A Phase II Pilot Trial to Estimate Survival After a Non-total Body Irradiation (TBI) Based Conditioning Regimen in Patients Diagnosed With B-acute Lymphoblastic Leukemia (ALL) Who Are Pre-allogeneic Hematopoietic Cell Transplantation (HCT) Next-generation-sequence (NGS) Minimal Residual Disease (MRD) Negative
Summary
This study will evaluate the use of non- TBI (total body irradiation) conditioning for B-ALL patients with low risk of relapse as defined by absence of NGS-MRD (next generation sequencing minimal residual disease) before receiving a hematopoietic cell transplant (HCT). Patients diagnosed with B-ALL who are candidates for HCT will be screened by NGS-MRD on a test of bone marrow done before the HCT. Subjects who are pre-HCT NGS-MRD negative will be eligible to receive a non-TBI conditioning regimen as part of the treatment cohort of the study. Subjects who are pre-HCT NGS-MRD positive will be treated as per treating center standard and will be followed in an observational cohort (HCT center standard of care).
Detailed description
A Phase II pilot trial will estimate survival after a non-TBI based conditioning regimen in patients diagnosed with B-acute lymphoblastic leukemia (ALL) who are pre-allogeneic hematopoietic cell transplantation (HCT) next-generation-sequence (NGS) minimal residual disease (MRD) negative. The relationship of NGS-MRD status to survival in children, adolescents, and young adults with B-ALL undergoing any approach to allogeneic HCT will be explored in a larger cohort (treatment \[phase II\] and observational arms of the study). The primary objective is to estimate 2-year event free survival (EFS) in pre-HCT NGS-MRD negative patients with B-ALL undergoing a non-TBI based conditioning regimen through a multi-center prospective trial. The accrual period is 3 years. Patients that are NGS-MRD negative with B-ALL may be eligible for the Treatment Arm, which is myeloablative non-TBI conditioning with busulfan, fludarabine, and thiotepa followed -matched related, unrelated, and umbilical cord blood transplants. Patients that are NGS-MRD positive will be followed on the observational arm for outcome. Study sampling will include NGS-MRD bone marrow (BM) aspirate and peripheral blood (PB) samples collected \[same day when possible\] pre-HCT (within 4 weeks), and post-HCT on days 42 ± 14, 100 ± 20, and 365 ± 60; PB samples only will also be collected day 180± 60 and 270± 60; day +30, day +100, and 1-year post-HCT. NGS-MRD peripheral blood sample only at 6 months and 9 months post-HCT; (Blast specimen at time of diagnosis or relapse is required for NGS-MRD testing).
Arms & interventions
- Diagnostic TestNGS-MRD
Next generation sequencing minimal residual disease (NGS-MRD) is a test that has increased sensitivity over multichannel flow cytometry to better identify risk of key outcomes after HCT. Patients that have a pre-HCT negative NGS-MRD results may be eligible to proceed to the treatment arm of the study that uses a non-TBI conditioning regimen.
- DrugMyeloablative allogeneic HCT with a non-TBI conditioning regimen
Myeloablative study regimen will consist of busulfan, fludarabine and thiotepa. day -7: Fludarabine and Busulfan day -6: Fludarabine and Busulfan day -5: Fludarabine and Busulfan day -4: Fludarabine and Busulfan day -3: Fludarabine day -2: Thiotepa day -1: Rest Day 0: Transplant
Outcome measures
Primary
Two Year Event-free Survival
The primary objective of this study is the two Year Event-free Survival for patients with high-risk or recurrent B-ALL who proceed to HCT and who are NGS-MRD negative when treated with a non-TBI preparative regimen.
Time frame: Two years
Eligibility criteria
Study locations (24)
Children's of Alabama/University of Alabama in Birmingham(UAB)
Birmingham, Alabama, 35233
Phoenix Children's Hospital
Phoenix, Arizona, 85016
City of Hope
Duarte, California, 91010
Children's Hospital Los Angeles
Los Angeles, California, 90027
UCLA Mattel Children's Hospital
Los Angeles, California, 90095
UCSF Benioff Children's Hospital Oakland
Oakland, California, 94609
UCSF
San Francisco, California, 94123
Children's Hospital Colorado
Aurora, Colorado, 80045
Yale University School of Medicine
New Haven, Connecticut, 06520
Alfred I. duPont Hospital for Children - Nemours Deleware
Wilmington, Delaware, 19803
University of Florida
Gainesville, Florida, 32610
Nicklaus Children's Hospital
Miami, Florida, 33155
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, 33701
Children's Healthcare of Atlanta
Atlanta, Georgia, 30322
Riley Hospital for Children - Indiana University
Indianapolis, Indiana, 46202
Floating Hospital for Children at Tufts Medical Center
Boston, Massachusetts, 02111
Dana Faber Cancer Institute/ Boston Children's Hospital
Boston, Massachusetts, 02215
Helen DeVos Children's Hospital at Spectrum Health
Grand Rapids, Michigan, 49503
Children's Mercy Hospital
Kansas City, Missouri, 64108
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Roswell Park Cancer Institute
Buffalo, New York, 14263
Atrium Health - Levine Cancer Center
Charlotte, North Carolina, 28203
The University of Texas M. D. Anderson Cancer Center
Houston, Texas, 77030
Methodist Healthcare System
San Antonio, Texas, 78229
References
- Andolina JR, Fries C, Boulware R, Vargas A, Fraint E, Barth M, Ambrusko S, Comito M, Monteleone P. Successful Bone Marrow Transplantation With Intensive Post-transplant Intrathecal Chemotherapy for CNS Relapsed AML in 2 Infants. J Pediatr Hematol Oncol. 2022 Jan 1;44(1):e264-e267. doi: 10.1097/MPH.0000000000002151.(PubMed)