Precursor B-Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Myeloid, Acute, Burkitt Lymphoma, Lymphoma, B-Cell, Lymphoma, Follicular, Lymphoma, Large B-Cell, Diffuse
Conditions
Keywords
Acute Lymphoblastic Leukemia/Lymphoma, Acute Myelogenous Leukemia, Mantel-Cell Lymphoma, Hematopoietic Transplant, Umbilical Cord Blood (UCB), Non-Myeloablative Transplant
Brief summary
A bone marrow transplant, which is a type of stem cell transplant, is a treatment option for people with leukemia or lymphoma. Recently, stem cell transplants using umbilical cord blood have become a treatment option for people with these types of cancers. This study will evaluate the effectiveness of a stem cell transplant using umbilical cord blood, along with lower doses of chemotherapy, to treat people with leukemia or lymphoma.
Detailed description
Leukemia and lymphoma are types of blood cancers. Chemotherapy is a common treatment option for people with these types of cancers, but if the cancer does not respond well to chemotherapy, or if the cancer returns, people may need to consider other options. A bone marrow transplant, which is a type of stem cell transplant in which healthy bone marrow is donated to a patient by a related or unrelated donor, is commonly used to treat leukemia and lymphoma. Recently, stem cell transplants using umbilical cord blood have become a viable option to treat these types of cancers. Traditionally, umbilical cord blood, which is the blood left over in the placenta after a baby is born, has been disposed of with the placenta. However, over the past few years, doctors have begun to collect and freeze the umbilical cord blood cells so that they may be used in stem cell transplant procedures at a later time. Typically, people who are undergoing a stem cell transplant receive high doses of chemotherapy before the transplant to prepare their bodies to accept the donor stem cells. In this study, participants will undergo a new type of stem cell transplant called a nonmyeloablative transplant, which is a reduced intensity method of transplantation that does not require high doses of chemotherapy. The purpose of the study is to examine the safety and effectiveness of a nonmyeloablative stem cell transplant that uses umbilical cord blood as a treatment option for people with leukemia or lymphoma. This study will enroll people with leukemia or lymphoma. Participants will be admitted to the hospital and will first receive a type of chemotherapy called cyclophosphamide, which will be given intravenously on the sixth day before the transplant. In addition, another type of chemotherapy, fludarabine, will be given intravenously each day for 5 days before the transplant. Three days before the transplant, participants will receive cyclosporine and mycophenolate mofetil (MMF), to help prevent the body from rejecting the stem cells and to help decrease the risk of developing a complication called graft-versus-host-disease (GVHD), which is an attack by the donor cells on the body's normal tissues. Some participants may receive tacrolimus instead of cyclosporine. After 6 days, participants will receive a small dose of radiation. The next day, participants will undergo the umbilical cord blood stem cell transplant. Participants will remain in the hospital for approximately 2 to 3 months total, but possibly longer if there are complications. Beginning on the first day after the transplant, participants will receive daily injections of a growth factor called granulocyte-colony stimulating factor (G-CSF), which is a natural protein that increases the white blood cell count; G-CSF will be continued until a participant's white blood cell count is normal again. Participants will continue to receive MMF for 30 days and cyclosporine or tacrolimus for 180 days after the transplant. While participants are in the hospital, blood samples will be collected regularly to evaluate the response and possible side effects to treatment, including GVHD. If necessary, participants will receive platelet and red blood cell transfusions. At follow-up study visits 6 months and 1 year after the transplant, blood samples will be obtained. Study researchers will keep track of participants' medical condition through phone calls or mailings to participants and their doctors once a year for the rest of the participants' lives.
Interventions
BIOLOGICALHematopoietic Umbilical Cord Blood Stem Cell Transplantation
The transplant preparative regimen is listed below. The - sign is the number of days before the transplant. * Fludarabine: 40 mg/m\^2 intravenously (IV) on Days -6, -5, -4, -3, and -2 * Cyclophosphamide: 50 mg/kg IV on Day -6 * Total body irradiation: 200 centigray (cGy) on Day -1
BIOLOGICALGVHD prophylaxis
GVHD prophylaxis regimen will consist of: * Cyclosporine: beginning on Day -3 with the dose adjusted to maintain a level of 200-400 mg/mL * MMF: 1 gram IV three times a day (TID) if greater than 50 kg, or 15 mg/kg IV TID if less than 50 kg beginning on Day -3; continued until Day 30 or 7 days after engraftment, whichever day is later Day 0 is the day of the infusion of the umbilical cord blood graft units, which will be obtained from partially HLA-matched unrelated donors. Beginning on Day 1, participants will receive G-CSF 5 mcg/kg/day until absolute neutrophil count (ANC) is greater than or equal to 2,000/mm\^3 for three consecutive measurements, each on different days.
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
Blood and Marrow Transplant Clinical Trials Network
National Cancer Institute (NCI)
National Marrow Donor Program
Medical College of Wisconsin
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Participants must be 21 to 70 years old; participants 1 to 21 years old are also eligible if they are ineligible for BMT CTN #0501 (NCT00412360) * Each unit must supply a minimum of 1.5 x 10\^7/kg pre-cryopreserved nucleated cell dose * Participants must have two partially human leucocyte antigen (HLA)-matched umbilical cord blood units. Each unit must match at a minimum of 4 of 6 at HLA-A, -B, -DRB1 loci with the recipient. This may include 0 to 2 antigen mismatches at each A or B (at the antigen level) or DRB1 (at the allele level) loci. Each unit must be a 4 to 6 HLA-A, B, and DRB1 antigen matched to each other, not necessarily at the same loci as with the recipient. All typing will be done using molecular typing. Though molecular level typing will be available, a match is defined at intermediate resolution for HLA-A and -B and at high resolution for -DRB1 for this study. An adult unrelated donor search is not required for a person to be eligible for this study if the clinical situation dictates an urgent transplant. Clinical urgency is defined as 6 to 8 weeks from referral to transplant center or low likelihood of finding a matched, unrelated donor. * Must have received cytotoxic chemotherapy within 3 months of the consent date (measured from the start date of chemotherapy) * Acute leukemias (includes T lymphoblastic lymphoma) in the second or subsequent complete remission (CR) * Burkitt's lymphoma in the second or subsequent CR * Lymphoma * Patients with adequate physical function, as measured by the following: * Heart: left ventricular ejection fraction at rest greater than 35%, or shortening fraction greater than 25% * Liver: bilirubin less than or equal to 2.5 mg/dL and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase less than or equal to five times the upper limit of normal * Kidney: serum creatinine within normal range for age, or if serum creatinine is outside the normal range for age, then kidney function (creatinine clearance or glomerular filtration rate (GFR) greater than 40 mL/min/1.73m\^2 * Lungs: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and carbon monoxide diffusing capacity (DLCO) greater than 50% predicted (corrected for hemoglobin). If unable to perform pulmonary function tests, then oxygen (O2) saturation must be greater than 92% on room air.
Exclusion criteria
* Have an HLA-matched, related, or 7 or 8/8 HLA allele matched (HLA-A, -B, -Cw, -DRB1) related donor able to donate * Had an autologous hematopoietic stem cell transplant in the 3 months before study entry * Pregnant or breastfeeding * Evidence of HIV infection or known HIV positive serology * Current uncontrolled bacterial, viral, or fungal infection (i.e., currently taking medication with evidence of progression of clinical symptoms or radiologic findings) * Prior allogeneic hematopoietic stem cell transplant * History of primary idiopathic myelofibrosis
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Overall Survival at 180 Days From the Time of Transplant | Measured at Month 6 and Year 1 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Primary Graft Failure | Measured at Day 100 | Primary graft failure is defined as \< 5% donor chimerism on all measurements prior to and day-100. |
| Secondary Graft Failure | Measured at Day 100 | Secondary graft failure is defined initial recovery followed by neutropenia with \< 5% donor chimerism. |
| Platelet Recovery to 20K | Measured at Days 56, 90, and 100 | Platelet recovery is defined as the first day of a minimum of three consecutive measurements on different days such that the patient has achieved a platelet count \>20,000/mm3 with no platelet transfusions in the preceding seven days. |
| Donor Cell Engraftment | Measured at Day 56 | Marrow or Blood Sample. Donor cell engraftment is defined as donor chimerism ≥ 5% on Day ≥ 56 after transplantation. Chimerism should be evaluated on Days \ 28, \ 56, \ 180, and \ 365 after transplantation. Chimerism may be evaluated in whole blood or mononuclear fraction. |
| Acute Graft-versus-host Disease (GVHD) | Measured at Day 100 | — |
| Neutrophil Recovery | Measured at Days 28, 56, 90, and 100 | Neutrophil recovery is defined as achieving an absolute neutrophil count ≥ 500/mm3 for three consecutive measurements on different days. |
| Progression-free Survival | Measured at Year 1 | Progression-free survival is defined as the minimum time interval to relapse/ recurrence/progression, to death or to last follow-up. |
| Treatment-related Mortality (TRM) | Measured at 6 months and 1 year | — |
| Incidence of Infections | Measured at Year 1 | Number of participants that experienced at least one infection. |
| Platelet Recovery to 50K | Measured at Days 56, 90, and 100 | Platelet recovery is defined as the first day of a minimum of three consecutive measurements on different days such that the patient has achieved a platelet count \>50,000/mm3 with no platelet transfusions in the preceding seven days. |
| Chronic GVHD | Measured at Year 1 | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| dUCB Transplant Hematopoietic Umbilical Cord Blood Stem Cell Transplantation using a non-myeloablative preparative regimen. | 50 |
| Total | 50 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Disease Relapse/Progression | 3 |
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | dUCB Transplant |
|---|---|
| Age, Continuous | 53.4 years STANDARD_DEVIATION 13.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 46 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants |
| HLA Typing Match Score - 1st Cord 4/6 | 24 participants |
| HLA Typing Match Score - 1st Cord 5/6 | 21 participants |
| HLA Typing Match Score - 1st Cord 6/6 | 5 participants |
| HLA Typing Match Score - 1st Cord to 2nd Cord 4/6 | 35 participants |
| HLA Typing Match Score - 1st Cord to 2nd Cord 5/6 | 11 participants |
| HLA Typing Match Score - 1st Cord to 2nd Cord 6/6 | 4 participants |
| HLA Typing Match Score - 2nd Cord 4/6 | 30 participants |
| HLA Typing Match Score - 2nd Cord 5/6 | 17 participants |
| HLA Typing Match Score - 2nd Cord 6/6 | 3 participants |
| Karnofsky Performance-status Score 100% | 10 participants |
| Karnofsky Performance-status Score 60% | 1 participants |
| Karnofsky Performance-status Score 70% | 2 participants |
| Karnofsky Performance-status Score 80% | 7 participants |
| Karnofsky Performance-status Score 90% | 30 participants |
| Primary Disease Acute Lymphoblastic Leukemia | 6 participants |
| Primary Disease Acute Myelogeneous Leukemia | 29 participants |
| Primary Disease Biphenotypic/Undifferentiated Leukemia | 1 participants |
| Primary Disease Burkitt's Lymphoma | 1 participants |
| Primary Disease Follicular Non-Hodgkins Lymphoma | 4 participants |
| Primary Disease Hodgkins Lymphoma | 5 participants |
| Primary Disease Large Cell Lymphoma | 3 participants |
| Primary Disease Marginal Zone B-cell Lymphoma | 1 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 45 Participants |
| Sex: Female, Male Female | 24 Participants |
| Sex: Female, Male Male | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 1 / 50 |
| serious Total, serious adverse events | 9 / 50 |
Outcome results
Primary
Overall Survival at 180 Days From the Time of Transplant
Time frame: Measured at Month 6 and Year 1
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Overall Survival at 180 Days From the Time of Transplant | 6 months | 73.5 percentage of participants |
| dUCB Transplant | Overall Survival at 180 Days From the Time of Transplant | 1 year | 54.0 percentage of participants |
Secondary
Acute Graft-versus-host Disease (GVHD)
Time frame: Measured at Day 100
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Acute Graft-versus-host Disease (GVHD) | Grade II-IV Acute GVHD | 40.0 percentage of participants |
| dUCB Transplant | Acute Graft-versus-host Disease (GVHD) | Grade III-IV Acute GVHD | 21.4 percentage of participants |
Secondary
Chronic GVHD
Time frame: Measured at Year 1
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| dUCB Transplant | Chronic GVHD | 25.3 percentage of participants |
Secondary
Donor Cell Engraftment
Marrow or Blood Sample. Donor cell engraftment is defined as donor chimerism ≥ 5% on Day ≥ 56 after transplantation. Chimerism should be evaluated on Days \ 28, \ 56, \ 180, and \ 365 after transplantation. Chimerism may be evaluated in whole blood or mononuclear fraction.
Time frame: Measured at Day 56
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Donor Cell Engraftment | Chimerism Performed | 36 participants |
| dUCB Transplant | Donor Cell Engraftment | Donor Percentage >=95% | 30 participants |
| dUCB Transplant | Donor Cell Engraftment | Donor Percentage 5%-95% | 6 participants |
| dUCB Transplant | Donor Cell Engraftment | Donor Percentage <5% | 0 participants |
Secondary
Incidence of Infections
Number of participants that experienced at least one infection.
Time frame: Measured at Year 1
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Incidence of Infections | 6-10 Infections | 8 Infections |
| dUCB Transplant | Incidence of Infections | 1 Infection | 11 Infections |
| dUCB Transplant | Incidence of Infections | 2 Infections | 11 Infections |
| dUCB Transplant | Incidence of Infections | 3 Infections | 3 Infections |
| dUCB Transplant | Incidence of Infections | 4 Infections | 4 Infections |
| dUCB Transplant | Incidence of Infections | 5 Infections | 3 Infections |
| dUCB Transplant | Incidence of Infections | >10 Infections | 1 Infections |
Secondary
Neutrophil Recovery
Neutrophil recovery is defined as achieving an absolute neutrophil count ≥ 500/mm3 for three consecutive measurements on different days.
Time frame: Measured at Days 28, 56, 90, and 100
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Neutrophil Recovery | Day 28 | 86.0 percentage of participants |
| dUCB Transplant | Neutrophil Recovery | Day 56 | 94.0 percentage of participants |
| dUCB Transplant | Neutrophil Recovery | Day 90 | 94.0 percentage of participants |
| dUCB Transplant | Neutrophil Recovery | Day 100 | 94.0 percentage of participants |
Secondary
Platelet Recovery to 20K
Platelet recovery is defined as the first day of a minimum of three consecutive measurements on different days such that the patient has achieved a platelet count \>20,000/mm3 with no platelet transfusions in the preceding seven days.
Time frame: Measured at Days 56, 90, and 100
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Platelet Recovery to 20K | Day 56 | 70.0 percentage of participants |
| dUCB Transplant | Platelet Recovery to 20K | Day 90 | 82.0 percentage of participants |
| dUCB Transplant | Platelet Recovery to 20K | Day 100 | 82.0 percentage of participants |
Secondary
Platelet Recovery to 50K
Platelet recovery is defined as the first day of a minimum of three consecutive measurements on different days such that the patient has achieved a platelet count \>50,000/mm3 with no platelet transfusions in the preceding seven days.
Time frame: Measured at Days 56, 90, and 100
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Platelet Recovery to 50K | Day 56 | 46.0 percentage of participants |
| dUCB Transplant | Platelet Recovery to 50K | Day 90 | 58.5 percentage of participants |
| dUCB Transplant | Platelet Recovery to 50K | Day 100 | 58.5 percentage of participants |
Secondary
Primary Graft Failure
Primary graft failure is defined as \< 5% donor chimerism on all measurements prior to and day-100.
Time frame: Measured at Day 100
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| dUCB Transplant | Primary Graft Failure | 5 participants |
Secondary
Progression-free Survival
Progression-free survival is defined as the minimum time interval to relapse/ recurrence/progression, to death or to last follow-up.
Time frame: Measured at Year 1
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| dUCB Transplant | Progression-free Survival | 45.7 percentage of participants |
Secondary
Secondary Graft Failure
Secondary graft failure is defined initial recovery followed by neutropenia with \< 5% donor chimerism.
Time frame: Measured at Day 100
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| dUCB Transplant | Secondary Graft Failure | 1 participants |
Secondary
Treatment-related Mortality (TRM)
Time frame: Measured at 6 months and 1 year
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| dUCB Transplant | Treatment-related Mortality (TRM) | 6 months | 16.3 percentage of participants |
| dUCB Transplant | Treatment-related Mortality (TRM) | 1 year | 23.8 percentage of participants |