrow Transplant (BMT) Standard of Care
    time Frame
    Up to 4 years
  5. description
    Will utilize either straight Kaplan-Meier based estimators or extensions of nonparametric survival models to account for competing risks.
    measure
    Overall Survival Assessed as Per Bone Marrow Transplant (BMT) Standard of Care
    time Frame
    Up to 4 years
  6. description
    Will utilize either straight Kaplan-Meier based estimators or extensions of nonparametric survival models to account for competing risks.
    measure
    1-Year Progression Free Survival (PFS) Rate Assessed as Per Bone Marrow Transplant (BMT) Standard of Care
    time Frame
    At 1 year
  7. description
    Count of participants that died by cohort.
    measure
    Treatment-related Mortality Rates
    time Frame
    All-Cause Mortality monitored/assessed up to 4 years. Adverse Events monitored/assessed from the start date of the conditioning regimen (Day -5) until 30 days after stem cell infusion will be reported, up to 12 months.
Full study description
brief Summary
This phase Ib/2 trial studies how well chemotherapy, total body irradiation, and post-transplant cyclophosphamide work in reducing rates of graft versus host disease in patients with hematologic malignancies undergoing a donor stem cell transplant. Drugs used in the chemotherapy, such as fludarabine phosphate and melphalan hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy and total-body irradiation before a donor stem cell transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer 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. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells (called graft versus host disease). Giving cyclophosphamide after the transplant may stop this from happening.
detailed Description
PRIMARY OBJECTIVES: I. To determine the cumulative incidence of extensive chronic graft versus host disease (GVHD) at 1 year after transplantation utilizing the novel conditioning/GVHD prophylactic regimen for patients undergoing allogeneic hematopoietic cell transplantation, in patients who do not progress before day 100. SECONDARY OBJECTIVES: I. To evaluate clinical response, engraftment rate, progression-free survival (PFS) at one year and, overall survival (OS). II. To determine the cumulative incidence of relapse. III. To evaluate the day 100 transplant-related mortality rate. IV. To determine the cumulative incidence of grade III-IV acute GVHD. OUTLINE: This is a dose-escalation study of melphalan hydrochloride. CONDITIONING REGIMEN: Patients receive fludarabine phosphate intravenously (IV) over 30 minutes on days -5 to -2 and melphalan hydrochloride IV over 30 minutes on day -2. Patients undergo total body irradiation (TBI) on day -1. STEM CELL INFUSION: Patients undergo allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS REGIMEN: Patients receive cyclophosphamide IV over 2 hours on days 3-4, mycophenolate mofetil IV over 2 hours on days 5-35, and tacrolimus IV and then orally (PO) once tolerated on days 5-180 with a taper beginning on day 100. After completion of study treatment, patients are followed up for 12 months and then annually thereafter.
Source references
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