A Phase 1 interventional study of Allogeneic Bone Marrow Transplantation and Allogeneic Hematopoietic Stem Cell Transplantation in Chronic Myelomonocytic Leukemia, Previously Treated Myelodysplastic Syndrome and Recurrent Adult Acute Lymphoblastic Leukemia, sponsored by Fred Hutchinson Cancer Center. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-12-10.
Sponsored by Fred Hutchinson Cancer Center · Phase 1, Interventional, and Treatment
This phase I trial studies the side effects and maximum tolerated dose of yttrium Y 90 anti-cluster of differentiation 45 (CD45) monoclonal antibody BC8 (90Y-BC8) followed by donor stem cell transplant in treating patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndrome (MDS) that is likely to come back or spread. Giving chemotherapy drugs, such as fludarabine phosphate (FLU), and total-body irradiation (TBI) before a donor peripheral blood stem cell (PBSC) or bone marrow transplant helps stop the growth of cancer or abnormal cells and helps stop the patient's immune system from rejecting the donor's stem cells. Radiolabeled monoclonal antibodies, such as 90Y-BC8, can find cancer cells and carry cancer-killing substances to them without harming normal cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving FLU, 90Y-BC8, and TBI before the transplant together with cyclosporine and mycophenolate mofetil after the transplant may stop this from happening.
PRIMARY OBJECTIVES:
I. To estimate the maximum tolerated dose (MTD) of radiation delivered via 90Y-DOTA-BC8 (90Y-BC8) when combined with FLU and 2 Gy TBI as a preparative regimen for patients aged >= 18 with advanced AML, ALL, and high-risk MDS.
SECONDARY OBJECTIVES:
I. To determine disease response and duration of remission.
II. To determine the rates of engraftment and donor chimerism resulting from this combined preparative regimen, and to correlate level of donor chimerism with estimated radiation doses delivered to hematopoietic tissues via antibody.
OUTLINE:
PREPARATIVE REGIMEN: Patients receive 90Y-BC8 via central line on approximately day -12 and FLU intravenously (IV) over 30 minutes on days -4 to -2.
TRANSPLANTATION: Patients undergo TBI followed by allogeneic PBSC or bone marrow transplant on day 0.
GRAFT-VS-HOST DISEASE (GVHD) PROPHYLAXIS: Patients receive mycophenolate mofetil orally (PO) or IV every 12 hours on days 0-27 (for patients with related donors) or every 8 hours on days 0-40 with taper to day 96 (for patients with unrelated donors). Patients also receive cyclosporine PO or IV every 12 hours on days -3 to 56 (for patients with related donors) or 100 (for patients with unrelated donors) with taper to day 180.
After completion of study treatment, patients are followed up at 6, 9, 12, 18, and 24 months, and then annually thereafter.
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Patients must have advanced AML, ALL or high-risk MDS meeting one of the following descriptions:
Patients must have an human leukocyte antigen (HLA)-identical sibling donor or an HLA-matched unrelated donor who meets standard Seattle Cancer Care Alliance (SCCA) and/or National Marrow Donor Program (NMDP) or other donor center criteria for PBSC or bone marrow donation, as follows:
Unrelated donor:
Exclusion Criteria:
PREPARATIVE REGIMEN: Patients receive 90Y-BC8 via central line on approximately day -12, fludarabine phosphate IV over 30 minutes on days -4 to -2, and 2 Gy TBI on day 0. TRANSPLANTATION: Patients undergo allogeneic PBSC or bone marrow transplant on day 0. GVHD PROPHYLAXIS: Patients receive mycophenolate mofetil PO or IV every 12 hours on days 0-27 (for patients with related donors) or every 8 hours on days 0-40 with taper to day 96 (for patients with unrelated donors). Patients also receive cyclosporine PO or IV every 12 hours on days -3 to 56 (for patients with related donors) or 100 (for patients with unrelated donors) with taper to day 180.
Procedure: Allogeneic Bone Marrow Transplantation · Procedure: Allogeneic Hematopoietic Stem Cell Transplantation · Drug: Cyclosporine · Drug: Fludarabine Phosphate · Biological: Indium In 111 Anti-CD45 Monoclonal Antibody BC8 · Other: Laboratory Biomarker Analysis · Drug: Mycophenolate Mofetil · Procedure: Peripheral Blood Stem Cell Transplantation · Other: Pharmacological Study · Radiation: Total-Body Irradiation · Radiation: Yttrium Y 90 Anti-CD45 Monoclonal Antibody BC8
Undergo allogeneic bone marrow transplant
Also known as: Allo BMT, Allogeneic BMT
Undergo allogeneic PBSC or bone marrow transplant
Also known as: allogeneic stem cell transplantation, HSC, HSCT
Given PO or IV
Also known as: 27-400, Ciclosporin, CsA, Cyclosporin, Cyclosporin A, Gengraf, Neoral, OL 27-400, Sandimmun, Sandimmune, SangCya
Given IV
Also known as: 2-F-ara-AMP, 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-, Beneflur, Fludara, SH T 586
Given IV (dosimetric dose)
Also known as: In 111 MOAB BC8, In 111 Monoclonal Antibody BC8, Indium In 111 Monoclonal Antibody BC8, monoclonal antibody BC8, indium In 111
Correlative studies
Given PO or IV
Also known as: Cellcept, MMF
Undergo allogeneic PBSC transplant
Also known as: PBPC transplantation, Peripheral Blood Progenitor Cell Transplantation, Peripheral Stem Cell Support, Peripheral Stem Cell Transplantation
Correlative studies
Undergo TBI
Also known as: TOTAL BODY IRRADIATION, Whole-Body Irradiation
Given via central line (therapeutic dose)
Also known as: 90Y Anti-CD45 MoAb BC8
The MTD of Radiation Delivered Via 90Y-DOTA-BC8 When Combined With FLU and 2 Gy TBI as a Preparative Regimen for Patients Aged ≥ 18 With Advanced AML, ALL, and High-risk MDS.
The MTD will be defined as the dose that is associated with a true DLT rate of 25%. The highest dose achieved was 28 Gy but none of the patients experienced a DLT. Thus, the MTD was not reached.
Time frame: Within the first 30 days following transplant
Achievement of Remission
Number of participants who are in complete remission (CR) 4 weeks after transplant. CR is defined as complete resolution of all signs of myelodysplasia or leukemia for at least 4 weeks with all of the following: 1. Normal bone marrow with blasts \<5% with normal cellularity, normal megakaryopoiesis, \> 15% erythropoiesis and \> 25% granulocytopoiesis 2. Normalization of blood counts (no blasts, platelets \> 100000/mm3, granulocytes \>1500/mm3) 3. No extramedullary disease.
Time frame: 4 weeks after transplant
Disease-free Survival
Number of study participants who are alive and remains in complete remission after transplant.
Time frame: 100 days after transplant
Duration of Remission
Median time to relapse after achieving complete remission (CR). CR is defined as complete resolution of all signs of myelodysplasia or leukemia for at least 4 weeks with all of the following: 1. Normal bone marrow with blasts \<5% with normal cellularity, normal megakaryopoiesis, \> 15% erythropoiesis and \> 25% granulocytopoiesis 2. Normalization of blood counts (no blasts, platelets \> 100000/mm3, granulocytes \>1500/mm3) 3. No extramedullary disease. Relapse Criteria: 1. After CR: \>5% blasts in the bone marrow and/or peripheral blood 2. After partial remission (PR): increase of blasts cells in the marrow to \>50% of those during PR 3. Extramedullary disease confirmed cytologically or histologically.
Time frame: 1 year
Estimation of Absorbed Radiation Doses to Normal Organs, Marrow and Tumor
The amount of energy absorbed per unit weight of the organ or tissue is called absorbed dose and is expressed in units of gray (Gy). One gray dose is equivalent to one joule radiation energy absorbed per kilogram of organ or tissue weight.
Time frame: Approximately day -20 to day -12 prior to transplant
Overall Survival
Number of participants who are still alive after transplant with or without disease.
Time frame: Up to 5 years
Rates of Acute GvHD
Number of participants who developed acute GVHD post-transplant, aGVHD stages: Skin: a maculopapular eruption involving \< 25% BSA a maculopapular eruption involving 25 - 50% BSA generalized erythroderma generalized erythroderma with bullous formation and often with desquamation Liver: bilirubin 2.0 - 3.0 mg/100 mL bilirubin 3 - 5.9 mg/100 mL bilirubin 6 - 14.9 mg/100 mL bilirubin \> 15 mg/100 mL Gut: Diarrhea is graded 1 - 4 in severity. Nausea and vomiting and/or anorexia caused by GVHD is assigned as 1 in severity. The severity of gut involvement is assigned to the most severe involvement noted. Patients with visible bloody diarrhea are at least stage 2 gut and grade 3 overall. aGVHD Grades Grade III: Stage 2 - 4 gut involvement and/or stage 2 - 4 liver involvement Grade IV: Pattern and severity of GVHD similar to grade 3 with extreme constitutional symptoms or death
Time frame: Up to 84 days post-transplant
Rates of Donor Chimerism
Number of participants who has 100% donor chimerism within 100 days after transplant
Time frame: Up to 100 days post-transplant
Rates of Engraftment
Average number of days to ANC \>= 500 after transplant
Time frame: Up to 84 days post-transplant
Rates of Non-relapse Mortality
Transplant-related deaths within 100 days after transplant
Time frame: Within the first 100 days following transplant
This protocol is open to participants age 18 and above, of either gender and any race/ethnicity. The study is looking at the use of Y-90-DOTA-BC8 in conjunction with a standard reduced-intensity transplant regimen.
| Milestone | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Started | 16 |
| Completed | 15 |
| Not completed | 1 |
| Withdrew: Hama + post dosimetry | 1 |
The MTD will be defined as the dose that is associated with a true DLT rate of 25%. The highest dose achieved was 28 Gy but none of the patients experienced a DLT. Thus, the MTD was not reached.
| Gy | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| The MTD of Radiation Delivered Via 90Y-DOTA-BC8 When Combined With FLU and 2 Gy TBI as a Preparative Regimen for Patients Aged ≥ 18 With Advanced AML, ALL, and High-risk MDS. | 28 |
Number of participants who are in complete remission (CR) 4 weeks after transplant. CR is defined as complete resolution of all signs of myelodysplasia or leukemia for at least 4 weeks with all of the following: 1. Normal bone marrow with blasts \<5% with normal cellularity, normal megakaryopoiesis, \> 15% erythropoiesis and \> 25% granulocytopoiesis 2. Normalization of blood counts (no blasts, platelets \> 100000/mm3, granulocytes \>1500/mm3) 3. No extramedullary disease.
| Participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Achievement of Remission | 13 |
Number of study participants who are alive and remains in complete remission after transplant.
| participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Disease-free Survival | 7 |
Median time to relapse after achieving complete remission (CR). CR is defined as complete resolution of all signs of myelodysplasia or leukemia for at least 4 weeks with all of the following: 1. Normal bone marrow with blasts \<5% with normal cellularity, normal megakaryopoiesis, \> 15% erythropoiesis and \> 25% granulocytopoiesis 2. Normalization of blood counts (no blasts, platelets \> 100000/mm3, granulocytes \>1500/mm3) 3. No extramedullary disease. Relapse Criteria: 1. After CR: \>5% blasts in the bone marrow and/or peripheral blood 2. After partial remission (PR): increase of blasts cells in the marrow to \>50% of those during PR 3. Extramedullary disease confirmed cytologically or histologically.
| days | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Duration of Remission | 213 (69 to 351) |
The amount of energy absorbed per unit weight of the organ or tissue is called absorbed dose and is expressed in units of gray (Gy). One gray dose is equivalent to one joule radiation energy absorbed per kilogram of organ or tissue weight.
| Gy | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Average absorbed dose to the marrow | 11.4 ± 9.2 |
| Average absorbed dose to the liver | 17.2 ± 6.8 |
| Average abosorbed dose total body | 3.1 ± 5.7 |
| Average absorbed dose to the spleen | 70 ± 43 |
Number of participants who are still alive after transplant with or without disease.
| Participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Overall Survival | 7 |
Number of participants who developed acute GVHD post-transplant, aGVHD stages: Skin: a maculopapular eruption involving \< 25% BSA a maculopapular eruption involving 25 - 50% BSA generalized erythroderma generalized erythroderma with bullous formation and often with desquamation Liver: bilirubin 2.0 - 3.0 mg/100 mL bilirubin 3 - 5.9 mg/100 mL bilirubin 6 - 14.9 mg/100 mL bilirubin \> 15 mg/100 mL Gut: Diarrhea is graded 1 - 4 in severity. Nausea and vomiting and/or anorexia caused by GVHD is assigned as 1 in severity. The severity of gut involvement is assigned to the most severe involvement noted. Patients with visible bloody diarrhea are at least stage 2 gut and grade 3 overall. aGVHD Grades Grade III: Stage 2 - 4 gut involvement and/or stage 2 - 4 liver involvement Grade IV: Pattern and severity of GVHD similar to grade 3 with extreme constitutional symptoms or death
| Participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Grade 0 acute GVHD | 4 |
| Grade I acute GVHD | 1 |
| Grade II acute GVHD | 6 |
| Grade III acute GVHD | 2 |
| Grade IV acute GVHD | 1 |
Number of participants who has 100% donor chimerism within 100 days after transplant
| Participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Rates of Donor Chimerism | 14 |
Average number of days to ANC \>= 500 after transplant
| days | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Rates of Engraftment | 16 ± 6.0 |
Transplant-related deaths within 100 days after transplant
| Participants | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Severe refractory GVHD | 1 |
| Bacterial infection | 1 |
Collected over Adverse events (AEs) will be monitored and recorded in study-specific case report forms (CRFs) from the time of first exposure to an investigational agent (i.e., the start of the Indium-111-DOTA-BC8 infusion) through day +100 after transplant or through discharge prior to that date from the SCCA system to the care of the patient's primary physician.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) | 5/15 (33.3%) | 9/15 (60%) | 11/15 (73.3%) |
| Event | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Febrile neutropeniaBlood and lymphatic system disorders | 7/15 |
| VomitingGastrointestinal disorders | 1/15 |
| Creatinine increasedInvestigations | 1/15 |
| AnorexiaMetabolism and nutrition disorders | 1/15 |
| Atrial fibrillationCardiac disorders | 1/15 |
| Oral painGastrointestinal disorders | 1/15 |
| Abdominal painGastrointestinal disorders | 1/15 |
| FeverGeneral disorders | 1/15 |
| Skin infectionInfections and infestations | 1/15 |
| HypokalemiaMetabolism and nutrition disorders | 1/15 |
| Event | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| NauseaGastrointestinal disorders | 9/15 |
| DiarrheaGastrointestinal disorders | 6/15 |
| FatigueGeneral disorders | 6/15 |
| Allergic reactionImmune system disorders | 6/15 |
| Rash maculo-papularSkin and subcutaneous tissue disorders | 6/15 |
| VomitingGastrointestinal disorders | 5/15 |
| MyalgiaMusculoskeletal and connective tissue disorders | 5/15 |
| Edema limbsGeneral disorders | 4/15 |
| AnorexiaMetabolism and nutrition disorders | 4/15 |
| HypomagnesemiaMetabolism and nutrition disorders | 4/15 |
| Age, Categorical(Participants) | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| <=18 years | 0 |
| Between 18 and 65 years | 8 |
| >=65 years | 8 |
| Sex: Female, Male(Participants) | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Female | 8 |
| Male | 8 |
| Ethnicity (NIH/OMB)(Participants) | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| Hispanic or Latino | 0 |
| Not Hispanic or Latino | 16 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Treatment (90Y-BC8, Allogeneic PBSC or Bone Marrow Transplant) |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 16 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
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