GVHD Prophylaxis With Methotrexate and Cyclosporine in Haploidentical Stem Cell Transplantation Using Posttransplant Cyclophosphamide in Hematologic Malignancies: Phase I/II Trial

Who is this study for? Patients with Graft versus Host Disease
What treatments are being studied? Methotrexate Injectable Solution
Status: Recruiting
Location: See all (4) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 1/Phase 2
SUMMARY

Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic strategy for many malignant and benign hematologic diseases. Haploidentical HCT has been increasingly used in patients lacking a HLA-matched donor due to its prompt availability, possibly lower cost and results comparable with other donor types. Graft-versus-host disease (GVHD) is the main cause of morbidity and mortality after HSCT, and prophylactic strategies are routinely used. In the context of haploidentical HCT, posttransplant cyclophosphamide plus cyclosporine and mycophenolate mofetil (MMF) is the most common platform used in Brazil. Data comparing MMF and methotrexate (MTX) as GVHD prophylaxes have proved controversial in other donor types, yet some large studies have showed that MTX is associated with lower risk of GVHD and improved long-term outcomes. Moreover, it is known that MMF is a potent inhibitor of natural killer (NK) cells, possibly interfering with the graft-versus-leukemia effect in haploidentical HCT. Given the possible advantages and the absence of consistent evidence regarding safety, efficacy and ideal dosage of MTX as GVHD prophylaxis in this setting, we propose a phase I / II study evaluating this drug in adult patients with hematologic malignancies undergoing haploidentical HCT with posttransplant cyclophosphamide.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Maximum Age: 70
Healthy Volunteers: f
View:

• Diagnosis of acute myeloid leukemia and chronic myeloid leukemia in complete morphologic remission, myelodysplastic syndrome with less than 10% in bone marrow or peripheral blood, Ph-negative acute lymphoblastic leukemia in complete morphologic remission, chemosensitive Hodgkin lymphoma or non-Hodgkin lymphoma in at least partial remission

• Donor type: haploidentical related donor

• Graft source: bone marrow or peripheral blood

• Recipients of non-myeloblative or myeloablative intensity conditioning

• Left Ventricle Ejection fraction \> 40%

• Estimated creatinine clearance \> 40 mL/min

• Adjusted DLCO ≥ 40% and FEV1 ≥ 40%

• Total bilirubin \< 2x ULN e ALT/AST \< 2.5x ULN

Locations
Other Locations
Brazil
Centro de Hematologia e Hemoterapia - HEMOCENTRO
RECRUITING
Campinas
Hospital Amaral Carvalho / Fundação Dr. Amaral Carvalho
RECRUITING
Jaú
Instituto Nacional de Câncer José Alencar Gomes Da Silva - Inca
RECRUITING
Rio De Janeiro
Hospital das Clinicas da Universidade de Sao Paulo
RECRUITING
São Paulo
Contact Information
Primary
Giancarlo Fatobene, MD
gian_fatobene@hotmail.com
+551126617575
Time Frame
Start Date: 2020-10-07
Estimated Completion Date: 2025-12
Participants
Target number of participants: 47
Treatments
Experimental: Experimental
GVHD prophylaxis will consist of high-dose PTCy (50 mg/kg i.v. on days +3 and +4) with mesna, cyclosporine (initiated on day +5) and methotrexate i.v (see doses on the right). Cyclosporine will be dosed with a target trough of 200 to 250 ng/mL and discontinued without taper at D+60 (if bone marrow graft) or until D+90 (is peripheral blood graft), unless acute GVHD is present. Filgrastim will be administered from day +5 until neutrophil recovery to ≥ 1,000/mcL for 3 days.
No_intervention: Control Group
GVHD prophylaxis will consist of high-dose PTCy (50 mg/kg i.v. on days +3 and +4) with mesna, cyclosporine (initiated on day +5) and mycophenolate mofetil (15 mg/kg/dose p.o. t.i.d. initiated on day +5). Cyclosporine will be dosed with a target trough of 200 to 250 ng/mL and discontinued without taper at D+60 (if bone marrow graft) or until D+90 (is peripheral blood graft), unless acute GVHD is present.
Sponsors
Leads: University of Sao Paulo General Hospital
Collaborators: Libbs Farmacêutica LTDA

This content was sourced from clinicaltrials.gov

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