RightFit
RecruitingPhase 2

Intensity Modulated Total Marrow Irradiation in Fully Human Leukocyte Antigen (HLA)-Matched and Partially-HLA Mismatched Allogeneic Transplantation Patients With High-Risk Acute Myeloid Leukemia (AML), Chronic Myeloid Leukemia (CML), and Myelodysplastic Syndrome (MDS)

A Phase II Study of Intensity Modulated Total Marrow Irradiation (IM-TMI) in Addition to Myeloablative Fludarabine/Busulfan and Post-Transplant Cyclophosphamide (PTCY) for Fully Human Leukocyte Antigen (HLA)-Matched and Partially-HLA Mismatched Allogeneic Transplantation Patients With High-Risk AML, CML, and MDS

Who can join

As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.

Age
18 Years to 65 Years
Sex
All sexes
Healthy volunteers
Not accepted
Compensation
Not stated

Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.

What to expect

No one can promise a trial will help you personally — that is what the research is trying to find out.

What participation involves

  • Procedures mentioned: Infusions

Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.

Show the study's own words
  • "Patients will receive the following conditioning regimen: fludarabine 40 mg/m2 IV piggyback daily, from day -5 (5 days before stem cell infusion) through Day -2, IV busulfan targeting a 4800 μM/min/ day, from day -5 through day -2."
Compensation
Not stated
  • Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
  • Participants are monitored closely by the research team throughout the study.
  • Some participants may receive access to an investigational treatment, which is still being studied.
  • Your participation helps researchers learn whether this approach could help future patients.

About this study

In plain language

This phase 2 study tests radiation aimed at bone marrow, along with chemotherapy, before a stem cell transplant from a donor. It is for adults ages 18–65 with certain high-risk blood cancers: acute myeloid leukemia (AML), chronic myeloid leukemia (CML), or myelodysplastic syndrome (MDS).

The study is a Phase II clinical trial. Patients will receive intensity-modulated total marrow irradiation (TMI) at a dose of 9 Gray (Gy) with standard myeloablative fludarabine intravenous (IV) and targeted busulfan (FluBu4) conditioning prior to allogeneic hematopoietic stem cell transplant (HSCT). Graft-versus-host disease (GVHD) prophylaxis will include Cyclophosphamide on Day +3 and +4, tacrolimus, and mycophenolate mofetil.

Compensation is read from the study's own description and may be missing — always confirm with the study team.

Eligibility

Who can join

  • Age 18–65.
  • Have AML, MDS, or CML that meets at least one of the disease rules below.
  • AML that has come back, has not responded to treatment, or is in a second remission (signs of cancer have decreased).
  • AML in a first remission, with fewer than 5% immature cancer cells in the bone marrow, and certain high-risk features. These include AML linked to an earlier blood disorder or certain gene or chromosome changes.
  • MDS with certain high-risk chromosome changes, a current or past intermediate-2 or high risk score, a link to earlier treatment, or diagnosis before age 21.
  • MDS that worsened or did not respond to standard DNA-methyltransferase inhibitor drugs, or causes dangerously low blood cell counts, including counts needing regular blood or platelet transfusions.
  • CML that has been in an accelerated or blast phase, when the disease grows faster.

Who can't join

  • Heart pumping strength below 50%.
  • Kidney filtering rate below 30 mL/min.
  • Bilirubin above 2.0 mg/dL, unless caused by Gilbert's syndrome or red blood cell breakdown, together with liver enzymes ALT and AST above 5 times normal.
  • Both breathing tests FEV1 and FVC below 50% of expected, or a lung oxygen-transfer test below 50% after adjusting for low red blood cells.
  • Karnofsky score below 70, a measure of ability to do daily activities and care for yourself.
  • Active viral hepatitis, HIV infection, or cirrhosis (severe liver scarring).
  • Pregnant, breastfeeding, or unable to sign the form agreeing to join the study.
  • Past radiation to more than 20% of areas that contain bone marrow.

Simplified for readability. The official criteria below are what the study team uses.

Official eligibility criteria

Inclusion Criteria: * 1\. Age 18-65 years. * 2\. Patients with CML, AML, or MDS who meet one of the following criteria: 2a. Relapsed or refractory AML (including AML in CR2) 2b. Poor-risk AML in first remission, with remission defined as \<5% bone marrow blasts morphologically: * AML arising from MDS, a myeloproliferative disorder, or secondary AML * Poor risk molecular features according to Leukemia Net including ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, STAG2, U2AF1, and/or ZRSR2 * Poor-risk cytogenetics: Monosomal karyotype, complex karyotype (\> 3 abnormalities), inv (3), t(3;3), t(6;9), MLL rearrangement with the exception of t(9;11), or abnormalities of chromosome 5 or 7. 2c. Primary refractory disease 2d. MDS with at least one of the following poor-risk features: * Poor-risk cytogenetics including 3q abnormalities, 7/7q minus or complex cytogenetics (\>3 abnormalities). * Current or previous INT-2 or high IPSS score. * Treatment-related MDS. * MDS diagnosed before the age of 21 years. * Progression on or lack of response to standard DNA-methyltransferase inhibitor therapy. * Life-threatening cytopenias, including those requiring regular PRBC or platelet transfusions. 2e. CML with a history of accelerated or blast phase. Exclusion Criteria: * 1\. Presence of significant co-morbidity as shown by: * 1a. Left ventricular ejection fraction \< 50% * 2b. Creatinine clearance \<30ml/min. * 3c. Bilirubin \> 2.0 mg/dL (unless due to Gilbert's syndrome or hemolysis), and ALT and AST \> 5 x ULN. * 4d. FEV1 and FVC \< 50% of predicted or DLCO \<50% of predicted once corrected for anemia. * 5e. Karnofsky score \<70 * 6f. Active viral hepatitis or HIV infection. * 7g. Cirrhosis. * 2\. Pregnancy or breast feeding * 3\. Patients unable to sign informed consent. * 4\. Patients previously received radiation to \>20% of bone marrow-containing areas.

Study sites (1)

IL