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PRO#1278: Fludarabine and Busulfan vs. Fludarabine, Busulfan and Total Body Irradiation

Information source: Hackensack University Medical Center
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Myeloid Malignancies; Acute Myelogenous Leukemia; Chronic Myelogenous Leukemia; Myeloproliferative Disorders; Myelodysplastic Syndrome

Intervention: Fludarabine and Busulfan plus/minus Total Body Irradiation (low dose) (Drug); Fludarabine and Busulfan + Low Dose Total Body Irradiation (LD TBI) (Drug)

Phase: Phase 3

Status: Recruiting

Sponsored by: Hackensack University Medical Center

Official(s) and/or principal investigator(s):
Michele Donato, MD, Principal Investigator, Affiliation: Hackensack University Medical Center

Overall contact:
Emily Brown, RN, Phone: 551-996-3923, Email: EmilyBrown@hackensackUMC.org

Summary

This is a single institution study of fludarabine and busulfan versus fludarabine, busulfan and low dose total body irradiation in patients undergoing allogeneic stem cell transplantation. A study population of 80 subjects will be enrolled from The John Theurer Cancer Center at Hackensack University Medical Center. Subjects who are eligible to receive allogeneic hematopoietic stem cell transplantation according to the eligibility criteria will be consented and enrolled. Subjects will be randomly assigned to receive one of 2 conditioning regimen: fludarabine and busulfan, or fludarabine busulfan and low dose total body irradiation (TBI). Subjects will be followed until 1 year post transplantation to assess the relapse rate in each arm and transplant-related toxicity. The combination of fludarabine and busulfan is the current standard of care for patients with myeloid malignancies (AML, CML and other myeloproliferative disorders, or MDS) undergoing allogeneic transplantation at HUMC. In this study we will be comparing in a randomized fashion the standard regimen to a regimen of fludarabine, busulfan and TBI.

Clinical Details

Official title: PRO#1278: A Phase III Study of Fludarabine and Busulfan Versus Fludarabine, Busulfan and Low Dose Total Body Irradiation in Patients Receiving an Allogeneic Hematopoietic Stem Cell Transplant

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: To compare the relapse rate at 1 year of patients with myeloid malignancies receiving each treatment

Detailed description: This is a single institution study of fludarabine and busulfan versus fludarabine, busulfan and low dose total body irradiation in patients undergoing allogeneic stem cell transplantation. A study population of 80 subjects will be enrolled from The John Theurer Cancer Center at Hackensack University Medical Center. Subjects who are eligible to receive allogeneic hematopoietic stem cell transplantation according to the eligibility criteria will be consented and enrolled. Subjects will be randomly assigned to receive one of 2 conditioning regimen: fludarabine and busulfan, or fludarabine busulfan and low dose total body irradiation (TBI). Subjects will be followed until 1 year post transplantation to assess the relapse rate in each arm and transplant-related toxicity. The combination of fludarabine and busulfan is the current standard of care for patients with myeloid malignancies (myelogenous leukemia, chronic myelogenous leukemia, other myeloproliferative disorder, or myelodysplastic syndrome) undergoing allogeneic transplantation at HUMC. In this study we will be comparing in a randomized fashion the standard regimen to a regimen of fludarabine, busulfan and TBI. Primary Objective The primary objective is to compare the relapse rate at 1 year of patients with myeloid malignancies receiving each regimen. Secondary Objectives The secondary objective is to compare the toxicity of each regimen

Eligibility

Minimum age: 18 Years. Maximum age: 70 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Diagnosis of acute myelogenous leukemia, chronic myelogenous leukemia, other

myeloproliferative disorder, or myelodysplastic syndrome

- Any stage of disease will be considered for transplantation

- Have a suitable related or unrelated donor (Section 3. 3)

- Age ≥18 but <70 yrs

- KPS of ≥70%

- Recovery from all hematologic and non-hematology toxicities from previous therapies.

Exclusion Criteria:

- Diagnosis other than acute myelogenous leukemia, myeloproliferative disorder, or

myelodysplastic syndrome

- Chemotherapy or radiotherapy within 14 days of initiating treatment in this study

with the exception of lenalidomide, decitabine, azacitidine, imatinib mesylate, dasatinib, nilotinib hydrochloride and hydroxyurea

- Prior dose-intense therapy requiring HSC support within 56 days of initiating

treatment in this study

- Uncontrolled bacterial, viral, fungal or parasitic infections

- Uncontrolled CNS metastases

- Known amyloid deposition in heart

- Organ dysfunction

- LVEF <40% or cardiac failure not responsive to therapy

- FVC, FEV1, or DLCO <50% of predicted and/or receiving supplementary continuous

oxygen

- Evidence of hepatic synthetic dysfunction, or total bilirubin >2x or AST >3x ULN

- Measured creatinine clearance <20 ml/min

- Karnofsky score <70%

- Life expectancy limited by another co-morbid illness

- Diagnosed or treated for another malignancy within 3 years of enrollment, with the

exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy

- Female subject is pregnant or breast-feeding (women) or unwilling to use acceptable

birth control methods (men or women) for twelve months after treatment. Confirmation that the subject is not pregnant must be established by a negative serum β-human chorionic gonadotropin (β-hCG) pregnancy test result obtained during screening. Pregnancy testing is not required for post-menopausal or surgically sterilized women.

- Documented hypersensitivity to fludarabine or melphalan or to bortezomib, boron or

mannitol or any components of the formulation

- Patients unable or unwilling to provide consent

- Myocardial infarction within 6 months prior to enrollment or has New York Heart

Association (NYHA) Class III or IV heart failure (see section 8. 4), uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any ECG abnormality at screening has to be documented by the investigator as not medically relevant

- Patient has received other investigational drugs with 14 days before enrollment

- Serious medical or psychiatric illness likely to interfere with participation in this

clinical study Donor Inclusion and Exclusion Criteria Donor Inclusion Criteria: HLA 6/6 (HLA-A, B, DrB1) related donor or 7/8 (HLA-A, B, C, DrB1) unrelated donor Related donors will be evaluated in accordance with HUMC standard practice guidelines for the evaluation and management of allogeneic donors Unrelated donors will be identified, evaluated, and managed in accordance with National Marrow Donor Program standards Age ≥18 and <70 yrs KPS of ≥70% Willing to donate bone marrow using standard techniques or peripheral blood HSC by leukapheresis Have adequate veins for apheresis or agree to placement of a central venous catheter (femoral, subclavian) if donating peripheral blood HSC Donor Exclusion Criteria Identical twin Female donors who are pregnant or breastfeeding Infection with HIV or viral hepatitis (B or C) Known allergy to filgrastim Current serious systemic illness Uncontrolled bacterial, viral, or fungal infection Receiving experimental therapy or investigational agents History of cancer other than treated basal cell cancer of the skin or carcinoma in situ of the cervix. Cancer treated with curative intent >5 yrs before donation will be reviewed on a case-by-case basis by the principal investigator

Locations and Contacts

Emily Brown, RN, Phone: 551-996-3923, Email: EmilyBrown@hackensackUMC.org

John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey 07601, United States; Recruiting
Emily Brown, RN, Email: EmilyBrown@hackensackUMC.org
Michele Donato, MD, Principal Investigator
Additional Information

Starting date: June 2010
Last updated: August 21, 2015

Page last updated: August 23, 2015

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