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HLA-Mismatched Unrelated Donor Hematopoietic Cell Transplantation With Post-Transplantation Cyclophosphamide

Status
Active
Cancer Type
Cancer-Related Syndrome
Leukemia
Lymphoma
Myelodysplastic Syndromes (MDS)
Trial Phase
Phase II
Eligibility
1 Years and older, Male and Female
Study Type
Treatment
NCT ID
NCT04904588
Protocol IDs
ACCESS (primary)
NCI-2021-06605
Study Sponsor
Center for International Blood and Marrow Transplant Research

Summary

This is a prospective, multi-center, Phase II study of hematopoietic cell transplantation
(HCT) using human leukocyte antigen (HLA)-mismatched unrelated donors (MMUD) for peripheral
blood stem cell transplant in adults and bone marrow stem cell transplant in children.
Post-transplant cyclophosphamide (PTCy), tacrolimus and mycophenolate mofetil (MMF) will be
used for for graft versus host disease (GVHD) prophylaxis. This trial will study how well
this treatment works in patients with hematologic malignancies.

Eligibility

  1. Age > 18 years and < 66 years (chemotherapy-based conditioning) or < 61 years (total body irradiation [TBI]-based conditioning) at the time of signing informed consent
  2. Planned MAC regimen as defined per protocol
  3. Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age < 35 years
  4. Product planned for infusion is PBSC
  5. HCT Comorbidity Index (HCT-CI) < 5
  6. One of the following diagnoses:
  7. Acute myeloid leukemia (AML) acute lymphoblastic leukemia (ALL), or other acute leukemia in 1st remission or beyond with = 5% marrow blasts and no circulating blasts or evidence of extra-medullary disease. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  8. Patients with myelodysplastic syndrome (MDS) with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS). Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  9. Cardiac function: Left ventricular ejection fraction > 45% based on most recent echocardiogram or multigated acquisition scan (MUGA) results
  10. Estimated creatinine clearance > 60 mL/min calculated by equation
  11. Pulmonary function: diffusing capacity of the lungs for carbon monoxide (DLCO) corrected for hemoglobin > 50% and forced expiratory volume in first second (FEV1) predicted > 50% based on most recent pulmonary function test results
  12. Liver function acceptable per local institutional guidelines
  13. Karnofsky performance status (KPS) of > 70%
  14. Subjects = 18 years of age or legally authorized representative must have the ability to give informed consent according to applicable regulatory and local institutional requirements. Stratum 2 Recipient Inclusion Criteria
  15. Age > 18 years at the time of signing informed consent
  16. Planned NMA/RIC regimen as defined per protocol
  17. Available partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age < 35 years
  18. Product planned for infusion is PBSC
  19. One of the following diagnoses:
  20. Patients with acute leukemia or chronic myeloid leukemia (CML) with no circulating blasts, no evidence of extramedullary disease, and with < 5% blasts in the bone marrow. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  21. Patients with MDS with no circulating blasts and with < 10% blasts in the bone marrow (higher blast percentage allowed in MDS due to lack of differences in outcomes with < 5% or 5-10% blasts in MDS.) Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  22. Patients with chronic lymphocytic leukemia (CLL) or other leukemias (including prolymphocytic leukemia) with chemosensitive disease at time of transplantation
  23. Patients with lymphoma with chemosensitive disease at the time of transplantation
  24. Cardiac function: Left ventricular ejection fraction > 45% based on most recent echocardiogram or MUGA results with no clinical evidence of heart failure
  25. Estimated creatinine clearance > 60 mL/min calculated by equation
  26. Pulmonary function: DLCO corrected for hemoglobin > 50% and FEV1 predicted > 50% based on most recent pulmonary function test results
  27. Liver function acceptable per local institutional guidelines
  28. KPS of > 60%
  29. Subjects = 18 years of age or legally authorized representative must have the ability to give informed consent according to applicable regulatory and local institutional requirements. Stratum 3 Recipient Inclusion Criteria
  30. Age > 1 years and < 21 years at the time of signing informed consent
  31. Partially HLA-MMUD (4/8-7/8 at HLA-A, -B, -C, and -DRB1 is required) with age < 35 years
  32. Product planned for infusion is BM
  33. Planned MAC regimen as defined per protocol
  34. One of the following diagnosis:
  35. AML in 1st remission or beyond with = 5% marrow blasts, no circulating blasts or evidence of extra-medullary disease. Pre-transplant MRD testing will be performed as per standard of practice at the treating institution. Patients with any MRD status are eligible and should be enrolled at the discretion of provider. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  36. Patients MDS with no circulating blasts and less than 10% blasts in the bone marrow. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  37. ALL in 1st remission or beyond with = 5% marrow blasts, no circulating blasts, or evidence of extra-medullary disease. Pre-transplant MRD testing will be performed as standard practice at the treating institution with the goal of achieving MRD of <0.01%. Patients with any MRD status are eligible and should be enrolled at the discretion of provider. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  38. Other leukemia (mixed-phenotype acute leukemia [MPAL], CML, or other leukemia) in morphologic remission with = 5% marrow blasts and no circulating blasts or evidence of extramedullary disease. Documentation of bone marrow assessment will be accepted within 45 days prior to the anticipated start of conditioning.
  39. Chemotherapy sensitive lymphoma in at least partial remission (PR)
  40. KPS or Lansky performance score = 70%
  41. Cardiac function: Left ventricular ejection fraction of = 50% and shortening fraction of = 27% based on most recent echocardiogram
  42. Glomerular Filtration Rate (GFR) of = 60ml/min/1.73m2 measured by nuclear medicine scan or calculated from a 24 hour urine collection
  43. Pulmonary function: DLCO corrected for hemoglobin, FEV1, and Forced Vital Capacity (FVC) of =50% if able to perform pulmonary function tests. If unable to perform pulmonary function tests, must have a resting pulse oximetry of >92% without supplemental oxygen.
  44. Hepatic: Total bilirubin = 2.5 mg/dL and alanine aminotransferase (ALT), aspartate aminotransferase (AST) < 3x the upper limit of normal
  45. Legal guardian permission must be obtained for subjects < 18 years of age. Pediatric subjects will be included in age appropriate discussion in order to obtain assent.
  46. Subjects = 18 years of age or legally authorized representative must have the ability to give informed consent according to applicable regulatory and local institutional requirements. Donor Inclusion Criteria:
  47. Must be unrelated to the subject and high-resolution HLA-matched at 4/8, 5/8, 6/8, or 7/8 (HLA-A, -B, -C, and -DRB1)
  48. Donor must be typed at high-resolution for a minimum of HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1
  49. Age > 18 years and < 35 years at the time of signing informed consent
  50. Meet the donor registries' medical suitability requirements for PBSC or BM donation
  51. Must undergo eligibility screening according to current Food and Drug Administration (FDA) requirements. Donors who do not meet one or more of the donor screening requirements may donate under urgent medical need.
  52. Must agree to donate PBSC (or BM for stratum 3)
  53. Must have the ability to give standard (non-study) informed consent according to applicable donor regulatory requirements Recipient Exclusion Criteria (Strata 1, 2 and 3):
  54. Suitable HLA-matched related or 8/8 high-resolution matched unrelated donor available
  55. Subject unwilling or unable to give informed consent, or unable to comply with the protocol including required follow-up and testing
  56. Primary myelofibrosis or myelofibrosis secondary to essential thrombocythemia, polycythemia vera, or MDS with grade 4 marrow fibrosis
  57. Subjects with a prior allogeneic transplant
  58. Subjects with an autologous transplant within the past 3 months
  59. Females who are breast-feeding or pregnant
  60. Uncontrolled bacterial, viral or fungal infection at the time of the transplant preparative regimen
  61. Concurrent enrollment on other interventional GVHD clinical trial (enrollment on supportive care trials may be allowed after discussion with Principal Investigators)
  62. Subjects who undergo desensitization to reduce anti-donor HLA antibody levels prior to transplant.
  63. Patients who are HIV+ with persistently positive viral load. HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
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