Myeloablative Conditioning, Prophylactic Defibrotide and Haplo AlloSCT for Patients With Sickle Cell Disease (NYMC-571)
The Safety and Efficacy of Prophylactic Defibrotide Administration in Children, Adolescents, and Young Adults With Sickle Cell Disease or Beta Thalassemia Following Myeloablative Conditioning (MAC) and Haploidentical or Matched Unrelated Donor (MUD) Stem Cell Transplantation Utilizing CD34 Enrichment and T-Cell (CD3) Addback
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Contact
Study Contact
- Name: Erin Morris, RN
- Phone Number: 714-964-5359
- Email: erin_morris@nymc.edu
Study Contact Backup
- Name: Mitchell S Cairo, MD
- Phone Number: 914-594-2150
- Email: Mitchell_Cairo@nymc.edu
Study Locations
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California
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Los Angeles, California, United States, 90095
- Recruiting
- University of California Los Angeles
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Principal Investigator:
- Theodore B Moore, MD
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Contact:
- Theodore B Moore, MD
- Phone Number: (310) 825-6708
- Email: tbmoore@mednet.ucla.edu
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Contact:
- Ricardo Ortega
- Phone Number: 310-794-8929
- Email: RicardoOrtega@mednet.ucla.edu
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Florida
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Gainesville, Florida, United States, 32610-0278
- Recruiting
- University of Florida
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Contact:
- Jordan Milner, MD
- Email: jordan.milner@peds.ufl.edu
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Contact:
- Giselle Moore-Higgs, PhD
- Email: mooregj@ufl.edu
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New York
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Valhalla, New York, United States, 10595
- Recruiting
- New York Medical College
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Contact:
- Erin Morris, RN
- Phone Number: 714-964-5359
- Email: erin_morris@nymc.edu
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Principal Investigator:
- Mitchell S Cairo, MD
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Contact:
- Megan Campbell, RN, PNP
- Phone Number: (914) 594-2154
- Email: Megan.Campbell@wmchealth.org
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Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Recruiting
- Medical College of Wisconsin
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Contact:
- Julie A Talano, MD
- Phone Number: 414-955-4185
- Email: jtalano@mcw.edu
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Principal Investigator:
- Julie A Talano, MD
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Contact:
- Meredith Beversdorf, BSN, RN
- Email: mbeversdorf@childrenswi.org
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Disease: Homozygous Hemoglobin S Disease, or Hemoglobin S B0/+ thalassemia, or Hemoglobin SC Disease, or Beta thalassemia intermedia/majora
- Patients must demonstrate one or more of the following Sickle Cell Disease Complications
- Clinically significant neurologic event (stroke) or any neurologic deficit lasting >24 hours that is accompanied by an infarct on cerebral MRI
- Acute chest syndrome in the preceding two year period prior to enrollment that have failed, been non-compliant or declined hydroxyurea treatment, or prior to chronic RBC transfusion therapy, exchange transfusion or erythrocyte pheresis.
- Recurrent painful events (at least 3 in the 2 years prior to enrollment or prior to chronic RBC transfusion therapy, exchange transfusion or erythrocyte pheresis).
- Abnormal TCD study requiring starting on chronic transfusion therapy and/or exchange transfusions.
- At least one silent infarct lesion on a MRI scan of the head. Or (directly or probably related to SCD)
- Sickle Cell nephropathy;
- Splenic sequestration requiring RBC transfusion;
- Aplastic crisis requiring RBC transfusion;
- Avascular necrosis of the hip diagnosed by MRI;
- Two episodes or more of leg ulcerations;
- Recurrent priapism .
- Infant dactylitis.
- all patients must meet disease, age, organ function and donor criteria;
Exclusion Criteria:
- Patients who are receiving concomitant systemic anticoagulants and/or fibrinolytic therapies.
- Patients with a previously known hypersensitivity reaction to defibrotide.
- Females who are pregnant or breast-feeding are not eligible
- Patients with documented uncontrolled infection at the time of study entry are not eligible.
- Patients who have an unaffected HLA matched sibling donor willing to proceed to donation will not be eligible for this study.
- Karnofsky or Lansky (age appropriate) Performance Score <50% (hemiplegia alone secondary to a previous stroke is not an exclusion)
- Demonstrated lack of compliance with medical care.
- Patients with clinically significant fibrosis or cirrhosis of the liver will not be eligible.
- Patients who have previously received a HSCT will not be eligible.
- Patients with contraindications to the use of defibrotide
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Defibrotide prophylaxis
defibrotide will be given prior to and during myeloablative immunotherapy conditioning (MAIC) followed by familial haploidentical (FHI) or matched unrelated donor (MUD) allogeneic stem cell transplantation (AlloSCT) with CD34 enrichment and t-cell addback in patients with high-risk sickle cell disease or beta thalassemia to reduced the risk and rate of the development of sinusoidal obstructive syndrome (SOS).
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defibrotide will be given prophylactically prior to AlloSCT to determine if it decreases the incidence of SOS in this high risk population, and determine that it is safe and feasible to give along with myeloimmunoablative therapy and allogeneic transplant.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
All patients will be monitored for known and unknown side effects of defibrotide with daily physical exams while in the hospital and then as needed in addition to daily laboratory values including chemistries, hematology labs as needed
Time Frame: 100 days
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Patients will be given Defibrotide prophylaxis starting 10 days before the stem cell infusion at 6.25 mg/kg IV q6h and continue through Day +21.
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100 days
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All patients will be monitored for the development of SOS.
Time Frame: 1 year
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All patients will get daily lab values while in patients and then as needed to monitor for elevation in liver function tests and other abnormal chemistry or hematology values.
Imaging on the liver will be performed as needed to determine if they develop SOS with defibrotide.
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1 year
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Mitchell Cairo, MD, New York Medical College
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Genetic Diseases, Inborn
- Hematologic Diseases
- Anemia, Hemolytic, Congenital
- Anemia, Hemolytic
- Anemia
- Hemoglobinopathies
- Congenital, Hereditary, and Neonatal Diseases and Abnormalities
- Hemic and Lymphatic Diseases
- Anemia, Sickle Cell
- Molecular Mechanisms of Pharmacological Action
- Fibrin Modulating Agents
- Fibrinolytic Agents
- Platelet Aggregation Inhibitors
- defibrotide
Other Study ID Numbers
Other Study ID Numbers
- NYMC 571
- 7837 (Other Grant/Funding Number: OPD)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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