Phase 2
N=422
HLA-Compatible Related or Unrelated Donors With CD34+ Enriched, T-cell Depleted Peripheral Blood Stem Cells Isolated by the CliniMACS System in the Treatment of Patients With Hematologic Malignancies
Acute Lymphoblastic Leukemia · Acute Myelogenous Leukemia · Myelodysplastic Syndrome · Multiple Myeloma
Bottom Line
View on ClinicalTrials.gov: NCT01119066 ↗Enrolled (actual)
422
Serious AEs
13.7%
Results posted
Aug 2022
Primary outcome: Primary: The Incidence of Durable Hematopoietic Engraftment for T-cell Depleted Transplants Fractionated by the CliniMACS System Administered After Each of the Four Disease Targeted Cytoreduction Regimens. — 118; 205; 45; 10 Participants
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- total body irradiation (Radiation); Thiotepa (Drug); Cyclophosphamide (Drug); Busulfan (Drug); Melphalan (Drug); Fludarabine (Drug); Clofarabine (Drug); (CliniMACS) T-cell depleted PBSC Transplant (Procedure)
- Age
- Pediatric, Adult, Older Adult
- Sex
- All
- Sponsor
- Memorial Sloan Kettering Cancer Center
- Primary completion
- Mar 2021
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY The Incidence of Durable Hematopoietic Engraftment for T-cell Depleted Transplants Fractionated by the CliniMACS System Administered After Each of the Four Disease Targeted Cytoreduction Regimens. |
118; 205; 45; 10; 0; 0 | — |
| PRIMARY Number of Participants With Acute and Chronic GVHD Following T-cell Depleted, CD34+ Progenitor Cell Enriched Transplants Fractionated by the CliniMACS System. |
34; 60; 10; 2; 2; 4 | — |
| PRIMARY Incidence of Non-relapse Mortality (Transplant-related Mortality) Following Each Cytoreduction Regimen and a Transplant Fractionated by the CliniMACS System. |
81; 145; 30; 8; 23; 24 | — |
| PRIMARY Survival and Disease-free Survival (DFS) |
68.7; 72.1; 63.8; 71.6; 58.9; 62.1 | — |
| PRIMARY Survival and Disease-free Survival (DFS) |
68.7; 72.1; 63.8; 71.6; 58.9; 62.1 | — |
| PRIMARY Survival and Disease-free Survival (DFS) |
68.7; 72.1; 63.8; 71.6; 58.9; 62.1 | — |
| SECONDARY Proportion of Patients Receiving Optimal CD3+ (<1x10^5/kg) Cell Doses the Proportion of Patients Receiving CD3+ T-cell Doses > 1x10^5/kg. |
120; 210; 47; 11; 0; 0 | — |
| SECONDARY Proportion of Patients Receiving Optimal CD34+ (> 5x10^6/kg) Cell Doses the Proportion Recurring Suboptimal Doses (< 2x10^6/kg) CD34+ Cells |
105; 169; 39; 11; 0; 1 | — |
| SECONDARY Correlation of Doses of CD34+ Progenitors and CD3+ T Cells With Engraftment |
103; 163; 38; 11; 1; 5 | — |
Summary
The purpose of this study is to find out the effects of using a system called CliniMACS to remove Tcells from blood stem cells. Removing T-cells may help stop a side effect called Graft-Versus-Host Disease (GVHD). Some studies have been done with CliniMACS, but the Food and Drug Administration (FDA) has not yet approved it.
Eligibility Criteria
Inclusion Criteria
- Malignant conditions or other life threatening disorders correctable by transplant for which CD34+ selected, T-cell depleted allogeneic hematopoietic stem cell transplantation is indicated such as:
- AML in 1st remission - for patients whose AML does not have 'good risk' cytogenetic features (i.e. t 8;21, t15;17, inv 16).
- Secondary AML in 1st remission
- AML in 1st relapse or > than or = to 2nd remission
- ALL/CLL in 1st remission clinical or molecular features indicating a high risk for relapse; or ALL/CLL > than or = to 2nd remission
- CML failing to respond to or not tolerating Imatinib or dasatinib in first chronic phase of disease; CML in accelerated phase second chronic phase or in CR after accelerated phase or blast crisis.
- Non-Hodgkins lymphoma with chemoresponsive disease in any of the following categories:
- intermediate or high grade lymphomas who have failed to achieve a first CR or have relapsed following a 1st remission who are not candidates for autologous transplants.
- any NHL in remission which is considered not curable with chemotherapy alone and not eligible/appropriate for autologous transplant.
- Myelodysplastic syndrome (MDS): RA//RARS/RCMD with high risk cytogenetic features or transfusion dependence as well as RAEB-1 and RAEB-2 and Acute myelogenous leukemia (AML) evolved from MDS, who are not eligible for transplantation and/or unable to enroll onto protocol IRB 08-008.
- Chronic myelomonocytic leukemia: CMML-1 and CMML-2.
- Multiple Myeloma with disease in the following categories:
- Patients with relapsed multiple myeloma following autologous stem cell transplantation who have achieved at least partial response following additional chemotherapy.
- Patients with high risk cytogenetics at diagnosis must have achieved a partial response following autologous stem cell transplantation. Patients must have complex karyotype, del17p, t4;14 and/or t14;16 by FISH and/or del13 by karyotyping.
- Other rare lethal disorders of Hematopoiesis and Lymphopoiesis for which a T-cell depleted transplant is indicated (e.g. hemophagocytic lymphohistiocytosis; refractory aplastic anemia or congenital cytopenias; non-SCID lethal genetic immunodeficiencies such as Wiskott Aldrich Syndrome, CD40 ligand deficiency, or ALPS, as well as refractory autoimmune cytopenias, PNH, metabolic storage diseases or heavily transfused congenital hemoglobinopathies).
- Accrual to each treatment arm will include up to 30 standard risk and 30 poor risk patients (60 patients/treatment arm) except for Regimen D, which will include 30 patients/treatment arm, all of which will be poor risk by virtue of risks of relapse and/or transplant related mortality.
- Standard risk patients will include eligible patients, as defined above, who are receiving transplants as treatment for MDS in RA//RARS/RCMD, AML in 1st or 2nd remission, ALL in 1st CR, NHL in 1st remission, MM in 1st remission, Very Good Partial Response, or 1st Partial Response or CML in the first chronic phase or 1st remission.
- All other patients, including those with treatment related malignancies and/or those who have AML derived from MDS, will have received extensive prior chemo/radiotherapy and, therefore, will be considered to be at poor risk of conditioning and transplant related morbidities, and potentially transplant related mortality. Patients with life threatening non-malignant genetic and acquired disorders will also, by virtue of their history of, optional transfusions and/or infection be considered poor risk. Stopping rules for non-relapse related mortality in these heavily treated patients are, therefore, slightly less stringent than patients in the poor risk transplant groups. Stopping rules for the principal endpoints of graft failure and GvHD are the same for all groups.
The following inclusion criteria are also required:
- Patient's age includes from birth on to or = to 70%
- Patients must have adequate organ function measured by:
Card
Data sourced from ClinicalTrials.gov (NCT01119066). 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.