- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02127905
Unrelated HSCT in Patients With Fanconi Anemia
A Study of Total Body Irradiation, Cyclophosphamide and Fludarabine Followed by Alternated Donor Hematopoietic Cell Transplantation in Patients With Fanconi Anemia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The major obstacle to successful alternate donor HCT for patients with Fanconi Anemia is graft failure. While T-cell depletion decreases the incidence of aGVHD, its effect on improving long term survival is unproven. To potentially improve engraftment rate, we have chosen a relatively new immunosuppressive agent, fludarabine (FLU), FLU is an antineoplastic agent that has been shown to be an effective immunosuppressive agen in BMT conditioning therapy. The addition of FLU to the commonly used preparative regimen of CY and TBU in Fanconi Anemia patients may improve engraftment rates.
Based on all presented data and its outcome, hematopoietic stem cell transplantation with the use of total body irradiation (450 cGy), cyclophosphamide (10 mg/kg IV) and fludarabine (35 mg/m2 IV) as preparative cytoreductive therapy has become the standard treatment for the hematologic manifestations of Fanconi Anemia at CHLA. However, the use of Isolex 300i will be replaced by CliniMACS in processing T-cell depletion.
The CliniMACS CD34 Reagent System is an investigational medical device that has not yet been approved by the FDA. This device is used in vitro to select and enrich specific cell populations. When using the CliniMACS CD34 Reagent, the system selects CD34+ cells from heterogenous hematological cell populations for transplantation in cases where this is clinically indicated. Based on the gathered data, CliniMACS has not been a contributing factor in the toxicity of patients, although may have a potential of eliciting "antibody" reactions in some patients, the process has been of significant life-saving benefit as compared to the potential risks.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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California
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Los Angeles, California, United States, 90027
- Children's Hospital Los Angeles
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients must be > 2 months and < 21 years of age with a diagnosis of Fanconi anemia.
- Patients must have an HLA-A, B, DRB1 identical or 1 antigen mismatched related (non-sibling) or unrelated donor. Patients and donors will be typed for HLA-A and B using serological or molecular techniques and for DRB1 using high resolution molecular typing. (Patients with a 2 antigen mismatched related donor will be eligible for the protocol but evaluated separately).
- Patients with FA must have high risk genotype or aplastic anemia (AA) or myelodysplastic syndrome without excess blasts.
Aplastic anemia is defined as having at least one of the following:
- platelet count <20 x 109/L
- ANC <5 x 108/L
- Hgb <8 g/dL with at least one of the following:
- transfusion dependence
- supportive care toxicity
- Myelodysplastic syndrome with multilineage dysplasia with or without chromosomal anomalies.
- High risk genotype (e.g. IVS-4 or exon 14 FANCC mutations)
- Adequate major organ function including:
- Cardiac: ejection fraction >45%
- Renal: creatinine clearance >40 mL/min.
- Hepatic: no clinical evidence of hepatic failure (e.g. coagulopathy, ascites)
- Karnofsky performance status >70% or Lansky >50%
- Women of child bearing age must be using adequate birth control and have a negative pregnancy test.
Exclusion Criteria:
- Available HLA-genotypically identical related donor.
- The harvested marrow (prior to TCD) should contain a minimum of 2.5 x 108 nucleated cells/kg recipient body weight with a goal of >5.0 x 108 nucleated cells/kg recipient body weight.
- Positive lymphocytotoxic crossmatch against donor (T cells and B cells)
- History of gram negative sepsis or systemic fungal infection (proven or suspected based on radiographic studies).
- Myelodysplastic syndrome with excess blasts or leukemia.
- Active CNS leukemia at time of HCT.
- Malignant solid tumor (e.g. squamous cell carcinoma of the head/neck/cervix) within 2 years of HCT.
- Pregnant or lactating female.
- Prior radiation therapy preventing use of TBI 450 cGy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: CD34+ selected cells
use of unrelated bone marrow or peripheral blood for hematopoietic stem cell transplantation with CD34+ selected cells
|
Compassionate treatment of Fanconi Anemia patients with unrelated bone marrow or peripheral blood HSCT followed by the infusion of CD34+ selected cells using CliniMACS
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Event free survival post stem cell transplant
Time Frame: 5 years
|
Patients who are alive at 5 years post transplants with assessments at 30, 60, 90, 180 and yearly up to 5 years
|
5 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Peripheral blood CBC counts for engraftment evaluation
Time Frame: 3 years
|
Normalization of Hemoglobin, platelets and neutrophil count
|
3 years
|
Chimerism assay for engraftment evaluation
Time Frame: 3 years
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Assessment of chimerism by FISH or STR on peripheral blood and bone marrow
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3 years
|
Graft Versus Host Disease (GVHD) surveillance after HSCT
Time Frame: 3 years
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GHVD disease surveilance done by clinical evaluation, to include history, physical examination, specifically for rash, jaundice, liver dysfunction, nausea and vomiting, diarrhea and failure to thrive
|
3 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Neena Kapoor, M.D., Children's Hospital Los Angeles, University of Southern California
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Metabolic Diseases
- Kidney Diseases
- Urologic Diseases
- Bone Marrow Diseases
- Hematologic Diseases
- Genetic Diseases, Inborn
- DNA Repair-Deficiency Disorders
- Anemia, Hypoplastic, Congenital
- Anemia, Aplastic
- Congenital Bone Marrow Failure Syndromes
- Bone Marrow Failure Disorders
- Renal Tubular Transport, Inborn Errors
- Anemia
- Fanconi Syndrome
- Fanconi Anemia
Other Study ID Numbers
- CCI-10-00176
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Clinical Study Report (CSR)
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.
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