Leukemia, Myelodysplastic/Myeloproliferative Diseases, Myelodysplastic Syndromes
Conditions
Keywords
refractory anemia, refractory anemia with ringed sideroblasts, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, childhood myelodysplastic syndromes
Brief summary
RATIONALE: Umbilical cord blood transplantation may allow doctors to give higher doses of chemotherapy or radiation therapy and kill more cancer cells. PURPOSE: This phase II trial is studying how well umbilical cord blood transplantation works in treating patients with severe aplastic anemia, malignant thymoma, or myelodysplasia.
Detailed description
OBJECTIVES: * Determine the rates of durable engraftment in patients with severe aplastic anemia, myelodysplastic syndrome, inborn errors of metabolism, or inherited hematopoietic disorders, refractory to medical management, who are undergoing high-dose chemoradiotherapy followed by unrelated cord blood (UCB) transplantation. * Evaluate the rate and quality of immunologic reconstitution in this patient population. OUTLINE: Patients are stratified according to weight (under 45 kg vs over 45 kg). Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT). The regimen varies according to the underlying cause of the anemia, but could include busulfan, cyclophosphamide or melphalan, anti-thymocyte globulin or methylprednisolone, and/or radiation therapy. One day after the conditioning regimen is completed, patients receive the UCBT. Patients are followed weekly for 3 months, at 6 months, then every 6 months for 2.5 years, then annually thereafter. PROJECTED ACCRUAL: A total of 4-90 patients will be accrued for this study within 5 years.
Interventions
BIOLOGICALanti-thymocyte globulin
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
DRUGbusulfan
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
DRUGcyclophosphamide
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
DRUGmelphalan
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
DRUGmethylprednisolone
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
PROCEDUREbone marrow ablation with stem cell support
PROCEDUREumbilical cord blood transplantation
One day after the conditioning regimen is completed, patients receive the UCBT.
RADIATIONradiation therapy
The regimen varies according to the underlying cause of the anemia.Patients receive high-dose chemotherapy and/or radiotherapy as a conditioning regimen beginning 6-9 days before the umbilical cord blood transplant (UCBT).
Sponsors
National Cancer Institute (NCI)
Case Comprehensive Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 55 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed diagnosis of severe aplastic anemia based on bone marrow cellularity of less than 20% * Must meet at least two of the following criteria: * Granulocyte count less than 500/mm\^3 * Platelet count less than 20,000/mm\^3 * Reticulocyte count less than 50,000/mm\^3 * Following etiologies eligible: * Fanconi's anemia * Hypoplastic leukemia * Monosomy 7 * Drug exposure (chloramphenicol, NSAIDS) * Viral exposure (EBV, hepatitis, parvovirus, HIV) * Nutritional deficiencies * Thymoma * Paroxysmal nocturnal hemoglobinuria * Amegakaryocytic thrombocytopenia OR * Histologically confirmed myelodysplastic syndrome (MDS) that is refractory to medical management or with cytogenic abnormalities predictive of transformation into acute leukemia, including 5q-, 7q-, monosomy 7, or trisomy 8 * The following etiologies only are eligible: * Refractory anemia * Refractory anemia with ringed sideroblasts * De novo primary MDS * Therapy-related secondary MDS OR * Confirmed diagnosis of inherited hematopoietic disorder that is refractory to medical management * Following etiologies eligible: * Severe combined immunodeficiency * Familial erythrophagocytic lymphohistiocytosis * Wiskott-Aldrich syndrome * Kostmann's syndrome (infantile histiocytosis) * Chronic granulomatous disease * Leukocytic adhesion deficiency * Chediak-Higashi syndrome * Paroxysmal nocturnal hemoglobinuria * Fanconi's anemia * Dyskeratosis congenita * Diamond-Blackfan anemia * Amegakaryocytic thrombocytopenia * Osteopetrosis * Gaucher's disease * Lesch-Nyhan syndrome * Mucopolysaccharidoses * Lipodoses * Autologous or haploidentical related peripheral blood stem cells available as backup * Serologically matched umbilical cord blood unit available in the New York Blood Center's Placental Blood Project, or other acceptable umbilical cord blood registry PATIENT CHARACTERISTICS: Age: * 55 and under Performance status: * Zubrod 0-1 * Karnofsky 80-100% Life expectancy: * At least 3 months Hematopoietic: * See Disease Characteristics Hepatic: * ALT/AST no greater than 4 times normal * Bilirubin no greater than 2.0 mg/dL Renal: * Creatinine no greater than 2.0 mg/dL * Creatinine clearance at least 50 mL/min Cardiovascular: * Normal cardiac function by echocardiogram or radionuclide scan * Shortening fraction or ejection fraction at least 80% normal for age * Non-Fanconi patients with acquired or congenital cardiomyopathy may receive melphalan as a substitute for cyclophosphamide Pulmonary: * FVC and FEV\_1 at least 60% of predicted for age * DLCO at least 60% of predicted in adult patients Other: * No active concurrent malignancy * No active infection * Not pregnant or nursing * HIV negative * Must have an available serologic matched Umbilical Cord Blood Unit (UCBU) in the New York Blood Center's Placental Blood Project, or other acceptable Umbilical Cord Blood (UCB) registry PRIOR CONCURRENT THERAPY: Biologic therapy: * Not specified Chemotherapy: * No concurrent cytotoxic chemotherapy Endocrine therapy: * No concurrent immunosuppressive medications Radiotherapy: * No concurrent radiotherapy Surgery: * Not specified
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Event-free survival by disease assessment | at 100 days and at 6, 9, 12, 18, and 24 months |
Secondary
| Measure | Time frame |
|---|---|
| Umbilical cord blood donor engraftment by chimerism and complete blood count (CBC) at time of myeloid recovery. | 100 days and at 6, 9, 12, 18, and 24 months |
Countries
United States
Outcome results
None listed