Relapsed and Refractory Acute Leukemia
Conditions
Keywords
acute leukemia, relapse, induction failure, allogeneic transplantation, graft versus leukemia effect
Brief summary
Patients with active acute leukemia have dismal prognoses even with allogeneic transplantation.Thus,new measures to enhance graft versus leukemia effect and reduce relapse rates are needed. Relapse risk after double umbilical cord transplantations have been shown to be significantly lower compared to matched sibling and matched unrelated donor transplantations due to better graft versus leukemia effect. The investigators hypothesize, that concomitant transplantation from 2 matched siblings may improve GVL effect and reduce relapse rate in patients with high risk acute leukemias and other high risk hematological malignancies.
Interventions
BIOLOGICALDouble matched sibling transplantation
Patients with poor risk active acute leukemia and who have 2 matched sibling donors can be included. Patients' conditioning may be myeloablative or non-myeloablative. Both matched donors will be mobilized with G-CSF and their peripheral blood stem cells will be collected on day 0.Equal numbers of CD34+ cells from both donors will be transfused to the patient. Patients will be followed for engraftment kinetics, chimerism, GVHD rate, severity and response to treatment, relapse rates, DFS and OS.
Sponsors
Rabin Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age 18 years or older 2. Patients with refractory or relapsed acute leukemia unable to receive myeloablative conditioning. 3. Patients with refractory or relapsed acute leukemia able to receive myeloablative conditioning but with the following factors: AML- 2 or more of the following: duration of CR1 \< 6 months, poor cytogenetics, circulating blasts, karnofsky \< 90. ALL- age \> 40 or second and additional relapse, or 2 or more of the following: BM blasts \> 25%, age 18-39,first refractory relapse, donor CMV positive. 4. Patients with 2 matched siblings and donor age \> 18 years old. 5. Patients with advanced multiple myeloma with life expectancy of less than 6 months with standard therapy or transplantation. 6. Patients with advanced lymphoma with life expectancy of less than 6 months with standard therapy or transplantation.
Exclusion criteria
1. Patient age \< 18 years. 2. Donor age \< 18 years. 3. Patients in remission or not fulfilling above disease criteria -
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Acute graft versus host disease rate,severity and response to treatment | 100 days |
Secondary
| Measure | Time frame |
|---|---|
| relapse rate | 12 months |
Countries
Israel
Contacts
Primary ContactMoshe Yeshurun, MD
Backup ContactRon Ram, MD
Outcome results
None listed