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Leukemia, Myelocytic, AcutePhase 3NCT00406393

Sirolimus/Tacrolimus Versus Tacrolimus/Methotrexate for Preventing Graft-Versus-Host Disease (GVHD) (BMT CTN 0402)

A Phase 3 study testing Tacrolimus, Methotrexate and Sirolimus in people with Leukemia, Myelocytic, Acute and Leukemia, Lymphocytic, Acute, run by Medical College of Wisconsin at 24 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The study is designed as a phase III, randomized, open label, multicenter, prospective, comparative trial of sirolimus and tacrolimus versus tacrolimus and methotrexate as graft-versus-host disease (GVHD) prophylaxis after human leukocyte antigen (HLA)-matched, related, peripheral blood stem cell transplantation in… Read more about this study

Who is it for?
Ages 2 to 60 years
What is being tested?
Tacrolimus, Methotrexate and Sirolimus
Could I receive a placebo?
No, everyone receives an active treatment
How many people
304 participants
Where
24 sitesin 2 countries
Study dates
Nov 2006to Oct 2015
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 60 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • 6/6 HLA-matched sibling, defined by Class I (HLA-A and B) serologic typing (or higher resolution) and Class II (HLA-DRBI) molecular typing, who is willing to donate peripheral blood stem cells, and meets institutional criteria for stem cell donation. The donor must be medically eligible to donate stem cells, according to individual transplant center criteria. Pediatric patients for whom a pediatric sibling donor is not anticipated to be a suitable leukapheresis candidate are not eligible.
  • Karnofsky performance status of at least 70% or Lansky performance status of at least 70% for participants less than 16 years old
  • For participants less than 18 years old, willing and able to take oral medications, per the treating physician's recommendations

Who cannot join

  • Prior allogeneic or autologous transplant using any hematopoietic stem cell source
  • Seropositive for the human immunodeficiency virus (HIV)
  • Uncontrolled bacterial, viral, or fungal infection (currently taking medication and progression of clinical symptoms)
  • Pregnant (positive serum human chorionic gonadotropin [β-HCG] test) or breastfeeding within 4 weeks of study entry
  • Kidney function: serum creatinine outside the normal range for age, or measured creatinine clearance less than 50 mL/min/1.72m^2 within 4 weeks of study entry
  • Liver function: most recent direct bilirubin, alanine aminotransferase (ALT), or aspartate aminotransferase (AST) greater than two times the upper limit of normal within 4 weeks of study entry
Show all 13Show fewer
  • Lung disease: in adults, forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) less than 60% of predicted value (corrected for hemoglobin); in children, overt hypoxemia, as measured by an oxygen saturation of less than 92% within 4 weeks of study entry
  • Cardiac ejection fraction of less than 45% in adults and children, or less than 26% shortening fraction in children within 4 weeks of study entry
  • Cholesterol level greater than 500 mg/dL or triglyceride level greater than 500 mg/dL while being treated, or not on appropriate lipid-lowering therapy within 4 weeks of study entry
  • Prior history of allergy to sirolimus
  • Requires voriconazole at time of study entry
  • Currently receiving another investigational drug unless cleared by the protocol officer or protocol chair
  • Participants with a history of cancer, other than resected basal cell carcinoma or treated carcinoma in-situ. Cancer treated with curative intent for more than 5 years previously will be allowed. Cancer treated with curative intent for less than 5 years previously will not be allowed unless approved by the protocol officer or protocol chair.

Trial locations and contacts

24 sites in 2 countries.

24 sites in 2 countries

United States23 sites
  • University of Michigan Medical Center

    Ann Arbor, Michigan, 48109-0914

  • Emory University

    Atlanta, Georgia, 30322

  • DFCI/Brigham & Women's Hospital

    Boston, Massachusetts, 02114

  • Roswell Park Cancer Institute

    Buffalo, New York, 14263

  • University Hospitals of Cleveland/Case Western

    Cleveland, Ohio, 44106-5061

  • Ohio State, Arthur G. James Cancer Hospital

    Columbus, Ohio, 43210

  • City of Hope National Medical Center

    Duarte, California, 91010

  • Duke University Medical Center

    Durham, North Carolina, 27705

  • University of Florida College of Medicine (Shands)

    Gainesville, Florida, 32610

  • Indiana University Medical Center

    Indianapolis, Indiana, 46202

  • University of Iowa Hospitals and Clinics

    Iowa City, Iowa, 52242-1009

  • UCSD Medical Center

    La Jolla, California, 92093

  • University of Wisconsin Hospital & Clinics

    Madison, Wisconsin, 53792-5156

  • University of Minnesota

    Minneapolis, Minnesota, 55455

  • University of Oklahoma Medical Center

    Oklahoma City, Oklahoma, 73104

  • University of Pennsylvania Cancer Center

    Philadelphia, Pennsylvania, 19104

  • University of Pittsburgh Cancer Institute

    Pittsburgh, Pennsylvania, 15232

  • Oregon Health & Science University

    Portland, Oregon, 97239

  • Virginia Commonwealth University/MCV Hospital

    Richmond, Virginia, 23298

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Texas Transplant Institute

    San Antonio, Texas, 78229

  • Washington University/Barnes Jewish Hospital

    St Louis, Missouri, 63110

  • Stanford Hospital and Clinics

    Stanford, California, 94305

Other trials in United States

France1 site
  • Hopital Saint-Louis

    Paris, CEDEX 10

Other trials in France

About this study

Official title: A Phase III Randomized, Multicenter Trial Comparing Sirolimus/Tacrolimus With Tacrolimus/Methotrexate as Graft-versus-Host Disease (GVHD) Prophylaxis After HLA-Matched, Related Peripheral Blood Stem Cell Transplantation (BMT CTN #0402)

The study is designed as a phase III, randomized, open label, multicenter, prospective, comparative trial of sirolimus and tacrolimus versus tacrolimus and methotrexate as graft-versus-host disease (GVHD) prophylaxis after human leukocyte antigen (HLA)-matched, related, peripheral blood stem cell transplantation in individuals with hematologic cancer. Participants will be stratified by transplant center and will be randomly assigned to the sirolimus/tacrolimus or tacrolimus/methotrexate arms at a 1:1 ratio.

Read the detailed description

BACKGROUND:

Stem cell transplantation is a standard therapy for acute and chronic leukemias and myelodysplastic disorders. A common problem that may occur after a stem cell transplant is a condition known as GVHD. The purpose of this study is to compare two combinations of medications to see which is better at preventing GVHD. The combinations of medications in this study are:

  • Sirolimus and tacrolimus
  • Methotrexate and tacrolimus

Doctors want to know if one combination is better than the other or if they both have the same result.

DESIGN NARRATIVE:

Participants will receive one of the two conditioning regimens described in the protocol, at the discretion of the transplant physician. The transplant physician must choose among these regimens prior to the participant's assignment to the GVHD prophylaxis treatment. Conditioning regimens will vary by center, but will be the same for all participants at each center. Stem cell donors will donate peripheral blood stem cells according to local institutional practices. Peripheral blood stem cells will not be manipulated or T-depleted prior to administration. Standard post-transplant care will be administered. Participants will be randomly assigned to one of two GVHD prophylaxis regimens and will be followed for the endpoints of interest.

Participants will be followed for 114 days post-randomization for evaluation of the primary endpoint, with additional follow-up for 2 years after transplantation for evaluation of secondary endpoints.

Keywords
Acute Myelogenous Leukemia, Acute Lymphoblastic Leukemia, Chronic Myelogenous Leukemia
Medical subject headings
Leukemia, Myeloid, Acute, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Myelodysplastic Syndromes

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TacrolimusDrug

    Also called Prograf®, FK506

    Adults and Children: Tacrolimus will be given at a dose of 0.02 mg/kg every 24 hours as a continuous intravenous infusion beginning on Day -3. An effort will be made to convert the tacrolimus to oral dosing at 2-3 times the total 24-hour intravenous dose, split into 2 doses given every 12 hours as soon as clinically feasible.

    The target serum level for tacrolimus is 5-10 ng/mL.

  • MethotrexateDrug

    Also called MTX

    Methotrexate will be given at a dose of 15 mg/m2 on Day 1 after transplantation, and at a dose of 10 mg/m2 on Days 3, 6 and 11 after transplantation.

  • SirolimusDrug

    Also called Rapamycin, Rapamune

    Adults: Sirolimus will be given in a loading dose of 12 mg on Day -3 followed by a daily oral dose of 4 mg per day. Doses may be repeated if the subject vomits within 15 minutes of an oral dose.

    Children: Children aged < 12.0 years OR weighing < 40.0 kg will be given an oral loading dose of sirolimus of 3 mg/m2 followed by a daily oral dose of 1 mg/m2, rounded to the nearest full milligram.

    The target serum level for sirolimus is 3-12 ng/mL.

Study groups in NCT00406393
Study groupRoleWhat they receive
Tacrolimus/MethotrexateActive comparatorPatients will be given Tacrolimus and Methotrexate for GVHD prophylaxis.
Receives: Drug: Tacrolimus; Drug: Methotrexate
Tacrolimus/SirolimusExperimentalPatients will be given Tacrolimus and Sirolimus for GVHD prophylaxis.
Receives: Drug: Tacrolimus; Drug: Sirolimus

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of Grades II-IV Acute GVHD-free Survival

    The primary objective is to compare rates of 114-day Grades II-IV acute GVHD-free survival post randomization for HLA-matched, related donor allogeneic peripheral blood stem cell transplantation using two different GVHD prophylaxis regimens. Participants are graded on a scale of 1 to 4 according to their symptoms and organs involved, where 4 represents a worse grade.

    Measured: Day 114

Secondary outcomes (11)
  1. Incidence of Acute GVHD

    Cumulative incidence of acute GVHD (grade II-IV) occurring 100 days from transplantation.

    Measured: Measured at Day 100

  2. Time to Neutrophil and Platelet Engraftment

    Neutrophil engraftment is defined as achieving an Absolute Neutrophil Count (ANC) > 500/mcL for three consecutive measurements on different days. Platelet engraftment is defined as a platelet count > 20,000/mcL for three consecutive measurements over three or more days.

    Measured: Measured through Day 100

  3. Mucositis Severity

    Mucositis severity will be scored per the modified Oral Mucositis Assessment Scale (OMAS) scoring system on a scale of 0 - 4, where 0 equals normal mucosa and 4 represents severe mucosa.

    Measured: Measured at Day 21

  4. Rate of Veno-occlusive Disease (VOD)

    VOD will be defined as the occurrence of VOD (based on the Baltimore Criteria for the diagnosis of VOD) in conjunction with other end-organ dysfunction.

    Measured: Measured through Day 100

  5. Thrombotic Microangiopathy (TMA) Infection

    The occurrence of TMA within the first 100 days after stem cell transplantation will be recorded. The first day of onset will be used for reporting purposes.

    Measured: Measured through Day 100

  6. Reactivation of Cytomegalovirus (CMV) Infection

    Measured: Measured at Year 2

  7. Treatment-related Mortality

    Measured: Measured at Day 100 and Year 2

  8. Malignant Disease Relapse

    Testing for recurrent malignancy in the blood, marrow or other sites will be used to assess relapse after transplantation. For the purpose of this study, relapse is defined by either morphological or cytogenetic evidence of AML, ALL, CML, MDS or CMML consistent with pre-transplant features.

    Measured: Measured at Year 2

  9. Overall Survival

    Measured: Measured at Year 2

  10. Infections

    Measured: Measured at Year 2

  11. Time to Discharge After Transplant

    Measured: Measured at Year 2

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Dec 2006 (estimated)
  2. Study startNov 2006
  3. Primary completionOct 2012
  4. Study completionOct 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
304 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00406393
Sponsor's protocol ID
BMTCTN0402
Other IDs
U01HL069294, BMT CTN 0402, U01HL069294-05
Status last verified
Dec 2022
First submitted
30 Nov 2006
Last updated
4 Jan 2023
Data monitoring committee
Yes
Individual data sharing
Yes: Findings will be published in a manuscript.

Publications

  • Cutler C, Logan B, Nakamura R, Johnston L, Choi S, Porter D, Hogan WJ, Pasquini M, MacMillan ML, Hsu JW, Waller EK, Grupp S, McCarthy P, Wu J, Hu ZH, Carter SL, Horowitz MM, Antin JH. Tacrolimus/sirolimus vs tacrolimus/methotrexate as GVHD prophylaxis after matched, related donor allogeneic HCT. Blood. 2014 Aug 21;124(8):1372-7. doi: 10.1182/blood-2014-04-567164. Epub 2014 Jun 30.

    PubMed 24982504

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tacrolimus, Methotrexate and Sirolimus in people with Leukemia, Myelocytic, Acute and Leukemia, Lymphocytic, Acute, run by Medical College of Wisconsin at 24 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jan 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 24 sites in United States, France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Mar 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of Grades II-IV Acute GVHD-free Survival (time frame: Day 114). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00406393, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jan 2023.

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