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Alkylating agents
Chemotherapy + Stem Cell Transplant for Fanconi Anemia (RAFA Trial)
Phase 2
Recruiting
Led By Parinda Mehta, MD
Research Sponsored by Children's Hospital Medical Center, Cincinnati
Eligibility Criteria Checklist
Specific guidelines that determine who can or cannot participate in a clinical trial Must have
Patients must have a diagnosis of Fanconi anemia
Patients must have adequate physical function measured by: Cardiac: asymptomatic or if symptomatic then 1) left ventricular ejection fraction (LVEF) at rest must be > 50% and must improve with exercise or 2) Shortening Fraction > 29%, Hepatic: < 5 x upper limit of normal (ULN) alanine transaminase (ALT) and < 2.0 mg/dl total serum bilirubin, Renal: serum creatinine <1.5 mg/dl or if serum creatinine is outside the normal range, then CrCl > 50 ml/min/1.73 m2, Pulmonary: asymptomatic or if symptomatic, DLCO > 50% of predicted
Must not have
Active uncontrolled viral, bacterial or fungal infection
Active CNS leukemia
Timeline
Screening 3 weeks
Treatment Varies
Follow Up 5 years
Awards & highlights
No Placebo-Only Group
Summary
This trial is testing a new, less intense chemotherapy treatment for people with Fanconi Anemia who are getting a stem cell transplant from a related or unrelated donor.
Who is the study for?
This trial is for patients with Fanconi Anemia who need a stem cell transplant. They should have specific blood conditions like severe aplastic anemia or leukemia, and be in good physical shape with a performance status over 70%. Pregnant or breastfeeding women can't join, nor can those with HIV, active CNS leukemia, or uncontrolled infections.
What is being tested?
The study tests if lower doses of busulfan without cyclosporine reduce side effects in FA patients getting transplants from mismatched related or unrelated donors. The regimen includes busulfan, fludarabine, anti-thymocyte globulin (ATG), and cyclophosphamide.
What are the potential side effects?
Possible side effects include lowered immunity leading to infection risk; mouth sores; nausea; liver issues signaled by jaundice; heart complications; kidney dysfunction indicated by changes in urine output or swelling; and lung problems like difficulty breathing.
Eligibility Criteria
Inclusion Criteria
You may be eligible if you check “Yes” for the criteria belowSelect...
I have been diagnosed with Fanconi anemia.
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My heart, liver, kidneys, and lungs are functioning well.
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I am not pregnant or breastfeeding and agree to pregnancy tests and avoiding pregnancy while in the study.
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I have a severe blood disorder such as SAA, MDS, or AML.
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My donor matches me genetically but is not my sibling.
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I am mostly active and can care for myself.
Exclusion Criteria
You may be eligible for the trial if you check “No” for criteria below:Select...
I do not have any ongoing serious infections.
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I have leukemia that has spread to my brain.
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I am not pregnant or breastfeeding.
Timeline
Screening ~ 3 weeks3 visits
Treatment ~ Varies
Follow Up ~ one year
Screening ~ 3 weeks
Treatment ~ Varies
Follow Up ~one year
Treatment Details
Study Objectives
Study objectives can provide a clearer picture of what you can expect from a treatment.Primary study objectives
Graft Failure or Rejection
Secondary study objectives
Post-transplant severe morbidity and mortality
Other study objectives
Graft Versus Host Disease
Leukemic Relapse
Secondary malignancies
Awards & Highlights
No Placebo-Only Group
All patients enrolled in this study will receive some form of active treatment.
Trial Design
3Treatment groups
Experimental Treatment
Group I: Arm C: High Risk PatientsExperimental Treatment6 Interventions
Patients 19 years old or older with marrow aplasia or MDS or AML will receive intravenous busulfan (4 doses x 2 days), cyclophosphamide (4 doses x 4 days) and fludarabine (4 doses x 4 days). In this study, we will test whether outcomes can be improved, yet engraftment maintained, with a slightly reduced dose of busulfan. Patients will receive rabbit ATG (4 doses x 4 days) prior to and G-CSF post transplant to promote engraftment. Cyclosporine will not be used for GVHD prophylaxis. The source of the stem cells will be peripheral blood stem cells collected from donors treated with G-CSF. T-cell depletion will be performed by positive CD34 selection with the use of the Miltenyi system (CliniMACS device). The maximum number of patients enrolled will be 10.
Group II: Arm B: Intermediate Risk PatientsExperimental Treatment6 Interventions
Patients 18 years old or younger with MDS or AML will receive intravenous busulfan (4 doses x 2 days), cyclophosphamide (4 doses x 4 days) and fludarabine (4 doses x 4 days). Busulfan pharmacokinetics will be used in this arm, as the dose of busulfan is higher. All patients will receive rabbit ATG (thymoglobulin) (4 doses x 4 days) prior to and G-CSF post transplant to promote engraftment. Cyclosporine will not be used for prophylaxis against GVHD. The source of the stem cells for all patients will be peripheral blood stem cells induced and mobilized by treatment of the donor. T-cell will be performed by positive CD34 selection with the use of the Miltenyi system (CliniMACS device).
The maximum number of patients enrolled in this arm will be 10.
Group III: Arm A: Good Risk PatientsExperimental Treatment6 Interventions
Patients 18 years old or younger with marrow aplasia or single lineage cytopenias will be receive intravenous busulfan (4 doses x 2 days), cyclophosphamide (4 doses x 4 days) and fludarabine (4 doses x 4 days), as used in our most current study that led to \> 90% survival rates . Busulfan pharmacokinetics will not be used. All patients will receive rabbit ATG (4 doses x 4 days) prior to and granulocyte-colony stimulating factor (G-CSF) after transplant to promote engraftment. Cyclosporine will not be used for GVHD prophylaxis. The source of the stem cells for all patients will be peripheral blood stem cells mobilized by treatment of the donor with G-CSF. T-cell depletion will be performed by positive CD34 selection with the use of the Miltenyi system (CliniMACS device). Enrollment on this arm will include up to 50 patients.
Treatment
First Studied
Drug Approval Stage
How many patients have taken this drug
G-CSF
2014
Completed Phase 4
~1610
Cyclophosphamide
2010
Completed Phase 4
~2310
Fludarabine
2012
Completed Phase 4
~1860
rabbit ATG
2013
N/A
~960
Busulfan
2008
Completed Phase 4
~1710
Find a Location
Who is running the clinical trial?
Children's Hospital Medical Center, CincinnatiLead Sponsor
839 Previous Clinical Trials
6,565,547 Total Patients Enrolled
9 Trials studying Fanconi Anemia
183 Patients Enrolled for Fanconi Anemia
Memorial Sloan Kettering Cancer CenterOTHER
1,977 Previous Clinical Trials
599,657 Total Patients Enrolled
4 Trials studying Fanconi Anemia
70 Patients Enrolled for Fanconi Anemia
Fred Hutchinson Cancer CenterOTHER
571 Previous Clinical Trials
1,340,901 Total Patients Enrolled
5 Trials studying Fanconi Anemia
81 Patients Enrolled for Fanconi Anemia
Media Library
Eligibility Criteria:
This trial includes the following eligibility criteria:- I have been diagnosed with Fanconi anemia.My heart, liver, kidneys, and lungs are functioning well.I am not pregnant or breastfeeding and agree to pregnancy tests and avoiding pregnancy while in the study.I have a severe blood disorder such as SAA, MDS, or AML.You have tested positive for HIV or HTLV infection.My gender or ethnic background does not limit my participation.I do not have any ongoing serious infections.I have leukemia that has spread to my brain.My donor matches me genetically but is not my sibling.I am mostly active and can care for myself.I am not pregnant or breastfeeding.
Research Study Groups:
This trial has the following groups:- Group 1: Arm C: High Risk Patients
- Group 2: Arm A: Good Risk Patients
- Group 3: Arm B: Intermediate Risk Patients
Awards:
This trial has 1 awards, including:- No Placebo-Only Group - All patients enrolled in this study will receive some form of active treatment.
Timeline:
This trial has the following timeline:- Screening: It may take up to 3 Weeks to process to see if you qualify in this trial.
- Treatment: The duration you will receive the treatment varies.
- Follow Ups: You may be asked to continue sharing information regarding the trial for 6 Months after you stop receiving the treatment.