Allogeneic Stem Cell Transplantation, Refractory Hematologic Cancer
Conditions
Brief summary
For patients with refractory acute leukemia, allogeneic stem cell transplantation is the only curative therapy. Only 20% of patients may achieve long-term survival mostly due to relapse or nor-relapse mortality (NRM). In previous study, we demonstrated that intensive leukemia debulking chemotherapy FLAG-IDA sequential with Flu-BU conditioning is feasible with \ 40% long-term survival. In the study, we further modified the chemotherapy with cladribine replacing fludarabine aiming a more potent anti-leukemia effect. Meanwhile, we reduce the dose of busulfan for patients with poor performance status and age over 45 aim to reduce the NRM. All patients will also receive post-transplantation maintenance therapy with low-dose decitabine to prevent relapse.
Detailed description
For patients with refractory acute leukemia, allogeneic stem cell transplantation is the only curative therapy. Only 20% of patients may achieve long-term survival mostly due to relapse or nor-relapse mortality (NRM). In previous study, we demonstrated that intensive leukemia debulking chemotherapy FLAG-IDA sequential with Flu-BU conditioning is feasible with \ 40% long-term survival. The most important cause of treatment failures were relapse and non-relpase mortality. The further analysis demonstrated that patients with higher bone marrow blast before allo-HSCT was associated with treatment failure and patients with poor perforce status or age over 45 had increased rate of NRM. To further optimization the protocol, we modified the chemotherapy with cladribine replacing fludarabine aiming a more potent anti-leukemia effect and replace idarubicin with VP-16. All patients will also receive post-transplantation maintenance therapy with low-dose decitabine (5mg/m2 daily for 5 days) to prevent the further reduce the relapse incidence. We anticipate LFS at 1 year should be above 50% and 1-year LFS of 20% is considered unacceptable.
Interventions
DRUGCLAGE-FluBu
Cladribine combined with cytarabine and VP16 sequential with Fludarabine combined with busulifan
Sponsors
Shanghai Jiao Tong University School of Medicine
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* refractory myeloid malignancies including acute myeloid leukemia (AML) or chronic myeloid leukemia in blastic crisis (CML-BC) * HLA matched sibling，unrelated donor, or haplo-identical donor * Patients with bone marrow blast \>5% and positive measurable disease via flowcytometry or PCR.
Exclusion criteria
* patients with active infection * liver function damage: ALT/AST above 2X normal range; and renal function damage Scr\>160µmol/L; insufficient pulmonary function (FEV1，FVC，DLCO\<50%）and heart failure or with EF \<50% * mental instability * unwilling to give inform consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| leukemia-free survival | 1 year | From enrollment to any event as relapse or death |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| non relapse mortality | 1 year | From enrollment to documentation of death without evidence of leukemia |
| overall survival | 1 year | From enrollment to death |
| relapse rate | 1 year | From enrollment to documentation of relapse |
Countries
China
Outcome results
None listed