A Phase II Single-Arm Study of Total Body Irradiation With Linac Based Volumetric Modulated Arc Therapy (VMAT) and Image Guided Radiation Therapy (IGRT)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 36
- 试验地点
- 1
- 主要终点
- Proportion of patients who achieve excellent coverage while sparing the lung
研究概览
简要总结
Single institution study of safety of linac based VMAT TBI for myeloablative treatment in hematologic malignancies.
详细描述
Total Body Irradiation (TBI) continues to play an important role in myeloablative and non-myeloablative conditioning regimens for Allogeneic Stem Cell Transplant (ASCT). When TBI is used as part of a myeloablative regimen, it is combined with chemotherapy to eradicate malignant cells, as well as to immunosuppress the host to prevent rejection of donor hematopoietic progenitor cells (HPC).
This study is a single-institution study to assess the safety of linac based VMAT TBI for myeablative sreatment in hematologic malignancies.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients undergoing related, unrelated (including cord blood) hematopoietic progenitor cell (HPC) transplant, in which the protocol requires >12 Gray of TBI, as part of the conditioning regimen.
- •a. Conditioning regimens outlined per BMT SOP: CLNTX007: Selection of Conditioning Regimens for Blood and Marrow Transplantation - ADULTS.
- •Referral from the blood and marrow transplant (BMT) program for full-dose TBI, who meet inclusion and
排除标准
- •l per BMT SOPs.
- •BMT program will initiate referral, utilizing Form: 170102, Radiation Oncology Consultation.
- •Patients undergo pre-transplant testing, as defined in BMT SOPs:CLNAL002: Related (MRD, Haplo) Allogeneic Recipient Evaluation and Management or CLNAL011: Unrelated (MUD, MMUD, CBU) Allogeneic Recipient Evaluation and Management, per below.
- •i. BMT SOP's include baseline pulmonary function tests (PFTs). Patient with decreased FVC, FEV1 and or DLCO (adjusted for hemoglobin) or pulmonary history will have pulmonary consult, at the discretion of the BMT physician prior to undergoing myeloablative radiation.
- •ii. Medical history and physical by BMT provider.
- •iii. The following laboratory tests (additional testing may be required for positive results):
- •ABO group and Rh type
- •Red Blood Cell Antibody Screen.
- •HLA typing and confirmatory typing
- •HLA antibody screen, class I and II, performed within 30 days of transplant.
- •Complete blood count (CBC) with differential.
- •Basic metabolic panel, including glucose and to include at a minimum electrolyte evaluation of potassium, calcium, magnesium, and phosphorus.
- •Blood urea nitrogen (BUN)
- •Creatinine
- •Liver Function Tests including: Total bilirubin, Alkaline phosphatase, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Lactate dehydrogenase (LDH), Albumin, Total Protein, Urinalysis
- •Exclusion Criteria:
- •Patient receiving less than 1200 cGy of TBI
- •Previous history of thoracic radiation therapy including previous TBI
- •All premenopausal women will require a urine qualitative pregnancy test to exclude pregnancy. Pregnant women will be excluded from the study.
- •Patient not meeting transplant criteria per BMT physician.
研究组 & 干预措施
Patients with Hematologic Malgnancies
干预措施: Linac Based VMAT TBI (Radiation)
结局指标
主要结局
Proportion of patients who achieve excellent coverage while sparing the lung
时间窗: Up to 1 year post-transplant
Excellent coverage while sparing the lung is quantified by meeting the following dosimetric parameters (all parameters must be met): 1. V100%= \>90% (90% of PTV volume getting 100% of the dose). 2. D98\>85% (98% of the volume getting at least 85% of the dose). 3. Mean Lung dose \<900cGy.
Proportion of Patients Who Achieve Excellent Coverage While Sparing the Lung
时间窗: Up to 1 year post-transplant
Excellent coverage while sparing the lung is quantified by meeting the following dosimetric parameters (all parameters must be met): 1. V100%= \>90% (90% of PTV volume getting 100% of the dose). 2. D98\>85% (98% of the volume getting at least 85% of the dose). 3. Mean Lung dose \<900cGy.
次要结局
- Cumulative incidence rate of idiopathic pneumonia syndrome(Up to 100 days post-transplant)
- Proportion of patients who achieved a mean dose to each kidney (Dmean) < 11Gy(Up to 150 days post-transplant)
- Occurrence of acute GVHD, transplant related mortality, or mortality in the first 100 days following transplant(100 days post-transplant)
- Proportion of patients who have achieved a maximum dose to 2cc of the entire body (D2cc) < 130% of Rx dose.(Up to 150 days post-transplant)
- Proportion of patients who have achieved a maximum dose to 0.03cc of OARs < 120% of Rx dose.(Up to 150 days post-transplant)
- Event Free Survival (EFS)(Up to 1 year post-transplant)
- Proportion of Patients Who Have Achieved a Maximum Dose to 2cc of the Entire Body (D2cc) < 130% of Rx Dose.(Up to 150 days post-transplant)
- Cumulative Incidence Rate of Idiopathic Pneumonia Syndrome(Up to 100 Days Post-Transplant)
- Proportion of Patients Who Have Achieved a Maximum Dose to 0.03cc of OARs < 120% of Rx Dose.(Up to 150 days post-transplant)
- Occurrence of Acute GVHD, Transplant Related Mortality, or Mortality in the First 100 Days Following Transplant(100 days post-transplant)
- Proportion of Patients Who Achieved a Mean Dose to Each Kidney (Dmean) < 11Gy(Up to 150 days post-transplant)