Recruiting
Phase 2

Reduced-Intensity Conditioning

Sponsor:

Thomas Jefferson University

Code:

NCT05031897

Conditions

Acute Lymphoblastic Leukemia

Acute Myeloid Leukemia

Adult T-Cell Leukemia/Lymphoma

Aplastic Anemia

Chronic Lymphocytic Leukemia

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

Fludarabine

Total-Body Irradiation

Donor Lymphocyte Infusion

Cyclophosphamide

Tacrolimus

Study Details

Brief summary:

This phase II clinical trial evaluates whether a modified modality of conditioning reduces treatment-related mortality (TRM) in patients who undergo a hematopoietic stem cell transplant (HSCT) for a hematological malignancy. HSCT is a curative therapy for many hematopoietic malignancies, however this regimen results in higher rates of TRM than other forms of treatment. In recent years, less intense conditioning regimens with radiation and chemotherapy prior to HSCT have been developed. Radiation therapy uses high energy sources to kill cancer cells and shrink tumors while chemotherapy drugs like fludarabine and cyclophosphamide work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. This study evaluates whether a two-step approach with lower-intensity regimens of these treatments prior to HSCT reduces the rate of TRM.

Conditions

Acute Lymphoblastic Leukemia

Acute Myeloid Leukemia

Adult T-Cell Leukemia/Lymphoma

Aplastic Anemia

Chronic Lymphocytic Leukemia

Study ID

NCT05031897

Start date

Oct 25, 2021

Status verified date

Oct, 2025

Completion date

Apr, 2032

Anticipated

Primary completion date

Apr, 2032

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Radiation-based cohort diagnoses:

  • Acute myeloid leukemia
  • Acute lymphoid leukemia in remission
  • Myelodysplasia (MDS)
  • Chronic lymphocytic leukemia (CLL) with no or minimal lymph node involvement
  • Multiple myeloma
  • Chronic myeloid leukemia
  • Myelofibrosis
  • Myeloid malignancy not otherwise specified
  • Chronic myelomonocytic leukemia
  • Essential thrombocytopenia or polycythemia vera
  • T cell leukemia
  • T cell lymphoma without significant lymph node disease burden
  • Any hematological malignancy or dyscrasia not cited above in which HSCT is potentially curable
  • Any patient who has a hematological disease that would normally be treated on a myeloablative study, but is prevented from doing so by factors in their past medical history. Examples are patients with previous treatment with radiation therapy precluding total-body irradiation (TBI), or a past history of myeloablative therapy, precluding a 2nd myeloablative regimen.
  • Patients must have a donor who is one-haplotype mismatched (number of mismatches in either direction not considered)
  • Chemotherapy-based cohort diagnoses:

  • Hodgkin or non-Hodgkin lymphoma
  • Small lymphocytic lymphoma/CLL
  • Any other diagnosis in which chemotherapy is thought to be superior to radiotherapy for treatment of the disease
  • Hematological malignancy in patients who cannot receive > 2 Gy radiation
  • Aplastic anemia and other non-malignant hematologic dyscrasias
  • Patients must have a donor who is one-haplotype mismatched (number of mismatches in either direction not considered)
  • Human leukocyte antigen (HLA) identical cohort diagnoses:

\* Patients in this group will be treated in parallel to the radiation-based cohort or the chemotherapy-based group based on what category their diagnosis falls into. However, these patients will have HLA identical related donors (one-antigen cross-over event included).
  • Left ventricular ejection fraction of >= 50%
  • Diffusion lung capacity of oxygen >= 50% and forced expiratory volume at 1 second >= 50% of predicted corrected for hemoglobin
  • Serum bilirubin =< 1.8
  • Aspartate aminotransferase or alanine aminotransferase =< 2.5 x upper limit of normal
  • Creatinine clearance of >= 60 mL/min
  • Patients must have adequate Karnofsky performance status (KPS) and Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) scores:

  • Patients < age 60 years must have a KPS of >= 60% and an HCT-CI score of 5 or less
  • Patients aged 60 to 65 years must have a KPS of >= 60% and an HCT-CI score of 4 or less
  • Patients aged 66 to 69 years must have a KPS of 90% and an HCT-CI score of 3 or less
  • Patients aged 70 years or more must have a KPS of 90% and an HCT-CI score of 2 or less
  • (Patients with greater than the allowable HCT-CI points for age can be enrolled for trial with approval of the principal investigator (PI) and at least 1 co-investigator (CI) not on the primary care team of the patient). This is an adjustment to account for healthy patients who meet the spirit of this protocol but have histories that result in higher than guideline HCT-CI points. An example is a patient with a solid tumor malignancy in their remote history (adds 3 points to HCT-CI total) where the treatment for the malignancy occurred years to decades before and there has been complete recovery of toxicities
  • Patients must be willing to use contraception if they have childbearing potential
  • Patient or patient's guardian is able to give informed consent
  • Patients should have a life expectancy of >= 6 months for reasons other than their underlying hematologic/oncologic disorder
  • Patients with evidence of another malignancy, exclusive of a skin cancer that requires only local treatment, should not be enrolled on this protocol
  • Patients should not be:

  • Human immunodeficiency virus positive
  • Have active involvement of the central nervous system with malignancy. This can be documented by a normal neurological exam, magnetic resonance imaging (MRI) of the head, and/or a negative cerebral spinal fluid analysis
  • Pregnant or breastfeeding

Study Design

Enrollment

63 participants

Anticipated

Allocation

Non randomized

Intervention Model

Parallel Assignment

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Arm 1: Radiation-Based Cohort (fludarabine, TBI, infusion)

Patients receive fludarabine IV on days -11, -10, -9, and -8, undergo TBI BID on days -10 and -9, undergo DLI on day -6, and receive cyclophosphamide IV on days -3 and -2. Patients begin tacrolimus and mycophenolate mofetil IV on day -1. Patients then undergo HSCT on day 0. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow biopsy/aspiration, imaging and blood sample collection throughout the study.

experimental: Arm 2: Chemotherapy-Based Cohort (fludarabine, melphalan, TBI)

Patients receive fludarabine IV on days -11, -10, -9, and -8 and melphalan IV on days -10 and -9. Patients undergo TBI and DLI once on day -6. Patients receive cyclophosphamide IV on days -3 and -2 and begin tacrolimus and mycophenolate mofetil on day -1. Patients undergo hematopoietic stem cell transplant on day 0. Patients undergo bone marrow biopsy/aspiration, imaging and blood sample collection throughout the study.

experimental: Arm 3: HLA- Identical cohort (radiation-based or chemotherapy-based conditioning)

This group (HLA- Identical cohort), which is expected to be small, can undergo HSCT with radiation-based or chemotherapy-based conditioning. Due to small numbers of patients with available HLA identical related donors, this third, descriptive arm is included so that this group, too small in number for a free-standing study, are treated on clinical trial. This is also a separate arm of the study and the outcome of patients treated on this arm will be analyzed descriptively without statistical comparison or power analysis.

Interventions

Fludarabine

Given IV

Total-Body Irradiation

Undergo TBI

Donor Lymphocyte Infusion

Undergo DLI

Cyclophosphamide

Given IV

Tacrolimus

Given IV

Mycophenolate Mofetil

Given IV

Hematopoietic Cell Transplantation

Undergo HSCT

Melphalan

Given IV

Bone Marrow Aspiration and Biopsy

Undergo bone marrow aspiration/ biopsy

Diagnostic Imaging

Undergo diagnostic imaging

Biospecimen Collection

Undergo blood sample collection

Primary outcome measure

  • Number of Participants Who Experience Treatment-Related Mortality (TRM) [ Time Frame: At 2 years post hematopoietic stem cell transplant (HSCT) ]

Central Contacts and Locations

Central contacts

Usama Gergis, MD

215-503-2455usama.gergis@jefferson.edu

Locations

Sidney Kimmel Cancer Center at Thomas Jefferson University

Recruiting

Philadephia, Pennsylvania, United States, 19107

Contacts

Usama Gergis, MD

215-503-2455usama.gergis@jefferson.edu

More Information

Sponsor

Thomas Jefferson University

Last update posted

Oct 30, 2025

Last verified

Oct, 2025

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-08. This information was provided to ClinicalTrials.gov by Thomas Jefferson University on 2025-10-30.