Clinical Trials (PDQ®)
|Phase II||Biomarker/Laboratory analysis, Treatment||Active||3 to 18||NCI, Other||ASCT1221|
NCI-2013-00738, U10CA098543, COG-ASCT1221, NCT01824693
This randomized phase II trial studies how well giving busulfan, cyclophosphamide, and melphalan or busulfan and fludarabine phosphate before donor hematopoietic cell transplant works in treating younger patients with juvenile myelomonocytic leukemia. Giving chemotherapy before a donor hematopoietic transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem 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. It is not yet known whether giving busulfan, cyclophosphamide, and melphalan or busulfan and fludarabine phosphate before a donor stem cell transplant is more effective in treating juvenile myelomonocytic leukemia.
Further Study Information
I. To compare - in a randomized fashion - the day 100 treatment related mortality (TRM) incidence for two myeloablative conditioning regimens, busulfan-fludarabine (fludarabine phosphate) (BU-FLU) and busulfan-cyclophosphamide-melphalan (BU-CY-MEL), prior to hematopoietic cell transplant (HCT) for children with juvenile myelomonocytic leukemia (JMML), in order to determine the preferred regimen for future trials.
II. To compare - in a randomized fashion - the 18-month event-free survival (EFS) following two different myeloablative conditioning regimens (BU-FLU vs. BU-CY-MEL) prior to HCT for children with JMML, in order to determine the preferred regimen for future trials.
I. To determine the 18-month relapse incidence (RI) following two different myeloablative conditioning regimens busulfan-fludarabine phosphate(BU-FLU vs. BU-CY-MEL) prior to HCT for children with JMML.
II. To determine the graft failure rates following two different myeloablative conditioning regimens (BU-FLU vs. BU-CY-MEL) prior to HCT for children with JMML.
I. To determine the rates of severe toxicities (grade 3/4) at day 100 post-HCT between the two myeloablative conditioning regimens (BU-FLU vs. BU-CY-MEL).
II. To determine the rates of acute and chronic (at 18 months post-HCT) graft-versus-host disease (GVHD) following HCT using two different conditioning regimens (BU-FLU vs. BU-CY-MEL) in children with JMML.
III. To create a JMML-specific pre-HCT index to allow better risk-stratification of future patients.
IV. To determine the feasibility of assessing post-transplant disease burden by donor chimerism measurements and allele-specific polymerase chain reaction (PCR) in mononuclear and sorted cell subsets.
V. To validate gene expression and methylation classifiers predictive of relapse in patients with JMML.
VI. To comprehensively assess genetic and biochemical alterations amongst patients with JMML who are treated on this transplant protocol.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
BU-CY-MEL (HCT conditioning regimen with busulfan, cyclophosphamide, melphalan):
CONDITIONING REGIMEN: Patients receive busulfan intravenously (IV) once daily (QD), twice daily (BID), or four times a day (QID) over 2-3 hours on days -8 to -5, cyclophosphamide IV QD over 60 minutes on days -4 and -3, and melphalan IV over 15-30 minutes on day -1.
TRANSPLANT: Patients undergo allogeneic HCT on day 0.
Patients receive tacrolimus IV then orally (PO) on days -1 to 98 (related donor) or 180 (unrelated donor) and mycophenolate mofetil IV over 2 hours TID then PO on days 1-30 (related donor) or 45 (unrelated donor).
BU-FLU (HCT conditioning regimen with busulfan, fludarabine phosphate):
CONDITIONING REGIMEN: Patients receive busulfan intravenously (IV) once daily (QD), twice daily (BID), or four times a day (QID) over 2-3 hours on days -8 to -5, and fludarabine phosphate IV over 1 hour on days -5 to -2.
TRANSPLANT: Patients undergo allogeneic HCT on day 0.
Patients receive tacrolimus IV then PO on days -1 to 98 (related donor) or 180 (unrelated donor) and mycophenolate mofetil IV over 2 hours TID then PO on days 1-30 (related donor) or 45 (unrelated donor).
After completion of study treatment, patients are followed up for 5 years.
- Patients must have a strong clinical suspicion of JMML, based on a modified category 1 of the revised diagnostic criteria; specifically, eligible patients must have all of the following:
- Absolute monocyte count (AMC) > 1000/uL
- Blasts in peripheral blood (PB)/bone marrow (BM) < 20%
- For the 7-10% of patients without splenomegaly, the diagnostic entry criteria must include all other features described above and at least 2 of the following criteria:
- Circulating myeloid precursors
- White blood cell (WBC) > 10,000/uL
- Increased fetal hemoglobin (HgbF) for age
- Sargramostim (GM-CSF) hypersensitivity
- Patients must be previously untreated with HCT
- Patients with a known germline mutation of Noonan's Syndrome (PTPN11) are not eligible
- Patients with a history of Neurofibromatosis type 1 (NF1) and either
- A history of a tumor of the central nervous system (astrocytoma or optic glioma), or
- A malignant peripheral nerve sheath tumor with a complete remission of < 1 year are not eligible
Trial Lead Organizations/Sponsors
Children's Oncology GroupNational Cancer Institute
|Christopher Dvorak, MD||Principal Investigator|
|Children's Hospital of Alabama at University of Alabama at Birmingham|
|Alyssa T Reddy||Ph: 205-934-0309|
|Phoenix Children's Hospital|
|Jessica Boklan||Ph: 602-546-0920|
|City of Hope Comprehensive Cancer Center|
|Anna B Pawlowska||Ph: 800-826-4673|
|Mattel Children's Hospital at UCLA|
|Theodore B Moore||Ph: 310-825-6708|
|Rady Children's Hospital - San Diego|
|William D Roberts||Ph: 858-966-5934|
|UCSF Helen Diller Family Comprehensive Cancer Center|
|Christopher C Dvorak||Ph: 877-827-3222|
|Alfred I. duPont Hospital for Children|
|Christopher N Frantz||Ph: 302-651-5755|
|Nemours Children's Clinic|
|Scott M Bradfield||Ph: 904-697-3529|
|All Children's Hospital|
|Gregory A Hale||Ph: 727-767-2423|
|AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Egleston Campus|
|Glen Lew||Ph: 404-785-1112|
|Riley's Children Cancer Center at Riley Hospital for Children|
|Robert J Fallon||Ph: 317-274-2552|
|Holden Comprehensive Cancer Center at University of Iowa|
|Ayman A El-Sheikh||Ph: 800-237-1225|
|Kosair Children's Hospital|
|Alexandra C Cheerva||Ph: 866-530-5516|
|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins|
|Allen R. Chen||Ph: 410-955-8804|
|Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute|
|Leslie E Lehmann||Ph: 866-790-4500|
|Wayne State University|
|Sureyya Savasan||Ph: 313-576-9363|
|Masonic Cancer Center at University of Minnesota|
|Michael R Verneris||Ph: 612-624-2620|
|Children's Mercy Hospital|
|Maxine L Hetherington||Ph: 816-234-3265|
|Hackensack University Medical Center Cancer Center|
|Jennifer A Krajewski||Ph: 201-996-2879|
|Montefiore Medical Center|
|Peter D Cole||Ph: 718-904-2730|
|Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center|
|Alice Lee||Ph: 212-305-8615|
|New York Medical College|
|Mehmet F Ozkaynak||Ph: 914-594-3794|
|Cincinnati Children's Hospital Medical Center|
|John P Perentesis||Ph: 513-636-2799|
|Seidman Cancer Center at University Hospitals/Case Medical Center|
|Yousif (Joe) H Matloub||Ph: 216-844-5437|
|Nationwide Children's Hospital|
|Mark A Ranalli||Ph: 614-722-2708|
|Knight Cancer Institute at Oregon Health and Science University|
|Eneida R Nemecek||Ph: 503-494-1080|
|Children's Oncology Group|
|Christopher C Dvorak||Ph: 415-476-2188|
|Children's Hospital of Pittsburgh of UPMC|
|Randy M Windreich||Ph: 412-692-5573|
|Hollings Cancer Center at Medical University of South Carolina|
|Jacqueline M Kraveka||Ph: 843-792-9321|
|Medical City Dallas Hospital|
|Carl Lenarsky||Ph: 972-566-5588|
|Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas|
|Victor M Aquino||Ph: 214-648-7097|
|Methodist Children's Hospital of South Texas|
|Jaime Estrada||Ph: 210-575-7000|
|Salt Lake City|
|Primary Children's Medical Center|
|Phillip E Barnette||Ph: 801-585-5270|
|Children's Hospital and Regional Medical Center - Seattle|
|Douglas S Hawkins||Ph: 866-987-2000|
|University of Wisconsin Paul P. Carbone Comprehensive Cancer Center|
|Kenneth B DeSantes||Ph: 608-262-5223|
|Princess Margaret Hospital for Children|
|Catherine H Cole||Ph: (08) 9340 8330|
|Rochelle A Yanofsky||Ph: 866-561-1026|
|Starship Children's Health|
|Lochie R Teague||Ph: 0800 728 436|
Link to the current ClinicalTrials.gov record.
NLM Identifer NCT01824693
ClinicalTrials.gov processed this data on March 27, 2014
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