Cyclophosphamide in Treating Patients Who Are Undergoing a Donor Bone Marrow Transplant for Fanconi's Anemia

Sponsor

Fred Hutchinson Cancer Center (Other)

Overall Status

Completed

CT.gov ID

NCT00317876

Collaborator

National Cancer Institute (NCI) (NIH)

Enrollment

Locations

8.3

Patients Per Site

Study Details

Study Description

Brief Summary

RATIONALE: Giving low doses of chemotherapy, such as cyclophosphamide, before a donor bone marrow transplant helps stop the growth of abnormal cells. It also stops the patient's immune system from rejecting the donor's bone marrow. The donated bone marrow stem cells may replace the patient's immune system and help destroy any remaining abnormal cells. Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving cyclosporine and methotrexate before or after transplant may stop this from happening.

PURPOSE: This phase I trial is studying the side effects and best dose of cyclophosphamide in treating patients who are undergoing a donor bone marrow transplant for Fanconi's anemia.

Condition or Disease	Intervention/Treatment	Phase
Fanconi Anemia	Drug: cyclophosphamide Drug: cyclosporine Drug: methotrexate Procedure: allogeneic bone marrow transplantation Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation	Phase 1

Detailed Description

OBJECTIVES:

Decrease the conditioning-related toxicity of cyclophosphamide without decreasing the engraftment rate to < 90% in patients undergoing allogeneic bone marrow transplantation for Fanconi's anemia.

OUTLINE: This is a multicenter, dose-finding study of cyclophosphamide.

Nonmyeloablative conditioning regimen: Patients receive cyclophosphamide IV on days -5 to -2.

Cohorts of 5-10 patients receive decreasing doses of cyclophosphamide until the optimal dose (OD) is determined. The OD is defined as the dose at which ≥ 4 of 5 patients achieve engraftment and < 1 of 10 patients experiences dose-limiting toxicity.

Allogeneic bone marrow transplantation (BMT): Patients undergo allogeneic BMT on day 0.
Graft-vs-host-disease (GVHD) prophylaxis: Patients receive cyclosporine orally or IV twice daily beginning on day -1 and continuing until day 49, followed by a taper on days 50-180 in the absence of GVHD. Patients also receive methotrexate IV on days 1, 3, 6, and 11.

After completion of study treatment, patients are followed periodically for 5 years.

PROJECTED ACCRUAL: A total of 27 patients will be accrued for this study.

Study Design

Study Type:

Interventional

Actual Enrollment :

25 participants

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Dose-Finding Study for Cyclophosphamide as Conditioning Regimens for Bone Marrow Transplantation From Related Donors in Patients With Fanconi Anemia

Study Start Date :

Jun 1, 1998

Actual Primary Completion Date :

Jul 1, 2003

Outcome Measures

Primary Outcome Measures

Conditioning-related toxicity [100 days post-transplant]
Graft rejection [100 days post-transplant]

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Diagnosis of Fanconi's anemia by chromosome fragility with a diepoxybutane (DEB) or mitomycin C test
Hemoglobin ≤ 8.0 g/dL, absolute granulocyte count ≤ 1,000/mm^{3, or platelet count
≤ 50,000/mm}3
No refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or acute leukemia
HLA-identical related donor available

PATIENT CHARACTERISTICS:

Glomerular filtration rate ≥ 30% predicted for age
No liver disease (e.g., active hepatitis or moderate to severe portal fibrosis/cirrhosis by biopsy)
No symptomatic cardiac insufficiency or symptomatic arrhythmia
No other diseases that would severely limit the probability of survival
No HIV seropositivity
Not pregnant or nursing
Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Not specified

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Seattle Cancer Care Alliance	Seattle	Washington	United States	98109-1023
2	Fred Hutchinson Cancer Research Center	Seattle	Washington	United States	98109-1024
3	Universidade Federal do Parana	Curitiba	Parana	Brazil	80.060-000