Hematologic Neoplasms
Conditions
Brief summary
To reduce the number of donors treated with IV AMD3100 who require a second collection to obtain the minimum cells necessary for allogeneic stem cell transplant.
Detailed description
* To reduce the number of donors treated with intravenous (IV) AMD3100 who require a second collection to obtain the minimum CD34/kg (2 X 106) necessary for allogeneic stem cell transplantation when compared to our historic group who received 240ug SC AMD3100 from 33% (8 in 24) to 11% (3 in 27). * To estimate with 95% confidence intervals the proportion of human leukocyte antigen (HLA)-identical sibling donors who experience grade 3-4 infusional toxicity and the proportion from whom ≥ 2.0 x 10e6 CD34+ cells/kg recipient weight are safely mobilized following one or two intravenous infusions. * To determine the kinetics of stem cell and lymphocyte mobilization using IV AMD3100 and to determine if peripheral blood stem cell products collected after mobilization with IV AMD3100 can be used safely for hematopoietic cell transplantation in HLA-matched recipients as measured by neutrophil engraftment by day +21. * To determine the pharmacokinetics and pharmacodynamics of IV AMD3100 on stem cell and T-cell phenotyping and on immune reconstitution after transplantation. * To determine the rate of acute graft-versus-host disease (GVHD) and chronic GVHD in patients who receive IV AMD3100 mobilized peripheral blood stem cells.
Interventions
Sponsors
Washington University School of Medicine
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Donor Eligibility * Donor is 18 to 70 years of age inclusive. * If female and of child-bearing age: must be non-pregnant, not breast feeding and agree to use adequate contraception. * Donor is a 6/6 HLA-matched sibling willing to donate PBSC for transplant. * Donor must be willing to provide written informed consent. * Adequate cardiac function with no history of congestive heart failure and no history of atrial fibrillation or ventricular tachyarrhythmia. * Adequate renal function as defined by a calculated serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation). * Adequate hepatic function as defined by a total bilirubin \<2x normal or absence of hepatic fibrosis/cirrhosis. * Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. No history of cerebrovascular accident or seizure disorder requiring anticonvulsant medication. * Donor must be HIV-1&2 antibody and HTLV-I&II antibody sero-negative, by Food and Drug Administration (FDA) licensed test. * Donor must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. * Donor must demonstrate ability to be compliant with study regimen. * Donor must not have an active infection at the time of study entry. * Donor does not have active alcohol or substance abuse within 6 months of study entry. * Donor is not currently enrolled on another investigational agent study. * Donor does not have any medical condition, which, in the opinion of the clinical investigator, would interfere with his/her evaluation. Recipient Eligibility * Recipient must have available the successful collection of an AMD3100 mobilized product. When an adequate collection cannot be obtained using G-CSF, some recipients may need to receive a combined product of mobilized cells with AMD3100 and g granulocyte-colony stimulating factor (G-CSF). Recipients who receive less than 2.0 X 106 CD34+ cells/kg/actual recipient weight after two days of IV AMD3100 will not be considered eligible but followed per protocol for safety purposes only. * Patient is 18 to 65 years of age inclusive. * Patient is willing and has a 6/6 HLA-matched sibling willing to donate PBSC for transplant. * Patient must provide signed informed consent. * If female and of child-bearing age: must be non-pregnant, not breast feeding, and uses adequate contraception. * Patient must have one of the following diagnoses: * Acute myelogenous leukemia (AML) in 1st or subsequent remission or in relapse, * Acute lymphoblastic leukemia (ALL) in 1st or subsequent remission or in relapse, * Myelodysplastic syndrome either intermediate 1 or 2, or high risk by the International Prognostic Scoring System, * Chronic myelogenous leukemia (CML) in accelerated or second chronic phase, * Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) in 2nd or greater complete remission, partial remission, or refractory relapse, * Chronic lymphocytic leukemia (CLL), Rai Stage 2-4, failing at least 2 prior regimens, OR * Multiple myeloma (MM), Stage 2-3. * Adequate cardiac function with a left ventricular ejection fraction ≥ 40%. * Adequate pulmonary function defined as NO severe or symptomatic restrictive or obstructive lung disease, and formal pulmonary function testing showing an FEV1 ≥50% of predicted and a DLCO ≥40% of predicted, corrected for hemoglobin. * Adequate renal function as defined by a serum creatinine clearance of ≥75% of normal (Cockcroft-Gault equation). * Adequate hepatic function as defined by a total bilirubin \<2x normal or absence of hepatic fibrosis/cirrhosis. * Adequate neurologic function as defined by NO evidence of a severe central or peripheral neurologic abnormality. Patients with a history of previous central nervous system (CNS) tumor involvement are eligible provided they are without symptoms or signs and the CNS is now free of disease on lumbar puncture and CT scan of the brain. * No evidence of active infection at the time of the transplant preparative regimen or at time of transplantation. * Patient must be HIV-1&2 antibody and HTLV-I & II antibody sero-negative, by FDA licensed test. * Patient has an ECOG performance status of 0 or 1. * Patient must demonstrate ability to be compliant with medical regimen. * Patient must not have active alcohol or substance abuse within 6 months of study entry. * Patient must not be enrolled on another investigational agent concurrently. * Patient must not have any medical condition, which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient.
Exclusion criteria
* See Inclusion criteria above
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of Donors Treated With IV AMD3100 Who Required a Second Collection to Obtain the Minimum CD34/kg (2 X 106) Necessary for Allogeneic Stem Cell Transplant | Completion of enrollment of all donors (17 months) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Recipients Who Have Neutrophil Engraftment | Day 21 | — |
| Pharmacokinetics of IV AMD3100 as Measured by the Mean Maximum Plasma Concentration (Cmax) | Day 1 and Day 2 | -Blood samples for pharmacokinetics were drawn on the following schedule: * prior to IV infusion * 15 minutes after start of infusion * 30 minutes after start of infusion * 1 hour after start of infusion * 4 hours after start of infusion * 6 hours after start of infusion * 9 hours after start of infusion * 24 hours after start of infusion |
| Pharmacokinetics of IV AMD3100 as Measured by Half Life | Day 1 and Day 2 | -Blood samples for pharmacokinetics were drawn on the following schedule: * prior to IV infusion * 15 minutes after start of infusion * 30 minutes after start of infusion * 1 hour after start of infusion * 4 hours after start of infusion * 6 hours after start of infusion * 9 hours after start of infusion * 24 hours after start of infusion |
| Pharmacokinetics of IV AMD3100 as Measured by Mean Area Under Curve (AUC) | Day 1 and Day 2 | — |
| Rate of Acute GVHD (Grade II-IV) in Recipients | Day 0-Day 100 (acute) | — |
| Rate of Acute GVHD (Grade III-IV) in Recipients | Day 0-Day 100 (acute) | — |
| Number of Donors Who Experience Grade 3-4 Infusional Toxicity | Up to Day 2 | — |
| Time to Platelet Engraftment for Recipients | Up to Day 100 | Measured by determining the first of 3 consecutive measurements of platelet count = 20,000/ul without platelet transfusion support for 7 days. |
| Transplant Related Mortality Rate for Recipients | Day 100 | Death that results from a transplant procedure related complication rather than from relapse of the underlying disease or unrelated cause. |
| Grade 3-4 Toxicity for Recipients | 1 year | Assessed and graded according to NCI Common Terminology for Adverse Events Version 3.0. |
| Rate of Chronic GVHD in Recipients | Day 101-1 year | — |
| Number of Donors Who Experience Grade 3-4 Mobilization Toxicity Due to Pheresis Procedure | Up to Day 2 | — |
| Time to Neutrophil Engraftment for Recipients | Up through Day 100 | Measured by determine the first 3 consecutive measurement of neutrophil count = 500/ul following conditioning regimen induced nadir. |
Countries
United States
Participant flow
Recruitment details
The study opened to participant enrollment on 08/12/2009 and closed to participants enrollment on 01/31/2011.
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 - Donor * Day 1
* AMD3100 320 ug/kg IV
* Leukopheresis
* Day 2 (if PBSC collected is not sufficient)
* AMD3100 320 ug/kg IV
* Leukopheresis | 34 |
| Arm 2 - Recipient Standard of care and physician choice myeloablative or non-myeloablative chemotherapy with or without total body irradiation (permitted = cyclophosphamide and single dose total body irradiation (TBI) / fludarabine and busulfan / fractionated TBI and cyclophosphamide / fractionated TBI, etoposide, and cyclophosphamide / busulfan and cyclophosphamide / fludarabine, busulfan, and ATGAM
Day 0 = Stem Cell Transplant | 33 |
| Total | 67 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Not eligible | 0 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Arm 1 - Donor | Arm 2 - Recipient | Total |
|---|---|---|---|
| Age, Continuous | 50 years | 54 years | 52 years |
| Region of Enrollment United States | 34 participants | 33 participants | 67 participants |
| Sex: Female, Male Female | 16 Participants | 12 Participants | 28 Participants |
| Sex: Female, Male Male | 18 Participants | 21 Participants | 39 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 33 / 33 | 33 / 33 |
| serious Total, serious adverse events | 0 / 33 | 0 / 33 |
Outcome results
Primary
Number of Donors Treated With IV AMD3100 Who Required a Second Collection to Obtain the Minimum CD34/kg (2 X 106) Necessary for Allogeneic Stem Cell Transplant
Time frame: Completion of enrollment of all donors (17 months)
Population: 3 donors failed to reach target after two collections and 1 donor withdrew consent after failing to reach the goal on the first collection.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 - Donor | Number of Donors Treated With IV AMD3100 Who Required a Second Collection to Obtain the Minimum CD34/kg (2 X 106) Necessary for Allogeneic Stem Cell Transplant | 10 participants |
Secondary
Grade 3-4 Toxicity for Recipients
Assessed and graded according to NCI Common Terminology for Adverse Events Version 3.0.
Time frame: 1 year
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 fatigue | 3 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 thrombocytopenia | 1 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 mucositis | 5 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 GI fistula | 1 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 increased transaminase | 2 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 febrile neutropenia | 32 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 bacteremia+ | 4 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 respiratory distress | 1 participants |
| Arm 2 - Recipient | Grade 3-4 Toxicity for Recipients | Grade 3 renal failure | 6 participants |
Secondary
Number of Donors Who Experience Grade 3-4 Infusional Toxicity
Time frame: Up to Day 2
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 - Donor | Number of Donors Who Experience Grade 3-4 Infusional Toxicity | 0 participants |
Secondary
Number of Donors Who Experience Grade 3-4 Mobilization Toxicity Due to Pheresis Procedure
Time frame: Up to Day 2
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 - Donor | Number of Donors Who Experience Grade 3-4 Mobilization Toxicity Due to Pheresis Procedure | 2 participants |
Secondary
Number of Recipients Who Have Neutrophil Engraftment
Time frame: Day 21
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 2 - Recipient | Number of Recipients Who Have Neutrophil Engraftment | 33 participants |
Secondary
Pharmacokinetics of IV AMD3100 as Measured by Half Life
-Blood samples for pharmacokinetics were drawn on the following schedule: * prior to IV infusion * 15 minutes after start of infusion * 30 minutes after start of infusion * 1 hour after start of infusion * 4 hours after start of infusion * 6 hours after start of infusion * 9 hours after start of infusion * 24 hours after start of infusion
Time frame: Day 1 and Day 2
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 - Donor | Pharmacokinetics of IV AMD3100 as Measured by Half Life | 5.42 hours | Standard Deviation 1.24 |
Secondary
Pharmacokinetics of IV AMD3100 as Measured by Mean Area Under Curve (AUC)
Time frame: Day 1 and Day 2
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 - Donor | Pharmacokinetics of IV AMD3100 as Measured by Mean Area Under Curve (AUC) | 5049 hr.ng/mL | Standard Deviation 1233 |
Secondary
Pharmacokinetics of IV AMD3100 as Measured by the Mean Maximum Plasma Concentration (Cmax)
-Blood samples for pharmacokinetics were drawn on the following schedule: * prior to IV infusion * 15 minutes after start of infusion * 30 minutes after start of infusion * 1 hour after start of infusion * 4 hours after start of infusion * 6 hours after start of infusion * 9 hours after start of infusion * 24 hours after start of infusion
Time frame: Day 1 and Day 2
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 - Donor | Pharmacokinetics of IV AMD3100 as Measured by the Mean Maximum Plasma Concentration (Cmax) | 1391 ng/mL | Standard Deviation 488 |
Secondary
Rate of Acute GVHD (Grade III-IV) in Recipients
Time frame: Day 0-Day 100 (acute)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 2 - Recipient | Rate of Acute GVHD (Grade III-IV) in Recipients | 4 participants |
Secondary
Rate of Acute GVHD (Grade II-IV) in Recipients
Time frame: Day 0-Day 100 (acute)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 2 - Recipient | Rate of Acute GVHD (Grade II-IV) in Recipients | 4 participants |
Secondary
Rate of Chronic GVHD in Recipients
Time frame: Day 101-1 year
Population: 8 patients are not evaluable because they were not alive for the outcome measure time frame.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 2 - Recipient | Rate of Chronic GVHD in Recipients | 7 participants |
Secondary
Time to Neutrophil Engraftment for Recipients
Measured by determine the first 3 consecutive measurement of neutrophil count = 500/ul following conditioning regimen induced nadir.
Time frame: Up through Day 100
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 2 - Recipient | Time to Neutrophil Engraftment for Recipients | 14 days |
Secondary
Time to Platelet Engraftment for Recipients
Measured by determining the first of 3 consecutive measurements of platelet count = 20,000/ul without platelet transfusion support for 7 days.
Time frame: Up to Day 100
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 2 - Recipient | Time to Platelet Engraftment for Recipients | 25 days |
Secondary
Transplant Related Mortality Rate for Recipients
Death that results from a transplant procedure related complication rather than from relapse of the underlying disease or unrelated cause.
Time frame: Day 100
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 2 - Recipient | Transplant Related Mortality Rate for Recipients | 1 participants |