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Donor Umbilical Cord Blood Transplant in Treating Patients With Advanced Hematological Cancer or Other Disease

Transplantation of Unrelated Donor Umbilical Cord Blood in Patients With Hematological Malignancies Using a Non-Myeloablative Preparative Regimen

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00719849
Enrollment
13
Registered
2008-07-22
Start date
2005-11-30
Completion date
2009-12-31
Last updated
2017-06-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic/Myeloproliferative Diseases, Myelodysplastic Syndromes

Keywords

chronic myelogenous leukemia, acute lymphoblastic leukemia, acute myeloid leukemia, atypical chronic myeloid leukemia, chronic myelomonocytic leukemia, anaplastic large cell lymphoma, splenic marginal zone lymphoma, nodal marginal zone B-cell lymphoma, recurrent adult Hodgkin lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent childhood large cell lymphoma, recurrent mycosis fungoides/Sezary syndrome, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent mantle cell lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, recurrent/refractory childhood Hodgkin lymphoma, childhood diffuse large cell lymphoma, childhood immunoblastic large cell lymphoma, refractory multiple myeloma, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, myelodysplastic/myeloproliferative disease, childhood myelodysplastic syndromes, recurrent childhood anaplastic large cell lymphoma, refractory anemia, refractory anemia with excess blasts, refractory anemia with ringed sideroblasts, refractory cytopenia with multilineage dysplasia, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, stage III adult immunoblastic large cell lymphoma, stage IV adult immunoblastic large cell lymphoma, stage III childhood anaplastic large cell lymphoma, stage III childhood large cell lymphoma, stage IV childhood anaplastic large cell lymphoma, stage IV childhood large cell lymphoma, stage III adult Hodgkin lymphoma, stage III childhood Hodgkin lymphoma, stage IV adult Hodgkin lymphoma, stage IV childhood Hodgkin lymphoma, stage II multiple myeloma, stage III multiple myeloma, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, stage III marginal zone lymphoma, stage IV marginal zone lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, stage IV grade 3 follicular lymphoma, Waldenstrom macroglobulinemia, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, stage III mycosis fungoides/Sezary syndrome, stage IV mycosis fungoides/Sezary syndrome, juvenile myelomonocytic leukemia, chronic eosinophilic leukemia, chronic idiopathic myelofibrosis, chronic neutrophilic leukemia, essential thrombocythemia, polycythemia vera

Brief summary

RATIONALE: Giving low doses of chemotherapy and total-body irradiation before a donor umbilical cord blood transplant helps stop the growth of cancer or abnormal cells. It may also stop the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells 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 and mycophenolate mofetil before and after transplant may stop this from happening. PURPOSE: This phase II trial is studying how well donor umbilical cord blood transplant with reduced intensity conditioning works in treating patients with advanced hematological cancer or other disease.

Detailed description

OBJECTIVES: Primary * To estimate the probability of survival at 1 year in patients with advanced hematological malignancies or other diseases treated with non-myeloablative unrelated donor umbilical cord blood transplantation. Secondary * Six month non-relapse mortality. * Chimerism at days 7, 14, 21, 28, 56, and 80, at 6 months, and at 1 and 2 years. * To determine the incidence of neutrophil engraftment at day 42. * To determine the incidence of platelet engraftment at 6 months. * To determine the incidence of grade II-IV and III-IV acute graft-versus-host-disease (GVHD) at day 100. * To determine the incidence of chronic GVHD at 1 year. * To determine the incidence of clinically significant infections at 6 months and at 1 and 2 years. * To determine the probability of progression-free survival at 1 and 2 years. * To determine the probability of survival at 2 years. * To determine the incidence of relapse or disease progression at 1 and 2 years. OUTLINE: Patients are stratified according to disease status and prior therapy (hematologic malignancy or other disease that was treated with an autologous stem cell transplant or ≥ 2 courses of multiagent chemotherapy within the past 3 months vs hematologic malignancy or other disease that was treated with an autologous stem cell transplant \> 12 months ago or with ≤ 1 course of multiagent chemotherapy or immunosuppressive chemotherapy within the past 3 months vs refractory leukemia or lymphoma for which patient was rendered aplastic either by induction chemotherapy or radioimmunoconjugated monoclonal antibody therapy). * Conditioning regimen: Patients receive fludarabine phosphate IV over 1 hour on days -6 to -2 and cyclophosphamide IV on day -6. Patients also undergo total body irradiation on day -1. Some patients also receive anti-thymocyte globulin IV on days -6 to -4. * Umbilical cord blood transplantation (UCBT): Patients undergo UCBT on day 0. * Immunosuppressive therapy (graft-versus-host disease prophylaxis): Patients receive cyclosporine IV over 1 hour or orally (as tolerated) every 8 or 12 hours beginning on day -3 and continuing for approximately 6 months. Patients also receive mycophenolate mofetil IV every 8 hours on days -3 to 5 and then orally on days 6-30. After completion of study treatment, patients are followed at 6 months and then annually thereafter.

Interventions

BIOLOGICALanti-thymocyte globulin

30mg/Kg Days -6 to -4

DRUGcyclophosphamide

50 mg/Kg Day -6

DRUGcyclosporine

Patients will receive cyclosporine A (CSA) therapy beginning on Day -3 maintaining a trough level between 250 and 500 ng/mL. For adults the initial dose will be 2.5 mg/kg IV over 1 hour every 12 hours. For children \< 40 kg the initial dose will be 2.5 mg/kg IV over 1 hour every 8 hours.

DRUGfludarabine phosphate

40mg/m2 Days -6 to -2

DRUGmycophenolate mofetil

1 gram every 8 hours for patients who are ≥ 40 kg. Pediatric patients (\<40 kilograms) will receive MMF at the dose of 15 mg/kg/dose every 8 hours. Stop MMF at Day +30 or 7 days after engraftment, whichever day is later, if no acute GVHD.

PROCEDUREumbilical cord blood transplantation

Single or double unit umbilical cord blood transplant

RADIATIONtotal body irradiation

200 cGy Day -1

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Fred Hutchinson Cancer Center
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
No minimum to 69 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Diagnosis of advanced hematologic malignancy or other disease not curable by conventional chemotherapy, including any of the following: * Acute myeloid leukemia in complete remission (CR)\* (as defined by hematologic recovery, \< 5% blasts in the bone marrow by morphology, and a cellularity of \> 15%), meeting one of the following criteria: * In first complete remission (CR1) AND has high-risk disease as evidenced by any of the following: * Preceding myelodysplastic syndromes (MDS) * High-risk cytogenetics (e.g., monosomy 5 or 7, or as defined by referring institution treatment protocol) * Required \> 2 courses of therapy to obtain CR * Erythroblastic or megakaryocytic leukemia * In second CR (CR2) or beyond * Acute lymphoblastic leukemia in CR\* (as defined by hematologic recovery, \< 5% blasts in the bone marrow by morphology, and a cellularity of \> 15%), meeting one of the following criteria: * In CR1 AND has high-risk disease as evidenced by any of the following: * t(9;22), t(1;19), t(4;11), or other MLL rearrangements * Hyplodiploid * Required \> 1 course of therapy to obtain CR * Beyond CR2 * Chronic myelogenous leukemia (CML) * All types are allowed (except refractory blast crisis CML) * Patients in chronic phase CML must have failed or been intolerant to prior imatinib mesylate (Gleevec) or other tyrosine kinase inhibitors * MDS * Any subtype allowed (including refractory anemia \[RA\]) * Severe pancytopenia or complex cytogenetics * Blasts must be \< 5% (if blasts are ≥ 5%, pre-transplant induction therapy is required to reduce blast count to \< 5%) * Large cell lymphoma, Hodgkin lymphoma, or multiple myeloma, meeting one of the following criteria: * Chemotherapy-sensitive disease that has failed prior therapy * Patients with large cell lymphoma or Hodgkin lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky) * Ineligible for an autologous stem cell transplant * Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), marginal zone B-cell lymphoma, or follicular lymphoma that has progressed after ≥ 2 prior therapies * Patients with bulky disease should be considered for debulking chemotherapy prior to transplant * Patients with refractory disease are eligible provided disease is non-bulky AND an estimated tumor doubling time is ≥ 1 month * Lymphoplasmacytic lymphoma, mantle cell lymphoma, or prolymphocytic leukemia * Chemotherapy-sensitive disease that was previously treated with initial therapy * Patients with mantle cell lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky) * Mycosis fungoides and Sezary syndrome * Bone marrow failure syndromes, except for Fanconi anemia * Myeloproliferative syndromes NOTE: \*Patients for whom adequate marrow/biopsy specimens can not be obtained to determine remission status by morphologic assessment must have fulfilled criteria of remission (\< 5% blasts by flow cytometry and recovery of peripheral blood counts with no circulating blasts) * Ineligible for autologous stem cell transplant due to any of the following: * Prior autologous stem cell transplant * Inadequate autologous stem cell harvest * Inability to withstand a myeloablative preparative regimen * Clinically aggressive/high-risk disease * No evidence of progressive disease by imaging modalities or biopsy (persistent PET scan activity allowed provided there are no CT scan changes indicating progression) * Acute leukemia that is refractory, persistent, or relapsed (defined as \> 5% blasts in normocellular bone marrow) allowed provided patient was rendered aplastic either by induction chemotherapy or radioimmunoconjugated monoclonal antibody therapy * Patients with stable disease are eligible provided the largest residual nodal mass is approximately \< 5 cm (largest residual mass must represent a 50% reduction and be approximately \< 7.5 cm for patients who have responded to prior therapy) * No active CNS malignancy * Umbilical cord blood (UCB) donor available * UCB graft matched at 4/6 HLA-A, -B, and -DRB1 antigens with the recipient * May include 0-2 antigen mismatches at the A, B, or DRB1 loci * Unit selection based on cryopreserved nucleated cell dose and HLA-A, -B, and -DRB1 using intermediate resolution A, B antigen and DRB1 allele typing * If 2 UCB units are required to reach the target cell dose, each unit must be a 3/6 HLA-A, -B, and -DRB1 antigen match to each other, as well as a 4/6 antigen match to the recipient * No 5-6/6 HLA-A, -B, and -DRB1 matched sibling donor available PATIENT CHARACTERISTICS: * Karnofsky performance status (PS) 60-100% OR Lansky PS 50-100% * Creatinine ≤ 2.0 mg/dL (adults) OR creatinine clearance \> 40 mL/min (pediatrics) * Adult patients with a creatinine \> 1.2 mg/dL or a history of renal dysfunction must have an estimated creatinine clearance of \> 40 mL/min * Not pregnant or nursing * Negative pregnancy test * LVEF ≥ 35% * DLCO \> 30% predicted * No requirement for O\_2 * No decompensated congestive heart failure * No uncontrolled arrhythmia * None of the following liver diseases or conditions: * Fulminant liver failure * Cirrhosis with evidence of portal hypertension or bridging fibrosis * Alcoholic hepatitis * Esophageal varices * History of bleeding esophageal varices, hepatic encephalopathy, or correctable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time * Ascites related to portal hypertension * Bacterial or fungal abscess * Biliary obstruction * Chronic viral hepatitis with total serum bilirubin \> 3 mg/dL * Symptomatic biliary disease * Recent mold infection (e.g., Aspergillus) allowed provided patient received ≥ 30 days of appropriate treatment AND infection is controlled and cleared by Infectious Disease * No evidence of HIV infection or known HIV-positive serology * No uncontrolled viral or bacterial infection PRIOR CONCURRENT THERAPY: * See Disease Characteristics * At least 3 months since prior myeloablative stem cell transplantation

Design outcomes

Primary

MeasureTime frameDescription
Probability of Survival at 1 Year1 year post transplantKaplan-Meier estimate of the probability of survival at 1 year

Secondary

MeasureTime frameDescription
Incidence of Non-relapse Mortality at 6 Months6 months post transplantNumber of Participants with Non-relapse Mortality at 6 Months
Chimerism7 days, 14 days, 21 days, 28 days, 56 days, and 80 days, 6 months, 1 and 2 years post transplantCount of participants who experienced dominance of one cord blood unit (defined by \>or= 95% contribution of one cord blood unit to BM and all PB fractions -- CD3+, CD33+, CD56+, and CD19+) at 7 days, 14 days, 21 days, 28 days, 56 days, and 80 days, 6 months, 1 and 2 years post transplant.
Incidence of Neutrophil Engraftment at Day 42Day 42 post transplantNumber of participants with neutrophil engraftment at day 42
Incidence of Platelet Engraftment at 6 Months6 months post transplantNumber of participants with platelet engraftment at 6 months
Incidence of Grade II-IV Acute Graft-versus-host-disease (GVHD) at Day 100Day 100 post transplantNumber of participants with Grade II-IV acute graft-versus-host-disease (GVHD) at day 100. Acute GVHD Staging and Grading: Overall grade 1: stage 1-2 skin, no liver or gut Overall grade 2: stage 3 skin or stage 1 liver or stage 1 gut Overall grade 3: stage 4 skin or stage 2-4 liver or stage 2-4 gut (without GVHD as a major contributing cause of death) Overall grade 4: stage 4 skin or stage 2-4 liver or stage 2-3 gut (with GVHD as a major contributing cause of death)
Incidence of Grade III-IV Acute Graft-versus-host-disease (GVHD) at Day 100Day 100 post transplantNumber of participants with Grade III-IV acute graft-versus-host-disease (GVHD) at day 100. Acute GVHD Staging and Grading: Overall grade 1: stage 1-2 skin, no liver or gut Overall grade 2: stage 3 skin or stage 1 liver or stage 1 gut Overall grade 3: stage 4 skin or stage 2-4 liver or stage 2-4 gut (without GVHD as a major contributing cause of death) Overall grade 4: stage 4 skin or stage 2-4 liver or stage 2-3 gut (with GVHD as a major contributing cause of death)
Incidence of Chronic Graft-versus-host-disease (GVHD) at 1 Year1 year post transplantNumber of participants with chronic graft-versus-host-disease (GVHD) at 1 year. Clinical Limited cGVHD 1. Oral abnormalities consistent with cGVHD, a positive skin or lip biopsy, and no other manifestations of cGVHD. 2. Mild liver test abnormalities (alkaline phosphatase \<2 x upper limit of normal, AST or ALT \<3 x upper limit of normal and total bilirubin \<1.6) with positive skin or lip biopsy, and no other manifestations of cGVHD. 3. Less than 6 papulosquamous plaques, macular-papular or lichenoid rash involving \<20% of body surface area (BSA), dyspigmentation involving \<20% BSA, or erythema involving \<50% BSA, positive skin biopsy, and no other manifestations of cGVHD. 4. Ocular sicca (Schirmer's test \<5mm with no more than minimal ocular symptoms), positive skin or lip biopsy, and no other manifestations of cGVHD. 5. Vaginal or vulvar abnormalities with positive biopsy, and no other manifestations of cGVHD.
Probability of Survival at 2 Years2 years post transplantKaplan-Meier estimate of the probability of survival at 2 years
Incidence of Clinically Significant Infections at 1 Year1 year post transplantNumber of participants with clinically significant infections at 1 year
Incidence of Clinically Significant Infections at 2 Years2 years post transplantNumber of participants with clinically significant infections at 2 years
Probability of Progression-free Survival at 1 Year1 year post transplantKaplan-Meier estimate of the probability of progression-free survival at 1 year
Probability of Progression-free Survival at 2 Years2 years post transplantKaplan-Meier estimate of the probability of progression-free survival at 2 years
Incidence of Relapse at 1 Year1 year post transplantNumber of participants with relapse at 1 year. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Incidence of Relapse at 2 Years2 years post transplantNumber of participants with relapse at 2 years. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.
Incidence of Clinically Significant Infections at 6 Months6 months post transplantNumber of participants with clinically significant infections at 6 months

Countries

United States

Participant flow

Participants by arm

ArmCount
Cyclophosphamide/Fludarabine/TBI
Subjects with hematological malignancies with prior autologous transplant, \>2 cycles of multiagent chemotherapy, or severely immune suppressive therapy in last 3 months, OR patients with refractory leukemia and lymphoma in aplasia after induction chemotherapy or radioimmunoconjugated monoclonal antibody therapy. * Cyclophosphamide 50 mg/Kg Day -6 * Fludarabine 40mg/m2 Days -6 to -2 * TBI 200 cGy Day -1 Immune suppression begin Day -3: cyclosporine and mycophenolate mofetil
4
Cyclophosphamide/Fludarabine/TBI/ATG
Subjects with hematological malignancies with prior autologous transplant \>12 mos or \<1 cycle of multiagent chemotherapy or NO immune suppressive chemotherapy in last 3 months, and who should receive ATG as part of their conditioning regimen. * Cyclophosphamide 50 mg/Kg Day -6 * Fludarabine 40mg/m2 Days -6 to -2 * TBI 200 cGy Day -1 * Equine ATG 30mg/Kg Days -6 to -4 Immune suppression begin Day -3: cyclosporine and mycophenolate mofetil
9
Total13

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath01

Baseline characteristics

CharacteristicCyclophosphamide/Fludarabine/TBICyclophosphamide/Fludarabine/TBI/ATGTotal
Age, Continuous52.5 years55.1 years53.6 years
Disease Diagnosis
AML (Acute Myeloid Leukemia)
4 Participants5 Participants9 Participants
Disease Diagnosis
CML (Chronic Myeloid Leukemia)
0 Participants1 Participants1 Participants
Disease Diagnosis
MDS (Myelodysplastic Syndromes)
0 Participants2 Participants2 Participants
Disease Diagnosis
NHL (Non-Hodgkin's Lymphoma)
0 Participants1 Participants1 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants2 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
4 Participants7 Participants11 Participants
Region of Enrollment
United States
4 Participants9 Participants13 Participants
Sex: Female, Male
Female
1 Participants4 Participants5 Participants
Sex: Female, Male
Male
3 Participants5 Participants8 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
2 / 43 / 9
serious
Total, serious adverse events
3 / 48 / 9

Outcome results

Primary

Probability of Survival at 1 Year

Kaplan-Meier estimate of the probability of survival at 1 year

Time frame: 1 year post transplant

ArmMeasureValue (NUMBER)
Cyclophosphamide/Fludarabine/TBIProbability of Survival at 1 Year0.25 survival probability
Cyclophosphamide/Fludarabine/TBI/ATGProbability of Survival at 1 Year0.50 survival probability
Secondary

Chimerism

Count of participants who experienced dominance of one cord blood unit (defined by \>or= 95% contribution of one cord blood unit to BM and all PB fractions -- CD3+, CD33+, CD56+, and CD19+) at 7 days, 14 days, 21 days, 28 days, 56 days, and 80 days, 6 months, 1 and 2 years post transplant.

Time frame: 7 days, 14 days, 21 days, 28 days, 56 days, and 80 days, 6 months, 1 and 2 years post transplant

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIChimerism2 years2 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 140 Participants
Cyclophosphamide/Fludarabine/TBIChimerism1 year2 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 211 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 561 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 70 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 801 Participants
Cyclophosphamide/Fludarabine/TBIChimerism6 months2 Participants
Cyclophosphamide/Fludarabine/TBIChimerismDay 281 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerism6 months7 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 285 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerism1 year7 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerism2 years7 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 806 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 70 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 140 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 211 Participants
Cyclophosphamide/Fludarabine/TBI/ATGChimerismDay 565 Participants
Secondary

Incidence of Chronic Graft-versus-host-disease (GVHD) at 1 Year

Number of participants with chronic graft-versus-host-disease (GVHD) at 1 year. Clinical Limited cGVHD 1. Oral abnormalities consistent with cGVHD, a positive skin or lip biopsy, and no other manifestations of cGVHD. 2. Mild liver test abnormalities (alkaline phosphatase \<2 x upper limit of normal, AST or ALT \<3 x upper limit of normal and total bilirubin \<1.6) with positive skin or lip biopsy, and no other manifestations of cGVHD. 3. Less than 6 papulosquamous plaques, macular-papular or lichenoid rash involving \<20% of body surface area (BSA), dyspigmentation involving \<20% BSA, or erythema involving \<50% BSA, positive skin biopsy, and no other manifestations of cGVHD. 4. Ocular sicca (Schirmer's test \<5mm with no more than minimal ocular symptoms), positive skin or lip biopsy, and no other manifestations of cGVHD. 5. Vaginal or vulvar abnormalities with positive biopsy, and no other manifestations of cGVHD.

Time frame: 1 year post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Chronic Graft-versus-host-disease (GVHD) at 1 Year0 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Chronic Graft-versus-host-disease (GVHD) at 1 Year3 Participants
Secondary

Incidence of Clinically Significant Infections at 1 Year

Number of participants with clinically significant infections at 1 year

Time frame: 1 year post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Clinically Significant Infections at 1 Year3 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Clinically Significant Infections at 1 Year3 Participants
Secondary

Incidence of Clinically Significant Infections at 2 Years

Number of participants with clinically significant infections at 2 years

Time frame: 2 years post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Clinically Significant Infections at 2 Years3 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Clinically Significant Infections at 2 Years3 Participants
Secondary

Incidence of Clinically Significant Infections at 6 Months

Number of participants with clinically significant infections at 6 months

Time frame: 6 months post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Clinically Significant Infections at 6 Months3 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Clinically Significant Infections at 6 Months3 Participants
Secondary

Incidence of Grade III-IV Acute Graft-versus-host-disease (GVHD) at Day 100

Number of participants with Grade III-IV acute graft-versus-host-disease (GVHD) at day 100. Acute GVHD Staging and Grading: Overall grade 1: stage 1-2 skin, no liver or gut Overall grade 2: stage 3 skin or stage 1 liver or stage 1 gut Overall grade 3: stage 4 skin or stage 2-4 liver or stage 2-4 gut (without GVHD as a major contributing cause of death) Overall grade 4: stage 4 skin or stage 2-4 liver or stage 2-3 gut (with GVHD as a major contributing cause of death)

Time frame: Day 100 post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Grade III-IV Acute Graft-versus-host-disease (GVHD) at Day 1002 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Grade III-IV Acute Graft-versus-host-disease (GVHD) at Day 1001 Participants
Secondary

Incidence of Grade II-IV Acute Graft-versus-host-disease (GVHD) at Day 100

Number of participants with Grade II-IV acute graft-versus-host-disease (GVHD) at day 100. Acute GVHD Staging and Grading: Overall grade 1: stage 1-2 skin, no liver or gut Overall grade 2: stage 3 skin or stage 1 liver or stage 1 gut Overall grade 3: stage 4 skin or stage 2-4 liver or stage 2-4 gut (without GVHD as a major contributing cause of death) Overall grade 4: stage 4 skin or stage 2-4 liver or stage 2-3 gut (with GVHD as a major contributing cause of death)

Time frame: Day 100 post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Grade II-IV Acute Graft-versus-host-disease (GVHD) at Day 1003 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Grade II-IV Acute Graft-versus-host-disease (GVHD) at Day 1006 Participants
Secondary

Incidence of Neutrophil Engraftment at Day 42

Number of participants with neutrophil engraftment at day 42

Time frame: Day 42 post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Neutrophil Engraftment at Day 423 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Neutrophil Engraftment at Day 427 Participants
Secondary

Incidence of Non-relapse Mortality at 6 Months

Number of Participants with Non-relapse Mortality at 6 Months

Time frame: 6 months post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Non-relapse Mortality at 6 Months2 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Non-relapse Mortality at 6 Months2 Participants
Secondary

Incidence of Platelet Engraftment at 6 Months

Number of participants with platelet engraftment at 6 months

Time frame: 6 months post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Platelet Engraftment at 6 Months2 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Platelet Engraftment at 6 Months2 Participants
Secondary

Incidence of Relapse at 1 Year

Number of participants with relapse at 1 year. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.

Time frame: 1 year post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Relapse at 1 Year1 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Relapse at 1 Year4 Participants
Secondary

Incidence of Relapse at 2 Years

Number of participants with relapse at 2 years. Patients with leukemia and lymphoma involving the BM and multiple myeloma will have this done by BM biopsy and additional special studies such as cytogenetics or flow cytometry as appropriate. Patients with lymphoma and myeloma will have radiology studies such as plain X-rays or CT scans and/or other studies such as blood tumor markers to document presence or absence of disease as clinically indicated.

Time frame: 2 years post transplant

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Cyclophosphamide/Fludarabine/TBIIncidence of Relapse at 2 Years1 Participants
Cyclophosphamide/Fludarabine/TBI/ATGIncidence of Relapse at 2 Years5 Participants
Secondary

Probability of Progression-free Survival at 1 Year

Kaplan-Meier estimate of the probability of progression-free survival at 1 year

Time frame: 1 year post transplant

ArmMeasureValue (NUMBER)
Cyclophosphamide/Fludarabine/TBIProbability of Progression-free Survival at 1 Year0.25 progression free survival probability
Cyclophosphamide/Fludarabine/TBI/ATGProbability of Progression-free Survival at 1 Year0.38 progression free survival probability
Secondary

Probability of Progression-free Survival at 2 Years

Kaplan-Meier estimate of the probability of progression-free survival at 2 years

Time frame: 2 years post transplant

ArmMeasureValue (NUMBER)
Cyclophosphamide/Fludarabine/TBIProbability of Progression-free Survival at 2 Years0.25 progression free survival probability
Cyclophosphamide/Fludarabine/TBI/ATGProbability of Progression-free Survival at 2 Years0.25 progression free survival probability
Secondary

Probability of Survival at 2 Years

Kaplan-Meier estimate of the probability of survival at 2 years

Time frame: 2 years post transplant

ArmMeasureValue (NUMBER)
Cyclophosphamide/Fludarabine/TBIProbability of Survival at 2 Years0.25 survival probability
Cyclophosphamide/Fludarabine/TBI/ATGProbability of Survival at 2 Years0.38 survival probability

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026