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Umbilical cord blood for hematopoietic rescue following myeloablative conditioning

Umbilical cord blood for hematopoietic rescue following non-myeloablative conditioning

cyclophosphamide (60mg/m2 days -6 \& -5), fludarabine (25 mg/m2 days -7, -6, \& -5) and total body irradiation (days -3, -2, \& -1, total 1200 cGy) followed by cord blood infusion on day 0.

Umbilical Cord Blood After Myeloablative Conditioning

Extracorporeal Photopheresis (days -8 \& -7), cyclophosphamide 50 mg/kg (day -6) pentostatin 4 mg/kg/d (continuous infusion days -5 \& -4), total body irradiation (days -3 \& -2, total 600cGy) followed by Umbilical Cord Blood Infusion day 0.

Umbilical Cord Blood After Reduced-Intensity Conditioning

Andreas Klein, MD

This study is designed to determine whether Umbilical Cord Transplantation (UCB) can be substituted for adult bone marrow cells in the standard stem cell transplant regimens used at this hospital for subjects who do not have stem cell donors.

Allogeneic stem cell transplantation (SCT) following myeloablative and non-myeloablative conditioning therapy has proven curative treatment for a number of inherited and acquired hematologic disorders. The success of allogeneic transplantation is largely determined by compatibility between donor and recipient, which predicts the risk of fatal graft-versus-host disease (GVHD). Unfortunately, less than one third of patients needing an allogeneic transplant have an available compatible donor in their family. Registries have been established to match patients with compatible volunteer (unrelated) donors, but many patients, and in particular minority patients, still lack stem cell donors.

Umbilical cord blood (UCB) is a rich source of hematopoietic stem cells, which is readily available from the placenta following childbirth. Blood banks have been established in the United States and abroad to collect, process and store UCB for use in allogeneic transplantation. To date, more than 2000 UCB transplants have been performed in adults and children around the world.

Rationale for use of Umbilical Cord Blood in Transplantation

UCB has a number of proven and theoretical advantages as an alternative source of hematopoietic stem cells for transplantation:

1. Placental or umbilical cord blood is an abundantly available source of stem cells, which is currently discarded and can be harvested at no risk to the mother or infant.
2. Important infectious agents, particularly CMV, are much less common in the newborn than adults, and are less likely to contaminate UCB collections.
3. UCB collections, typed, cryopreserved and banked, are available on demand, eliminating delays and uncertainties that now complicate marrow collection from unrelated donors. At present, UCB can be delivered for infusion within days of the initiation of a search. This compares with a median of 3 months from search to delivery of stem cells through the registries of volunteer adult donors.
4. The intensity of graft-versus-host reactivity of fetal lymphocytes appears to be less than that of adult cells and consequently fetal lymphocytes are more tolerant of HLA incompatibility. Published studies have shown that transplantation of UCB matched at 4-5/6 antigens results in a comparable incidence of GVHD to transplantation of unrelated stem cells fully matched at 6/6 antigens.
5. Frozen UCB can be easily shipped, stored at the treating institution, and thawed for use when needed, compared to freshly donated stem cells which have a limited shelf-life of one day or less, necessitating coordination between harvesting surgeons, transportation, and transplantation teams.

This research study has been designed for people who have been diagnosed with a blood tumor, which has not responded to treatment or has recurred, a bone marrow failure state such as aplastic anemia, or one of certain inherited metabolic disorders; and whose doctor feels the best treatment is an allogeneic stem cell transplant (alloSCT) but a related or unrelated adult donor is not available. Instead, a single unit of umbilical cord blood (UCB) will be used as the source of the subject's immune system. This study is designed to determine whether a single unit of UCB can be substituted for adult bone marrow cells in the standard stem cell transplant regimens used at this hospital for subjects who do not have stem cell donors.

A Phase II Study of Umbilical Cord Blood Transplantation

A Phase II Study of Umbilical Cord Blood Transplantation Following Myeloablative or Reduced-Intensity Conditioning

Number of participants with neutrophil engraftment receiving umbilical cord blood for hematopoietic rescue following myeloablative or non-myeloablative conditioning

Proportion of patients engrafting by days +45, +90, and +180.

Composite endpoint of GVH or infection. Too few events to compare between arms.

Tufts Medical Center

Patients receiving umbilical cord blood for hematopoietic rescue following myeloablative conditioning

Umbilical Cord Blood Transplantation After Myeloablative Conditioning: Fully-myeloablative Conditioning Regimen: cyclophosphamide (60mg/m2 days -6 \& -5), fludarabine (25 mg/m2 days -7, -6, \& -5) and total body irradiation (days -3, -2, \& -1, total 1200 cGy) followed by cord blood infusion on day 0.

Myeloablative Conditioning

Patients receiving umbilical cord blood for hematopoietic rescue following non-myeloablative conditioning

Umbilical Cord Blood Transplantation After Reduced-Intensity Conditioning: Reduced Intensity Conditioning Regimen: Extracorporeal Photopheresis (days -8 \& -7), cyclophosphamide 50 mg/kg (day -6) pentostatin 4 mg/kg/d (continuous infusion days -5 \& -4), total body irradiation (days -3 \& -2, total 600cGy) followed by Umbilical Cord Blood Infusion day 0.

Reduced Intensity Conditioning

Total

Age, Categorical

Age, Continuous

Sex: Female, Male

United States

Region of Enrollment

Early termination leading to small numbers of subjects analyzed.

Patients receiving umbilical cord blood for hematopoietic rescue following myeloablative conditioning.

2/2 evaluable subjects engrafted at +45 and +90 days.

Patients receiving umbilical cord blood for hematopoietic rescue following non-myeloablative conditioning

1/2 evaluable subjects engrafted at +45 and +90 days.

Only 2 subjects were evaluable from each group at the +45 day mark. The same number were evaluable at the +90 day mark.

Number of Participants With Neutrophil Engraftment

Platelet Engraftment +45 days

Platelet Engraftment +90 days

Platelet Engraftment +180 days

Patients receiving umbilical cord blood for hematopoietic rescue following myeloablative conditioning.

Patients receiving umbilical cord blood for hematopoietic rescue following non-myeloablative conditioning

Proportion of Subjects With Platelet Engraftment

Incidence of Acute GVHD

Infectious Complications in UCB Recipients.

No subject receiving reduced intensity conditioning was evaluable for the event of chronic GVHD (0/3 subjects survived to day +100)

Incidence of Chronic GVHD

Patients receiving umbilical cord blood for hematopoietic rescue following myeloablative conditioning.

2/2 evaluable subjects engrafted at +45 and +90 days. 3 evaluable subjects for toxicity.

Patients receiving umbilical cord blood for hematopoietic rescue following non-myeloablative conditioning

1/2 evaluable subjects engrafted at +45 and +90 days. 3 evaluable subjects for toxicity.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
A Phase II Study of Umbilical Cord Blood Transplantation	NCT00676806	Leukemia Lymphoma Multiple Myelom... Aplastic Anemia	Umbilical Cord ... Umbilical Cord ...	- 70 Years	Tufts Medical Center
A Phase II Study of Umbilical Cord Blood Transplantation	NCT00676806	Leukemia Lymphoma Multiple Myelom... Aplastic Anemia	Umbilical Cord ... Umbilical Cord ...	- 70 Years	Tufts Medical Center

Spots Global Cancer Trial Database for umbilical cord blood after myeloablative conditioning