- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04015947
Allogeneic Skin Grafting
Allogeneic Skin Grafting in the Treatment of Chronic Cutaneous Graft-versus-host Disease: a Pilot Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
While the mechanisms are still under active study, GVHD is thought to be a donor T-cell mediated attack that preferentially targets three organs: skin, intestine, and liver. T lymphocytes from the donor identify the patient's organ tissues as foreign and initiate inflammation, leading to end organ damage. The investigator's traditional approach has been to use immune suppressing drugs to dampen this inflammatory response after transplantation. However, this approach is ultimately ineffective for a significant percentage of patients. Therefore, the primary objective of this proposal is to test a novel non-immunosuppressive approach to treatment of cutaneous GVHD using allogeneic skin grafting in an effort to tolerize the engrafted immune system to skin it previously recognized as foreign. The potential benefit to transplant patients is tremendous, including reduced immunosuppression, improved quality of life and lower mortality.
A potential novel approach is to apply split-thickness skin grafts from the bone marrow donor to the affected patient's skin. There are four existing case reports that have shown positive outcomes in wound healing in chronic GVHD-associated ulcers. In all four cases, skin grafts were harvested from the patient's allogeneic HLA-matched sibling donors and placed over non-healing wounds (2-5). One case described global improvement in affected skin distant from the site of skin graft application, allowing for tapering of immunosuppressive medications. This suggests potential induction of tolerance by immune cells within the donated skin.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Minnesota
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Minneapolis, Minnesota, United States, 55414
- University of Minnesota
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria - Patient (Recipient)
- Subjects will be eligible to participate in the study if all of the following conditions exist:
- Diagnosis of chronic, sclerotic, cutaneous graft versus host disease with one or more areas of cutaneous sclerosis and
- More than 1 year after HCT with stable hematopoietic engraftment and original transplant donor is available and agrees to be the epidermal donor for this study
- Stable (mixed or full) donor hematopoietic engraftment
- Original transplant donor is available and willing to be the epidermis donor
- Site for skin grafting free of cellulitis or other evidence of infection
- Insurance pre-authorization for procedure
- Voluntary written consent prior to any research related procedures or treatment.
Inclusion Criteria - Donor
- Age > 18 years (based on prior safety testing of the device)
- Healthy on physical examination in the opinion of the evaluating physician
- Known negativity for Hepatitis B and C, HIV, and HTLV1/2
- Voluntary written consent prior to any research related procedures
Exclusion Criteria
Subjects will be excluded from participation in the study if any of the following conditions exist:
- Patient with cutaneous infection
- Patient with recent change in medical management of chronic cutaneous GVHD (new medication or therapy, or change in dosing of existing medication) within one month of start date.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Device Feasibility
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Active treatment
This is an open label, single-institution pilot study to evaluate local response to split-thickness skin grafts from a matched bone marrow donor to chronic GVHD-affected skin in a hematopoietic stem cell transplant patient.
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split-thickness skin grafts from a matched bone marrow donor using the CelluTome® Epidermal Harvesting System
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in CGAA
Time Frame: Change from baseline up to 12 months
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Evaluation of clinical improvement in inflammation and sclerosis based on visual inspection and photodocumentation with outcome outcomes determined using the Chronic GVHD Activity Assessment (CGAA) to measure therapeutic response.
The CGAA is an 8-item assessment measuring symptom severity of GVHD on a scale from 0 (not present) to 10 (as bad as you can imagine).
Global score is calculated by summing items.
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Change from baseline up to 12 months
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Change in ELISA Markers of GVHD
Time Frame: Change from baseline up to 12 months
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Chronic GVHD lesions will be assessed following transplantation through serum ELISA assays of elafin and CXCL10 (validated biomarkers for assessment of GVHD disease activity)
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Change from baseline up to 12 months
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
Other Study ID Numbers
- DERM-2016-25255
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.
Clinical Trials on GVHD
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Shanghai Jiao Tong University School of MedicineCompleted
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MaaT PharmaRecruitingSteroid Refractory GVHD | Intestinal GVHDFrance
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Mats RembergerThe Swedish Research CouncilRecruitingGVHD, AcuteSweden, Norway, Denmark
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CSL BehringTerminated
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Weill Medical College of Cornell UniversityTerminatedGlucocorticosteroid Refractory Acute GVHDUnited States
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Fondazione Policlinico Universitario Agostino Gemelli...Recruiting
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daphne brockingtonUnknownChronic GVHD After HCT for Cancer or Immune DiseaseCanada
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Nationwide Children's HospitalDaisy FoundationCompletedGVHD | Hematopoietic Stem Cell TransplantUnited States
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University of SalamancaRecruitingGVHD, Chronic | GVHD,AcuteSpain
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IRCCS Azienda Ospedaliero-Universitaria di BolognaCompletedGVHD | Allogeneic Stem Cell TransplantationItaly
Clinical Trials on CelluTome® Epidermal Harvesting System
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Masonic Cancer Center, University of MinnesotaCompletedEpidermolysis BullosaUnited States
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LifeBridge HealthKinetic Concepts, Inc.WithdrawnWounds and InjuriesUnited States
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Massachusetts General HospitalTerminatedActinic Keratosis | Extensive Photodamage | History of Numerous Skin CancersUnited States
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Massachusetts General Hospital3MRecruiting
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Momelan TechnologiesUnknownNeoplasm of SkinUnited States
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Momelan TechnologiesUnknownSurgical Wound | Hypo-pigmented SkinUnited States
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University College, LondonCompletedWounds and Injuries | Ulcer | Skin UlcerUnited Kingdom
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Assistance Publique - Hôpitaux de ParisTerminated
-
SerenaGroup, Inc.Kinetic Concepts, Inc.TerminatedVenous Insufficiency of Leg | Impaired Wound Healing | Diabetic UlcersUnited States
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Avita MedicalBiomedical Advanced Research and Development AuthorityTerminatedSkin; DeformityUnited States