N99-02: Melphalan and Buthionine Sulfoximine Followed by Bone Marrow or Peripheral Stem Cell Transplantation in Treating Children With Resistant or Recurrent Neuroblastoma
Status: Recruiting
Phase: Phase 1
Diagnosis: Pediatric Neuroblastoma
NCT ID: NCT00005835
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 09-225
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with bone marrow or peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of melphalan and buthionine sulfoximine followed by bone marrow or peripheral stem cell transplantation in treating children who have resistant or recurrent neuroblastoma.
Conducting Institutions:
Children's Hospital Boston, Dana-Farber Cancer Institute
Overall PI:
Suzanne Shusterman, MD,
Dana-Farber Cancer Institute
Site-responsible Investigators:
Contacts:
Dana-Farber Cancer Institute:
Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP,
ctip@partners.org
Eligibility Criteria
DISEASE CHARACTERISTICS:
- Diagnosis of high-risk neuroblastoma confirmed by histology and/or tumor cells in bone
marrow with elevated urinary catecholamine metabolites
- Meets 1 of the following response status criteria:
- Current or previous progressive disease
- Mixed or no response following completion of minimum of 4 courses of induction
therapy
- Meets 1 of the following criteria:
- Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by
conventional techniques OR ≥ 10 mm by spiral CT scan
- Metaiodobenzylguanidine (MIBG) scan with uptake at a minimum of one site
- Bone marrow disease documented by standard morphology of bilateral bone marrow
aspirate and biopsy specimens
- Documentation by positive immunocytology is not sufficient
- Biopsy of a lesion seen on bone scan that is non-avid for MIBG and that
demonstrates viable neuroblastoma
- Meets 1 of the following criteria for harvested autologous stem cells:
- Availability of at least 1.5 x 10^6 CD34-positive unpurged autologous peripheral
blood stem cells per kg of body weight*
- Availability of at least 1.0 x 10^6 viable CD34-positive purged autologous
peripheral blood stem cells per kg of body weight*
- A backup source of stem cells is required if there are < 1.5 x 10^6
CD34-positive viable cells/kg available for infusion
- Availability of at least 1 x 10^8 purged autologous mononuclear bone marrow cells
per kg of body weight* NOTE: *Product to be infused must have 0 tumor cells by
immunocytology
- No history of intraparenchymal brain lesion
- No concurrent intraparenchymal brain lesion or meningeal/parameningeal soft tissue
mass extending directly into the cranial cavity by CT, MRI, or metaiodobenzylguanidine
scan
PATIENT CHARACTERISTICS:
Age:
- Over 9 months to 30 years
Performance status:
- ECOG or Zubrod 0-1
Life expectancy:
- At least 2 months
Hematopoietic:
- Absolute neutrophil count at least 500/mm^3
- Platelet count at least 20,000/mm^3 (transfusion allowed)
- Hemoglobin at least 10 g/dL (transfusion allowed)
Hepatic:
- Bilirubin normal
- AST and ALT no greater than 2.5 times normal
- No active hepatitis if HIV positive
Renal:
- Glomerular filtration rate or creatinine clearance ≥ 100 mL/min
- Creatinine ≤ 1.5 times normal
Cardiovascular:
- Ejection fraction at least 55% by echocardiogram or MUGA scan OR
- Fractional shortening at least 30% by echocardiogram
Pulmonary:
- No dyspnea at rest or exercise intolerance
- No active pneumonia if HIV positive
Neurologic:
- No grade 1 or greater neurological function abnormality except grade 1 irritability,
headache, dizziness, insomnia, or somnolence (if due to narcotic analgesics)
- No history of seizures
Other:
- No other active health problems if HIV positive
- No concurrent neoplastic or nonneoplastic disease of any major organ system that would
preclude study participation
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- See Disease Characteristics
- At least 3 weeks since prior biologic therapy and recovered
Chemotherapy:
- At least 3 weeks since prior chemotherapy (6 weeks for mitomycin or nitrosoureas) and
recovered
- No other concurrent anticancer chemotherapy
Endocrine therapy:
- Not specified
Radiotherapy:
- Recovered from prior radiotherapy
- Prior diagnostic radiotherapy allowed
- More than 6 months since prior radiotherapy to mantle and Y ports
- More than 3 months since prior therapeutic metaiodobenzylguanidine (^131I-MIBG) and no
more than 20 mCl/kg total dose received
- At least 2 weeks since prior radiotherapy to all other sites
- More than 6 months since prior radiotherapy to kidneys, liver, heart, skull, or face
- No more than 25% of the liver can have received > 1800 cGy
- No more than 20% of one of the kidneys can have received > 1200 cGy
- No more than a 10 cc volume of the brain can have received > 1000 cGy
- No prior total body irradiation
- No prior total cranial or craniospinal radiotherapy
- No concurrent radiotherapy
Surgery:
- Not specified
Other:
- Recovered from any prior therapy
- At least 7 days since prior antibiotics, antifungals, or antivirals
- No acetaminophen or cephalosporin antibiotics for at least 7 days before, during, and
until at least 2 weeks after buthionine sulfoximine infusion
- No prophylactic antimicrobials (i.e., nystatin or sulfamethoxazole/trimethoprim) for
at least 7 days before, during, and until at least 7 days after buthionine sulfoximine
infusion
- No concurrent antiretroviral medications for HIV-positive patients