Multi-center, Open Label, Randomized Trial Comparing Single Versus Double Umbilical Cord Blood (UCB) Transplantation in Pediatric Patients With High Risk Leukemia and Myelodysplasia (BMT CTN #0501)

Medical College of Wisconsin38 个研究点分布在 3 个国家目标入组 224 人开始时间: 2006年12月最近更新: 2021年10月28日

适应症

干预措施

试验速览

阶段: 3 期
状态: 已完成
发起方: Medical College of Wisconsin
入组人数: 224
试验地点: 38
主要终点: Percentage of Participants With Overall Survival

研究概览研究设计入排标准研究组 & 干预措施结局指标研究者研究点记录与标识符相似试验

研究概览

简要总结

This study is a Phase III, randomized, open-label, multi-center, prospective study of single umbilical cord blood (UCB) transplantation versus double UCB transplantation in pediatric patients with hematologic malignancies.

详细描述

BACKGROUND:

In nearly every large single center or registry analysis of outcomes after UCB transplantation, cell dose is identified as an important factor influencing the incidence and rate of hematopoietic recovery, risk of transplant-related mortality, and probability of survival. Pilot data suggest that infusion of two partially human leukocyte antigen (HLA)-matched UCB units, which always augments the graft cell dose, is safe and may improve neutrophil recovery and survival. To determine whether the infusion of two UCB units enhances survival, a multi-center, open-label, randomized trial is proposed. As adequate single UCB units can be identified for more than 80% of pediatric recipients (in contrast to less than 30% for adults), this study will be open only to pediatric patients. The population will be restricted to patients with high-risk hematologic malignancy, the most common indication of UCB transplantation in children.

DESIGN NARRATIVE:

Participants will include patients 1 to 21 years of age with a diagnosis of hematological malignancy and with two partially HLA-matched UCB units. Units must be HLA-matched at 3 of 6 HLA-A and B (intermediate resolution molecular typing) and DRB1 (high resolution molecular typing) with each other and 4 of 6 with the recipient. Two appropriately HLA-matched units must be available such that one unit delivers a pre-cryopreserved, nucleated cell dose of at least 2.5 x 10^7 per kilogram and the second unit delivers at least 1.5 x 10^7 per kilogram.

Patients will be randomized no more than 14 days prior to initiation of conditioning. UCB units will be shipped prior to initiation of conditioning.

研究设计

研究类型: Interventional
分配方式: Randomized
干预模型: Single Group
主要目的: Treatment
盲法: None

入排标准

年龄范围: 1 Year 至 21 Years（Child, Adult）
性别: All
接受健康志愿者: 否

入选标准

•Two partially HLA-matched UCB units. Units must be HLA-matched minimally at 4 of 6 HLA-A and B (at intermediate resolution by molecular typing) and DRB1 (at high resolution by molecular typing) loci with the patient, and the units must be HLA-matched at 3 of 6 HLA- A, B, DRB1 loci with each other (using same resolution of molecular typing as indicated above). Two appropriately HLA-matched units must be available such that one unit delivers a pre-cryopreserved nucleated cell dose of at least 2.5 x 10^7 per kilogram and the second unit at least 1.5 x 10^7 per kilogram.
•Acute myelogenous leukemia (AML) at the following stages:
•High risk first complete remission (CR1), defined as the following:
•Having preceding myelodysplasia (MDS)
•High risk cytogenetics (high risk cytogenetics: del (5q) -5, -7, abn (3q), t (6;9) complex karyotype [at least 5 abnormalities],)the presence of a high FLT3 ITD-AR (> 0.4)
•Requiring more than 1 cycle of chemotherapy to obtain complete remission (CR);
•Second or greater CR
•First relapse with less than 25% blasts in bone marrow
•Morphologic complete remission with incomplete blood count recovery
•Therapy-related AML for which prior malignancy has been in remission for at least 12 months
•Acute lymphocytic leukemia (ALL) at the following stages:
•High risk first remission, defined as one of the following conditions:
•Philadelphia chromosome-positive adult lymphoblastic leukemia (Ph+ ALL)
•Mixed lineage leukemia (MLL) rearrangement with slow early response (defined as having M2 [5-25% blasts] or M3 [more than 25% blasts on bone marrow examination on Day 14 of induction therapy])
•Hypodiploidy (less than 44 chromosomes or DNA index less than 0.81)
•End of induction M3 bone marrow
•End of induction M2 with M2-3 at Day 42
•Evidence of minimal residual disease (MRD). If a patient's only high risk criterion is MRD, approval by a protocol chair or protocol officer is required for enrollment. For COG centers, this will only be for MRD greater than 1 percent by flow MRD at the end of extended induction.
•High risk second remission, defined as one of the following conditions:
•Philadelphia chromosome-positive adult lymphoblastic leukemia (Ph+ ALL)
•Bone marrow relapse less than 36 months from induction
•T-lineage relapse at any time
•Very early isolated central nervous system (CNS) relapse (6 months from diagnosis)
•Slow reinduction (M2-3 at Day 28) after relapse at any time
•Evidence of minimal residual disease (MRD). If a patient's only high risk criterion is MRD, approval by a protocol chair or protocol officer is required for enrollment. For COG centers, this will only be for MRD greater than 1 percent by flow MRD at the end of extended induction.
•Any third or subsequent CR
•NK cell lymphoblastic leukemia in any CR
•Biphenotypic or undifferentiated leukemia in any CR or if in first relapse must have less than 25% blasts in bone marrow (BM)
•Myelodysplastic syndrome (MDS) at any stage
•Chronic myelogenous leukemia (CML) in chronic or accelerated phase
•All patients with evidence of CNS leukemia must be treated and be in CNS CR to be eligible for study.
•Patients 16 years old or older must have a Karnofsky score of at least 70% and patients younger than 16 years old must have a Lansky score of at least 70%.
•Patients with adequate physical function as measured by:
•Cardiac: Left ventricular ejection fraction greater than 40% or shortening fraction greater than 26%
•Hepatic: Bilirubin no more than 2.5 mg/dL; alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) no more than 5 times the upper limit of normal (ULN)
•Renal: Serum creatinine within normal range for age, or if serum creatinine is outside normal range for age, then renal function (creatinine clearance or GFR) greater than 70 mL/min/1.73 m^2
•Pulmonary: Diffusing capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in one second (FEV1), or forced vital capacity (FVC) greater than 50% of predicted value (corrected for hemoglobin); if unable to perform pulmonary function tests, then O2 saturation greater than 92% of room air

排除标准

•Pregnant (β-positive human chorionic gonadotropin [HCG]) or breastfeeding
•Evidence of HIV infection or HIV positive serology
•Current uncontrolled bacterial, viral, or fungal infection (currently taking medication and progression of clinical symptoms)
•Autologous transplant less than 12 months prior to enrollment
•Prior autologous transplant for the disease for which the UCB transplant will be performed
•Prior allogeneic hematopoietic stem cell transplant
•Active malignancy other than the one for which the UCB transplant is being performed within 12 months of enrollment
•Inability to receive TBI
•Requirement of supplemental oxygen
•HLA-matched related donor able to donate