- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02928991
Fludarabine Based RIC for Bone Marrow Failure Syndromes
Fludarabine-Based Conditioning for Matched Related Donor Bone Marrow Transplantation in Patients With Bone Marrow Failure Syndromes
Study Overview
Status
Conditions
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Early Phase 1
Contacts and Locations
Study Contact
- Name: Patricia Hankins, RN
- Phone Number: 215-590-5168
- Email: hankinsp@chop.edu
Study Contact Backup
- Name: Meghan Rys, MS, CCRP
- Phone Number: 215-590-6625
- Email: rysm@chop.edu
Study Locations
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19104
- Recruiting
- Children's Hospital of Philadelphia
-
Principal Investigator:
- Timothy Olson, MD
-
Contact:
- Patricia Hankins, RN
- Phone Number: 215-590-5168
- Email: hankinsp@chop.edu
-
Contact:
- Meghan Rys, MS, CCRP
- Phone Number: 215-590-6625
- Email: rysm@chop.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Patients 0-22 years with acquired aplastic anemia or a diagnosed inherited bone marrow failure syndrome, and a fully Human leukocyte antigen (HLA)-matched (10/10) related donor.
Inclusion Criteria:
Patient:
- Ages 0-22 years at time of enrollment
Diseases:
Patients with severe or very severe acquired AA, defined by:
- Bone marrow biopsy demonstrating cellularity of <25% (at least 2 weeks from last dose of G-CSF), in addition to 2 of the following: absolute neutrophil count (ANC) <500/µL, platelets < 20,000/µL and absolute reticulocytes <40,000/µL
- Negative evaluation for inherited bone marrow failure conditions and negative evaluation for dysplasia or cytogenetic abnormalities associated with myelodysplastic syndromes
- Patients with concurrent paroxysmal nocturnal hemoglobinuria (PNH) clones are eligible, as long as they meet criteria for severe or very severe aplastic anemia as defined above
Patients with clinically diagnosed and/or genetically proven iBMF syndromes, resulting in chronic red blood cell or platelet-transfusion dependence and/or an absolute neutrophil count <500/µL. These disorders include, but are not limited to:
- Fanconi Anemia
- Dyskeratosis Congenita
- Severe Congenital Neutropenia
- Diamond-Blackfan Anemia
- Congenital Dyserythropoietic/Sideroblastic Anemias
- Congenital Amegakaryocytic Thrombocytopenia
- Shwachman-Diamond Syndrome
- Lansky or Karnofsky performance >60
- HLA matched related donor available.
- No active untreated infection
- Females of childbearing potential must have negative pregnancy test.
Organ Function:
- Serum creatinine <1.5xupper limit of normal for age Hepatic: Transaminases <5x normal
- Cardiac shortening fraction >27%
- Bilirubin <2.5x normal (unless elevation due to Gilberts disease).
Donor Selection Criteria:
- Donor selection will comply with U.S. Food and Drug Administration's Code of Federal Regulations
- Fully HLA-matched related donor.
- Donor must be at least 6 months of age
- Donor suitable for bone marrow collection and meets eligibility for donation, including fulfilling infectious disease criteria as per SOP, including HIV, Hepatitis B, Hepatitis C Polymerase chain reaction (PCR) negative.
- If subject has confirmed iBMF syndrome, donor must be evaluated for this disorder and testing must be negative
- Children's Hospital of Philadelphia (CHOP) bone marrow transplant (BMT) procedures apply for determining donor eligibility, including donor screening and testing for relevant communicable disease agents and diseases.
- Donor evaluation and collection procedure as per CHOP Standard Operating Procedures (SOP)
Exclusion Criteria:
- Uncontrolled bacterial, viral or fungal infections
- HLA matched related donor unable to donate bone marrow.
- No eligible fully HLA-matched related donor
- Pregnant females
- Patients with a clinical diagnosis of Myelodysplastic syndrome (MDS) defined by combination of bone marrow dysplasia and classic cytogenetic lesion (Monosomy 7, Trisomy 8 eg.), with or without excess blasts.
- Patients with PNH without underlying bone marrow aplasia
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Acquired Aplastic Anemia (AA)
Patients with severe or very severe acquired aplastic anemia (AA).
Patients will receive a matched related donor bone marrow transplant following reduced intensity conditioning (RIC) including thymoglobulin (ATG), fludarabine and dose-reduced cyclophosphamide.
|
Fludarabine: Dose: 30mg/m2/day (<10kg will receive 1mg/kg/day) Days: -7, -6, -5, -4, -3 Cyclophosphamide: Dose: 60mg/kg/day Days: -5, -4 Thymoglobulin: Dose: 3mg/kg/day Days: -4, -3, -2 Bone marrow infusion: Day 0 |
Experimental: Inherited Bone Marrow Failure Syndrome + Trilineage Aplasia
Patients with inherited bone marrow failure (iBMF) syndromes with trilineage aplasia includes those with diagnoses of Fanconi Anemia, Dyskeratosis Congenita, and related conditions.
Patients will receive a matched related donor bone marrow transplant following conditioning with fludarabine, cyclophosphamide, thymoglobulin.
|
Fludarabine: Dose: 30mg/m2/day (<10kg will receive 1mg/kg/day) Days: -7, -6, -5, -4, -3 Cyclophosphamide: Dose: 10 mg/kg/day Days: -6, -5, -4, -3 Thymoglobulin: Dose: 3mg/kg/day Days: -4, -3, -2 Bone marrow infusion: Day 0 |
Experimental: Inherited Bone Marrow Failure Syndrome no Trilineage Aplasia
Patients with inherited bone marrow failure (iBMF) syndromes without trilineage aplasia includes those with diagnoses of Severe Congenital Neutropenia, Diamond-Blackfan Anemia, and related conditions.
Patients will receive a matched related donor bone marrow transplant following conditioning with thymoglobulin, busulfan and fludarabine.
|
Fludarabine: Dose: 30mg/m2/day (<10kg will receive 1mg/kg/day) Days: -6, -5, -4, -3, -2 Busulfan: Dose: every 6 hours for a total of 12 doses with dosing adjustments to achieve a steady state concentration of 900-1200ng/mL OR daily for a total of 3 doses targeting AUC 3600-6000 (micromole/liter)*minute Days: -7, -6, -5, -4 Thymoglobulin: Dose: 3mg/kg/day Days: -10, -9, -8 Bone marrow infusion: Day 0 |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of graft failure
Time Frame: Up to 1 year post transplant
|
Combined rate of primary and secondary graft failure.
Primary graft failure is defined as no evidence of neutrophil engraftment by day +28 after stem cell infusion.
Secondary graft failure is defined as an ANC<100 for >7-10 days after initial engraftment occurs and is confirmed by hypocellular bone marrow biopsy and donor engraftment <20%.
|
Up to 1 year post transplant
|
Time to neutrophil engraftment
Time Frame: Up to 1 year post transplant
|
The time from the day of transplant until neutrophil engraftment, which is defined as the first day of ANC >500/ul for the first of 3 consecutive days.
|
Up to 1 year post transplant
|
Transplant-related mortality
Time Frame: Up to 100 days post transplant
|
Up to 100 days post transplant
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Rate of overall survival
Time Frame: Up to 1 year post transplant
|
Up to 1 year post transplant
|
Rate of disease free survival
Time Frame: Up to 1 year post transplant
|
Up to 1 year post transplant
|
Collaborators and Investigators
Investigators
- Principal Investigator: Timothy Olson, MD, PhD, Children's Hospital of Philadelphia
Study record dates
Study Major Dates
Study Start
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Anemia
- Anemia, Hemolytic
- Myelodysplastic Syndromes
- Syndrome
- Anemia, Aplastic
- Bone Marrow Failure Disorders
- Pancytopenia
- Hemoglobinuria, Paroxysmal
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Fludarabine
- Fludarabine phosphate
- Vidarabine
Other Study ID Numbers
- 14-011465
- 14BT057 (Other Identifier: Children's Hospital of Philadelphia)
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.
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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