Autologous Peripheral Blood Stem Cell Transplant for Germ Cell Tumors

Masonic Cancer Center, University of Minnesota1 site in 1 country23 target enrollmentStarted: December 19, 2006Last updated: May 17, 2022

Conditions

Interventions

Drugs

Trial Snapshot

Phase: Phase 2
Status: Completed
Sponsor: Masonic Cancer Center, University of Minnesota
Enrollment: 23
Locations: 1
Primary Endpoint: Overall Survival (OS)

Study Overview Study Design Eligibility Criteria Arms & Interventions Outcomes Investigators Sites Records & Identifiers Similar Trials

Study Overview

Brief Summary

RATIONALE: Germ cell tumors (GCT) are highly sensitive to chemotherapy such that even with metastatic disease at diagnosis, many patients can be cured. Patients who fall into the poor risk category or others who relapse can be successfully salvaged with high dose chemotherapy and autologous stem cell transplant (AuSCT). As in other diseases such as myeloma, sequential high dose chemotherapy and AuSCT may improve overall and disease free survival.

PURPOSE: Because prior investigations in GCT suggest that a subset of high risk or relapsed patients may be cured with sequential cycles of high dose chemotherapy and AuSCT, we propose investigating how well non-cross resistant conditioning regimens work in treating patients with relapsed or high risk GCT.

Detailed Description

OBJECTIVES:

Primary

Determine overall survival (OS) of patients with germ cell tumors treated with tandem autologous stem cell transplantation with non-cross-resistant conditioning regimens.

Secondary

Determine disease-free survival (DFS) of patients treated with this regimen.
Determine the toxicity of tandem transplants
Determine the time to engraftment of neutrophils and platelets in patients treated for each transplant
Determine the number of patients unable to adequately mobilize sufficient peripheral blood stem cells (PBSC) for tandem transplantation.
Identify prognostic factors of patients unlikely to mobilize sufficient PBSC for tandem transplantation.
Compare OS and DFS of patients undergoing single vs tandem transplantation.

Study Design

Study Type: Interventional
Allocation: Na
Intervention Model: Single Group
Primary Purpose: Treatment
Masking: None

Eligibility Criteria

Ages: 10 Years to 69 Years (Child, Adult, Older Adult)
Sex: All
Accepts Healthy Volunteers: No

Inclusion Criteria

•Diagnosis: Poor Prognosis Non-Seminomas Germ Cell Tumor in ≥ PR1/CR1 or Good or Intermediate Prognosis Seminomas and Non- Seminomas Germ Cell Tumor in ≥ PR1 or ≥ CR2 as defined by the International Germ Cell Cancer Consensus Classification. Patients with increasing tumor markers only (i.e. no imaging evidence of progressive disease) are eligible for transplant.
•Age: ≥ 10 years and < 70 years of age.
•Performance status: Karnofsky ≥ 80% (subjects ≥ 16 years of age) Lansky ≥ 80% for subject 10 - 15 years of age
•Life expectancy: Greater than 8 weeks.
•Patients must have normal organ function as defined below:
•Hematologic:
•Hemoglobin > 8 gm/dL without transfusion and off erythropoietin for 14 days or Aranesp for 21 days
•White blood cells (WBC) > 2.5 x 10^9/L with an absolute neutrophile count (ANC) > 1.5 x 10^9/L and off G-CSF or GM-CSF for 10 days or Neulasta for 21 days
•Platelets > 100 x 10^9/L without transfusion and/or a bone marrow cellularity of ≥ 20%
•Renal: Creatinine ≤ 2.0 mg/dl or creatinine clearance > 50 ml/min.
•Hepatic: Total bilirubin ≤ 2.0 mg/dl, AST and alkaline phosphatase < 5 x upper limit of normal. No history of severe prior or ongoing chronic liver disease.
•Cardiac: Patients must be free of symptoms of uncontrolled cardiac disease including unstable angina, decompensated congestive heart failure, or arrhythmia. LVEF ≥45% by MUGA/ECHO.
•Pulmonary: Patients must have no significant obstructive airways disease (FEV1 must be ≥ 50% of predicted) and must have acceptable diffusion capacity (corrected DLCO > 50% of predicted).
•Patients with a history of CNS tumor involvement are eligible if they have completed treatment for CNS disease (radiotherapy or surgery or chemotherapy), have recovered from or stabilization of the side effects associated with the therapy and have no evidence of progressive CNS disease at the time of enrollment.

Exclusion Criteria

•Patients with serious uncontrolled infections will not be eligible.
•Male and female patients of reproductive potential must use an approved contraceptive method if appropriate (for example, intrauterine device [IUD], birth control pills, or barrier device) during and for the duration of study participation. The drugs used in this study are pregnancy category D - clear evidence of risk in pregnancy.
•Pregnant and breast feeding women will not be eligible.
•Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
•Additional Eligibility prior to Transplant Two:
•Total Collection of ≥ 4 x 10^6 CD34 cells/kg prior to transplant one
•Transplant able to occur between day +30 and day +90 from transplant one
•Recovery of blood counts as demonstrated by:
•WBC > 2.5 x 10^9/L with an ANC > 1.5 x 10^9/L and off G-CSF for 3 days
•Platelets > 50 x 10^9/L without transfusion in the prior 7 days
•Renal: Creatinine ≤ 2.0 mg/dl or creatinine clearance > 50 ml/min
•Hepatic: Total bilirubin ≤ 2.0 mg/dl, AST and alkaline phosphatase < 5 x upper limit of normal
•Infection: Patients with serious uncontrolled infections at the time of planned transplant will be excluded
•Patients with progressive disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria by imaging techniques are not eligible to proceed to the second transplant. Tumor marker increase alone is not sufficient to diagnose disease progression.

Arms & Interventions

2 Transplants/1 Transplant (Overall)

Experimental

2 Transplants: Patients with Germ Cell Tumors (GCT) treated with a second tandem autologous stem cell transplant (AuSCT) with non-cross-resistant conditioning regimens.