RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Umbilical cord blood transplantation may be able to replace cells destroyed by chemotherapy. PURPOSE: Phase I trial to study the effectiveness of combination chemotherapy followed by umbilical cord blood transplantation in treating patients who have hematologic cancer or severe aplastic anemia.
OBJECTIVES: * Determine the incidence and severity of acute toxicity in patients with hematologic malignancies or severe aplastic anemia treated with a non-myeloablative conditioning regimen followed by umbilical cord blood transplantation. * Determine the incidence and severity of acute and chronic graft-versus-host-disease in patients treated with this regimen. * Determine the incidence of relapse, disease-free survival, and overall survival of patients treated with this regimen. * Determine the survival rate at 100 days post-transplantation in patients treated with this regimen. * Determine the incidence of regimen-related complications (infection, hepatic veno-occlusive disease, and interstitial pneumonitis) in patients treated with this regimen. * Determine the incidence of primary and secondary graft failure in patients treated with this regimen. * Determine the rates and kinetics of donor-derived lymphoid, myeloid, neutrophil, RBC, and platelet engraftment in patients treated with this regimen. OUTLINE: Patients receive a non-myeloablative conditioning regimen comprising fludarabine IV over 30 minutes on days -8 to -4, cyclophosphamide IV over 2 hours on days -3 to -2, and anti-thymocyte globulin (ATG) IV over at least 4 hours on days -2 to -1. Patients unable to tolerate ATG may receive methylprednisolone IV over 1 hour on days -3 to -1. Patients undergo multiple unit umbilical cord blood transplantation on days 0-1. Patients receive filgrastim (G-CSF) subcutaneously beginning on day 7 and continuing until blood counts recover. Patients are followed monthly for 6 months; at 9, 12, 14, 16, 18, and 24 months; and then annually thereafter. PROJECTED ACCRUAL: A total of 24 patients will be accrued for this study within 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
55
anti-thymocyte globulin (ATG) IV over at least 4 hours on days -2 to -1
Patients receive filgrastim (G-CSF) subcutaneously beginning on day 7 and continuing until blood counts recover.
cyclophosphamide IV over 2 hours on days -3 to -2
fludarabine IV over 30 minutes on days -8 to -4
Patients undergo multiple unit umbilical cord blood transplantation on days 0-1.
Patients unable to tolerate ATG may receive methylprednisolone IV over 1 hour on days -3 to -1.
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Event-free survival by disease assessment
Time frame: at 28 and 100 days and then at 6, 9, 12, 18, and 24 months
Umbilical cord blood donor engraftment by chimerism and complete blood count (CBC)
Time frame: monthly for 6 months and then at 9, 12, 18, and 24 months
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