Sitagliptin Umbilical Cord Blood Transplant Study

Phase 2

Completed

Conditions: Myelodysplasia
Leukemia, Myelogenous, Chronic
Lymphoma, Non-Hodgkin
Leukemia, Myeloid, Acute
Acute Lymphoblastic Leukemia

Interventions: Drug: Sitagliptin

Registration Number: NCT00862719

Lead Sponsor: Indiana University School of Medicine

Brief Summary: The main purpose of this trial is to study whether the drug sitagliptin can be given safely to patients undergoing umbilical cord blood transplantation to speed up engraftment (recovery of blood counts after transplant).

Detailed Description: Umbilical cord blood (UCB) is increasingly used as a source of stem cells for patients with blood cancers who need an allogeneic stem cell transplant (a transplant with stem cells from another person) but who have no suitably matched donors. The advantages of UCB are that (1) it is associated with less risk of transmitting an infection from a donor, (2) it can be more safely given even if not completely matched compared to bone marrow or blood stem cells, and (3) it is much more quickly available than unrelated donor bone marrow or blood stem cells. While more commonly used for transplantation in children, UCB is increasingly being used in adults. However, because they are larger than children, the relatively smaller stem cell dose in UCB is major limitation for transplantation in adults, and engraftment can be delayed. This study is investigating whether the drug sitagliptin can be used to increase and speed up engraftment in adults receiving UCB transplantation, overcoming the limitation of small stem cell doses associated with umbilical cord blood.

Sitagliptin is a drug given in tablet form that has been recently approved by the Food and Drug Administration (FDA) for the treatment of certain patients with diabetes mellitus (a disease that results in high blood sugar). Sitagliptin has been given to both normal healthy volunteers and diabetic patients and has been found to be safe and well-tolerated. The drug improves control of blood sugar in diabetics by inhibiting an enzyme called "CD26/DPP-IV." Recent studies at Indiana University (and other centers) have shown that this same enzyme plays an important role in the way transplanted stem cells find their way to the bone marrow and engraft. Transplant studies in mice have found that inhibiting CD26/DPP-IV significantly increases the engraftment of stem cells. Based on these studies, it is believed that drugs that inhibit CD26/DPP-IV, such as sitagliptin, may also increase engraftment in patients who receive clinical stem cell transplants.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 29

Inclusion Criteria

Patients must have one of the following disease types with disease-specific features as outlined in the protocol:
- Acute myeloid leukemia (AML)
- Acute lymphoblastic leukemia (ALL)
- Myelodysplasia
- Chronic myelogenous leukemia
- Patients with aggressive non-Hodgkin's lymphoma (NHL), including diffuse large cell lymphoma, mediastinal B-cell lymphoma, transformed lymphoma, mantle cell lymphoma, and peripheral T cell lymphoma
- Hodgkin's lymphoma
- Relapsed Multiple Myeloma
At least 35 days following start of preceding leukemia induction cytotoxic chemotherapy
Patient age 18-55 years
Karnofsky Performance status ≥ 70%
No availability of a consenting HLA-matched related donor who is either matched fully matched or mismatched at only one locus of HLA-A, -B, and DRB1.
No availability of a readily available HLA-matched volunteer unrelated donor (8 of 8 allele match at HLA-A, -B, -C and -DRB1). Patients with unstable disease who are in danger of significant disease progression while waiting to procure volunteer donor cells will be eligible to be treated on this protocol, even if a matched donor is available.
Patients must have a matched or partially matched UCB unit with greater than 1.8 x10-7 nucleated cells/kg of recipient weight at the time of cryopreservation.
No current uncontrolled bacterial, viral or fungal infection (defined as currently taking medication and progression of clinical symptoms).
No HIV disease. Patients with immune dysfunction are at a significantly higher risk of infection from intensive immunosuppressive therapies.
Non pregnant and non-nursing. Treatment under this protocol would expose a fetus to significant risks.
Required baseline laboratory values as defined in the protocol

Exclusion Criteria

Symptomatic uncontrolled coronary artery disease or congestive heart failure.
Severe hypoxemia with room air PaO2 less than 70, supplemental oxygen dependence, or DLCO less than 50 percent predicted
Patients with central nervous system (CNS) involvement refractory to intrathecal chemotherapy
Prior allogeneic or autologous hematopoietic stem cell transplant in the last 6 months

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Sitagliptin twice per day	Sitagliptin	600 mg sitagliptin twice per day orally starting on Day -1 for a total of 8 doses
Sitagliptin once per day	Sitagliptin	600 mg sitagliptin once per day orally starting on Day -1 for a total of 4 doses
Sitagliptin three times per day	Sitagliptin	600 mg sitagliptin three times per day orally starting on Day -1 for a total of 12 doses

Primary Outcome Measures

Name	Time	Method
Cumulative Incidence of Patients With Engraftment by Day +30 Following Transplant	Transplant (Day 0) through Day +30	Evaluate the efficacy of CD26/DPP-IV inhibition in increasing the cumulative incidence of adult patients with hematological malignancies engrafting by day +30 following transplantation of UCB by 30 percent. The cumulative incidence of patients achieving this will be reported. The value of the estimate will be from bootstrapping 1000 samples with replacement of the data and the 95% confidence interval will be calculated using the percentile method.

Secondary Outcome Measures

Name	Time	Method
Time to Neutrophil Engraftment	Transplant (Day 0) up to 1 year	Time to neutrophil engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of neutrophils is defined as the time from day 0 to the date of the first of three consecutive days after transplantation during which the absolute neutrophils count (ANC) is at least 0.5 x109/l. Patients who did not have neutrophil engraftment before death will be censored at the date of death. The median and 95% confidence intervals will be provided. For the RCD group, all patients engrafted before day +30, except one patient who died at day 28 before engraftment. For the PD group, all patients engrafted before day +100, except one patient who died on day +103 before engraftment. For the 600 mg sitagliptin/12 hours group, two patients engrafted before day +100, and the other two patients died before day +100 before engraftment. The one patient on 600 mg sitagliptin/8 hours died on day +14 before engraftment.
Time to Platelet Engraftment	Transplant (Day 0) up to 1 year	Time to platelet engraftment will be analyzed by the Kaplan-Meier method. The time to engraftment of platelets is defined as the time from day 0 to the first of seven consecutive days after transplantation during which the platelet count is at least 20 x109/l without transfusion support. Only patients who achieved engraftment of platelets will be included in the analysis. The median and 95% confidence intervals will be provided.
Treatment Related Adverse Events Grade 3 or Higher for Non-hematological Toxicity	Transplant (Day 0) up to 3 years	Number of unique patients who had a treatment related (possible, probable or definite) non-hematological adverse event that was graded 3 or greater.