Patients Treated for Wiskott-Aldrich Syndrome (WAS) Since 1990

Analysis of Patients Treated for Wiskott-Aldrich Syndrome Since January 1, 1990 (RDCRN PIDTC-6904)

Wiskott - Aldrich syndrome (WAS) is a rare serious medical condition that causes problems both with the immune system and with easy bruising and bleeding. The immune abnormalities cause patients with WAS to be very susceptible to infections. Depending on the specific type of primary immune deficiency diseases, there are effective treatments, including antibiotics, cellular therapy and gene therapy, but studies of large numbers of patients are needed to determine the full range of causes, natural history, or the best methods of treatment for long term success.

This multicenter study combines retrospective, prospective and cross-sectional analyses of the transplant experiences for patients with WAS who have already received HCT since 1990, or who will undergo Hematopoietic cell transplant (HCT) during the study period. The retrospective and prospective portions of the study will address the impact of a number of pre and post-transplant factors on post-transplant disease correction and ultimate benefit from HCT and the cross-sectional portion of the study will assess the benefit of HCT 2 years post-HCT in consenting surviving patients.

Study Overview

Status

Completed

Study Type

Observational

Enrollment (Actual)

305

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Alberta
      • Calgary, Alberta, Canada, T3B 6A8
        • Alberta Children's Hospital
    • British Columbia
      • Vancouver, British Columbia, Canada, V6H 3V4
        • Children's & Women's Health Centre of British Columbia
    • Manitoba
      • Winnipeg, Manitoba, Canada, R3E 0V9
        • Cancer Care Manitoba, University of Manitoba
    • Ontario
      • Toronto, Ontario, Canada, M5G 1XB
        • The Hospital for Sick Children
    • Quebec
      • Montreal, Quebec, Canada, H3T 1C5
        • CHU Sainte-Justine, Department of Pediatrics, University of Montreal
    • Alabama
      • Birmingham, Alabama, United States, 35233
        • Department of Pediatrics, University of Alabama at Birmingham
    • Arizona
      • Phoenix, Arizona, United States, 85016
        • Phoenix Children's Hospital
    • California
      • Los Angeles, California, United States, 90027
        • Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California
      • Los Angeles, California, United States, 90095-1752
        • Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles,
      • Palo Alto, California, United States, 94304
        • Lucile Salter Packard Children's Hospital at Stanford
      • San Francisco, California, United States, 94143-1278
        • University of California, San Francisco Benioff Children's Hospital
    • Colorado
      • Denver, Colorado, United States, 80220
        • Children's Hospital Denver, University of Colorado
    • Delaware
      • Wilmington, Delaware, United States, 19803
        • Nemours Alfred I. Dupont Hospital for Children
    • District of Columbia
      • Washington, District of Columbia, United States, 20010-2970
        • Children's National Hospital-George Washington University School of Medicine and Health Sciences
    • Florida
      • Saint Petersburg, Florida, United States, 33701
        • Blood and Marrow Transplant Program, Johns Hopkins All Children's Hospital
    • Georgia
      • Atlanta, Georgia, United States, 30322
        • Aflac Cancer and Blood Disorders Center, Emory/Children's Healthcare of Atlanta
    • Illinois
      • Chicago, Illinois, United States, 60614
        • Ann & Robert H. Lurie Children's Hospital of Chicago
    • Louisiana
      • New Orleans, Louisiana, United States, 70118
        • Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • Boston Children's Hospital
    • Michigan
      • Ann Arbor, Michigan, United States, 48109
        • Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan
    • Minnesota
      • Minneapolis, Minnesota, United States, 55455
        • Division of Pediatric Blood and Marrow Transplantation, University of Minnesota
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic Children's Center
    • Missouri
      • Saint Louis, Missouri, United States, 63104
        • Cardinal Glennon Children's Hospital, Saint Louis University
      • Saint Louis, Missouri, United States, 63110
        • Saint Louis Children's Hospital, Washington University
    • New Jersey
      • Hackensack, New Jersey, United States, 07601
        • Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center
    • New York
      • New York, New York, United States, 10065
        • Department of Pediatrics, Memorial Sloan Kettering Cancer Center
      • Rochester, New York, United States, 14642
        • Department of Pediatrics, Golisano Children's Hospital, University of Rochester
      • Valhalla, New York, United States, 10595
        • Maria Fareri Children's Hospital, New York Medical College
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University Medical Center
    • Ohio
      • Cincinnati, Ohio, United States, 45229-3039
        • Cincinnati Children's Hospital Medical Center, University of Cincinnati
      • Cleveland, Ohio, United States, 44106
        • Rainbow Babies and Children's Hospital
      • Columbus, Ohio, United States, 43205
        • Nationwide Children's Hospital
    • Oregon
      • Portland, Oregon, United States, 97239
        • Division of Pediatric Hematology/Oncology, Oregon Health and Science University
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Children's Hospital of Philadelphia, University of Pennsylvania
      • Pittsburgh, Pennsylvania, United States, 15224
        • University of Pittsburgh Children's Hospital of Pittsburgh
    • Tennessee
      • Memphis, Tennessee, United States, 38105
        • St. Jude Children's Research Hospital
    • Texas
      • Dallas, Texas, United States, 75390-9263
        • Pediatrics, University of Texas Southwestern Medical Center
      • Houston, Texas, United States, 77030-2399
        • Baylor College of Medicine Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital
      • San Antonio, Texas, United States, 78229
        • Texas Transplant Institute, Methodist Children's Hospital
    • Utah
      • Salt Lake City, Utah, United States, 84113
        • Primary Children's Hospital, University of Utah
    • Washington
      • Seattle, Washington, United States, 98109
        • Fred Hutchinson Cancer Research Center and University of Washington-Seattle Children's Hospital
    • Wisconsin
      • Madison, Wisconsin, United States, 53705-2275
        • American Family Children's Hospital, University of Wisconsin
      • Milwaukee, Wisconsin, United States, 53226
        • Children's Hospital of Wisconsin-Milwaukee

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Sampling Method

Non-Probability Sample

Study Population

Male WAS participants treated at consortium centers Since 1990

Description

Inclusion Criteria:

  • WAS participants will be defined as males who have:

    1. thrombocytopenia (< 100K) AND EITHER molecular diagnosis of WAS OR reduced WASP expression; OR
    2. thrombocytopenia (< 100K) AND positive family history consistent with WAS diagnosis; OR
    3. chronic thrombocytopenia (< 100K for minimum of 3 months) AND low mean platelet volume (MPV below normal range for age) AND EITHER recurrent and/or severe infections requiring treatment and/or eczema OR lack of antibody response to polysaccharide antigens or low IgM.
  • Longitudinal Analysis (Retrospective and Prospective)

    1. Stratum A. Participants with WAS who have or will Receive HCT

      • Participants with WAS who have received an HCT since January 1, 1990
    2. Stratum B. Participants with WAS who have or will Receive Gene Transfer

      • Participants in which the intention is to treat with gene transfer with autologous modified cells
  • Cross-Sectional Analysis (Strata A and B) 1. Participants with WAS who are surviving and at least 2 years after the most recent HCT or gene therapy.

Exclusion Criteria:

  • As this is a natural history study, for both the Longitudinal Analysis and the Cross-Sectional Analysis we will not exclude any patients due to race or age who fit the inclusion criteria.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Retrospective Cohort (Longitudinal Analysis)
Participants with WAS treated at consortium centers since 1990 who have received transplant (Stratum A) or gene therapy (Stratum B)
Prospective Cohort (Longitudinal Analysis)
Participants treated at consortium centers since 1990 who will receive transplant (Stratum A) or gene therapy (Stratum B)
Cross-Sectional Cohort (Cross-sectional Analysis)
Living participants with WAS who have received transplant (Stratum A) or gene therapy (Stratum B) at Consortium Centers 1990-Present And >= 2 Years Post-Transplant

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Longitudinal Analysis: Overall Survival From Time of HCT/Gene Therapy
Time Frame: an expected average of 5 years
The event analyzed is death from any cause. The time to this event is the time from HCT/gene therapy to death or last follow-up.
an expected average of 5 years
Cross-Sectional Analysis: Proportion of Participants Achieving Full T Cell Reconstitution
Time Frame: an expected average of 5 years

Full T cell reconstitution is defined by all of the following:

  • CD3 cell count within normal range for age.
  • CD4 cell count within normal range for age.
  • CD8 cell count within normal range for age
  • Donor T cell chimerism > 95%
  • Lymphocyte proliferation to PHA. Proliferative responses to PHA within the normal range (at or above the lower limit of normal).

When possible the proliferation to PHA should be calculated as a percentage of the lower limit of normal controls for that laboratory; alternatively, the lower limit of normal controls for the day may be used

an expected average of 5 years
Cross-Sectional Analysis: Proportion of Participants Achieving Full B Cell Reconstitution
Time Frame: an expected average of 5 years

Full B cell reconstitution is defined by all of the following:

  • Quantitative immunoglobulins (IgG, IgM, and IgA) within normal range; each immunoglobulin level will be assessed separately.
  • Serologic confirmation of post immunization tetanus titer in protective range.
  • Serologic confirmation of post immunization pneumococcal titers in protective range (protective titers for > 50% of the serotypes contained in the vaccine) following immunization
an expected average of 5 years
Cross-Sectional Analysis: Proportion of Participants Achieving Resolution of thrombocytopenia
Time Frame: an expected average of 5 years
Resolution of thrombocytopenia defined by Platelets ≥ 150,000/microliter (transfusion independent for at least 7 consecutive days)
an expected average of 5 years
Cross-Sectional Analysis: Day of Recovery of Absolute Neutrophil Count (ANC) to 500 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Absolute Neutrophil Count (ANC) to 500 / uL is defined as the first day of at least 3 different days the ANC is measured as 500 / uL or greater
an expected average of 5 years
Cross-sectional Analysis: Day of Recovery of Platelet Count to 20,000 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Platelet Count to 20,000 / uL is defined as the first day of at least 3 laboratory values obtained on different days where the platelet count was measured as 20,000 / uL or greater, AND without platelet transfusions for at least 7 consecutive days immediately preceding this day.
an expected average of 5 years
Cross-sectional Analysis: Day of Recovery of Platelet Count to 50,000 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Platelet Count to 50,000 / uL is defined as the first day of at least 3 laboratory values obtained on different days where the platelet count was measured as 50,000 / uL or greater, AND without platelet transfusions for at least 7 consecutive days immediately preceding this day.
an expected average of 5 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Longitudinal Analysis: Proportion of Participants Achieving Hematologic Reconstitution
Time Frame: an expected average of 5 years

Hematologic Reconstitution is defined as attainment of each of the following lab test values:

  • Hemoglobin within normal range for age
  • WBC count within normal range for age
  • Absolute neutrophil count (ANC) within normal range for age
  • Platelet count ≥ 150,000/microL and without transfusion for at least 7 consecutive days
an expected average of 5 years
Longitudinal Analysis: Day of Recovery of Absolute Neutrophil Count (ANC) to 500 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Absolute Neutrophil Count (ANC) to 500 / uL is defined as the first day of at least 3 different days the ANC is measured as 500 / uL or greater.
an expected average of 5 years
Longitudinal Analysis: Day of Recovery of Platelet Count to 20,000 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Platelet Count to 20,000 / uL is defined as the first day of at least 3 laboratory values obtained on different days where the platelet count was measured as 20,000 / uL or greater, AND without platelet transfusions for at least 7 consecutive days immediately preceding this day.
an expected average of 5 years
Longitudinal Analysis: Day of Recovery of Platelet Count to 50,000 / uL
Time Frame: an expected average of 5 years
Day of Recovery of Platelet Count to 50,000 / uL is defined as the first day of at least 3 laboratory values obtained on different days where the platelet count was measured as 50,000 / uL or greater, AND without platelet transfusions for at least 7 consecutive days immediately preceding this day.
an expected average of 5 years
Longitudinal Analysis: Proportion of Participants Achieving Full T Cell Immune Reconstitution
Time Frame: an expected average of 5 years
  • Absolute CD3 T cell count within normal range for age
  • Absolute CD4 T cell count within normal range for age
  • Absolute CD8 T cell count within normal range for age
  • Proliferative responses to PHA within the normal range (at or above the lower limit of normal).
  • When possible the proliferation to PHA should be calculated as a percentage of the lower limit of normal controls for that laboratory; alternatively, the lower limit of normal controls for the day may be used.
an expected average of 5 years
Longitudinal Analysis: Proportion of Participants Achieving Full B Cell Immune Reconstitution
Time Frame: an expected average of 5 years
  • Quantitative immunoglobulins (IgG, IgM, and IgA) within normal range for age; each immunoglobulin level will be assessed separately.
  • Serologic confirmation of post immunization tetanus titer in protective range.
  • Serologic confirmation of post immunization pneumococcal titers in protective range (protective titers for > 50% of the serotypes contained in the vaccine) following immunization.
  • Patients who remain on IVIG will be considered not B cell reconstituted.
  • Normalization of isohemagglutinin titers.
an expected average of 5 years
Longitudinal Analysis: State of Lineage Specific Chimerism (HCT Stratum)
Time Frame: an expected average of 5 years
Peripheral blood chimerism will be assessed by FISH XX/XY, STRs, or WASP expression.
an expected average of 5 years
Longitudinal Analysis: Definition of Graft Failure / Rejection
Time Frame: an expected average of 5 years
  • Less than 5% of donor cells in all lineages or in whole blood by 100 days post-HCT using standard PCR based or in situ hybridization techniques OR
  • Second transplant by 100 days post-HCT (unless > 5% CD3 and purpose is to boost immune recovery).

Failure to achieve ≥5% donor cells in all lineages or in whole blood by 100 days post-HCT will be defined as graft failure/rejection. Patients who receive a second transplant by day 100 will be considered graft failure.

an expected average of 5 years
Longitudinal Analysis: Severe bleeding episodes
Time Frame: an expected average of 5 years
Any severe bleeding episode requiring platelet and/or RBC transfusion(s)
an expected average of 5 years
Longitudinal Analysis: Malignancy
Time Frame: an expected average of 5 years
New onset or relapse of lymphoid malignancy confirmed by relevant pathologic and genetic features.
an expected average of 5 years
Longitudinal Analysis: Growth
Time Frame: an expected average of 5 years
Z score of weight and height pre-HCT/gene therapy and post-HCT/gene therapy.
an expected average of 5 years
Longitudinal Analysis: Incidence of Acute GVHD
Time Frame: an expected average of 5 years
The occurrence of skin, gastrointestinal or liver abnormalities fulfilling the Consensus criteria of Grades IIIV or grades III-IV acute GVHD1 are considered events. Death is a competing risk, and patients alive without acute GVHD will be censored at the time of last follow-up.
an expected average of 5 years
Longitudinal Analysis: Incidence of Chronic GVHD
Time Frame: an expected average of 5 years
Chronic GVHD will be graded as limited or extensive.2 Occurrence of symptoms in any organ system that meet the criteria of chronic GVHD will be recorded. Death is a competing risk, and patients alive without chronic GVHD will be censored at time of last follow-up.
an expected average of 5 years
Longitudinal Analysis: Autoimmunity disorders
Time Frame: an expected average of 5 years
Incidence of documented autoimmunity disorders
an expected average of 5 years
Longitudinal Analysis: Infections / blood borne infections
Time Frame: an expected average of 5 years
  1. Clinical resolution of any pre-HCT opportunistic infections including but not limited to CMV, HSV1, adenovirus, EBV, and VZV. Approximate time to resolution (clinically well, off treatment, and/or negative culture/PCR assay) will be measured from the day of HCT.
  2. Incidence of documented severe (requiring hospitalization or resulting in death) and/or recurrent bacterial, viral or fungal infection post HCT. These will be reported by site of disease, organism, date of onset post HCT, and whether or not the infection resolved.
  3. Presence and resolution of severe warts (verruca vulgaris, flat warts) from the day of HCT. Whether the subject had complete resolution, partial resolution, persistent or recurrent warts will be recorded.
  4. New episodes of infections due to meningococcus, pneumococcus or hemophilus.
  5. Lymphoproliferative disease due to EBV.
an expected average of 5 years
Cross-sectional Analysis: Current State of Lineage Specific Chimerism (HCT Stratum)
Time Frame: an expected average of 5 years
Peripheral blood donor chimerism will be assessed by FISH XX/XY, STR, and/or WASP expression
an expected average of 5 years
Cross-sectional Analysis: Current frequency and severity of infections
Time Frame: an expected average of 5 years
an expected average of 5 years
Cross-sectional Analysis: Current Status of Growth
Time Frame: an expected average of 5 years
Current Z score of weight and height pre-HCT/gene therapy and post-HCT/gene therapy.
an expected average of 5 years
Cross-Sectional Analysis: Graft-versus-host Disease (GvHD)
Time Frame: an expected average of 5 years
Presence of chronic GVHD, current assessment; graded as limited or extensive
an expected average of 5 years
Cross-Sectional Analysis: Autoimmunity Disorders
Time Frame: an expected average of 5 years
Presence of autoimmunity disorders
an expected average of 5 years
Cross-sectional Analysis: Severe Bleeding Episodes
Time Frame: an expected average of 5 years
Any severe bleeding episode requiring platelet and/or RBC transfusion(s) during the previous year.
an expected average of 5 years
Cross-sectional Analysis: fertility
Time Frame: an expected average of 5 years
Whether the subject has biological offspring will be recorded.
an expected average of 5 years
Cross-sectional Analysis: malignancy
Time Frame: an expected average of 5 years
New onset or relapse of lymphoid malignancy confirmed by relevant pathologic and genetic features.
an expected average of 5 years
Cross-sectional Analysis: Quality of Life Questionnaire
Time Frame: an expected average of 5 years
Age appropriate testing will be performed at the cross-sectional visit inpatients surviving at least two years post-transplant
an expected average of 5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Study Chair: Lauri M. Burroughs, MD, Fred Hutchinson Cancer Center
  • Study Chair: David J. Rawlings, MD, Department of Pediatrics, University of Washington-Seattle Children's Hospital
  • Study Chair: Luigi D. Notarangelo, MD, National Institute of Allergy and Infectious Diseases, NIH
  • Study Chair: Alexandra H. Filipovich, MD, Children's Hospital Medical Center, Cincinnati

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 2, 2014

Primary Completion (Actual)

May 1, 2019

Study Completion (Actual)

May 1, 2019

Study Registration Dates

First Submitted

February 13, 2014

First Submitted That Met QC Criteria

February 14, 2014

First Posted (Estimate)

February 17, 2014

Study Record Updates

Last Update Posted (Actual)

August 10, 2020

Last Update Submitted That Met QC Criteria

August 6, 2020

Last Verified

August 1, 2020

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Wiskott-Aldrich Syndrome

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