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This trial will use two cord blood units for transplantation using a reduced intensity regimen rather than using intense doses of chemotherapy and radiation therapy. Two cord blood units (double cord blood) are being used, as the numbers of blood cells in one unit are too few to allow successful growth of these cells.
Because the risk of infection, particularly virus infection, is high after double cord blood transplant, this study seeks to reduce the rise of virus infection by using a reduced intensity regimen without a medicine called antithymocyte globulin (ATG), as used in prior cord blood transplants. Subjects will receive two chemotherapy drugs, melphalan and fludarabine, and low dose of total body radiation (one treatment) instead of the ATG. The number of patients with virus infections in this study will be compared to our prior experience using the ATG.
Subjects will receive their transplants as in-patients.
IV-Catheter
Conditioning
Immunosuppressive Therapy
Infusion of Cord Blood units
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fludarabine/Melphalan/TBI | Experimental | All patients receive same therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fludarabine | Drug | 30 mg/m2/day IV x 6 days |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With a Clinically Significant Infection | The one year significant infection rate (infections requiring medical intervention) after double umbilical cord blood transplant using a novel conditioning regimen of fludarabine/melphalan/low dose total body radiation. The data is shown as the number of significant infections participants experienced during the first year, measured from the start of treatment. | 1 Year |
| Measure | Description | Time Frame |
|---|---|---|
| Median Time to Neutrophil Engraftment | The median number of days measured from the time of transplantation, until the first documented neutrophil engraftment. neutrophil engraftment is defined as the first of 3 consecutive days of absolute neutrophil count > 500 neutrophils per microliter of blood. | From the time of transplantation, until the time of neutrophil engraftment, median duration of 24 days |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Zachariah DeFilipp, MD | Massachusetts General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Massachusetts General Hospital | Boston | Massachusetts | 02114 | United States | ||
| Beth Israel Deaconess Medical Center |
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| ID | Title | Description |
|---|---|---|
| FG000 | Fludarabine/Melphalan/TBI | All patients receive same therapy Fludarabine: 30 mg/m2/day IV x 6 days Melphalan: 100 mg/m2/day IV x 1 day Total Body Radiation: 200 cGy on Day 0 Cord Blood: 2 cord blood units IV |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Oct 6, 2016 |
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| Melphalan | Drug | 100 mg/m2/day IV x 1 day |
|
| Total Body Radiation | Radiation | 200 cGy on Day 0 |
|
| Cord Blood | Biological | 2 cord blood units IV |
|
| Median Time to Platelet Engraftment | The time to platelet engraftment is measured from the time of transplantation until the time of first documented platelet engraftment. Platelet engraftment is defined as a platelet count ≥ 20,000/µL for three consecutive measurements over three or more days. The first of the three days will be designated the day of platelet engraftment. Subjects must not have had platelet transfusions during the preceding 3 days or in the following 7 days after the day of engraftment, unless the platelet transfusion is being given specifically to achieve a platelet threshold to allow an elective invasive procedure, such as a central catheter removal. | From the time of transplantation, until the time of platelet engraftment, median duration of 52 days |
| Number of Participants With Primary Graft Failure | Primary graft failure is defined as the failure to achieve an absolute neutrophil count (ANC) >500/ µL by day 42, in the absence of relapse. | From the time of transplantation until 42 days post transplantation |
| Rates of Grade II-IV and Grade III-IV Acute Graft Versus Host Disease (GVHD) at 100 Days | Acute GVHD is assessed using Consensus Criteria: Organ Classifications:
Overall Clinical Grade:
| 100 Days |
| The Rate of Chronic GVHD | Chronic Graft Versus Host Disease (GVHD) is assessed using the National Institutes of Health (NIH) consensus criteria. | From the time of transplantation until the time of chronic GVHD onset, up to 1 year |
| 100-day Treatment Related Mortality | The percentage of treatment related participant deaths within 100 days of receiving umbilical cord blood transplantation. All deaths in the absence of relapse of the primary malignancy will be considered treatment related mortality. | 100 Days |
| Immune Reconstitution - Median CD4 Count at 12 Months | 1 Year |
| Relapse-free Survival | The percentage of participants that have not died or had disease progression by two years. Relapse is defined by either morphological or cytogenetic evidence of the original malignancy consistent with pre-transplant features. | 2 years |
| Overall Survival | The percentage of participants alive at two years | 2 years |
| 1 Year Relapse Rate | The percentage of participants that relapsed within 12 months. Relapse is defined by either morphological or cytogenetic evidence of the original malignancy consistent with pre-transplant features. | 1 year |
| Rate of Post-transplant Lymphoma | The number of participants that were found to have lymphoma post-transplant. | 2.5 years |
| Median Thrombopoietin Levels After Transplant | 30 Days |
| Boston |
| Massachusetts |
| 02215 |
| United States |
| Dana-Farber Cancer Institute | Boston | Massachusetts | 02215 | United States |
| Received Transplant |
|
| COMPLETED |
|
| NOT COMPLETED |
|
|
The two participants found to be ineligible after being consented and registered were excluded from the analysis.
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| ID | Title | Description |
|---|---|---|
| BG000 | Fludarabine/Melphalan/TBI | All patients receive same therapy Fludarabine: 30 mg/m2/day IV x 6 days Melphalan: 100 mg/m2/day IV x 1 day Total Body Radiation: 200 cGy on Day 0 Cord Blood: 2 cord blood units IV |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Full Range | years |
| |||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||||
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
| |||||||||||||||||
| Region of Enrollment | Count of Participants | Participants |
| ||||||||||||||||||
| Performance Status | Eastern Cooperative Oncology Group (ECOG) Performance Status:
| Count of Participants | Participants |
| |||||||||||||||||
| Disease | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With a Clinically Significant Infection | The one year significant infection rate (infections requiring medical intervention) after double umbilical cord blood transplant using a novel conditioning regimen of fludarabine/melphalan/low dose total body radiation. The data is shown as the number of significant infections participants experienced during the first year, measured from the start of treatment. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Count of Participants | Participants | 1 Year |
|
|
| ||||||||||||||||||||||||||||||
| Secondary | Median Time to Neutrophil Engraftment | The median number of days measured from the time of transplantation, until the first documented neutrophil engraftment. neutrophil engraftment is defined as the first of 3 consecutive days of absolute neutrophil count > 500 neutrophils per microliter of blood. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. In addition to those two participants, the 8 participants that did not achieve engraftment were not included in the analysis. | Posted | Median | Full Range | Days | From the time of transplantation, until the time of neutrophil engraftment, median duration of 24 days |
|
| ||||||||||||||||||||||||||||||
| Secondary | Median Time to Platelet Engraftment | The time to platelet engraftment is measured from the time of transplantation until the time of first documented platelet engraftment. Platelet engraftment is defined as a platelet count ≥ 20,000/µL for three consecutive measurements over three or more days. The first of the three days will be designated the day of platelet engraftment. Subjects must not have had platelet transfusions during the preceding 3 days or in the following 7 days after the day of engraftment, unless the platelet transfusion is being given specifically to achieve a platelet threshold to allow an elective invasive procedure, such as a central catheter removal. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. In addition to those two participants, the 10 participants that did not achieve engraftment were not included in the analysis. | Posted | Median | Full Range | Days | From the time of transplantation, until the time of platelet engraftment, median duration of 52 days |
|
| ||||||||||||||||||||||||||||||
| Secondary | Number of Participants With Primary Graft Failure | Primary graft failure is defined as the failure to achieve an absolute neutrophil count (ANC) >500/ µL by day 42, in the absence of relapse. | Posted | Count of Participants | Participants | From the time of transplantation until 42 days post transplantation |
|
| ||||||||||||||||||||||||||||||||
| Secondary | Rates of Grade II-IV and Grade III-IV Acute Graft Versus Host Disease (GVHD) at 100 Days | Acute GVHD is assessed using Consensus Criteria: Organ Classifications:
Overall Clinical Grade:
| The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Number | 95% Confidence Interval | percentage of participants | 100 Days |
| |||||||||||||||||||||||||||||||
| Secondary | The Rate of Chronic GVHD | Chronic Graft Versus Host Disease (GVHD) is assessed using the National Institutes of Health (NIH) consensus criteria. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Number | 95% Confidence Interval | percentage of participants | From the time of transplantation until the time of chronic GVHD onset, up to 1 year |
|
| ||||||||||||||||||||||||||||||
| Secondary | 100-day Treatment Related Mortality | The percentage of treatment related participant deaths within 100 days of receiving umbilical cord blood transplantation. All deaths in the absence of relapse of the primary malignancy will be considered treatment related mortality. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Number | 95% Confidence Interval | percentage of participants | 100 Days |
|
| ||||||||||||||||||||||||||||||
| Secondary | Immune Reconstitution - Median CD4 Count at 12 Months | CD4 counts were only available for 11 participants at the 12 months time point | Posted | Median | Full Range | cells/mm3 | 1 Year |
|
| |||||||||||||||||||||||||||||||
| Secondary | Relapse-free Survival | The percentage of participants that have not died or had disease progression by two years. Relapse is defined by either morphological or cytogenetic evidence of the original malignancy consistent with pre-transplant features. | The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Number | 95% Confidence Interval | percentage of participants | 2 years |
|
| ||||||||||||||||||||||||||||||
| Secondary | Overall Survival | The percentage of participants alive at two years | The two participants found to be ineligible after being consented and registered were excluded from the analysis. | Posted | Number | 95% Confidence Interval | percentage of participants | 2 years |
|
| ||||||||||||||||||||||||||||||
| Secondary | 1 Year Relapse Rate | The percentage of participants that relapsed within 12 months. Relapse is defined by either morphological or cytogenetic evidence of the original malignancy consistent with pre-transplant features. | Posted | Number | 95% Confidence Interval | percentage | 1 year |
|
| |||||||||||||||||||||||||||||||
| Secondary | Rate of Post-transplant Lymphoma | The number of participants that were found to have lymphoma post-transplant. | Posted | Count of Participants | Participants | 2.5 years |
|
| ||||||||||||||||||||||||||||||||
| Secondary | Median Thrombopoietin Levels After Transplant | Posted | Median | Full Range | pg/mL | 30 Days |
|
|
|
Adverse events are assessed from the start of treatment until the end of follow-up, up to two years.
The two participants found to be ineligible after being consented and registered were excluded from the analysis.
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Fludarabine/Melphalan/TBI | All patients receive same therapy Fludarabine: 30 mg/m2/day IV x 6 days Melphalan: 100 mg/m2/day IV x 1 day Total Body Radiation: 200 cGy on Day 0 Cord Blood: 2 cord blood units IV | 1 | 31 | 10 | 31 | 26 | 31 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Blood and lymphatic system disorders - Other, specify | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Death NOS | General disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Edema cerebral | Nervous system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Encephalitis infection | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Febrile neutropenia | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Fever | General disorders | CTCAE (4.0) | Systematic Assessment |
| |
| General disorders and administration site conditions - Other, specify | General disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Infections and infestations - Other, specify | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Lung infection | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Meningitis | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Rectal perforation | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Respiratory failure | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Reversible posterior leukoencephalopathy syndrome | Nervous system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Sepsis | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Thromboembolic event | Vascular disorders | CTCAE (4.0) | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Acidosis | Metabolism and nutrition disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Acute kidney injury | Renal and urinary disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Anemia | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Anorexia | Metabolism and nutrition disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Blood and lymphatic system disorders - Other, specify | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Blood bilirubin increased | Investigations | CTCAE (4.0) | Systematic Assessment |
| |
| Colitis | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Creatinine increased | Investigations | CTCAE (4.0) | Systematic Assessment |
| |
| Diarrhea | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Encephalitis infection | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Febrile neutropenia | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Fever | General disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Headache | Nervous system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hypertension | Vascular disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hyperuricemia | Metabolism and nutrition disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hypomagnesemia | Metabolism and nutrition disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hyponatremia | Metabolism and nutrition disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hypotension | Vascular disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Hypoxia | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Lung infection | Infections and infestations | CTCAE (4.0) | Systematic Assessment |
| |
| Mucositis oral | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Neutrophil count decreased | Investigations | CTCAE (4.0) | Systematic Assessment |
| |
| Platelet count decreased | Investigations | CTCAE (4.0) | Systematic Assessment |
| |
| Pleural effusion | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Systematic Assessment |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Zachariah DeFilipp | Massachusetts General Hospital | 617-643-3944 | ZDEFILIPP@mgh.harvard.edu |
| Jun 5, 2018 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D008228 | Lymphoma, Non-Hodgkin |
| D006689 | Hodgkin Disease |
| D009101 | Multiple Myeloma |
| D015451 | Leukemia, Lymphocytic, Chronic, B-Cell |
| D015470 | Leukemia, Myeloid, Acute |
| D008223 | Lymphoma |
| D007938 | Leukemia |
| D000741 | Anemia, Aplastic |
| ID | Term |
|---|---|
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
| D054219 | Neoplasms, Plasma Cell |
| D020141 | Hemostatic Disorders |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010265 | Paraproteinemias |
| D001796 | Blood Protein Disorders |
| D006402 | Hematologic Diseases |
| D006474 | Hemorrhagic Disorders |
| D015448 | Leukemia, B-Cell |
| D007945 | Leukemia, Lymphoid |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007951 | Leukemia, Myeloid |
| D000740 | Anemia |
| D000080983 | Bone Marrow Failure Disorders |
| D001855 | Bone Marrow Diseases |
Not provided
Not provided
| ID | Term |
|---|---|
| C024352 | fludarabine |
| C042382 | fludarabine phosphate |
| D008558 | Melphalan |
| D014916 | Whole-Body Irradiation |
| ID | Term |
|---|---|
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D010649 | Phenylalanine |
| D024322 | Amino Acids, Aromatic |
| D000598 | Amino Acids, Cyclic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011878 | Radiotherapy |
| D013812 | Therapeutics |
| D008919 | Investigative Techniques |
Not provided
Not provided
| 1 |
|
| 2 |
|
|
| Hodgkin's Disease (HD) |
|
| Myelodysplastic Syndromes (MDS) |
|
| Myeloproliferative Disorder (MPD) |
|
| Non-Hodgkin Lymphoma (NHL) |
|
|
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| Title | Denominators | Categories | ||||
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