Clofarabine and Low Dose Total Body Irradiation as a Preparative Regimen for Stem Cell Transplant in Leukemia.

Completed · Phase 1

Conditions studied: Leukemia Lymphoblastic, Acute, Acute Myeloid Leukemia, Neoplasm Recurrent

In brief

Stem cell transplant is an important therapeutic option for pediatric patients with relapsed or refractory leukemia. Although, full myeloablative transplants are widely used for patients with acute leukemia, myeloablative chemo-radiotherapy may not be feasible in some specific settings. These settings include 1) patients with pre-existing health issues and organ toxicities; 2) patients who have relapsed post-ablative transplant and need a second stem cell transplant; and 3) leukemia patients with advanced disease who have been heavily pre-treated. Clofarabine, a new purine nucleoside anti-metabolite, has the advantage of significant antileukemic activity in addition to its possible immuno-suppressive properties. In this study we plan to determine the maximum feasible dose (MFD) of Clofarabine in combination with total body irradiation that can achieve durable donor engraftment without causing excessive toxicity.

Key facts

Study ID

NCT01041508

Run by

Therapeutic Advances in Childhood Leukemia Consortium

People needed

18

Starts

2010-01-29

Expected to finish

2014-08-01

Last updated by the study team

2024-02-01

Who can join

Age: 1 and older, up to 21. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Since this is a Phase 1 study, any patient who is a candidate for a non-myeloablative SCT because he/she cannot tolerate the standard myeloablative preparative therapy is eligible for this trial. Briefly, the following groups of patients will be targeted and are eligible for this trial:
• Patients with presence of organ system dysfunction or severe systemic infections that significantly increase the risk of TRM with standard myeloablative regimens.
• History of previous myeloablative allogeneic or autologous transplantation.
• Heavily pre-treated leukemia patients, eg. Patients in CR after failure of ≥2 prior regimens.(eg. ALL CR ≥ 3).
• Combination of toxicities or co-morbidities that leads the investigator to feel that the child is at high risk (>50%) of TRM with standard ablative regimens.
• The eligibility criteria listed below are interpreted literally and cannot be waived.
• Age: Patients must be >1 and < 21 years of age at the of study entry.
• Diagnosis
• Patients must have a diagnosis of ALL or AML.
• ALL patients must be in clinical remission defined as BM morphology <5% blasts and CNS 1 status.
• AML patients must be in M1 (<5% blasts) or M2 (<20% blasts) marrow status with CNS 1 status.
• Patient must have an ANC > 750/ul.
• Donor Selection: Patient must have one of the appropriate donor types as described below:
• HLA identical sibling donor.
• Complete matched unrelated donor, (matched at A, B, C, DR B1 and DQ, B1 at the allelic level based on high resolution typing for Class I and II antigens, 10/10 match).
• 1 allelic mis-matched unrelated donor (antigen mis-matches are not allowed).
• Stem Cell Source: The stem cell source from the donor must be one of the following:
• Bone Marrow or Peripheral blood stem cells (PBSC) from a matched related donor.
• PBSC from an unrelated donor. (Bone marrow is not acceptable for unrelated donors)
• Performance Level: Karnofsky > 50% for patients > 10 years of age and Lansky > 50% for patients < 10 years of age.
• Reproductive Function
• Female patients of childbearing potential must have a negative serum pregnancy test confirmed within 2 weeks prior to enrollment.
• Female patients with infants must agree not to breastfeed their infants while on this study.
• Male and female patients of child-bearing potential must agree to use an effective method of contraception approved by the investigator during the study.
• Renal and Hepatic Function: Patient must have adequate renal and hepatic functions as indicated by the following laboratory values:

You may not qualify if…

• Patients will be excluded if they meet any of the following criteria:
• Infection
• Patients will be excluded if they have evidence of an active, progressive invasive infection. All patients with existing infections at the time study entry should be discussed with the study chair.
• Patients may have stable invasive infections and still be eligible.
• Patients with infections that are responsive to medical or surgical treatment as shown by radiographic and or microbial assessment may still be eligible.
• Patients will be excluded if they have an active, uncontrolled systemic fungal, bacterial, viral or other infection. All patients with existing infections at the time of study entry should be discussed with the study chair.
• An active uncontrolled infection is defined as exhibiting ongoing signs and symptoms related to the infection (fevers, positive blood cultures, chills, tachycardia, etc) despite appropriate antibiotics or other treatment.
• Patient has a diagnosis of CML or MDS.
• Patient has CNS 2 or CNS 3 status.
• Patient is HIV positive.
• Current or planned treatment with chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
• Use of investigational agents within 30 days or any anticancer therapy within 2 weeks before study entry.
• Have any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney (including dialysis patients), liver, or other organ system that may place the patient at undue risk to undergo treatment.
• Patients with a systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment).
• Any significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or compliance, study participation, follow up, or interpretation of study results.

Where it is running

• Childrens Hospital Los Angeles — Los Angeles, California, United States
• Nationwide Childrens Hospital — Columbus, Ohio, United States
• Oregon Health and Science University — Portland, Oregon, United States
• Vanderbilt Children's Hospital — Nashville, Tennessee, United States
• Primary Children's Hospital — Salt Lake City, Utah, United States
• Seattle Children's Hospital — Seattle, Washington, United States

Full record on ClinicalTrials.gov

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