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Fludarabin (post-allograft immunosuppressive therapy modulation and DLI Mononuclear cells from allogenic blood)

Patrick LACARIN

Olivier Tournilhac

Usually Chronic lymphocytic leukemia (CLL) is a disease of the elderly patients. However, the diagnosis in young patients become more frequently with poor prognosis. The identification of new prognostic factors permits early determination of the high risk population and provide them the therapeutic intensification. Allogeneic transplantation of hematopoietic stem cells transplantation (AHSCT) allows to long-term remission and in some cases complete and definitive eradication of the disease. After chemotherapy or antibodies, the Minimal Residual Disease (MRD) negativity is associated with better disease-free survival. MRD negativity occurs in some patients with the appearance of GVHD, stopping the immunosuppression or after donor lymphocyte injection (DLI). The negativity of MRD in the first year post-transplant is correlated with better progression-free survival or overall survival (Dreger 2010, Farina 2009, Caballero 2005, Algrin, 2011). So, MRD negativity may be an objective after AHSCT. The aim of this prospective study is to evaluate a standardized preemptive immunointervention of post-allograft immunosuppressive therapy modulation and DLI administration according to MRD level. The objective is to obtain MRD negativity at 12 months after AHSCT.

Patients will receive AHSCT with Fludarabine-Busulfan based conditioning :

* Fludarabine : 30 mg/m2/day - from Day-6 to Day-2
* Busulfan IV : 3.2 mg/kg/day - on Day-5 and Day-4
* ATG (Anti-thymocyte Globulin) : 2.5 mg/kg/day on Day-2 and Day-1

Preemptive immunointervention post AHSCT consists in reduce immunosuppressive treatment more or less associated with DLI according to :

* the presence or absence of severe Graft versus host disease (GVHD) (acute grade 2 and / or chronic)
* the presence or absence of a response on criteria of response IWCLL
* Getting or not a blood MRD negative (\<-10 \^ -4) evaluated by flow cytometry

Eradication of Residual Disease by Preemptive Immunointervention After Allogeneic Hematopoietic Stem Cells Transplantation in Chronic Lymphocytic Leukemia

Reduced Intensity Conditioning Allogeneic Transplantation for CLL With Preemptive MDR Management (ICLL 03 RICAC-PMM)

The aim of this prospective study is to evaluate a standardized preemptive immunointervention of post-allograft immunosuppressive therapy modulation and DLI administration according to MRD level. The objective is to obtain MRD negativity at 12 months after AHSCT

Pierre Fabre Laboratories

University Hospital, Clermont-Ferrand

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Eradication of Residual Disease by Preemptive Immunointervention After Allogeneic Hematopoietic Stem Cells Transplantation in Chronic Lymphocytic Leukemia	NCT01849939	Chronic Lymphoc... Lymphocytic Lym...	Fludarabin (pos...	18 Years - 70 Years	University Hospital, Clermont-Ferrand
Eradication of Residual Disease by Preemptive Immunointervention After Allogeneic Hematopoietic Stem Cells Transplantation in Chronic Lymphocytic Leukemia	NCT01849939	Chronic Lymphoc... Lymphocytic Lym...	Fludarabin (pos...	18 Years - 70 Years	University Hospital, Clermont-Ferrand
Eradication of Residual Disease by Preemptive Immunointervention After Allogeneic Hematopoietic Stem Cells Transplantation in Chronic Lymphocytic Leukemia	NCT01849939	Chronic Lymphoc... Lymphocytic Lym...	Fludarabin (pos...	18 Years - 70 Years	University Hospital, Clermont-Ferrand

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