Overview

Combination Chemotherapy, Total Body Irradiation, and Donor Blood Stem Cell Transplant in Treating Patients With Secondary Myelofibrosis

Status:
Recruiting
Trial end date:
2023-05-24
Target enrollment:
0
Participant gender:
All
Summary
This pilot phase I trial studies the side effects of combination chemotherapy, total body irradiation, and donor blood stem cell transplant in treating patients with secondary myelofibrosis. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. Giving combination chemotherapy and total body irradiation before a donor blood stem cell transplant helps to stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer 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.
Phase:
Phase 1
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
City of Hope Medical Center
Collaborator:
National Cancer Institute (NCI)
Treatments:
Cyclophosphamide
Fludarabine
Fludarabine phosphate
Mechlorethamine
Melphalan
Mycophenolate mofetil
Mycophenolic Acid
Nitrogen Mustard Compounds
Tacrolimus
Criteria
Inclusion Criteria:

- Diagnosis of primary of secondary myelofibrosis with transplant indication by Dynamic
International Prognostic Scoring System (DIPSS)-plus (> intermediate-1)

- Patients >= age 50 must have a comorbidity score (hematopoietic cell
transplant-comorbidity index [HCT-CI]) < 4 (Sorror)

- Patients can be in chronic phase (CP) with bone marrow (BM) blast count =< 15% as long
as no evidence of disease acceleration per principal investigator (PI) and treating
physician's opinion or after progression to acute myeloid leukemia (AML) and achieved
=< 5% BM blasts (morphologic complete remission [CR] prior to transplant)

- Lack of an human leukocyte antigen (HLA) matched donor or need to proceed fast to
transplantation when a patient does not have an immediately available matched
unrelated donor (typed by high-resolution in the registry)

- Performance status >= 70% (Karnofsky); patients > 50 years should have adequate
cognitive function; any concerns regarding cognitive function should be addressed by a
geriatrician/neurologist

- Alanine aminotransferase (ALT)/aspartate aminotransferase (AST)/bilirubin =< 5 X upper
limit of normal (ULN)

- Measured creatinine clearance > 60 mls/min

- Left ventricular ejection fraction (LVEF) >= 50%

- Corrected carbon monoxide diffusing capability (DLCOc) >= 50%

- No active infections

- Prior treatment with JAK2 inhibitor therapy is not excluded; a JAK2 inhibitor will
need to be stopped 1-2 days prior to starting conditioning regimen

- DONOR: Documented informed consent per local, state and federal guidelines

- DONOR: Genotypically haploidentical as determined by HLA typing

- Preferably a non-maternal HLA haploidentical relative due to data of high
incidence of graft failure with use of maternal HLA haploidentical cells

- Eligible donors include biological parents, siblings or half-siblings, children,
or cousins in rare instances

- DONOR: Absence of pre-existing donor-specific anti-HLA antibodies (DSA) in the
recipient; Patients with pre-existing DSA could undergo desensitization per City of
Hope (COH) standard operating procedures [SOP] and should have DSA < MFI of 2000 prior
to conditioning at discretion of PI

- DONOR: Infectious disease screening performed within 30 days prior to stem cell
mobilization per federal guidelines and is:

- Seronegative for HIV 1+2 antibody (Ab) and/or HIV polymerase chain reaction
(PCR), human T-cell leukemia virus (HTLV) I/II Ab, hepatitis B virus surface
antigen (HBsAg), hepatitis B virus surface antibody (HBcAb), hepatitis C virus
(HCV) Ab

- Negative rapid plasma reagin (RPR) for syphilis

- DONOR: Women of childbearing potential (WOCBP): Urine pregnancy testing performed
within 7 days prior to stem cell mobilization

- DONOR: Is approved and completed evaluation prior to recipient initiation of the
preparative regimen per institutional guidelines

Exclusion Criteria:

- Evidence of severe portal hypertension with evidence of decompensation either with
bleeding varices, large volume ascites, or hepatic encephalopathy

- In a bone marrow biopsy 4 weeks prior to start of conditioning on study:

- > 15% bone marrow blasts at transplant if no history of AML and per PI and
treating physician's opinion of disease acceleration

- > 5% if had previous progression to AML

- Human immunodeficiency virus (HIV) positive; active hepatitis B or C

- Patients with active infections; the PI is the final arbiter of the eligibility

- Patients with evidence of severe pulmonary hypertension by echocardiogram and
confirmed by a subsequent right side cardiac catheterization pre-enrollment

- Liver cirrhosis

- Prior central nervous system (CNS) involvement by tumor cells

- History of another primary malignancy that has not been in remission for at least 3
years (the following are exempt from the 3-year limit: non-melanoma skin cancer, fully
excised melanoma in situ [stage 0], curatively treated localized prostate cancer, and
cervical or breast carcinoma in situ on biopsy or a squamous intraepithelial lesion on
papanicolaou [PAP] smear)

- Positive beta human chorionic gonadotropin (HCG) test in a woman with child bearing
potential defined as not post-menopausal for 12 months or no previous surgical
sterilization

- Noncompliance - inability or unwillingness to comply with medical recommendations
regarding therapy or follow-up, including smoking tobacco

- DONOR: Has undergone solid organ, stem cell, bone marrow or blood transplantation

- DONOR: Receiving any investigational agents, or concurrent biological, chemotherapy,
immunosuppression or radiation therapy

- DONOR: Active infection

- DONOR: Thrombocytopenia < 150,000 cells /mm^3 at baseline evaluation

- DONOR: Sero-positive for HIV-1 & 2 antibody, HTLV-I & II antibody, hepatitis B virus
(HBV) and HCV

- DONOR: Medical or physical reason which makes the donor unlikely to tolerate or
cooperate with growth factor therapy and leukapheresis

- DONOR: Factors which place the donor at increased risk for complications from
leukapheresis or G-CSF therapy

- DONOR: WOCBP: Pregnant or =< 6 months breastfeeding