- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03145545
Expanded Access Protocol Using Alpha/Beta T and CD19+ Depleted PBSC
Expanded Access Protocol Using TCR Alpha/Beta T Cell/CD19+ Depleted Donor Peripheral Stem Cells
Study Overview
Status
Intervention / Treatment
Detailed Description
Study Type
Expanded Access Type
- Treatment IND/Protocol
Contacts and Locations
Study Locations
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-
Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Available
- Children's Hospital of Philadelphia
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
PATIENT AND DONOR ELIGIBILITY
Enrollment on this study includes patients undergoing a primary or non emergent subsequent hematopoietic stem cell transplant, an urgent subsequent transplant in the setting of graft failure or marrow aplasia, or an unconditioned stem cell boost for graft dysfunction or declining donor chimerism. Differences in eligibility criteria among these scenarios are outlined below.
Inclusion Criteria: Applicable to all Subjects
- Signed, informed consent
- Participants of childbearing potential must have a negative pregnancy test as per institutional SOP
- Patients who do not meet criteria for current open, institutional protocols using CliniMACs device for β T/CD19+ depletion
Patients with the following transplantable diseases:
- Non-malignant diseases
- Metabolic storage diseases correctable by HSCT
- Bone marrow failure syndromes
- Immunodeficiencies/immune dysregulation syndromes
- Sickle cell disease or thalassemia
Other diseases treated with HSCT
o Malignant diseases
- Acute leukemias
- Chronic leukemias
- Lymphomas
- Myelodyplastic syndrome
Inclusion Criteria: Primary transplant or non-emergent subsequent transplant
The conditioning prescribed to the patient will be determined based on the disease and organ status and will include agents that are standard. Appropriate combinations of chemotherapy, immunotherapy and/or radiation will be determined on an individual basis. Patient eligibility will be assessed as per our current institutional standard operating procedures. Patients that meet the following criteria may be eligible:
- Lansky or Karnofsky performance ≥ 60
- Hematologic and Organ Function as per current institutional SOP
- Infectious Evaluation as per current institutional SOP
Inclusion Criteria: Urgent subsequent transplant, with conditioning, in the setting of graft failure or severe marrow dysfunction
For subjects undergoing an urgent subsequent transplant, conditioning will be individualized based on the underlying disease, prior transplant history, and current organ function. Subjects with the following may be eligible:
- Adequate organ function as determined by the transplant physician to safely tolerate the planned conditioning regimen
- No active, uncontrolled infection
- Patients whose initial transplant was performed under this protocol, under another clinical protocol, or using a bone marrow graft
- Previously collected TCRαβ/CD19 depleted stem cells from this or another approved protocol may be used if available.
Inclusion Criteria: Unconditioned Stem Cell Boost/Transplant These subjects will not be required to meet the performance status, hematologic and organ function, or infectious evaluation criteria listed above, as conditioning will not be administered.
- Patients with cytopenias due to bone marrow dysfunction, declining donor chimerism, or other treatment needs as determined by the subject's clinical course
- Patients with active infections are eligible, as the stem cell boost will be administered without conditioning
- Previously collected TCRαβ/CD19 depleted stem cells from this or another approved protocol may be used if available.
- Patients who received their initial transplant either on this protocol or on a separate protocol
Exclusion Criteria: Applicable to all Subjects
- Suitable and available HLA matched sibling donor. However, patients with fully matched related donors (including siblings) may be eligible in special circumstances where use of an unmanipulated bone marrow graft has increased risks for donor or recipient.
- Donor unable to donate peripheral stem cells
- Pregnant participants
Donor Eligibility Patients must have an identified living donor
- Donor selection will comply with 21 CFR 1271*
- Unrelated donor that meets the matching criteria of the NMDP with allele matching at HLA -A, -B, -C, -DRB1, and -DQB1: Unrelated donors may be a 10/10 match, a 9/10 match, or an 8/10 match if one of the mismatches is at DQB1.
- Related donor mismatched at one to five HLA alleles (haploidentical)
- Matched related donor may be considered suitable donors for this protocol if a peripheral stem cell donation is deemed by the clinical team to be a safer donation option (if donor is not a suitable candidate for a bone marrow harvest) or if there is concern that bone marrow harvest would not yield adequate cell doses Additionally, a matched related donor would be considered suitable for this protocol if there are safety concerns regarding a patient receiving a standard T cell replete bone marrow transplant due to individualized GVHD risk or risk related to standard GVHD prevention medications.
- Donor suitable for mobilization of peripheral stem cells and apheresis and fulfills infectious disease criteria as per our institutional SOP, including HIV, HepB, HepC PCR negative.
- We assess donor eligibility as per our Allogenic Donor Evaluation for Eligibility standard operating procedure. These procedures apply for determining donor eligibility, including donor screening and testing for relevant communicable disease agents and diseases. Our donor collection program is FACT accredited.
- Related donors will be consented and enrolled under IRB approved research protocol for cell collection per IRB 04-004078 CHP 784 Clinical and Research Collection and Future Research Use of Bone Marrow, Stem Cells or T Cells.
- Unrelated donor identified through the National Marrow Donor Program (NMDP) and fulfills the NMDP criteria for donation. Unrelated donor willing and able to undergo mobilization of peripheral stem cells and apheresis.
- The donors selected for this IDE will either be unrelated donors identified through the National Marrow Donor Program (NMDP) or related donors. Regarding the unrelated donors, NMDP procedures for determining donor eligibility include donor screening and testing for relevant communicable disease agents and diseases
Study Plan
How is the study designed?
Collaborators and Investigators
Investigators
- Principal Investigator: Tim Olson, MD, PhD, Children's Hospital of Philadelphia
Publications and helpful links
General Publications
- Bertaina A, Merli P, Rutella S, Pagliara D, Bernardo ME, Masetti R, Pende D, Falco M, Handgretinger R, Moretta F, Lucarelli B, Brescia LP, Li Pira G, Testi M, Cancrini C, Kabbara N, Carsetti R, Finocchi A, Moretta A, Moretta L, Locatelli F. HLA-haploidentical stem cell transplantation after removal of alphabeta+ T and B cells in children with nonmalignant disorders. Blood. 2014 Jul 31;124(5):822-6. doi: 10.1182/blood-2014-03-563817. Epub 2014 May 28.
- Bethge WA, Faul C, Bornhauser M, Stuhler G, Beelen DW, Lang P, Stelljes M, Vogel W, Hagele M, Handgretinger R, Kanz L. Haploidentical allogeneic hematopoietic cell transplantation in adults using CD3/CD19 depletion and reduced intensity conditioning: an update. Blood Cells Mol Dis. 2008 Jan-Feb;40(1):13-9. doi: 10.1016/j.bcmd.2007.07.001. Epub 2007 Sep 14.
- Handgretinger R. Negative depletion of CD3(+) and TcRalphabeta(+) T cells. Curr Opin Hematol. 2012 Nov;19(6):434-9. doi: 10.1097/MOH.0b013e3283582340.
- Godder KT, Henslee-Downey PJ, Mehta J, Park BS, Chiang KY, Abhyankar S, Lamb LS. Long term disease-free survival in acute leukemia patients recovering with increased gammadelta T cells after partially mismatched related donor bone marrow transplantation. Bone Marrow Transplant. 2007 Jun;39(12):751-7. doi: 10.1038/sj.bmt.1705650. Epub 2007 Apr 23.
- Bunin N, Aplenc R, Grupp S, Pierson G, Monos D. Unrelated donor or partially matched related donor peripheral stem cell transplant with CD34+ selection and CD3+ addback for pediatric patients with leukemias. Bone Marrow Transplant. 2006 Jan;37(2):143-9. doi: 10.1038/sj.bmt.1705211.
- Barfield RC, Otto M, Houston J, Holladay M, Geiger T, Martin J, Leimig T, Gordon P, Chen X, Handgretinger R. A one-step large-scale method for T- and B-cell depletion of mobilized PBSC for allogeneic transplantation. Cytotherapy. 2004;6(1):1-6. doi: 10.1080/14653240310004411.
- Starr TK, Jameson SC, Hogquist KA. Positive and negative selection of T cells. Annu Rev Immunol. 2003;21:139-76. doi: 10.1146/annurev.immunol.21.120601.141107. Epub 2002 Oct 16.
- Vodanovic-Jankovic S, Drobyski WR. Gammadelta T cells do not require fully functional cytotoxic pathways or the ability to recognize recipient alloantigens to prevent graft rejection. Biol Blood Marrow Transplant. 2006 Nov;12(11):1125-34. doi: 10.1016/j.bbmt.2006.08.033.
- Drobyski WR, Vodanovic-Jankovic S, Klein J. Adoptively transferred gamma delta T cells indirectly regulate murine graft-versus-host reactivity following donor leukocyte infusion therapy in mice. J Immunol. 2000 Aug 1;165(3):1634-40. doi: 10.4049/jimmunol.165.3.1634.
- Drobyski WR, Majewski D, Hanson G. Graft-facilitating doses of ex vivo activated gammadelta T cells do not cause lethal murine graft-vs.-host disease. Biol Blood Marrow Transplant. 1999;5(4):222-30. doi: 10.1053/bbmt.1999.v5.pm10465102.
- Drobyski WR, Majewski D. Donor gamma delta T lymphocytes promote allogeneic engraftment across the major histocompatibility barrier in mice. Blood. 1997 Feb 1;89(3):1100-9.
- Wilhelm M, Kunzmann V, Eckstein S, Reimer P, Weissinger F, Ruediger T, Tony HP. Gammadelta T cells for immune therapy of patients with lymphoid malignancies. Blood. 2003 Jul 1;102(1):200-6. doi: 10.1182/blood-2002-12-3665. Epub 2003 Mar 6.
- Gertner-Dardenne J, Castellano R, Mamessier E, Garbit S, Kochbati E, Etienne A, Charbonnier A, Collette Y, Vey N, Olive D. Human Vgamma9Vdelta2 T cells specifically recognize and kill acute myeloid leukemic blasts. J Immunol. 2012 May 1;188(9):4701-8. doi: 10.4049/jimmunol.1103710. Epub 2012 Mar 30.
- Bonneville M, O'Brien RL, Born WK. Gammadelta T cell effector functions: a blend of innate programming and acquired plasticity. Nat Rev Immunol. 2010 Jul;10(7):467-78. doi: 10.1038/nri2781. Epub 2010 Jun 11.
- Chaleff S, Otto M, Barfield RC, Leimig T, Iyengar R, Martin J, Holiday M, Houston J, Geiger T, Huppert V, Handgretinger R. A large-scale method for the selective depletion of alphabeta T lymphocytes from PBSC for allogeneic transplantation. Cytotherapy. 2007;9(8):746-54. doi: 10.1080/14653240701644000. Epub 2007 Oct 4.
- Beatty PG, Anasetti C, Hansen JA, Longton GM, Sanders JE, Martin PJ, Mickelson EM, Choo SY, Petersdorf EW, Pepe MS, et al. Marrow transplantation from unrelated donors for treatment of hematologic malignancies: effect of mismatching for one HLA locus. Blood. 1993 Jan 1;81(1):249-53.
- Speiser DE, Tiercy JM, Rufer N, Grundschober C, Gratwohl A, Chapuis B, Helg C, Loliger CC, Siren MK, Roosnek E, Jeannet M. High resolution HLA matching associated with decreased mortality after unrelated bone marrow transplantation. Blood. 1996 May 15;87(10):4455-62.
- Davies SM, Shu XO, Blazar BR, Filipovich AH, Kersey JH, Krivit W, McCullough J, Miller WJ, Ramsay NK, Segall M, et al. Unrelated donor bone marrow transplantation: influence of HLA A and B incompatibility on outcome. Blood. 1995 Aug 15;86(4):1636-42.
- Flomenberg N, Baxter-Lowe LA, Confer D, Fernandez-Vina M, Filipovich A, Horowitz M, Hurley C, Kollman C, Anasetti C, Noreen H, Begovich A, Hildebrand W, Petersdorf E, Schmeckpeper B, Setterholm M, Trachtenberg E, Williams T, Yunis E, Weisdorf D. Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood. 2004 Oct 1;104(7):1923-30. doi: 10.1182/blood-2004-03-0803. Epub 2004 Jun 10.
- Ash RC, Casper JT, Chitambar CR, Hansen R, Bunin N, Truitt RL, Lawton C, Murray K, Hunter J, Baxter-Lowe LA, et al. Successful allogeneic transplantation of T-cell-depleted bone marrow from closely HLA-matched unrelated donors. N Engl J Med. 1990 Feb 22;322(8):485-94. doi: 10.1056/NEJM199002223220801.
- Bunin N, Aplenc R, Iannone R, Leahey A, Grupp S, Monos D, Pierson G. Unrelated donor bone marrow transplantation for children with severe aplastic anemia: minimal GVHD and durable engraftment with partial T cell depletion. Bone Marrow Transplant. 2005 Feb;35(4):369-73. doi: 10.1038/sj.bmt.1704803.
- Camitta B, Ash R, Menitove J, Murray K, Lawton C, Hunter J, Casper J. Bone marrow transplantation for children with severe aplastic anemia: use of donors other than HLA-identical siblings. Blood. 1989 Oct;74(5):1852-7.
- Handgretinger R, Lang P. The history and future prospective of haplo-identical stem cell transplantation. Cytotherapy. 2008;10(5):443-51. doi: 10.1080/14653240802251507.
- Chen X, Hale GA, Barfield R, Benaim E, Leung WH, Knowles J, Horwitz EM, Woodard P, Kasow K, Yusuf U, Behm FG, Hayden RT, Shurtleff SA, Turner V, Srivastava DK, Handgretinger R. Rapid immune reconstitution after a reduced-intensity conditioning regimen and a CD3-depleted haploidentical stem cell graft for paediatric refractory haematological malignancies. Br J Haematol. 2006 Nov;135(4):524-32. doi: 10.1111/j.1365-2141.2006.06330.x. Epub 2006 Sep 28.
- Ciofani M, Zuniga-Pflucker JC. Determining gammadelta versus alphass T cell development. Nat Rev Immunol. 2010 Sep;10(9):657-63. doi: 10.1038/nri2820. Epub 2010 Aug 20.
- Chiplunkar S, Dhar S, Wesch D, Kabelitz D. gammadelta T cells in cancer immunotherapy: current status and future prospects. Immunotherapy. 2009 Jul;1(4):663-78. doi: 10.2217/imt.09.27.
- Balashov D, Shcherbina A, Maschan M, Trakhtman P, Skvortsova Y, Shelikhova L, Laberko A, Livshits A, Novichkova G, Maschan A. Single-Center Experience of Unrelated and Haploidentical Stem Cell Transplantation with TCRalphabeta and CD19 Depletion in Children with Primary Immunodeficiency Syndromes. Biol Blood Marrow Transplant. 2015 Nov;21(11):1955-62. doi: 10.1016/j.bbmt.2015.07.008. Epub 2015 Jul 15.
Study record dates
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
Other Study ID Numbers
- 16-013527
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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