Phase 2
N=34
Hematopoietic Stem Cell Transplantation in the Treatment of Infant Leukemia
Leukemia · Myelodysplastic Syndromes · Childhood Acute Myeloid Leukemia in Remission · Recurrent Childhood Acute Myeloid Leukemia · Secondary Acute Myeloid Leukemia
Bottom Line
View on ClinicalTrials.gov: NCT00357565 ↗Enrolled (actual)
34
Serious AEs
41.2%
Results posted
Aug 2025
Primary outcome: Primary: Incidence of Engraftment — 100; 93; 100 Percentage of participants
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- filgrastim (Biological); busulfan (Drug); cyclosporine (Drug); fludarabine phosphate (Drug); melphalan (Drug); mycophenolate mofetil (Drug); umbilical cord blood transplantation (Procedure)
- Age
- Pediatric
- Sex
- All
- Sponsor
- Masonic Cancer Center, University of Minnesota
- Primary completion
- Jun 2024
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Incidence of Engraftment |
100; 93; 100 | — |
| SECONDARY Incidence of Transplant-related Mortality (TRM) |
33; 13; 0 | — |
| SECONDARY Incidence of Platelet Engraftment |
80; 100; 100 | — |
| SECONDARY Incidence of Acute Graft-versus-host Disease (GVHD) Grade II-IV and Grade III-IV |
40; 33; 0 | — |
| SECONDARY Incidence of Chronic Graft-versus-host Disease (GVHD) |
13; 0; 0 | — |
| SECONDARY Incidence of Relapse |
13; 20; 0; 13; 20; 25 | — |
| SECONDARY Overall Survival |
0.53; 0.67; 100; 0.47; 0.67; 0.67 | — |
| SECONDARY Disease-free Survival |
0.13; 0.2; 0; 0.13; 0.20; 0.33 | — |
Summary
RATIONALE: Giving chemotherapy, such as busulfan, fludarabine, and melphalan, before a donor umbilical cord blood stem cell transplant helps stop the growth of abnormal or cancer cells and prepares the patient's bone marrow for the stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil may stop this from happening.
PURPOSE: This phase II trial is studying how well combination chemotherapy followed by a donor umbilical cord blood transplant works in treating infants with high-risk acute leukemia or myelodysplastic syndromes.
Eligibility Criteria
Inclusion Criteria
- Matched sibling donor (HLA 8/8), if available, or a unrelated partially HLA matched single unit based on the following priority:
- 1st priority: 4/6 matched unit, cell dose >5 x 10-7 nucleated cells/kg
- 2nd priority: 5/6 matched unit, cell dose > 4 x 10-7 nucleated cells/kg
- 3rd priority: 6/6 matched unit, cell dose > 3 x 10-7 nucleated cells/kg
- Patients aged ≤ 3 years at diagnosis (not age of transplant) with hematological malignancy as detailed below:
- Acute myeloid leukemia: high risk CR1 as evidenced by:
- High risk cytogenetics t(4;11) or other MLL rearrangements; chromosome 5, 7, or 19 abnormalities; complex karyotype (>5 distinct changes); ≥ 2 cycles to obtain complete response (CR); CR2 or higher; Preceding myelodysplastic syndrome (MDS); All patients must be in CR or early relapse (i.e., 1 cycle to obtain CR; CR2 or higher; All patients must be in CR as defined by hematological recovery, AND 0.1% residual cells in the blast gate with immune phenotype of original leukemic clone), by molecular techniques (PCR or FISH) or conventional cytogenetics (g-banding).
- New Leukemia Subtypes: A major effort in the field of pediatric hematology is to identify patients who are of high risk for treatment failure so that patients can be appropriately stratified to either more (or less) intensive therapy. This effort is continually ongoing and retrospective studies identify new disease features or characteristics that are associated with treatment outcomes. Therefore, if new high risk features are identified after the writing of this protocol, patients can be enrolled with the approval of two members of the study committee.
- Recipients must have a Lansky score ≥ 50% and have acceptable organ function defined as:
- Renal: glomerial filtration rate > 60ml/min/1.73m^2
- Hepatic: bilirubin, AST/ALT, ALP 92%
- Cardiac: left ventricular ejection fraction > 45%.
- Voluntary written informed consent before performance of any study-related procedure not part of normal medical care.
Exclusion Criteria
- Active infection at time of transplantation (including active infection with Aspergillus or other mold within 30 days).
- History of HIV infection or known positive serology
- Myeloablative transplant within the last 6 months.
- Evidence of active extramedullary disease (including central nervous system leukemia).
Data sourced from ClinicalTrials.gov (NCT00357565). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.