Clinical trial · Interventional
Early Administration of ATG Followed by Cyclophosphamide, Busulfan and Fludarabine Before a Donor Stem Cell Transplant in Patients With Hematological Cancer
Pre-administration of Rabbit Antithymocyte Globulin to Optimize Donor T-Cell Engraftment Following Reduced Intensity Allogeneic Peripheral Blood Progenitor Cell Transplantation From Matched-Related Donors
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
RATIONALE: Giving low doses of chemotherapy before a donor stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving antithymocyte globulin before the transplant and tacrolimus and methotrexate after the transplant may stop this from happening. PURPOSE: This phase II trial is studying how well giving antithymocyte globulin together with cyclophosphamide, busulfan, and fludarabine works in treating patients with hematological cancer or kidney cancer undergoing donor stem cell transplant.
Conditions
Conditions (7)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Kidney Cancer | Malignant Kidney Neoplasm | CURATED_EXACT | 0.92 |
| Leukemia | Leukemia | ONTOLOGY_EXACT | 0.90 |
| Lymphoma | Lymphoma | ONTOLOGY_EXACT | 0.90 |
| Multiple Myeloma and Plasma Cell Neoplasm | — | UNRESOLVED | — |
| Myelodysplastic/Myeloproliferative Diseases | Myelodysplastic/Myeloproliferative Neoplasm | ALIAS | 0.90 |
| Myelodysplastic Syndromes | Myelodysplastic Syndrome | ALIAS | 0.90 |
| Myeloproliferative Disorders | Myeloproliferative Neoplasm | ALIAS | 0.90 |
Interventions
Interventions (7)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| anti-thymocyte globulin | Biological | — | UNRESOLVED |
| busulfan | Drug | Busulfan | ALIAS |
| cyclophosphamide | Drug | Cyclophosphamide | ALIAS |
| fludarabine phosphate | Drug | Fludarabine | ALIAS |
| methotrexate | Drug | Methotrexate | ALIAS |
| nonmyeloablative allogeneic HSCT | Procedure | — | UNRESOLVED |
| tacrolimus | Drug | — | UNRESOLVED |
Design
Arms and outcomes
Arms (1)
- type
- EXPERIMENTAL
- label
- ATG, Cytoxan, Bu/Flu based Allogeneic Transplant
- description
- All patients will receive an ATG, Cyclosphosphamide, Busulfan and Fludarabine based Allogeneic Transplant
- interventionNames
- Biological: anti-thymocyte globulin
- Drug: busulfan
- Drug: cyclophosphamide
- Drug: fludarabine phosphate
- Drug: methotrexate
- Drug: tacrolimus
- Procedure: nonmyeloablative allogeneic HSCT
Primary outcomes (1)
- measure
- Achievement of > 90% (Full) Donor Chimerism in the T-cell Lineage as Measured by PCR at Day 30 Post-transplantation
- timeFrame
- Day 30
- description
- Chimerism analysis of peripheral blood mononuclear cells using PCR for STR/VNTR will be performed post transplant. On each occasion, the peripheral blood will be separated into the T-cell component (using e.g. CD3 selection) and the myeloid component (using e.g.CD14/15 selection) before assessment of chimerism.
Eligibility
Eligibility (as posted)
- Sex
- All
- Maximum age
- 75 Years
Show eligibility criteria text
DISEASE CHARACTERISTICS:
* Histologically confirmed diagnosis of one of the following:
* Chronic myeloid leukemia (CML)
* Philadelphia chromosome (Ph)- and/or BCR-ABL-positive disease
* In chronic or accelerated phase
* Suboptimal response to imatinib mesylate (i.e., no hematologic complete response by 3 months, no major cytogenetic response by 6 months, or no complete cytogenetic response by 1 year)
* CML in blastic transformation allowed provided patient achieved complete remission (CR) or second chronic phase after treatment with imatinib mesylate or chemotherapy
* Chronic lymphocytic leukemia meeting one of the following criteria:
* Rai stage III or IV disease
* Rai stage I or II disease that failed standard therapy (i.e., disease is progressing after ≥ 1 course of standard therapy)
* Non-Hodgkin lymphoma (NHL) meeting one of the following criteria:
* Indolent NHL
* Clinical stage III or IV disease or bulky stage II disease (i.e., ≥ one lymphoid mass \> 5 cm in ≥ one dimension)
* Relapsed after primary therapy OR is refractory to therapy
* Aggressive NHL
* Is not considered curable with standard chemotherapy or autologous stem cell transplantation (i.e., relapsed after autologous stem cell transplantation)
* Chemotherapy-responsive disease
* Multiple myeloma
* Durie-Salmon stage II or III disease
* Durie Salmon stage I disease allowed provided β2 microglobulin level \> 3 mg/dL
* Acute myeloid leukemia or acute lymphocytic leukemia
* In CR (defined as \< 5% blasts in bone marrow and no circulating blasts) AND has any of the following poor prognostic features:
* WBC \> 100,000/mm\^3 at presentation
* In second or greater remission
* Adverse-risk cytogenetics (i.e., Ph1-positive, 11q23 translocation, -5, -7, complex translocations, or other recognized adverse-risk cytogenetics)
* Renal cell carcinoma
* Stage IV disease
* Clear cell morphology
* Myelodysplastic syndromes
* Bone marrow blasts ≤ 10% on last bone marrow biopsy prior to transplantation
* Myeloproliferative disease
* Anticipated life expectancy on conventional therapy \< 10 years
* No uncomplicated essential thrombocythemia or primary polycythemia
* Hodgkin lymphoma
* Relapsed after ≥ 1 standard-dose chemotherapy regimen
* Not considered curable by autologous stem cell transplantation
* No clinical evidence of active CNS involvement
* Previously treated leptomeningeal disease allowed provided CSF cytology is negative at the time of assessment for transplantation
* Available 6/6 allele match (i.e., HLA-A, B, DRβ1)matched related donor
PATIENT CHARACTERISTICS:
* ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
* Bilirubin \< 3 times normal (unless abnormality due to malignancy)
* AST and ALT \< 3 times normal (unless abnormality due to malignancy)
* Creatinine ≤ 2.0 mg/dL
* LVEF ≥ 40% by MUGA or ECHO
* DLCO ≥ 40% of predicted
* FEV-1 ≥ 50% of predicted
* Not pregnant or nursing
* Fertile patients must use effective contraception
* Deemed to be an appropriate candidate for allogeneic SCT
* No evidence of myocardial infarction within the past 6 months
* No psychological or social condition that may interfere with study participation
* No serious uncontrolled localized or active systemic infection
* No second malignancy within the past 3 years except for completely excised nonmelanotic skin cancer or in situ carcinoma of the cervix
* No chronic inflammatory disorder requiring the continued use of glucocorticoids or other immunosuppressive medications
* No known HIV positivity
* No hypersensitivity to E. coli-derived proteinsReferences
Publications (8)
- BACKGROUNDRao SS, Peters SO, Crittenden RB, Stewart FM, Ramshaw HS, Quesenberry PJ. Stem cell transplantation in the normal nonmyeloablated host: relationship between cell dose, schedule, and engraftment. Exp Hematol. 1997 Feb;25(2):114-21. PMID 9015211
- BACKGROUNDStorb R, Yu C, Wagner JL, Deeg HJ, Nash RA, Kiem HP, Leisenring W, Shulman H. Stable mixed hematopoietic chimerism in DLA-identical littermate dogs given sublethal total body irradiation before and pharmacological immunosuppression after marrow transplantation. Blood. 1997 Apr 15;89(8):3048-54. PMID 9108426
- BACKGROUNDGiralt S, Estey E, Albitar M, van Besien K, Rondon G, Anderlini P, O'Brien S, Khouri I, Gajewski J, Mehra R, Claxton D, Andersson B, Beran M, Przepiorka D, Koller C, Kornblau S, Korbling M, Keating M, Kantarjian H, Champlin R. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood. 1997 Jun 15;89(12):4531-6. PMID 9192777
- BACKGROUNDSlavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G, Varadi G, Kirschbaum M, Ackerstein A, Samuel S, Amar A, Brautbar C, Ben-Tal O, Eldor A, Or R. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood. 1998 Feb 1;91(3):756-63. PMID 9446633
- BACKGROUNDMcSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG, Chauncey TR, Gooley TA, Hegenbart U, Nash RA, Radich J, Wagner JL, Minor S, Appelbaum FR, Bensinger WI, Bryant E, Flowers ME, Georges GE, Grumet FC, Kiem HP, Torok-Storb B, Yu C, Blume KG, Storb RF. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood. 2001 Jun 1;97(11):3390-400. doi: 10.1182/blood.v97.11.3390. PMID 11369628
- Champlin R, Khouri I, Anderlini P, De Lima M, Hosing C, McMannis J, Molldrem J, Ueno N, Giralt S. Nonmyeloablative preparative regimens for allogeneic hematopoietic transplantation. Biology and current indications. Oncology (Williston Park). 2003 Jan;17(1):94-100; discussion 103-7.