Leukemia, Lymphoma
Conditions
Keywords
Graft-Versus-Host Disease, GVHD Prevention, Hodgkin's Disease, Leukemia, Lymphoma, Methotrexate, Tacrolimus, Pentostatin
Brief summary
Primary Objective: 1\. To determine efficacy of escalating doses of pentostatin in combination with tacrolimus and methotrexate for the prevention of acute graft-versus-host disease (GVHD) in the context of unrelated donor and one antigen mismatched related donor transplantation. Secondary Objectives: 1. To determine safety of escalating doses of pentostatin in combination with tacrolimus and methotrexate. 2. To reduce the incidence of acute GVHD following transplants with unrelated donor to 40%. 3. To document blood levels of tacrolimus when combined with pentostatin.
Detailed description
During the study, patients will have blood, urine, bone marrow, and X-ray exams done. These exams are done to monitor the results of the transplantation. Blood tests will be done daily while patients are hospitalized. Patients in this study will receive chemotherapy and/or radiation to treat their malignancy and prevent graft rejection. This is given before the infusion of donor cells. Patients with myeloid leukemias may receive busulfan by vein (IV) for 4 days and cyclophosphamide by vein for 2 days. Patients with lymphoid malignancies may receive thiotepa by vein in one dose, cyclophosphamide by vein for 2 days, and irradiation for 4 days. Other chemotherapy treatments may be used before donor cell infusion. IV injections will be given through a previously inserted catheter that extends into the vena cava (a large chest vein). Patients will be randomly picked (as in the toss of a coin) to receive one of five different treatments. This is done to learn the benefit of pentostatin treatment and the appropriate dose. Four of the treatments will use different dose schedules of pentostatin. The fifth treatment group will receive no pentostatin at all. All patients receive tacrolimus and methotrexate. Pentostatin will be given by vein in 4 doses during the first month after transplant. Tacrolimus (FK506) will be given by vein or mouth for 6 months. Methotrexate will be given by vein for 3 doses in the first week after transplant. Patients will receive blood and platelet transfusions after the transplant. The number of transfusions will depend on how quickly the blood cell counts return to a normal range. Patients will remain in the hospital for about 4-6 weeks and in the Houston area for 100 days after the transplant. This is an investigational study. All of the study drugs are commercially available. Pentostatin will not be used for GVHD prevention outside of this study. A total of 150 patients will take part in this study.
Interventions
DRUGPentostatin
Given intravenously on days +8, +15, +22 and +30 post transplant: Group 2 - Pentostatin 0.5 mg/m\^2 Group 3 - Pentostatin 1 mg/m\^2 Group 4 - Pentostatin 1.5 mg/m\^2 Group 5 - Pentostatin 2 mg/m\^2
DRUGTacrolimus
Given intravenously from day -2, and will be switched to oral dosing when tolerated.
DRUGMethotrexate
Given intravenously on days +1, +3, and +6 at the dose of 5 mg/m2.
Sponsors
Astex Pharmaceuticals, Inc.
M.D. Anderson Cancer Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1. Patients receiving allogeneic hematopoietic transplants from an unrelated donor or one antigen mismatched related donors. 2. Patients with AML, ALL, Hodgkin's disease, MDS (including CMML), CML in late chronic or accelerated phase or in blast crisis, and lymphoma in first or later relapses. 3. Patients must have bilirubin \< 1.5 mg/dL, DLCO \> 50% predicted, LVEF \> 45% and performance status 0 or 1. 4. Candidates must have a creatinine level \< 1.5 mg/dL or a calculated creatinine clearance \> 60 ml/min.
Exclusion criteria
1. HIV seropositivity 2. Uncontrolled infection 3. Pregnancy 4. Candidates should not have received chemotherapy other than hydroxyurea or Gleevec for at least 3 weeks prior to treatment. Maintenance therapy with oral chemotherapy is acceptable. Treatment day is defined as transplant day +8, which is the date of first dose of pentostatin. 5. Diagnosis of myelofibrosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients Without GVHD at 100 Days | 100 days | The primary efficacy endpoint of escalating doses Pentostatin with Tacrolimus + Methotrexate is success, defined to be that the patient is alive, engrafted, and without acute graft-versus-host disease (GVHD) at 100 days. |
Countries
United States
Participant flow
Recruitment details
Recruitment Period: September 15, 2000 to July 26, 2007; All recruitment done at UT MD Anderson Cancer Center
Pre-assignment details
A total of 150 patients were enrolled, and 147 were available for analysis. Two patients assigned to the 1.5 mg/m\^2 arm were removed without receiving treatment (due to ineligibility, and poor donor cell collection). A patient assigned to arm 2.0 mg/m\^2 withdrew consent before being treated.
Participants by arm
| Arm | Count |
|---|---|
| No Pentostatin Group 1: No Pentostatin | 37 |
| Pentostatin 0.5 Group 2: Pentostatin 0.5 mg/m\^2 | 10 |
| Pentostatin 1 Group 3: Pentostatin 1 mg/m\^2 | 29 |
| Pentostatin 1.5 Group 4: Pentostatin 1.5 mg/m\^2 | 63 |
| Pentostatin 2 Group 5: Pentostatin 2 mg/m\^2 | 11 |
| Total | 150 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Overall Study | Physician Decision | 0 | 0 | 0 | 2 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 0 | 0 | 0 | 1 |
Baseline characteristics
| Characteristic | Pentostatin 0.5 | Pentostatin 1 | Pentostatin 1.5 | No Pentostatin | Pentostatin 2 | Total |
|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 1 Participants | 2 Participants | 1 Participants | 0 Participants | 4 Participants |
| Age, Categorical Between 18 and 65 years | 10 Participants | 28 Participants | 61 Participants | 36 Participants | 11 Participants | 146 Participants |
| Age, Continuous | 42 years STANDARD_DEVIATION 23 | 47 years STANDARD_DEVIATION 20 | 50 years STANDARD_DEVIATION 22 | 50 years STANDARD_DEVIATION 19 | 45 years STANDARD_DEVIATION 32 | 46.8 years STANDARD_DEVIATION 23.2 |
| Region of Enrollment United States | 10 participants | 29 participants | 63 participants | 37 participants | 11 participants | 150 participants |
| Sex: Female, Male Female | 3 Participants | 11 Participants | 30 Participants | 15 Participants | 7 Participants | 66 Participants |
| Sex: Female, Male Male | 7 Participants | 18 Participants | 33 Participants | 22 Participants | 4 Participants | 84 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 28 / 37 | 9 / 10 | 17 / 29 | 40 / 61 | 7 / 10 |
| serious Total, serious adverse events | 0 / 27 | 0 / 10 | 0 / 29 | 0 / 61 | 0 / 10 |
Outcome results
Primary
Number of Patients Without GVHD at 100 Days
The primary efficacy endpoint of escalating doses Pentostatin with Tacrolimus + Methotrexate is success, defined to be that the patient is alive, engrafted, and without acute graft-versus-host disease (GVHD) at 100 days.
Time frame: 100 days
Population: All analysis was intention to treat (ITT).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Pentostatin | Number of Patients Without GVHD at 100 Days | 100 participants |