This phase II trial is studying how well giving treosulfan together with fludarabine phosphate and total-body irradiation followed by donor stem cell transplant works in treating patients with high-risk acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia. Giving chemotherapy, such as treosulfan and fludarabine phosphate, and total-body irradiation before a donor bone marrow or peripheral blood stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving tacrolimus and methotrexate before and after transplant may stop this from happening
PRIMARY OBJECTIVES: I. Decrease the incidence of relapse to \< 15% at 6 month post transplant in patients with high risk acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) transplanted from related or unrelated donors, without unacceptably increasing toxicity (10% non-relapse mortality \[NRM\] at 6 months). SECONDARY OBJECTIVES: I. Evaluate the incidence of NRM at 180 days and 1 year after hematopoietic cell transplantation (HCT). II. Evaluate overall survival (OS) and relapse-free survival (RFS). III. Incidence of grades II-IV acute graft-versus-host disease (GVHD). IV. Incidence of chronic GVHD. V. Donor chimerism on days +28 and +100. OUTLINE: CONDITIONING REGIMEN: Patients receive fludarabine phosphate intravenously (IV) over 30 minutes on days -6 to day -2 and treosulfan IV over 2 hours on days -6 to day -4. Patients also undergo total-body irradiation on day 0. TRANSPLANTATION: Patients undergo allogeneic peripheral blood stem cell transplantation or bone marrow transplantation on day 0. GVHD PROPHYLAXIS: Patients receive tacrolimus IV continuously or orally (PO) twice daily (BID) on days -1 to 56, followed by a taper until day 180 in the absence of GVHD. Patients also receive methotrexate IV on days 1, 3, 6, and 11. After completion of study treatment, patients are followed up periodically.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
96
Given IV
Given IV
Low dose starting at 2Gy
Given IV per institutional standard practice
Given IV or PO
Given IV per institutional standard practice
Given IV per institutional standard practice
Given IV
University of Colorado
Denver, Colorado, United States
Oregon Health and Science University
Portland, Oregon, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States
Relapse Incidence
Time frame: At 6 months
Non Relapse Mortality (NRM) Incidence
Cumulative incidence of NRM at 6 months. NRM includes all deaths without relapse or disease progression.
Time frame: At 6 months
Non Relapse Mortality Incidence
Time frame: 1 year after HCT
Overall Survival (OS)
Time frame: at 2 years
Relapse-free Survival
Time frame: at 2 years
Incidence of Grades II-IV Acute GVHD
Time frame: at 6 months
Incidence of Chronic GVHD
Time frame: at 6 months
Median Donor CD3 + T Lymphocyte Chimerism in Peripheral Blood
Donor chimerism was evaluated in peripheral blood T cells
Time frame: Day 28 after HCT
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