Bendamustine With or Without Cyclophosphamide in Preventing GVHD in Patients Undergoing Stem Cell Transplant

Last updated: March 28, 2025
Sponsor: M.D. Anderson Cancer Center
Overall Status: Active - Recruiting

Phase

1/2

Condition

N/A

Treatment

Filgrastim-sndz

Total-Body Irradiation

Melphalan

Clinical Study ID

NCT04022239
2018-0972
NCI-2019-03900
2018-0972
  • Ages 18-70
  • All Genders

Study Summary

This phase I/II trial studies the side effects and best dose of bendamustine when given with or without cyclophosphamide in preventing graft versus host disease (GVHD) in patients undergoing stem cell transplant. Drugs used in chemotherapy, such as bendamustine and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy and total body irradiation before or after a stem cell transplant helps kills cancer cells that are in the body and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to grow. Sometimes, the transplanted cells from a donor can attack the body's normal cells called GVHD. Giving tacrolimus, mycophenolate mofetil, and filgrastim after the transplant may stop this from happening.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patient with hematologic malignancies.

  • Donor: Matched sibling, matched unrelated, mismatched or haploidentical

  • Zubrod performance 0 to 2 or Karnofsky of at least 60.

  • Adequate organ function at time of study entry:

  1. Creatinine less than or equal to 1.6 mg/dL and creatinine clearance >/= 30ml/min. Creatinine clearance will be calculated using the Cockcroft-Gaultequation

  2. Total bilirubin less than < 1.5 x UNL

  3. SGPT < 2.5 x ULN

  4. Ejection fraction >/= 40%

  5. FEV1, FVC and DLCO >/= 40%

  • Female patients of childbearing potential must agree to use an effective method ofbirth control while on study and for 6 months after the last dose of bendamustine.Male patients with female partners of childbearing potential must agree to use aneffective method of birth control while on study and for 3 months after the lastdose of bendamustine.

Exclusion

Exclusion Criteria:

  • Pregnant or nursing women.

  • Known to be HIV positive

  • Active and uncontrolled disease/infection

  • Unable or unwilling to sign consent

  • Current active hepatic or biliary disease (with exception of Gilbert's syndrome)

  • Active hepatitis B or C.

  • Toxicities (grade > 1) unresolved from prior treatment (including chemotherapy,targeted therapy, immunotherapy, experimental agents radiation, or surgery.

  • Patients with standard risk acute leukemia in first complete remission and patientswith chronic myeloid leukemia in first chronic will be excluded during escalatedphase.

Study Design

Total Participants: 25
Treatment Group(s): 10
Primary Treatment: Filgrastim-sndz
Phase: 1/2
Study Start date:
March 13, 2020
Estimated Completion Date:
July 31, 2025

Study Description

PRIMARY OBJECTIVE:

I. Evaluate the safety of substituting the standard post-transplant cyclophosphamide (PT-CY) given on day +3 and +4 with post-transplant bendamustine (PT-BEN) in patients undergoing HLA-mismatched hematopoietic cell transplantation.

SECONDARY OBJECTIVES:

I. To evaluate treatment-related mortality. II. To assess acute and chronic graft-versus-host disease (GVHD). III. To assess overall survival, progression-free survival and relapse rates. IV. To evaluate the risk of acute cystitis. V. To evaluate immune reconstitution after transplantation.

OUTLINE: This is a dose-escalation study of bendamustine. Patients are assigned to 1 of 2 treatment schedules.

SCHEDULE I (NON-LYMPHOMA): Patients receive fludarabine intravenously (IV) over 1 hour on days -5 to -2, melphalan IV over 30 minutes on days -5 and -4, and undergo total body irradiation (TBI) on day -1 and stem cell transplantation IV over 2-6 hours on day 0. Depending on when the trial was joined, patients receive cyclophosphamide IV over 3 hours or bendamustine IV over 30-60 minutes or cyclophosphamide IV over 3 hours and bendamustine IV over 30-60 minutes on day 3. Patients also receive bendamustine IV over 30-60 minutes on day 4. Beginning day 5, patients receive tacrolimus IV followed by orally (PO) once daily (QD) or twice daily (BID) for 6 months and mycophenolate mofetil PO thrice daily (TID) until day 100. Beginning day 7, patients receive filgrastim-sndz subcutaneously (SC) QD until blood cell levels return to normal.

SCHEDULE II (LYMPHOID MALIGNANCIES): Patients receive fludarabine IV over 1 hour, bendamustine IV over 30-60 minutes on days -5 to -3 and undergo TBI on day -1 and stem cell transplantation over 2-6 hours on day 0. Depending on when the trial was joined, patients receive cyclophosphamide IV over 3 hours or bendamustine IV over 30-60 minutes or cyclophosphamide IV over 3 hours and bendamustine IV over 30-60 minutes on day 3. Patients also receive bendamustine IV over 30-60 minutes on day 4. Beginning day 5, patients receive tacrolimus IV followed by PO QD or BID for 6 months and mycophenolate mofetil PO TID until day 100. Beginning day 7, patients receive filgrastim-sndz SC QD until blood cell levels return to normal. CD20+ patients receive rituximab IV over 4-6 hours on days -13, -6, 1, and 8.

After completion of study treatment, patients are followed weekly for 3 months, every 3 months in year 1, and every 6 months in year 2.

Connect with a study center

  • M D Anderson Cancer Center

    Houston, Texas 77030
    United States

    Active - Recruiting

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