Unrelated Bone Marrow Transplantation With Cyclophosphamide and Total Body Irradiation For Hematologic Malignancies and Bone Marrow Failure States
anti-thymocyte globulin
+ filgrastim
+ sargramostim
Anemia+29
+ Bone Marrow Diseases
+ Chronic Disease
Treatment Study
Summary
Study start date: August 1, 1996
Actual date on which the first participant was enrolled.OBJECTIVES: Study the curative potential of high-dose cyclophosphamide and total-body irradiation followed by rescue with bone marrow from volunteer HLA-matched donors in patients with a variety of hematologic malignancies and bone marrow failure states. Study the toxic effects associated with matched unrelated bone marrow transplantation in this patient population. Participate in collaborative research studies with the National Marrow Donor Program. OUTLINE: All patients receive myeloablative therapy with high-dose cyclophosphamide and total body irradiation over 4 days; patients with severe aplastic anemia also receive antithymocyte globulin. Patients then undergo allogeneic bone marrow transplantation. Filgrastim (G-CSF) is given after transplant to accelerate engraftment. Sargramostim (GM-CSF) may be given in case of graft failure. All patients receive graft-versus-host-disease (GVHD) prophylaxis with tacrolimus, methotrexate, and gamma globulin. Established GVHD is treated with corticosteroids and, as necessary, antithymocyte globulin. Patients are followed at 100 days, 6 months, and 1 year after transplant, then annually thereafter. PROJECTED ACCRUAL: A total of 10 patients per year will be accrued for this study over 5 years.
Protocol
This section provides details of the study plan, including how the study is designed and what the study is measuring.10 patients to be enrolled
Total number of participants that the clinical trial aims to recruit.Treatment Study
Eligibility
Researchers look for people who fit a certain description, called eligibility criteria: person's general health condition or prior treatments.Any sex
Biological sex of participants that are eligible to enroll.From 17 to 60 Years
Range of ages for which participants are eligible to join.Healthy volunteers not allowed
If individuals who are healthy and do not have the condition being studied can participate.Conditions
Pathology
Criteria
DISEASE CHARACTERISTICS: One of the following hematologic malignancies/disorders: Acute lymphoblastic leukemia In second or subsequent complete remission (CR) In first CR with high-risk features (e.g., Philadelphia chromosome-positive) In first relapse and failed conventional salvage therapy Acute myelogenous leukemia (AML) In second or subsequent CR In early first relapse In full first relapse and failed conventional salvage therapy In first CR with high-risk features, e.g., trisomy 8 or FAB 6/7 Standard-risk AML offered conventional-dose consolidation chemotherapy or autologous bone marrow transplantation Chronic myelogenous leukemia in chronic, accelerated, or second chronic phase No blast crisis Severe aplastic anemia that has failed at least 1 course of immunosuppressive therapy Paroxysmal nocturnal hemoglobinuria with high-risk features (e.g., disseminated intravascular coagulation, thrombotic events) Myelodysplastic syndrome, i.e.: Symptomatic, transfusion-dependent refractory anemia with excess blasts (RAEB) or RAEB in transformation Secondary leukemia in CR following conventional-dose induction chemotherapy Unrelated marrow donor available who is 8 out of 10-, 9 out of 10-, or 10 out of 10-antigen serologically HLA-matched at A, B, C, DRb, and DQB loci by molecular typing No CNS malignancy PATIENT CHARACTERISTICS: Age: 17 to 60 Performance status: Karnofsky 70-100% Life expectancy: No reduction due to other serious illness Hematopoietic: Not specified Hepatic: Bilirubin less than 3 mg/dL AST/ALT no greater than twice normal Renal: Creatinine no greater than 2.0 mg/dL Creatinine clearance greater than 60 mL/min Cardiovascular: Left ventricular ejection fraction at least 45% No severe hypertension Pulmonary: DLCO, FEV_1, and FVC at least 50% Other: HIV negative No active infection at time of transplant No advanced diabetes No significant neurologic deficit No active drug or substance abuse No emotional disorders Able to participate in frequent medical care for at least 1-2 years Willing to comply with National Marrow Donor Program policies PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics Chemotherapy See Disease Characteristics Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified
Study Centers
These are the hospitals, clinics, or research facilities where the trial is being conducted. You can find the location closest to you and its status.This study has 1 location
Fox Chase-Temple Cancer Center
Philadelphia, United StatesOpen Fox Chase-Temple Cancer Center in Google Maps