Chemotherapy and Donor Stem Transplant for the Treatment of Patients With High Grade Brain Cancer
Study Details
Study Description
Brief Summary
This phase I trial investigates the side effects and effectiveness of chemotherapy followed by a donor (allogeneic) stem cell transplant when given to patients with high grade brain cancer. Chemotherapy drugs, such as fludarabine, thiotepa, etoposide, melphalan, and rabbit anti-thymocyte globulin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy before a donor stem cell transplant helps kill cancer cells in the body and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to grow. When the healthy stem cells from a donor are infused into a patient, they may help the patient's bone marrow make more healthy cells and platelets and may help destroy any remaining cancer cells.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 1 |
Detailed Description
PRIMARY OBJECTIVE:
- To assess tolerability of allogenic hematopoietic cell transplantation (HCT) among patients with chemo-responsive high-grade central nervous system (CNS) malignancies as defined by transplant-related mortality (TRM) at day 30 as well as rate of grade III organ toxicity or higher (Bearman Regimen-Related Toxicities Scale) attributable to conditioning occurring within 30 days.
SECONDARY OBJECTIVES:
- Median time to platelet and neutrophil engraftment. II. Incidence of acute graft-versus-host disease (aGVHD) by day 100. III. Incidence of chronic GVHD at day 100 and one year. IV. Rate of grade II organ toxicity through day 100. V. Rate of graft failure (primary and secondary) through day 100. VI. Rate of infectious complications through day
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- Progression free survival at day 180. VIII. Cumulative incidence of relapse, overall survival, and progression-free survival at 100 days and 1 year.
OUTLINE:
Patients receive thiotepa intravenously (IV) over 2-4 hours and etoposide IV over 60 minutes on days -8 to -6, melphalan IV over 20 minutes on days -5 and -4, and fludarabine phosphate IV over 1 hour on days -5 to -3. Patients receiving umbilical cord transplant only also receive lapine T-lymphocyte immune globulin IV over 4-12 hours on days -4 and -3. Patients then undergo HCT on day 0. Patients also receive tacrolimus IV or cyclosporine IV beginning on day -2 to and mycophenolate mofetil orally (PO) every 8 hours or IV from days 0-40 and tapered to day 90.
After completion of study treatment, patients are followed up at 100, 180, 270 and 360 days.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Treatment (chemotherapy, HCT) Patients receive thiotepa IV over 2-4 hours and etoposide IV over 60 minutes on days -8 to -6, melphalan IV over 20 minutes on days -5 and -4, and fludarabine phosphate IV over 1 hour on days -5 to -3. Patients receiving umbilical cord transplant only also receive lapine T-lymphocyte immune globulin IV over 4-12 hours on days -4 and -3. Patients then undergo HCT on day 0. Patients also receive tacrolimus IV or cyclosporine IV beginning on day -2 to and mycophenolate mofetil PO every 8 hours or IV from days 0-40 and tapered to day 90. |
Drug: Etoposide
Given IV
Other Names:
Drug: Fludarabine Phosphate
Given IV
Other Names:
Procedure: Hematopoietic Cell Transplantation
Undergo HCT
Other Names:
Biological: Lapine T-Lymphocyte Immune Globulin
Given IV
Other Names:
Drug: Melphalan
Given IV
Other Names:
Drug: Mycophenolate Mofetil
Given PO or IV
Other Names:
Drug: Tacrolimus
Given IV
Other Names:
Drug: Thiotepa
Given IV
Other Names:
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Outcome Measures
Primary Outcome Measures
- Transplant-related mortality [At day 30]
Will be reported together with the corresponding 95% Bayesian credible interval. Will be estimated using the method of Gooley.
- Rate of grade III or higher organ toxicity attributable to conditioning [Within 30 days]
Assessed per Bearman Regimen-Related Toxicities Scale. Will be reported together with the corresponding 95% Bayesian credible interval.
Secondary Outcome Measures
- Failure of platelet and neutrophil engraftment rates [Day 100]
Will be calculated and illustrated from the time of transplant by the method of Kaplan and Meier.
- Incidence of acute graft-versus-host (GVHD) disease [Up to day 100]
Will be estimated using the method of Gooley.
- Incidence of chronic GVHD [At day 100 and 1 year]
Will be estimated using the method of Gooley.
- Rate of grade II organ toxicity [Up to day 100]
Will be reported as counts with percentages.
- Rate of graft failure (primary and secondary) [Up to day 100]
Will be reported as counts with percentages.
- Rate of infectious complications [Up to day 100]
Will be reported as counts with percentages.
- Progression free survival [At day 180]
- Cumulative incidence of relapse [At day 100 and 1 year]
Will be calculated and illustrated from the time of transplant by the method of Kaplan and Meier.
- Overall survival [At day 100 and 1 year]
Will be calculated and illustrated from the time of transplant by the method of Kaplan and Meier.
- Progression-free survival [At day 100 and 1 year]
Will be calculated and illustrated from the time of transplant by the method of Kaplan and Meier.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Pathological criteria for any high grade primary or recurrent malignant brain tumor - medulloblastoma (patients who are ineligible for tandem autologous transplants or who are at least 3 months post autologous HCT), primitive neuroectodermal tumor (PNET), atypical teratoid rhabdoid tumor (ATRT), malignant glioma, CNS germ cell tumor, intracranial sarcomas, choroid plexus carcinoma, anaplastic ependymoma. High grade tumors defined as those that are grade III or higher based on World Health Organization (WHO) classification grading system or for medulloblastoma: group 3 and 4 molecular subtypes
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Patients have to be in at least, a chemo-responsive disease status
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Available suitable HCT donor
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Creatinine clearance or glomerular filtration rate (GFR) >= 50 ml/min/1.73m^2, and not requiring dialysis
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Diffusion capacity of the lung for carbon monoxide (DLCO) (corrected for hemoglobin)
= 50% predicted. If unable to perform pulmonary function tests, then O2 saturation >= 92% in room air
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Bilirubin =< 3x upper limit of normal (ULN) (with the exception of isolated hyperbilirubinemia due to Gilbert's syndrome)
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Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 5x for age
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DONOR: HCT will be done using stem cell sources in the following order of preference (and fulfilling minimal cell dose requirements per institutional standards):
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Matched related donor bone marrow (10 of 10 human leukocyte antigen [HLA] alleles [HLA-A, B, C, DR, and DQ]). Matched related donor peripheral blood stem cell (PBSC) is allowed only if collection of bone marrow (BM) is not available or refused by guardian/donor
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Matched allogeneic umbilical cord blood: related
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High-resolution matching at A,B, DRB1 (minimum 4/6)
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Killer-cell immunoglobulin-like receptor (KIR) major histocompatibility complex (MHC) class 1 preferential mismatch (minimum 4/6)
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Matched allogeneic umbilical cord blood: unrelated
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High-resolution matching at A,B, DRB1(minimum 4/6)
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KIR MHC class 1 preferential mismatch (minimum 4/6)
Exclusion Criteria:
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Lack of histocompatible suitable graft source
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End-organ failure that precludes the ability to tolerate the transplant procedure, including conditioning regimen
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Renal failure requiring dialysis
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Congenital heart disease resulting in congestive heart failure
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Ventilatory failure: requires invasive mechanical ventilation
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Human immunodeficiency virus (HIV) infection
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Uncontrolled bacterial, viral, or fungal infections
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A female of reproductive potential who is pregnant, planning to become pregnant during the study, or is nursing a child
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Any patient who does not fulfill inclusion criteria listed above
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | M D Anderson Cancer Center | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- M.D. Anderson Cancer Center
Investigators
- Principal Investigator: Kris M Mahadeo, MD, M.D. Anderson Cancer Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 2020-0495
- NCI-2020-05878
- 2020-0495