Allogeneic Transplantation for Pediatric Leukemias With Unrelated Donors

Ann & Robert H Lurie Children's Hospital of Chicago

Status and phase

Unknown

Phase 2

Phase 1

Conditions

Leukemia

Treatments

Radiation: Total Body Irradiation

Drug: Thymoglobulin

Drug: Fludarabine

Drug: Busulfan

Study type

Interventional

Funder types

Other

Identifiers

NCT00679536

SCT 0208

Details and patient eligibility

About

The study proposes the use of Fludarabine, Busulfan, Anti Thymocyte Globulin Rabbit (ATG) and Total Body Irradiation as a preparative regimen before hematopoietic stem cell transplant from unrelated donor peripheral blood stem cells (PBSC). The hypothesis states that the 100 day mortality after this type of transplant will be significantly below the accepted standards, which is about 30% for unrelated donors.

Full description

The primary objective of this study is to evaluate the toxicity (as measured as 100 day survival) after hematopoietic stem cell transplant from an unrelated donor with a novel preparative regimen of Fludarabine, Busulfan, Anti-Thymocyte Globulin, and Total Body Irradiation for pediatric patients with leukemia. The secondary objectives are to evaluate the relapse-free and overall survival after hematopoietic stem cell transplant as well as to evaluate the incidence of acute and chronic graft-versus-host disease after this preparative regimen.

Enrollment

30 estimated patients

Sex

All

Ages

Under 21 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Ages 0-21
AML in one of the following stages:
- Having preceding myelodysplasia (MDS)
- High Risk cytogenetics
- Requiring > 2 cycles chemotherapy to obtain complete remission
- High allelic ratio FLT3/ITD+,
- Standard risk cytogenetics with positive MRD at end of Induction
- Second or greater CR
- First relapse with < 25% blasts in bone marrow
- With therapy-related AML whose prior malignancy has been in remission for at least 12 months
ALL in one of the following stages:
High risk first remission, defined as:
- Ph+ ALL; or,
- MLL rearrangement with slow early response [defined as having M2 (5-25% blasts) or M3 (>25% blasts on bone marrow examination on Day 14 of induction therapy)]; or,
- Hypodiploidy (< 44 chromosomes or DNA index < 0.81); or,
- End of induction M3 bone marrow; or,
- End of induction M2 marrow or MRD>1% with M2-3 marrow or MRD>1% at Day 42.
- High-risk infant ALL defined as age <6 months at diagnosis with MLL (11q23) translocation.
High risk second remission, defined as:
- Bone marrow relapse < 36 months from induction; or >36 mths if a matched sibling donor is available
- T-lineage relapse at any time; or,
- Very early isolated CNS relapse (<18 months from diagnosis); or,
- Slow reinduction (M2-3 at Day 28) after relapse at any time.
Any third or subsequent CR.
Biphenotypic or undifferentiated leukemia in any CR or if in first relapse must have < 25% blasts in bone marrow
MDS at any stage; prior therapies allowed
CML in chronic or accelerated phase; prior therapies allowed
Patient also must have the following organ requirements:
- Adequate renal function defined as serum creatinine <2x normal, or creatinine clearance > 40 ml/min/m^2 or 70 ml/min.
- Adequate liver function as defined by total bilirubin less than or equal to 2 times normal and AST and ALT less than or equal to 4 times normal.
- Adequate cardiac function as defined by: shortening fraction > 24% by echocardiogram, or ejection fraction > 30% by radionuclide angiogram.
- Adequate pulmonary function as defined by DLCO, FEV1/FVC > 60% by pulmonary function tests. For children who are uncooperative for PFTs and have no evidence of dyspnea at rest or exercise intolerance, pulse oximetry > 94% on room air is considered acceptable, with a normal chest xray.
- Adequate venous access; a double lumen central vascular access device or its equivalent and an additional PICC line will be required for all patients.
Women of childbearing potential and sexually active males should use effective contraception while on study.

Exclusion criteria

Inability to give informed consent or assent
Inability to obtain a suitable donor
Patient who is HIV-positive
Patient who has active Hepatitis B
Patient who is pregnant
Patient who is otherwise considered unsuitable for transplant at the discretion of the principal investigator.