This phase II trial studies how well naive T-cell depletion works in preventing chronic graft-versus-host disease in children and young adults with blood cancers undergoing donor stem cell transplant. Sometimes the transplanted white blood cells from a donor attack the body's normal tissues (called graft versus host disease). Removing a particular type of T cell (naive T cells) from the donor cells before the transplant may stop this from happening.
Patients are randomized to 1 of 2 arms. All patients receive 1 of 3 conditioning regimens. CONDITIONING REGIMEN A: Patients undergo total body irradiation (TBI) twice daily (BID) on days -10 to -7, then receive thiotepa intravenously (IV) over 3 hours once daily (QD) on days -6 and -5, and fludarabine IV over 30 minutes once daily on days -6 to -2. CONDITIONING REGIMEN B: Patients undergo TBI BID on days -8 to -5, then receive fludarabine IV over 30 minutes QD on days -4 to -2, and cyclophosphamide IV over 1 hour QD on days -3 and -2. CONDITIONING REGIMEN C: Patients receive fludarabine IV over 30 minutes QD on days -6 to -2, busulfan IV over 180 minutes QD on days -5 to -2, and undergo total body irradiation BID on day -1. ARM I: Patients receive naive T-cell depleted PBSCs on day 0. ARM II: Patients receive unmanipulated T cell-replete BM on day 0. GVHD PROPHYLAXIS: All patients receive tacrolimus IV on days -1 to +50 followed by a taper in the absence of grade II-IV aGVHD. Patients also receive methotrexate IV on days +1, +3, +6, and +11. Additionally, all patients undergo echocardiography (ECHO) and cerebrospinal fluid (CSF) collection at baseline as well as blood sample collection and bone marrow aspiration with or without biopsy throughout the trial. After completion of study treatment, patients are followed up at days 28, 56, 90, 180, 270, and 365 and then at months 15, 18, 21, and 24.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
68
Undergo TBI
Given IV
Given IV
Given IV
Given IV
Receive unmanipulated T cell replete BM
Given IV
Given IV
Receive naive T-cell depleted PBSCs
Undergo ECHO
Undergo CSF and blood sample collection
Undergo bone marrow aspiration
Undergo bone marrow biopsy
Children's Hospital of Los Angeles
Los Angeles, California, United States
RECRUITINGChildren's National Medical Center
Washington D.C., District of Columbia, United States
WITHDRAWNChildren's Healthcare of Atlanta
Atlanta, Georgia, United States
NOT_YET_RECRUITINGUniversity of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, United States
RECRUITINGDana Farber / Boston Children's Hospital
Boston, Massachusetts, United States
NOT_YET_RECRUITINGUH Rainbow Babies and Children's Hospital (University Hospitals Cleveland Medical Center)
Cleveland, Ohio, United States
NOT_YET_RECRUITINGCleveland Clinic Foundation
Cleveland, Ohio, United States
RECRUITINGOregon Health and Science University
Portland, Oregon, United States
RECRUITINGChildren's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
RECRUITINGFred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
RECRUITINGFeasibility achievement
Success defined as achievement of cell selection goals for two consecutive Naive T cells (TN)-depleted peripheral blood stem cells (PBSC) hematopoietic cell transplantation (HCTs) at each study site (Feasibility)
Time frame: Up to 2 years
Engraftment of neutrophils by day 28 (Feasibility)
Success defined as achievement neutrophil engraftment (absolute neutrophil count \[ANC\] \>= 500/mm\^3) on first day of three consecutive laboratory values obtained on different days.
Time frame: At day 28
Current-graft versus host disease (GVHD)-free, relapse-free survival (Randomized Controlled Trial [RCT])
Defined as alive, no relapse after HCT, no current GVHD requiring prednisone, no graft rejection or graft failure. The proportion of subjects meeting the primary endpoint will be described in each arm with 90% confidence intervals (CI) and compared between arms using the chi-square test. A two-sided 10% significance level will be used for this comparison.
Time frame: At 1 year
Chronic GVHD (cGVHD) meeting National Institutes of Health (NIH) criteria and requiring prednisone (RCT)
Cumulative incidence curve will be computed for each arm along with a 90% CI at 1 year and 2 years post-HCT. Death and/or relapse prior to occurrence of cGVHD will be considered as competing risks. The cumulative incidence curves will be compared between arms using Gray's test. The maximum severity of cGVHD will also be described in each arm and compared using the chi-squared test.
Time frame: At 1 and 2 years
Proportion of subjects alive and off prednisone (or equivalent systemic corticosteroid) for treatment of GVHD (RCT)
Proportions of subjects alive without requiring use of prednisone (or equivalent systemic corticosteroid) for GVHD will be estimated with 90% CI for both arms at time points over 24 months, and compared using the chi-squared test.
Time frame: At 3, 6, 9, 12, 15, 18, 21 and 24 months post HCT
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