Prospective Assessment of Allogeneic Hematopoietic Cell Transplantation in Patients With Myelofibrosis
Study Details
Study Description
Brief Summary
This observational study will compare outcomes of a prospectively-enrolled cohort of Hematopoietic Stem Cell Transplant (HCT) recipients with outcomes of a cohort of age-matched historical non-HCT controls. Patients undergoing alloHCT will receive HCT in a US transplant center and be reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) using well-established CIBMTR report forms and data collection procedures as well as a study-specific supplemental form. Data on the historical non-HCT controls will be collected at 14 US academic centers. These centers will provide data on all consecutive patients with PMF, post-ET MF, or post-PV MF referred to their institutions between 2000 and 2012.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Patients with primary MF (PMF), post-essential thrombocythemia (ET) MF, or post-polycythemia vera (PV) MF, with intermediate-2 or high-risk disease as determined by the DIPSS, and aged ≥55 at the time of DIPSS assessment are eligible for this study. For the allogeneic HCT arm of the HLA-Matched Donor HCT Study, donors must be either 6/6 HLA-matched related donors, defined by Class I (HLA-A and -B) intermediate resolution or high resolution DNA-based typing and Class II (HLA-DRBI) at high resolution DNA-based typing (but not monozygotic twins), OR an 8/8 HLA-A, -B, -C, and -DRB1 at high resolution DNA-based typing matched unrelated donors; both peripheral blood stem cells and bone marrow grafts are allowed, and all conditioning regimen intensities and graph versus host disease (GVHD) prophylaxis regimens are allowed. For the Haploidentical Donor Study, donors must be haploidentical.
This study will target accrual of 650 patients receiving alloHCT, including approximately 225 receiving myeloablative conditioning. Participating centers are expected to provide data for approximately 2,400 patients to form the non-HCT historical control cohort.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Hematopoietic Stem Cell Transplant (HCT) Patients undergoing alloHCT in a US transplant center and reported to the CIBMTR |
Other: Hematopoietic Stem Cell Transplant
This observational study will compare outcomes of prospectively enrolled HCT recipients with outcomes of a cohort of age-matched non-HCT controls.
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| Non-HCT Historical non-transplant controls collected from 14 US academic centers. Centers will provide data on all consecutive patients with PMF, post-ET MF, or post-PV MF referred to their institutions between 2000 and 2012. |
Outcome Measures
Primary Outcome Measures
- Compare five year survival [Five years post transplant]
Compare the five-year survival probabilities from DIPSS assessment between the two study arms: alloHCT recipients (arm 1) and non-HCT therapies (ruxolitinib / best supportive care) recipients (arm 2).
Secondary Outcome Measures
- Compare leukemia-free survival [Five years post transplant]
Compare leukemia-free survival at five years from DIPSS assessment date to the date of progression to AML or death from any cause, whichever comes first. Two co-secondary analyses will be conducted, one for all alloHCT patients versus Arm 2 and one for the subset of patients receiving MAC prior to alloHCT versus Arm 2. Observation is censored at the date of last follow-up for patients known to be alive without leukemia. Progression to AML is defined as >20% leukemia blasts in bone marrow or in the peripheral blood.
- Cumulative incidences of chronic GVHD [Five years post transplant]
Occurrence of symptoms in any organ system fulfilling the criteria of chronic GVHD. Patients are censored at last follow-up or second transplant.
- Cumulative incidences of acute GVHD [Five years post transplant]
Occurrence of grade II, III, and/or IV skin, gastrointestinal, or liver abnormalities fulfilling the Consensus criteria of acute GVHD. Patients are censored at last follow-up or second transplant.
- Cumulative incidence of treatment related mortality [Five years post transplant]
Death from any cause in the first 28 days post-transplantation, irrespective of relapse status. Death beyond day +28 will only be considered transplant-related if the disease is in remission. This event will be summarized as a cumulative incidence estimate with relapse/persistence as the competing risk.
- The impact of certain patient, disease and HCT related factors on survival in the alloHCT arm. [Five years post transplant]
Evaluation of the impact of response to ruxolitinib therapy, patient age (<65 years vs. >= 65 years, disease duration and DIPSS on overall survival in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
- The impact of certain patient, disease and HCT related factors on leukemia free survival in the alloHCT arm. [Five years post transplant]
Evaluation of the impact of response to ruxolitinib therapy, patient age (<65 vs. >= 65 years), disease duration and DIPSS on leukemia free survival in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
- The impact of certain patient, disease and HCT related factors on hematopoietic recovery in the alloHCT arm. [Five years post transplant]
Evaluation of the impact of response to ruxolitinib therapy, patient age (<65 vs >=65 years), disease duration and DIPSS on hematopoietic recovery in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
- The impact of certain patient, disease and HCT related factors on acute and chronic GVHD in the alloHCT arm. [Five years post transplant]
Evaluation of the impact of response to ruxolitinib therapy, patient age (<65 vs >= 65 years), disease duration and DIPSS on acute and chronic GVHD in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
- The impact of certain patient, disease and HCT related factors on treatment related mortality in the alloHCT arm. [Five years post transplant.]
Evaluation of the impact of response to ruxolitinib therapy, patient age (<65 vs >=65 years), disease duration, and DIPSS on treatment related mortality in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
- The impact of certain patient, disease and HCT related factors on relapse. [Five years post transplant.]
Evaluation of the impact of response to ruxolitinib therapy, patient age (65 vs >=65 years), disease duration and DIPSS on relapse in the alloHCT arm. The time to event in the analyses will start at the time of transplant.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients fulfilling the following criteria will be eligible for inclusion in the study:
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PMF, post-ET MF, or post-PV MF.
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Int-2 or high-risk disease as determined by the DIPSS.
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Age ≥55 at the time of DIPSS assessment.
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For the alloHCT arm:
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Donors must be a 6/6 HLA-matched related donors, defined by Class I (HLA-A and -B) intermediate resolution or high resolution DNA-based typing and Class II (HLA-DRBI) at high resolution DNA-based typing (but not monozygotic twins) OR an 8/8 HLA-A, -B, -C, and -DRB1 at high resolution DNA-based typing matched unrelated donor identified through the National Marrow Donor Program (NMDP)/Be The Match. Donors must meet institutional or NMDP/Be The Match selection criteria; there is no age restriction for sibling donors.
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Both peripheral blood stem cells and bone marrow grafts are allowed.
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All conditioning regimen intensities are allowed.
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All GVHD prophylaxis regimens are allowed.
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Haploidentical donors are allowed in the Haploidentical Donor Study
Exclusion Criteria:
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Patients with the following criteria will be ineligible for entry into the study:
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AlloHCT using umbilical cord blood unit(s) or HLA-mismatched adult donors (< 6/6 HLA alleles for related and < 8/8 HLA alleles for unrelated).
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Overlap syndromes.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Center for International Blood and Marrow Transplant Research | Minneapolis | Minnesota | United States | 55401 |
Sponsors and Collaborators
- Center for International Blood and Marrow Transplant Research
- National Marrow Donor Program
- National Institutes of Health (NIH)
- National Cancer Institute (NCI)
Investigators
- Study Chair: Wael Saber, MD, Medical College of Wisconsin
- Study Chair: Laura Michaelis, MD, Medical College of Wisconsin
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 16-CMS-MF
- U24CA076518