Clinical trial
Phase 2 Study of Personalized r-ATG Dosing to Improve Survival Through Enhanced Immune Reconstitution in Pediatric and Adult Patients Undergoing Ex-vivo CD34-Selected Allogeneic-HCT (PRAISE-IR)
Name
21-193
Description
The purpose of this study is to see if conditioning regimens that include personalized rabbit ATG (P-rATG) help the immune system recover sooner and decrease the chances of transplant-related side effects. Participants in this study will be children and adults who have acute leukemia or myelodysplastic syndrome (MDS), and will receive a standard conditioning regimen to prepare the body for an allogeneic hematopoietic cell transplant (allo-HCT). The conditioning regimen will include r-ATG, one of two combinations of chemotherapy, and possibly total body irradiation (TBI).
Trial arms
Trial start
2021-04-30
Estimated PCD
2025-04-01
Trial end
2025-04-01
Status
Active (not recruiting)
Phase
Early phase I
Treatment
Personalized rATG (P-rATG)
P-rATG days (always starting on Day -12 to -10)
Arms:
P-rATG with busulfan, melphalan and fludarabine, P-rATG with total body irradiation, thiotepa, cyclophosphamide
Hyper fractionated total body irradiation
(1375 - 1500cGy\*) Day -9 to -6
\*TBI dose in 125cGy fractions (with lung shielding) and total dose to be determined by treating physician/radiation oncology and is based off age, stage of disease, and anesthesia requirements.
Arms:
P-rATG with total body irradiation, thiotepa, cyclophosphamide
Thiotepa
(5mg/kg/day x 2 day) Day -5 to -4
Arms:
P-rATG with total body irradiation, thiotepa, cyclophosphamide
Cyclophosphamide
(60mg/kg/day x 2 days) Day -3 to -2
Arms:
P-rATG with total body irradiation, thiotepa, cyclophosphamide
GCSF
Day +7
Arms:
P-rATG with busulfan, melphalan and fludarabine, P-rATG with total body irradiation, thiotepa, cyclophosphamide
Busulfan
Day -9 to -7 doses 2-3 to be adjusted per PK for target cumulative exposure of 65 mg\*h/L
Arms:
P-rATG with busulfan, melphalan and fludarabine
Melphalan
(70mg/m2/day x 2 days) Day -6 to -5
Arms:
P-rATG with busulfan, melphalan and fludarabine
Fludarabine
(25mg/m2/day x 5 days) Day -6 to -2
Arms:
P-rATG with busulfan, melphalan and fludarabine
Size
59
Primary endpoint
proportion of patients who achieve CD4+IR
within 100 days of HCT
Eligibility criteria
Inclusion Criteria:
* Patients receiving first peripheral blood mobilized ex-vivo CD34-selected T cell depleted allo-HCT for the following hematologic malignant conditions:
* Acute myeloid leukemia (AML) with intermediate or high-risk features in CR1 or Relapse AML in ≥ CR2.
* Must have MRD \<5% (flow cytometry, molecular and/or cytogenetics accepted).
* Acute leukemias of ambiguous lineage in ≥ CR1.
* Must have MRD \<5% (flow cytometry, molecular and/or cytogenetics accepted).
* Acute lymphoid leukemia (ALL) in CR1 with clinical, flow cytometric, or molecular features indicating a high risk for relapse, or ALL in ≥ CR2.
* Adult Patients - recommended but not required to be MRDnegative (by flow cytometry, molecular and/or cytogenetics).
* Pediatric Patients - Must be MRD-negative by flow cytometry, molecular and/or cytogenetics.
* Myelodysplastic syndromes (MDS) with least one of the following:
* Revised International Prognostic Scoring System risk score of intermediate or higher at the time of transplant evaluation.
* Life-threatening cytopenia.
* Karyotype or genomic changes that indicate high risk for progression to acute myelogenous leukemia, including abnormalities of chromosome 7 or 3, mutations of TP53, or complex or monosomal karyotype.
* Therapy related disease or disease evolving from other malignant processes.
* Able to tolerate cytoreduction
* Patients age:
* Regimen A: 4 - 60 years
* Regimen B - no age restriction
* Adequate organ function is required, defined as follows:
* Hepatic: Serum bilirubin ≤ 2 mg/dL, unless benign congenital hyperbilirubinemia. Patients with hyperbilirubinemia related to paroxysmal nocturnal hemoglobinuria or other hemolytic disorders are eligible with PI approval.
* Hepatic: AST, ALT, and alkaline phosphatase \< 2.5 times the upper limit of normal unless thought to be disease-related.
* Renal: serum creatinine \<1.5x normal for age. If serum creatinine is outside the normal range, then CrCl \> 50 mL/min/1.73m2 (calculated or estimated) or GFR (mL/min/1.72m2) \>30% of predicted normal for age.
* Normal GFR by Age
* 1 week 40.6 + / - 14.8
* 2 - 8 weeks 65.8 + / - 24.8
°\> 8 weeks 95.7 +/- 21.7
* 2 - 12 years 133 +/- 27
* 13 - 21 years (males) 140 +/- 30
* 13 - 21 years (females) 126.0 + / - 22.0
* Cardiac: LVEF ≥ 50% by MUGA or resting echocardiogram.
* Pulmonary: Pulmonary function testing (FEV1 and corrected DLCO) ≥ 50% predicted (pediatric patients unable to complete PFTs will need oxygen saturation as recorded by pulse oximetry of ≥92% on room air).
* Adequate performance status:
* Age ≥ 16 years: ECOG ≤ 1 or Karnofsky 70%
* Age \< 16 years: Lansky 70%
* Each patient must be willing to participate as a research subject and must sign an informed consent form or legal guardian with assent as appropriate.
Exclusion Criteria:
* Patients with active extramedullary disease.
* Patients with active central nervous system malignancy.
* Uncontrolled infection at the time of allo-HCT.
* Patients who have undergone previous allo-HCT.
* Patient seropositivity for HIV I/II and/or HTLV I/II.
* Females who are pregnant or breastfeeding.
* Patients unwilling to use contraception during the study period.
* Patient or parent or guardian unable to give informed consent or unable to comply with the treatment protocol including research tests.
Donor Inclusion Criteria:
* Related or Unrelated Donors:
°8/8 HLA matched at A, B, C, and DRB1 loci, as tested by DNA analysis.
* Able to provide informed consent for the donation process per institutional standards.
* Meet standard criteria for donor collection (e.g. National Marrow Donor Program Guidelines or collecting center guidelines as approved by treating physician).
* Provide GSCF mobilized peripheral blood stem cells
Protocol
{'studyType': 'INTERVENTIONAL', 'phases': ['PHASE2'], 'designInfo': {'allocation': 'NON_RANDOMIZED', 'interventionModel': 'PARALLEL', 'interventionModelDescription': 'This phase 2 study is to assess the effects of personalized rabbit ATG (P-rATG) dosing on CD4+ immune reconstitution (CD4+IR) based on a pharmacokinetic/pharmacodynamic (PK/PD) model in patients with hematologic malignancies undergoing peripheral blood mobilized, ex-vivo CD34+ T cell depleted, allogeneic, hematopoietic cell transplantation (CD34+/TCD allo-HCT)1.', 'primaryPurpose': 'TREATMENT', 'maskingInfo': {'masking': 'NONE'}}, 'enrollmentInfo': {'count': 59, 'type': 'ACTUAL'}}
Updated at
2024-04-18
1 organization
3 products
3 drugs
3 indications
Organization
Memorial Sloan Kettering Cancer CenterProduct
ThiotepaIndication
Acute Myeloid LeukemiaIndication
Acute Lymphoid LeukemiaIndication
Myelodysplastic SyndromesDrug
cyclophosphamideDrug
GCSFProduct
BusulfanDrug
MelphalanProduct
Fludarabine