Vorinostat to Prevent Graft Versus Host Disease Following Reduced Intensity, Related Donor Stem Cell Transplant

NCT00810602 | Completed Phase 1 Results DMC

• 1 other identifier: UMCC 2008.095
• Study Type: interventional
• Target: 61
• Locations: 1 country
• Sites: 2

Brief Summary

The proposed research study is to test the drug vorinostat, in a new use as an additional medication, with other standard treatments for the prevention of severe acute graft versus host disease (GVHD). If this treatment is safe and effective, when combined with a reduced intensity transplant, the research may achieve a more effective therapy for patients with high-risk, blood cell related cancers. All subjects will receive an identical, known treatment to test if the treatment is safe and effective (a phase II trial). For patients to take part they must have a high-risk, blood cell cancer, be suitable candidates to receive a reduced intensity transplant and have a matched, related donor. Adult subjects (age 18 years and older) will be considered as subjects provided, as detailed in the protocol, they meet additional criteria and are not excluded from participating. About fifty (50) subjects will be enrolled in this study at the University of Michigan. Patients who receive blood stem cell transplants (HSCT), also called bone marrow transplants, to treat their cancer are at risk for serious complications, which may sometimes be fatal. The more common, serious ones are relapse (return of their disease), body organ injury from the intensity of the chemotherapy given prior to their transplant, and a serious complication called graft versus host disease (GVHD). GVHD is a form of rejection, where the transplanted cells of the donor attack the recipient's body as foreign, and do damage to organs and tissues. To decrease the side effects of the chemotherapy given before a transplant, reduced intensity treatment plans(regimens)have recently been developed at a number of transplant centers. A decrease in the side effects of chemotherapy (called toxicities) has been achieved; however, this success with "less intensive" treatments has been partially offset by less successful results in controlling the patient's cancer. As mentioned above, GVHD is a form of transplant rejection. GVHD can affect the digestive system, skin, liver and other body systems. GVHD can increase the risk of infection. After a matched, related donor stem cell transplant, GVHD when severe, is a major cause of discomfort, organ damage, and even death. When a graft vs host reaction develops, but is kept under control, studies show there may be a beneficial graft versus tumor effect, helping to destroy tumor cells in the patient, and thus providing a more effective control of their cancer. The goal of this study is to try to maximize the potential benefits, of giving patients less intense chemotherapy to reduce the toxic effects, letting the graft vs host effect help in destroying tumor cells, but preventing acute severe GVHD by using the drug vorinostat, combined with standard medicines, to reduce the chance of serious GVHD-related complications.

Conditions

Hematologic Malignancies; Graft vs Host Disease

Outcome Measures

Primary Outcomes (1)

• 100-day Cumulative Incidence of Grade 2-4 Acute Graft Versus Host Disease (GVHD)

  Assess if the addition of Vorinostat to standard GVHD prophylaxis regimen can reduce the rate of grades 2-4 acute GVHD when compared to 48% in a cohort of identically treated RIC HSCT patients without vorinostat. A reduction of incidence to less than 25% will be considered successful.

  100 days

Secondary Outcomes (3)

• Number of Serious Adverse Events

  100 days

• Percent Cumulative Incidence of Relapse at 2 Years.

  two years

• Percent Survival at 2-years

  two years

Study Arms (1)

Vorinostat prophylaxis

EXPERIMENTAL

Vorinostat,combined with standard GVHD prevention medications(tacrolimus, mycophenolate) for adults who received a reduced intensity, related donor stem cell transplant

Procedure: reduced intensity, related donor stem cell transplant; Drug: tacrolimus (standard GVHD prophylaxis); Drug: mycophenolate (standard GVHD prophylaxis); Drug: vorinostat

Interventions

reduced intensity, related donor stem cell transplant PROCEDURE

Fludarabine /Busulfan(FluBu2)regimen Fludarabine: 40 mg/m2/day in 0.9 NS, administered IV on days -5 to day -2 pre-transplant for a total of 4 doses. Busulfan: 3.2 mg/kg in 0.9 NS administered IV on days -5 and -4 for a total of 2 doses. Total body irradiation 200 cGy delivered in a single fraction will be given on day 0 for patients receiving an HLA-mismatched transplant.

Vorinostat prophylaxis

tacrolimus (standard GVHD prophylaxis) DRUG

Tacrolimus will begin on day -3, IV or oral. Target trough level for tacrolimus is 8-12 ng/ml. In the absence of GVHD, tacrolimus tapering will begin on day +56 post transplant

Vorinostat prophylaxis

mycophenolate (standard GVHD prophylaxis) DRUG

Mycophenolate will begin on day 0 at 10 mg/kg/dose (up to 1 gram per dose) every 8 hours orally or intravenously and will continue until day 28.

Vorinostat prophylaxis

vorinostat DRUG

Vorinostat given at a dose 100 mg PO BID starting day -10. If tolerated, vorinostat will be continued until day 100 post-transplant,whether or not acute GVHD develops. Dose escalation/ de-escalation Ten subjects treated at a dose of 100 mg PO BID. If dosing modifications are not required, during the pre-engraftment period in more than 4 patients, AND no more than two observed drug related toxicities CTC grade 4 or higher \[probably or definitely related to the drug\] then vorinostat dose will be escalated to 200 mg PO BID. If dose escalation does not occur due to failure to meet the above criteria,then the study will enroll at the 100 mg PO BID dosing, subject to the protocol stopping rules. If dose escalation occurs, subjects will be treated at 200 mg PO BID dosing level. If the probability of unacceptable toxicity exceeds the rules in protocol, then the dose of vorinostat will be de-escalated to 100 mg PO BID for the remainder of study.

Also known as: ZOLINZA

Vorinostat prophylaxis

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Have a 7/8 or 8/8 HLA A, B, C and DR, HLA-matched related donor willing and able to donate allogeneic stem cells.
• For patients with multiple myeloma, CLL, and lymphoma: must be in CR, PR, or stable disease.
• For MDS, acute leukemia or CML: must have \<20% blasts on marrow exam.
• For all other diseases: must have non-refractory disease.
• and meet at least ONE of the next three criteria:
• Any patient ≥ 18 years of age with a hematological malignancy and not considered a candidate for allogeneic myeloablative transplant due to illness and/or age (≥55 years).
• Any patient ≥ 18 years of age who has relapsed following prior autologous or allogeneic transplant for a hematologic malignancy.
• Any patient ≥ 18 years of age diagnosed with a hematological malignancy for which reduced intensity transplant is institutionally preferred over myeloablative transplant (eg, chronic lymphocytic leukemia).

You may not qualify if:

• Less than 18 years of age.
• Currently taking any HDAC inhibitors, or have taken an HDAC inhibitor within 30 days of the trial.
• Positive serum tests for HIV, HTLV1 / HTLV2.
• Detectable hepatitis B virus (HBV), hepatitis C (HCV) or Epstein-Barr (EBV).
• Pregnancy.
• One or more of the following organ system function criteria
• Cardiac: Ejection fraction ≤ 40%
• Renal: Estimated or actual GFR ≤ 40 ml/min (corrected for BSA)
• Pulmonary: FEV1, FVC, or DLCO ≤ 40% predicted
• Hepatic: Total bilirubin ≥3 mg% and AST/ALT \>5 x institutional normal for age
• Karnofsky score ≤50 (Requires considerable assistance and frequent medical care).
• Persistent invasive infections not controlled by antimicrobial medication.
• Any physical or psychological condition that, in the opinion of the investigator, would pose unacceptable risk to the patient.

Sponsors & Collaborators

• Pavan Reddy, MD: lead

Study Sites (2)

University of Michigan Cancer Center

Ann Arbor, Michigan, 48109, United States

Location

Washington University School of Medicine

St Louis, Missouri, 63110, United States

Location

Related Publications (1)

• Choi SW, Braun T, Chang L, Ferrara JL, Pawarode A, Magenau JM, Hou G, Beumer JH, Levine JE, Goldstein S, Couriel DR, Stockerl-Goldstein K, Krijanovski OI, Kitko C, Yanik GA, Lehmann MH, Tawara I, Sun Y, Paczesny S, Mapara MY, Dinarello CA, DiPersio JF, Reddy P. Vorinostat plus tacrolimus and mycophenolate to prevent graft-versus-host disease after related-donor reduced-intensity conditioning allogeneic haemopoietic stem-cell transplantation: a phase 1/2 trial. Lancet Oncol. 2014 Jan;15(1):87-95. doi: 10.1016/S1470-2045(13)70512-6. Epub 2013 Nov 30.

  PMID: 24295572 RESULT

MeSH Terms

Conditions

Hematologic Neoplasms; Graft vs Host Disease

Interventions

Tacrolimus; Mycophenolic Acid; Vorinostat

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Hematologic Diseases; Hemic and Lymphatic Diseases; Immune System Diseases

Intervention Hierarchy (Ancestors)

Macrolides; Lactones; Organic Chemicals; Caproates; Acids, Acyclic; Carboxylic Acids; Fatty Acids; Lipids; Anilides; Amides; Aniline Compounds; Amines; Hydroxamic Acids; Hydroxylamines; Hydroxy Acids

Results Point of Contact

• Title: Dr. Sung Choi
• Organization: University of Michigan Comprehensive Cancer Center

sungchoi@med.umich.edu

734-764-8630

Study Officials

• Pavan Reddy, MD

  University of Michigan Rogel Cancer Center

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: December 17, 2008
• First Posted: December 18, 2008
• Study Start: January 1, 2009
• Primary Completion: April 1, 2013
• Study Completion: July 1, 2013
• Last Updated: April 11, 2014
• Results First Posted: April 11, 2014

Record last verified: 2014-03

Locations

US (2)