The goal of this clinical trial is to determine the effectiveness of Reduced Dose Post-Transplant Cyclophosphamide (PTCy) in patients with hematologic malignancies after receiving an HLA-Mismatched Unrelated Donor (MMUD) . The main question\[s\] it aims to answer are: * Does a reduced dose of PTCy reduce the occurrence of infections in the first 100 days after transplant? * Does a reduced dose of PTCy maintain the same level of protection against Graft Versus Host Disease (GvHD) as the standard dose of PTCy?
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
313
Given IV or PO pre-transplant as part of conditioning regimen
Given IV pre-transplant as part of conditioning regimen
Peripheral blood stem cell graft is infused from a mismatched unrelated donor on Day 0
Cyclophosphamide (25mg/kg) is administered on Day 3 and Day 4 post-transplant as an IV infusion over 1-2 hours. First 20 subjects with a 4-6/8 HLA mismatched unrelated donor will receive an intermediate dose of post-transplant cyclophosphamide of 37.5 mg/kg Day 3 and Day 4 post-transplant.
Mesna is given in divided doses IV 30 min pre- and at 3, 6, and 8 hours post cyclophosphamide.
Tacrolimus is given at a dose of 0.05 mg/kg PO or an IV dose of 0.03 mg/kg of ideal body weight (IBW) starting on Day +5 post-transplant with taper recommended at Day + 90 and finished by Day +180.
Mycophenolate mofetil (MMF) is given at a dose of 15 mg/kg three times daily IV or PO from Day +5 to Day +35 post-transplant.
Survey assessments will be administered to study participants pre transplant, at Day + 100, Day + 180, and Day +365 post transplant.
Given IV pre transplant as part of conditioning regimen
Administered pre-transplant as part of conditioning regimen
Given IV pre-transplant as part of conditioning regimen
Mayo Clinic Arizona
Phoenix, Arizona, United States
Honor Health
Scottsdale, Arizona, United States
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
City of Hope
Duarte, California, United States
University of California San Francisco
San Francisco, California, United States
Infection Free Survival
Survival at 100 days without grades 2-3 infections (per BMT CTN grading criteria)
Time frame: 100 days post-HCT
Overall Survival
Defined as time interval between date of transplant and death from any cause
Time frame: 1-year post-HCT
Progression-free survival
Defined as disease relapse or progression, or death by any cause
Time frame: 1-year post-HCT
Infection-free survival
Defined as death and grades II-III infection (per BMT CTN criteria)
Time frame: 1-year post-HCT
Graft versus host disease relapse free survival
Defined as relapse or progression of underling disease (by 1 year), grade III-IV acute GvHD (by 6 months), chronic GvHD requiring systemic immune suppression (by 1 year), or death by any cause (by 1 year).
Time frame: 1-year post-HCT
Non-relapse mortality
Defined as death without evidence of disease progression or recurrence
Time frame: 1-year post-HCT
Cumulative incidence of neutrophil recovery
Defined as achieving an absolute neutrophil count (ANC) greater than or equal to 500/mm3 for three consecutive measurements on three different days
Time frame: Day 28 post-HCT
Cumulative incidence of platelet recovery
Defined as platelet count ≥20,000/mm\^3 or ≥50,000/mm\^3 with no platelet transfusions within seven days.
Time frame: Day 28 post-HCT
Cumulative incidence of primary and secondary graft failure
Primary graft failure is defined as no neutrophil recovery to ≥ 500 cells/mm3 by Day 28 post HCT. Secondary graft failure is defined as as initial neutrophil count recovery followed by subsequent decline in absolute neutrophil counts \<500 cells/mm3, unresponsive to growth factor therapy, but cannot be explained by infection, disease relapse, or medications.
Time frame: Day 28 and 1-year post-HCT
Donor T-Cell Chimerism
Defined as percent of donor chimerism via peripheral blood
Time frame: Day 28, 100 and 365 post-HCT
Cumulative incidence of acute GvHD
Defined as cumulative incidence of grades II-IV acute GvHD
Time frame: Day 100 and Day 180 post-HCT
Cumulative incidence of chronic GvHD
Time frame: 1-year post-HCT
Cumulative incidence of grade 2-3 bacterial, fungal, and viral infections
Defined as grades 2-3 infection as defined by BMT CTN grading criteria.
Time frame: Day 100 and 1-year post-HCT
Cumulative incidence of grades 2-3 BK virus hemorrhagic cystitis
Defined as incidence of BK virus hemorrhagic cystitis per BMT CTN grading criteria
Time frame: 1-year post-HCT
Cumulative incidence of relapse/progression
Defined as disease relapse or progression from Day 0 to 1-year post-HCT
Time frame: 1-year post-HCT
Overall Toxicity
To tabulate adverse events (AEs, experienced by recipients, defined as grade 3-5 unexpected and grade 5 expected AEs according to CTCAE v5
Time frame: 1-year post-HCT
Incidence and Severity of cytokine release syndrome
Defined and graded using the ASTCT grading criteria.
Time frame: within 14 days post-HCT
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Stanford University
Stanford, California, United States
Colorado Blood Cancer Institute at Presbyterian St. Luke's
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Mayo Clinic Jacksonville
Jacksonville, Florida, United States
University of Miami Sylvester Cancer Center
Miami, Florida, United States
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...and 22 more locations