Recruiting
Phase 2

Cord Blood Transplant, Cyclophosphamide, Fludarabine, TBI

Sponsor:

Fred Hutchinson Cancer Center

Code:

NCT06013423

Conditions

Acute Leukemia of Ambiguous Lineage

Acute Lymphoblastic Leukemia

Acute Myeloid Leukemia

Blastic Plasmacytoid Dendritic Cell Neoplasm

Hematopoietic and Lymphatic System Neoplasm

Eligibility Criteria

Sex: All

Age: 0 - 65

Healthy Volunteers: Not accepted

Interventions

Biospecimen Collection

Bone Marrow Aspirate

Cyclophosphamide

Cyclosporine

Diagnostic Imaging

Study Details

Brief summary:

This phase II trial studies how well giving an umbilical cord blood transplant together with cyclophosphamide, fludarabine, and total-body irradiation (TBI) works in treating patients with hematologic diseases. Giving chemotherapy, such as cyclophosphamide, fludarabine and thiotepa, and TBI before a donor cord blood transplant (CBT) helps stop the growth of cancer and abnormal cells and helps stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil after transplant may stop this from happening in patients with high-risk hematologic diseases.

Conditions

Acute Leukemia of Ambiguous Lineage

Acute Lymphoblastic Leukemia

Acute Myeloid Leukemia

Blastic Plasmacytoid Dendritic Cell Neoplasm

Hematopoietic and Lymphatic System Neoplasm

Study ID

NCT06013423

Start date

Jul 23, 2024

Status verified date

Jul, 2026

Completion date

Oct 31, 2032

Anticipated

Primary completion date

Oct 31, 2031

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 0 - 65

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Patients aged 6 months to =< 65 years at time of consent.
  • Acute myelogenous leukemia (AML):

  • Complete first remission (CR1), complete second remission (CR2) or greater (CR2+), must have < 5% marrow blasts at the time of transplant.
  • Patients in morphologic remission with persistent cytogenetic, flow cytometric, or molecular aberrations are eligible.
  • Acute lymphoblastic leukemia (ALL):

  • Complete first remission (CR1) at high risk for relapse such as any of the following:

  • Presence of any high-risk cytogenetic abnormalities such as t(9;22), t(1;19), t(4;11) or other MLL rearrangements (11q23) or other high-risk molecular abnormality.
  • Failure to achieve MRD- complete remission after induction therapy.
  • Persistence or recurrence of minimal residual disease on therapy.
  • Any patient unable to tolerate consolidation and/or maintenance chemotherapy as would have been deemed appropriate by the treating physician.
  • Other high-risk features not defined above.
  • Complete second remission (CR2) or greater (CR2+).

  • Note: ALL with less than 5% blasts at time of transplant but persistent cytogenetic, flow cytometric or molecular aberrations are eligible.
  • Other acute leukemias: Acute leukemias of ambiguous lineage or mixed phenotype with less than 5% blasts. Leukemias in morphologic remission with persistent cytogenetic, flow cytometric or molecular aberrations are eligible.
  • Chronic Myeloid Leukemia (CML): Excluding refractory blast crisis. To be eligible in first chronic phase (CP1) patient must have failed or be intolerant to tyrosine kinase inhibitor therapy.
  • Myelodysplastic syndromes (MDS) and myeloproliferative disorders (MPD) other than myelofibrosis:

  • MDS/MPD overlap syndromes without myelofibrosis.
  • MDS/ MPD patients must have less than 10% bone marrow myeloblasts and absolute neutrophil count (ANC) > 0.2 (growth factor supported if necessary) at transplant work-up.
  • Non-Hodgkin lymphoma (NHL) at high-risk of relapse or progression if not in remission:

  • Eligible patients with aggressive histology (such as, but not limited to, diffuse large B-cell NHL, mantle cell NHL, and T-cell histology) in CR by PET/CT imaging.
  • Eligible patients with indolent B-cell NHL (such as, but not limited to, follicular, small cell or marginal zone NHL) will have 2nd or subsequent progression with PR or CR by PET/CT imaging.
  • Blastic plasmacytoid dendritic cell neoplasm (BPDCN) in morphologic remission.
  • Only for adult patients, to prevent graft rejection, patients who received only non-lymphodepleting agents for their malignancy (hypomethylating agents, venetoclax, hydroxyurea, TKIs etc.), or patients who received lymphodepleting chemotherapy > 3 months prior to scheduled admission, may receive fludarabine 25 mg/m\^2 daily x 3 days for lymphodepletion 14-42 days (aiming for 2-4 weeks) at the discretion of the principal investigator (PI).
  • For patients > 18 years old, Karnofsky score ≥ 70%. For patients =< 18 years old, Lansky score ≥ 50%.
  • Calculated creatinine clearance > 70 ml/min.
  • Bilirubin < 1.5 mg/dL (unless benign congenital hyperbilirubinemia or hemolysis).
  • Alanine transaminase (ALT) < 3 x upper limit of normal (ULN).
  • For patients > 18 years old, pulmonary function (spirometry and corrected diffusing capacity for carbon monoxide \[DLCO\]) > 60% predicted. For patients =< 18 years old, or any patient unable to perform pulmonary function tests, O2 saturation > 92% on room air.
  • Left ventricular ejection fraction > 50%.
  • Albumin > 3.0 g/dL.
  • For patients > 18 years old, Hematopoietic Cell Transplantation Comorbidity index (HCT-CI) =< 5.
  • UCB units will be selected according to current umbilical cord blood graft selection algorithm. One or two UCB units may be used to achieve the required cell dose.
  • The UCB graft is matched at 4-6 HLA-A, B, DRB1 antigens with the recipient. This may include 0-2 antigen mismatches at the A or B or DRB1 loci. Unit selection based on cryopreserved nucleated cell dose and HLA-A, B, DRB1 using intermediate resolution A, B antigen and DRB1 allele typing.

Exclusion Criteria:

  • Diagnosis of myelofibrosis or other malignancy with moderate-severe bone marrow fibrosis.
  • Patients persistent with central nervous system (CNS) involvement in cerebrospinal fluid (CSF) or CNS imaging at time of screening0
  • Prior checkpoint inhibitors/ blockade in the last 12 months.
  • Two prior stem cell transplants of any kind.
  • One prior autologous stem cell transplant within the preceding 12 months.
  • Prior allogeneic transplantation.
  • Prior involved field radiation therapy that would preclude safe delivery of 400cGy total body irradiation (TBI) in the opinion of radiation oncology.
  • Active and uncontrolled infection at time of transplantation.
  • HIV infection.
  • Inadequate performance status/ organ function.
  • Pregnancy or breast feeding.
  • Patient or guardian unable to give informed consent or unable to comply with the treatment protocol including appropriate supportive care, long-term follow-up, and research tests.

Study Design

Enrollment

54 participants

Anticipated

Allocation

Non randomized

Intervention Model

Single group

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Arm I (myeloablative UCBT)

See detailed description.

experimental: Arm II (myeloablative UCBT)

See detailed description.

Interventions

Biospecimen Collection

Undergo blood sample collection

Bone Marrow Aspirate

Undergo bone marrow aspirate

Cyclophosphamide

Receive IV

Cyclosporine

Receive IV or PO

Diagnostic Imaging

Undergo diagnostic imaging

Echocardiography

Undergo ECHO

Fludarabine Phosphate

Receive IV

Multigated Acquisition Scan

Undergo MUGA

Mycophenolate Mofetil

Receive IV

Survey Administration

Ancillary studies

Thiotepa

Receive IV

Total-Body Irradiation

Undergo high-dose or middle-intensity TBI

Umbilical Cord Blood Transplantation

Undergo UCBT

Primary outcome measure

  • Overall survival [ Time Frame: At 1 year ]

Central Contacts and Locations

Central contacts

Ann Dahlberg

206-667-1959adahlber@fredhutch.org

Locations

Fred Hutch/University of Washington Cancer Consortium

Recruiting

Seattle, Washington, United States, 98109

Contacts

Ann Dahlberg

206-667-1959adahlber@fredhutch.org

Principal Investigator:

Ann Dahlberg

More Information

Sponsor

Fred Hutchinson Cancer Center

Last update posted

Jul 22, 2026

Last verified

Jul, 2026

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-08. This information was provided to ClinicalTrials.gov by Fred Hutchinson Cancer Center on 2026-07-22.