Clinical trial · Interventional
Cyclophosphamide for Prevention of Graft-Versus-Host Disease After Allogeneic Peripheral Blood Stem Cell Transplantation in Patients With Hematological Malignancies
A Phase II Study to Evaluate the Efficacy of Posttransplant Cyclophosphamide for Prevention of Chronic Graft-versus-Host Disease After Allogeneic Peripheral Blood Stem Cell Transplantation
- 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)
This phase II trial studies how well cyclophosphamide works in preventing chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplant in patients with hematological malignancies. Giving chemotherapy and total-body irradiation before transplantation helps stop the growth of cancer cells and prevents the patient's immune system from rejecting the donor's stem cells. Healthy stem cells from a donor that are infused into the patient help the patient's bone marrow make blood cells; red blood cells, white blood cells, and platelets. Sometimes, however, the transplanted donor cells can cause an immune response against the body's normal cells, which is called graft-versus-host disease (GVHD). Giving cyclophosphamide after transplant may prevent this from happening or may make chronic GVHD less severe.
Conditions
Conditions (68)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Accelerated Phase Chronic Myelogenous Leukemia | Accelerated Phase Chronic Myeloid Leukemia, BCR-ABL1 Positive | ALIAS | 0.90 |
| Adult Acute Lymphoblastic Leukemia in Remission | Adult Acute Lymphoblastic Leukemia | CURATED_BROADER | 0.78 |
| Adult Acute Megakaryoblastic Leukemia (M7) | Adult Acute Megakaryoblastic Leukemia | ONTOLOGY_EXACT | 0.85 |
| Adult Acute Myeloid Leukemia in Remission | Adult Acute Myeloid Leukemia | CURATED_BROADER | 0.78 |
| Adult Erythroleukemia (M6a) | Adult Erythroleukemia | ONTOLOGY_EXACT | 0.85 |
| Adult Nasal Type Extranodal NK/T-cell Lymphoma | Adult Nasal Type Extranodal NK/T-Cell Lymphoma | ONTOLOGY_EXACT |
Interventions
Interventions (7)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| allogeneic hematopoietic stem cell transplantation | Procedure | — | UNRESOLVED |
| busulfan | Drug | Busulfan | ALIAS |
| cyclophosphamide | Drug | Cyclophosphamide | ALIAS |
| cyclosporine | Drug | — | UNRESOLVED |
| fludarabine phosphate | Drug | Fludarabine | ALIAS |
| peripheral blood stem cell transplantation | Procedure | — | UNRESOLVED |
| total-body irradiation | Radiation | — | UNRESOLVED |
Design
Arms and outcomes
Arms (1)
- type
- EXPERIMENTAL
- label
- Treatment (TBI, PBSCT, and cyclophosphamide GVHD prophylaxis)
- description
- PREPARATIVE REGIMEN: Patients receive TBI BID on days -4 or -3 to -1. Some patients also receive fludarabine IV daily on days -5 to -2 and busulfan IV over 3 hours QD or over 2 hours every 6 hours on days -5 to -2. Patients may also undergo CNS prophylaxis, testicular irradiation, and/or involved field irradiation as per standard practice. TRANSPLANTATION: Patients undergo allogeneic PBSCT on day 0 per standard practice. GVHD PROPHYLAXIS: Patients receive cyclophosphamide IV over 1-2 hours on days 3-4. Patients also receive cyclosporine IV every 12 hours or every 8 hours beginning on day 5 with taper on days 56-126.
- interventionNames
- Drug: cyclophosphamide
- Drug: cyclosporine
- Procedure: peripheral blood stem cell transplantation
- Radiation: total-body irradiation
- Drug: fludarabine phosphate
- Drug: busulfan
- Procedure: allogeneic hematopoietic stem cell transplantation
Primary outcomes (1)
- measure
- Chronic GVHD Requiring Systemic Immunosuppressive Treatment
- timeFrame
Eligibility
Eligibility (as posted)
- Sex
- All
- Maximum age
- 65 Years
Show eligibility criteria text
Inclusion Criteria: * Acute lymphocytic leukemia (ALL) in morphologic first complete remission (CR1) with high risk features defined as, but not limited to: evidence of adverse cytogenetics such as t(9;22), t(1;19), t(4;11), or mixed-lineage leukemia (MLL) rearrangements; presence of minimal residual disease; progenitor B-cell immunophenotype; high white blood cells (WBC) at diagnosis (\> 30,000/ul in B-ALL; \> 100,000/ul in T-ALL); or delayed attainment of CR (\> 4 weeks) after induction therapy; additional clinical characteristics deemed to confer a high relapse risk may be discussed with and approved by the Principal Investigator (PI) * Acute myeloid leukemia (AML) in CR1 EXCEPT patients with low-risk features defined as: * Inv 16 or t(8;21) in the absence of c-kit mutations * Normal karyotype who are FLT3-ITD-negative and NPM1-positive in the absence of c-kit mutations * Patients with respective "low-risk" features are eligible, however, if (i) more than 1 cycle of induction therapy was required to achieve CR1 (ii) the patient had a preceding myelodysplastic syndrome (MDS) other than myelofibrosis, or (iii) secondary AML * Acute leukemia in 2nd or greater CR (CR \>= 2) * Refractory or relapsed AML with =\< 10% bone marrow blasts and no circulating blasts or proven extramedullary disease * AML transformed from myelodysplastic syndrome (MDS) with \< 10% bone marrow blasts * MDS with following high risk features: * High risk cytogenetics (including, but not limited to: 7q--, inv\[3\], t\[3q\], del\[3q\] or complex karyotype) * International Prognostic Scoring System (IPSS) intermediate (INT)-2 or greater * Treatment-related MDS * Any phase of MDS if patient is \< 21 years of age * Chronic myelogenous leukemia (CML) beyond 1st chronic phase or resistant or intolerant to tyrosine kinase inhibitors (adults) or any phase (pediatric \< 21 years) * Chronic myelomonocytic leukemia * Philadelphia-negative myeloproliferative disorder * Lymphoma: relapsed chemotherapy-sensitive (complete or partial response) Hodgkin or non-Hodgkin lymphoma * Multiple myeloma-stage III * The patient or legal representative must be able to understand and give written informed consent * DONORS: The donor must be a genotypically HLA-identical sibling, a phenotypically HLA-matched first-degree relative, or an unrelated donor who is molecularly matched with the patient at HLA-A, B, C, DRB1 * DONORS: Donors must meet the selection criteria for administration of G-CSF (filgrastim) and apheresis defined by the Foundation for the Accreditation of Cell Therapy (FACT) and will be screened per the American Association of Blood Banks (AABB) * DONORS: Donors must be capable of giving informed consent Exclusion Criteria: * Prior autologous or allogeneic stem cell transplant * Performance status \> 2 (Eastern Cooperative Oncology Group \[ECOG\]) or \< 50 (Lansky; for patients \< 16 years old) * Uncontrolled infection; the protocol principal investigator (PI) will be final arbiter if there is uncertainty regarding whether a previous infection is under adequate control to allow enrollment in the study * Positive serology for human immunodeficiency virus (HIV)-1, 2 or human T cell lymphotropic virus (HTLV)-1, 2 * Left ventricular ejection fraction \< 45% or shortening fraction \< 25%; no uncontrolled arrhythmias or symptomatic cardiac disease * Symptomatic pulmonary disease; forced expiratory volume in one second (FEV1), forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO) =\< 50% of predicted (corrected for hemoglobin); if pulmonary function tests cannot be performed, an oxygen saturation \< 92% on room air * Calculated (Cockcroft-Gault or appropriate calculation for pediatric patients) serum creatinine clearance =\< 60 mL/min; if the calculated CrCl is 50-60 mL/min, but a measured CrCl by 24 hour urine collection is \> 60 mL/min, this measurement is acceptable * Total serum bilirubin more than twice upper normal limit * Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) more than 3-fold higher than laboratory upper normal limits * Female patient must have negative serum pregnancy test (all women of child bearing-potential must have test performed) * DONORS: Potential donors who for psychological, physiological, or medical reasons cannot tolerate administration of G-CSF or apheresis * DONORS: Donors who are allergic to filgrastim or Escherichia (E.) coli-derived proteins * DONORS: Donor-related risks to recipients * DONORS: Positive anti-donor lymphocytotoxic crossmatch * DONORS: Donors who are positive for HIV
References
Publications (1)
- DERIVEDMielcarek M, Furlong T, O'Donnell PV, Storer BE, McCune JS, Storb R, Carpenter PA, Flowers ME, Appelbaum FR, Martin PJ. Posttransplantation cyclophosphamide for prevention of graft-versus-host disease after HLA-matched mobilized blood cell transplantation. Blood. 2016 Mar 17;127(11):1502-8. doi: 10.1182/blood-2015-10-672071. Epub 2016 Jan 13. PMID 26764356