Bone Marrow Transplant From Donor Using Less Toxic Conditioning for Patient With High Risk Hemoglobinopathies

Allo SCT From HLA Haploidentical Related Donors Using Sub-Myeloablative Conditioning For Patients With High Risk Hemoglobinopathies: Hemo SS, Hemo SC, Hemo SB0/+ Thalassemia, Homozygous B0/+ Thalassemia or Severe B0/+ Thalassemia Variants

The major goal of this study is to determine the risks and benefits of stem cell transplants in combination with a newer, less toxic conditioning chemotherapy treatment in patients with severe sickle cell disease (SCD) or sickle hemoglobin variants (hemoglobin SC or hemoglobin SB0/+), or homozygous b0/+ thalassemia or severe B0/+ thalassemia variants. Participation in this project will be for one year, with follow up evaluations done every 6 months thereafter for 10 years or until participants are 18 years old.

Study Overview

• Status: Terminated
• Conditions: Sickle Cell Anemia; Thalassemia; Hemoglobinopathy
• Intervention / Treatment: Drug: FK506; Drug: FLUDARABINE; Drug: CAMPATH-IH; Procedure: Total Body Irradiation; Drug: G-SCF (Granulocyte-colony stimulating factor)

Detailed Description

To do the stem cell transplant, we must first kill most of the cells in the bone marrow that make the sickle hemoglobin or abnormal blood cells of severe beta thalassemia. We will do this by using a single dose of body irradiation and two drugs called Fludarabine and Campath-IH.

The treatment schedule is as follows:

Day - 6: Total body irradiation Day - 5: Fludarabine and Campath 1H Day - 4: Fludarabine and Campath 1H Day - 3: Fludarabine and Campath 1H Day - 2: Fludarabine and Campath 1H Day - 1: REST Day 0: Stem Cell Transplant (infusion)

After the drug treatment, participants will be given healthy stem cells from a related donor that partially matches their HLA (immune) type, most likely from a parent or sibling. This is known as the stem cell transplant.

The healthy stem cells will be put into a blood vein in the same way that transfusions are given. The cells then travel to the right places in the body, where they should grow and make new blood cells that do not sickle.

• Study Type: Interventional
• Enrollment: 15
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • The Methodist Hospital
    • Houston, Texas, United States, 77030
      • Texas Children's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 day to 65 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion:

• Patients with a haploidentical related HLA donor and hemoglobin SS, hemoglobin SC, or hemoglobin Sb0/+ thalassemia and at least one of the following conditions:

  1. previous central nervous system vaso-occlusive episode with or without residual neurologic findings;
  2. frequent painful vaso-occlusive episodes which significantly interfere with normal life activities and which necessitate chronic transfusion therapy;
  3. recurrent SCD chest syndrome events, which necessitate chronic transfusion therapy;
  4. severe anemia, which prevents acceptable quality of life and necessitates chronic transfusion therapy.
• Patients with a haploidentical related HLA donor and homozygous b0/+ thalassemia or severe variants of b0/+ thalassemia and require chronic transfusion therapy.
• Women of childbearing potential must have a negative pregnancy test.
• Between the ages of birth and 65 years.

Exclusion:

• HLA identical or 5/6 HLA matched sibling donor
• Biopsy proven chronic active hepatitis or portal fibrosis.
• SCD chronic lung disease > stage 3 Severe renal dysfunction defined as creatinine clearance <40 ml/min/1.73 M2.
• Severe cardiac dysfunction defined as shortening fraction <25%.
• HIV infection.
• Unspecified chronic toxicity serious enough to detrimentally affect the patient's capacity to tolerate Stem Cell Transplant.
• Patient or guardian(s) unable to understand the nature and risks inherent in the stem cell transplant process.
• Pregnant or lactating females and those unwilling to use acceptable contraception.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Collaborators and Investigators

• Sponsor: Baylor College of Medicine
• Collaborators: The Methodist Hospital Research Institute
• Investigators: Principal Investigator: Malcolm K. Brenner, MD, FRCP, Baylor College of Medicine

Study record dates

Study Major Dates

• Study Start: August 1, 2000
• Primary Completion (Actual): November 21, 2003
• Study Completion (Actual): November 21, 2003

Study Registration Dates

• First Submitted: June 26, 2002
• First Submitted That Met QC Criteria: June 26, 2002
• First Posted (Estimate): June 27, 2002

Study Record Updates

• Last Update Posted (Actual): January 18, 2020
• Last Update Submitted That Met QC Criteria: January 15, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Hematologic Diseases; Genetic Diseases, Inborn; Anemia; Anemia, Hemolytic, Congenital; Anemia, Hemolytic; Anemia, Sickle Cell; Thalassemia; Hemoglobinopathies; Physiological Effects of Drugs; Antineoplastic Agents; Immunologic Factors; Antineoplastic Agents, Immunological; Adjuvants, Immunologic; Lenograstim; Fludarabine; Alemtuzumab
• Other Study ID Numbers: H8750; Smallo