Leukemia, Graft-versus-host-disease
Conditions
Keywords
hematopoietic stem cell transplantation, graft-versus-host disease
Brief summary
A single-arm trial using Tocilizumab for acute GVHD prophylaxis after haploidentical HSCT.
Detailed description
This study will enroll haploidentical HSCT patients with high risk for acute GVHD. Tocilizumab (8mg/kg) will be added to the conventional acute GVHD prophylaxis regime (CsA+Methotrexate(MTX)+low dose mycophenolate mofetil(MMF)+ATG) on day -1 of transplant. The previous patients will be used as control.
Interventions
DRUGCytarabine
4 mg/m2/day administered IV day -10 through -9.
DRUGBusulfan
3.2 mg/kg/day administered IV day -8 through -6.
DRUGCyclophosphamide
1.8 g/m2/day administered IV day -5 through -4.
DRUGMe-CCNU
250mg/m2 once administered orally on day -3.
1.5mg/kg/day administered IV day -5 through -2.
DRUGTocilizumab
8mg/kg administered IV on day -1.
PROCEDUREAllogeneic HSCT
Day 0
DRUGCyclosporin A
2.5 mg/kg/day administered intravenously from day -7, target: 200-300ng/mL. Usually tapered during the second month, and ended in complete withdrawal during the ninth month after transplantation.
DRUGMycophenolate Mofetil
500 mg/day administered intravenously from day -9, ended in complete withdrawal on day +100.
DRUGMTX
15 mg/m2 administered intravenously on day +1, 10mg/m2 on day +3, +6, and +9.
Sponsors
Yi Luo
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients with hematological malignancies in complete remission (CR) who are eligible and planned for haploidentical HSCT. The donor specific antibody is negative * Patient age 16-60 years * Mother donor, or female donor (age \>50) for female-male transplant * Eastern Cooperative Oncology Group (ECOG) performance status \< 2 * Creatinine clearance rate \> 60 mL/min (estimate by Cockcroft-Gault Equation) * alanine transaminase (ALT) and aspartate aminotransferase (AST)≤ 2.5×upper limit of normal (ULN), and total bilirubin ≤ 1.5×ULN （upper limit of normal, ULN） * Left ventricular ejection fraction (LVEF) ≥50% as measured by echocardiography * Acceptation to sign the informed consent
Exclusion criteria
* History of previous HSCT * Present active infection (including bacterial, virus or fungal) * History of Tocilizumab infection * History of inflammatory bowel disease * History of demyelinating disease * Patients who are HIV-positive, or with uncontrolled chronic hepatitis B virus (HBsAg positive) or hepatitis C virus (anti-HCV) infections * Women who are pregnant (β-chorionic gonadotropin+) or breast feeding * Refusal to sign the informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative incidence of grade II-IV acute graft-versus-host disease | 100 days | Date of symptom onset, maximum clinical grade, and dates and types of treatment will be recorded. Dates of symptom onset of grade II-IV acute graft-versus-host disease (aGVHD) will be recorded. The aGVHD score of each affected organ will be recorded. |
| Cumulative incidence of non grade II-IV acute graft-versus-host disease survival | 100 days | All patients will be tracked from Day 0 to date of grade II-IV acute graft-versus-host disease (aGVHD) onset. Patients who did not present grade II-IV aGVHD or died will be censored at the last date they were assessed and deemed free of grade II-IV aGVHD. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival (OS) | 2 years | All patients will be tracked from Day 0 to date of first objective disease progression, death from any cause, or last patient evaluation. Patients who have not progressed or died will be censored at the last date they were assessed and deemed free of relapse or progression. |
| Progression-free survival (PFS) | 2 years | All patients will be tracked from Day 0 to date of first objective disease progression, death from any cause, or last patient evaluation. Patients who have not progressed or died will be censored at the last date they were assessed and deemed free of relapse or progression. |
| Cumulative incidence of engraftment | 100 days | All patients will be tracked from Day 0 to date of myeloid and platelet engraftments, respectively. |
| Cumulative incidence of disease relapse or progression | 2 years | All patients will be tracked from Day 0 to date of first objective disease progression, death from any cause, or last patient evaluation. Patients who have not progressed or died will be censored at the last date they were assessed and deemed free of relapse or progression. |
| Cumulative incidence of transplant-related nonrelapse mortality (NRM) | 2 years | All patients will be tracked from Day 0 to date of first objective disease progression, death from any cause, or last patient evaluation. Patients who have not progressed or died will be censored at the last date they were assessed and deemed free of relapse or progression. |
| Cumulative incidence of infections | 2 years | All patients will be tracked from Day 0 to date of infection diagnosis as proved by relevant standard diagnostic criteria. |
Countries
China
Contacts
Primary ContactYi Luo, MD
Backup ContactLizhen Liu, MD
Outcome results
None listed