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Allogeneic Blood or Marrow Transplantation for Hematologic Malignancy and Aplastic Anemia (NCT00003816)

RATIONALE: Giving chemotherapy drugs and total-body irradiation before a donor stem cell helps stop the growth of cancer or abnormal cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. It is not yet known which combination chemotherapy regimen is most effective when given before a donor stem cell transplant in treating aplastic anemia or hematologic cancer. PURPOSE: This phase II/III trial is studying different combination chemotherapy regimens to compare how well they work when given before donor stem cell transplant in treating patients with aplastic anemia or hematologic cancer.
  • Biological: anti-thymocyte globulin
    Given IV
    • Drug: busulfan
      Given IV
      • Drug: carboplatin
        Given IV
        • Drug: cyclophosphamide
          Given IV
          • Drug: etoposide
            Given IV
            • Drug: fludarabine phosphate
              Given IV
              • Drug: melphalan
                Given IV
                • Drug: thiotepa
                  Given IV
                  • Radiation: total-body irradiation
                    Given twice daily for 3 days
                    Ages eligible for Study
                    4 Years to 70 Years
                    Genders eligible for Study
                    All
                    Accepts Healthy Volunteers
                    No
                    OBJECTIVES:

                    - Compare the morbidity, mortality, and overall outcome of patients with severe aplastic anemia or hematologic malignancy treated with standard vs novel conditioning regimens followed by allogeneic stem cell transplantation.

                    - Examine the influence of donor histocompatibility on outcome by comparing matched/related, mismatched/related (with or without T-cell depletion), and matched/unrelated transplants with stratification for type of preparative regimen.

                    - Ensure that patients with uncommon diagnoses will be treated in a uniform fashion with the best therapy available.

                    OUTLINE: Patients are stratified according to risk of relapse (standard-risk: acute leukemia in first complete remission, chronic myelogenous leukemia in first chronic phase, lymphoma in sensitive first relapse or second remission, primary or untreated myelodysplastic syndromes, or untreated severe aplastic anemia vs high-risk: all others).

                    Patients are assigned to one of the following conditioning regimens based on diagnosis, risk of relapse, and donor relatedness:

                    - Regimen 1: Patients receive busulfan IV over 2 hours every 6 hours on days -7 to -4 and cyclophosphamide IV over 2 hours on days -3 and -2.

                    - Regimen 2: Patients receive cyclophosphamide IV over 2 hours on days -5 to -2 and anti-thymocyte globulin IV over 4-8 hours on days -5 to -3.

                    - Regimen 3: Patients receive cyclophosphamide IV over 2 hours on days -5 and -4 and total-body irradiation (TBI) twice daily on days -3 to -1.

                    - Regimen 4: Patients receive fludarabine IV over 30 minutes on days -6 to -2 and melphalan IV over 1 hour on days -3 and -2.

                    - Regimen 5: Patients receive etoposide IV over 26 hours beginning on day -5, cyclophosphamide IV over 2 hours on day -4, and TBI twice daily on days -3 to -1.

                    - Regimen 6: Patients receive cyclophosphamide IV over 24 hours, carboplatin IV over 24 hours, and thiotepa IV over 24 hours on days -7 to -4.

                    - Regimen 7: Patients receive fludarabine IV over 30 minutes on days -5 to -1 and anti-thymocyte globulin IV over 4-8 hours on days -5 to -2.

                    - Regimen 8: Patients receive cyclophosphamide IV over 2 hours on days -5 and -4, TBI twice daily on days -3 to -1, and anti-thymocyte globulin IV over 4-8 hours on days -3 to -1.

                    - Regimen 9: Patients receive busulfan IV over 2 hours every 6 hours and anti-thymocyte globulin IV over 4-8 hours on days -7 to -4 and cyclophosphamide IV over 2 hours on days -3 and -2.

                    All patients then receive donor stem cell infusions on day 0. Some patients may undergo involved-field radiotherapy 4-8 weeks after transplant.

                    Patients are followed periodically post-transplant.

                    PROJECTED ACCRUAL: At least 405 patients will be accrued for this study within 5 years.

                    1 locations

                    United States (1)
                    • Roswell Park Cancer Institute
                      Not specified
                      Buffalo, New York, United States, 14263-0001
                    Status:
                    active not recruiting
                    Type:
                    Interventional
                    Phase:
                    Ⅱ, Ⅲ
                    Start:
                    18 October, 1998
                    Updated:
                    04 July, 2017
                    Participants:
                    362
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