This pilot phase I clinical trial studies how well donor bone marrow transplant works when given together with standard chemotherapy in treating patients with castration-resistant prostate cancer that has spread to other places in the body. Drugs used in chemotherapy, such as fludarabine and cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving standard chemotherapy and donor bone marrow transplant may work better in treating patients with castration-resistant prostate cancer.
Additional locations may be listed on ClinicalTrials.gov for NCT02995330.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVES:
I. Estimate the percentage of patients with complete biochemical response at 6 months post-transplant (prostate-specific antigen [PSA] < 0.1 ng/mL for patients post-prostatectomy and PSA < 1 ng/mL for patients post-radiation therapy).
SECONDARY OBJECTIVES:
I. Estimate the incidence of transplant-related mortality (TRM) following allogeneic bone marrow transplantation (alloBMT).
II. Estimate PSA response rate (proportion of patients achieving a PSA decline >= 50% according to Prostate Cancer Working Group [PCWG2] criteria).
III. Estimate objective response rate in patients with measurable disease on computed tomography (CT) scan using Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
IV. Estimate time to PSA progression based on PCWG2 criteria.
V. Estimate time to clinical/radiographic progression based upon PCWG2 and RECIST criteria.
VI. Assess incidence of acute graft versus host disease grades 2-4 and grades 3-4.
VII. Assess incidence of chronic graft versus host disease (GVHD).
VIII. Assess incidence of donor chimerism and graft failure.
IX. Assess the effects of post-transplantation cyclophosphamide on the immune reconstitution of T cells, B cells, and natural killer (NK) cells.
X. Evaluate incidence of HLA specific antibodies developed after histocompatibility antigen (HLA) mismatched, allogeneic partially HLA-mismatched bone marrow transplantation.
OUTLINE:
Patients receive fludarabine intravenously (IV) over 30 minutes on days -6 to -2, cyclophosphamide IV over 1-2 hours on days -6, -5, 3, and 4. Patients undergo total body irradiation (TBI) on day -1 and allogeneic bone marrow transplantation (BMT) on day 0. Patients then receive tacrolimus IV once daily (QD) or orally (PO) twice a day (BID) on days 5-180, mycophenolate mofetil PO thrice daily (TID) on days 5-35, and testosterone cypionate or testosterone enanthate intramuscularly (IM) on days 60, 90, and 120. Patients without previous surgical castration maintain on LHRH agonist/antagonist therapy until day 180.
After completion of study treatment, patients are follow up for 3 years post-BMT.
Lead OrganizationJohns Hopkins University/Sidney Kimmel Cancer Center
Principal InvestigatorSamuel Ray Denmeade