- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04188678
Resiliency in Older Adults Undergoing Bone Marrow Transplant (REBOUND)
REBOUND: REsiliency in Older Adults UNDergoing BOne Marrow Transplant - A Pilot Study of Resiliency Measures in Older Patients Undergoing Allogeneic Blood and Marrow Transplant
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Allogeneic blood and marrow transplantation (alloBMT) is the only potentially curative therapy for many forms of leukemia, lymphoma, and other hematologic malignancies. As with many forms of cancer, many of the most common indications for alloBMT disproportionally affect older people. Although treatments have improved for older adults undergoing therapies for these diseases, the outcomes are variable and there is little biological knowledge to help identify specific factors that would predict why some people do well with treatment and others develop functional and cognitive decline and other adverse health outcomes.
Data specific to patients older than 60 who have undergone alloBMT are sparse even though the 1 year non-relapse mortality rate in patients older than age 50 at Johns Hopkins is 12%. In none of these studies have geriatric assessment measures in domains such as cognition and function been evaluated. Given the low incidence of non-relapse mortality in the investigators' older patients, the investigators have a unique opportunity to study the factors that influence not only mortality but function after hematopoietic stem cell transplantation. The investigators aim to be able to counsel patients more specifically about likely outcomes after transplant.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Philip Imus, MD
- Phone Number: 410-955-8839
- Email: pimus1@jhmi.edu
Study Locations
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Maryland
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Baltimore, Maryland, United States, 21287
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Undergoing allogeneic bone marrow transplant at Johns Hopkins Hospital, the indication for which is a hematologic malignancy
- Age ≥60 years
- Ability to walk without human assistance
- Enrollment in concomitant clinical research is permitted but not required
- English-speaking
- Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
- Unwillingness or inability to return at 6 months after transplantation for repeated evaluation
- Non-English-speaking
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Interventional Arm- Bone Marrow Transplant
Study visits will include the performance of assessments prior to the start of conditioning chemotherapy and at 1 month and 6 months post-BMT. Assessments include:
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Bone marrow transplantation will be conducted according to the investigators' institution's standard of care, or else according to research protocol (if applicable).Study visits that include the performance of assessments will occur prior to the start of conditioning chemotherapy and at 1 month and 6 months post-BMT.
All dates are +/- 7 days.
The initial study visit will take place during standard of care pre-transplant evaluations, which typically span 3-4 days.
The post-BMT visits will take place before or after regularly-scheduled BMT follow up.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Physical Performance as assessed by Short Physical Performance Battery (SPPB)
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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5 measured criteria: unintentional weight loss, exhaustion, low energy expenditure, low grip strength, and slowed waking speed.
Scores of 3, 4 and 5 are consistent with frailty, scores of 1 and 2 are consistent with pre-frailty status, and a score of 0 is consistent with a robust or resilient status.
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in ability to perform activities of daily living as assessed by Instrumental Activities of Daily Living questionnaire
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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questions about ability to perform activities of daily living (IADL).
Scored low functioning (0) to high functioning (8).
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in upper extremity function as assessed by accelerometry
Time Frame: 7 consecutive days pre-BMT, at Day 30 and at Day 180
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device worn on wrist for a 24hr period that measures physical activity and sedentary activity.
Higher scores= more active.
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7 consecutive days pre-BMT, at Day 30 and at Day 180
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Change in catecholamines levels as assessed in overnight urine collection samples
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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Changes in catecholamines level will be assessed in overnight urine collection samples.
Levels fluctuate.
Analysis will use the Johns Hopkins University (JHU) normal reference range for an adult is Metanephrine (normotensive):45-290 μg/24 hours.
Metanephrine (hypertensive): 35-460 μg/24 hours .
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in Frailty as assessed by the Frailty Phenotype instrument
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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Frailty Phenotype instrument is used to measure participants' walking speed and grip strength, includes questions about exhaustion, physical activity, weight loss.
Higher scores indicate better functional state.
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in Pittsburgh Fatigability Scale for Older Adults score
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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self-report tool that normalizes activities in terms of intensity and duration (PFS) this has a range of 0-50 with higher scores indicating greater physical fatigability.
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in Borg Rating of Perceived Exertion Scale score
Time Frame: Pre-BMT, Day 30 and Day 180 post transplant
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scale will be used immediately after a slow-paced 5-minute treadmill walk to assess fatigability (RPE).
Higher score indicates higher perceived exertion.
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Pre-BMT, Day 30 and Day 180 post transplant
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Change in medical history and diseases/conditions self reporting
Time Frame: Pre-BMT and Day 180 post transplant
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Questionnaire of past medical history as reported by a subject.
This questionnaire does not have a score.
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Pre-BMT and Day 180 post transplant
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Change in health behaviors as assessed by a questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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This assessment is of self determined overall health as reported by a participant, it has no score.
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Pre-BMT and Day 180 post transplant
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Change in reporting of patients traumas as assessed by the Hospitalizations, Surgeries, and Falls Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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Questionnaire includes items on hospitalizations, surgeries, and falls.
it has no score.
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Pre-BMT and Day 180 post transplant
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Change in pain reporting as assessed by the Pain Assessment Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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questions on overall bodily pain intensity/frequency and pain-related function/interference.
Higher scores equal more pain.
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Pre-BMT and Day 180 post transplant
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Change in anxiety reporting as assessed by the anxiety questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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Questions to assess the presence and severity of anxiety; higher scores = more anxiety.
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Pre-BMT and Day 180 post transplant
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Change in trauma reporting as assessed by the trauma questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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Questions to assess a participants reporting of any past experiences of several kinds of trauma.
It has no score.
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Pre-BMT and Day 180 post transplant
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Change in cognitive function as assessed by Modified Mini-Mental State Examination
Time Frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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measure of global cognitive function (range 0-100).
A score of 100 represents total cognitive function according to 3MS.
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Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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Change in cognitive ability as assessed by the Montreal Cognitive Assessment
Time Frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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measures global cognitive function (MoCA).
Scores range between 0 and 30.
A score of 26 or over is considered to be normal.
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Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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Change in cognitive function as assessed by the Digit Symbol Substitution Test (DSST)
Time Frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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participant fill in a series of symbols correctly coded within 90 seconds.
The higher the score, the better the participant's performance.
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Pre-BMT, Day 30, Day 56 and Day 180 post transplant
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Change in ability to cope with life challenges as assessed by the Coping Self-Efficacy Scale
Time Frame: Pre-BMT and Day 180 post transplant
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11-point Likert scale measures perceived ability to cope effectively with life.
Scale is 0-10 with 10 = best ability to cope and 0 = no ability to cope.
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Pre-BMT and Day 180 post transplant
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Change in sense of well-being as assessed by the Subscale of Ryff Psychological Well-being Scale
Time Frame: Pre-BMT and Day 180 post transplant
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7-item Likert type scale (from strongly disagree to strongly agree) measures sense of direction and perception of purpose.
Scale is 0-7 with 7 = best sense of well-being and 0 = no sense of well-being.
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Pre-BMT and Day 180 post transplant
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Change in perception and satisfaction with life as assessed by the Meaning in Life Questionnaire and Scale
Time Frame: Pre-BMT and Day 180 post transplant
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Likert-type scale measuring perception of meaning and satisfaction with life (MLQ) Scale is 0-7 with 7 = best sense that life has meaning and 0 = no sense that life has meaning.
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Pre-BMT and Day 180 post transplant
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Change in personality as measured by the Ten Item Personality Inventory (TIPI) Scale
Time Frame: Pre-BMT and Day 180 post transplant
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7 point Likert-type scale of disagree to agree with various aspects of personality measuring: extraversion, agreeableness, neuroticism, openness, conscientiousness.
TIPI scale scoring.
Extraversion: 1, 6R; Agreeableness: 2R, 7; Conscientiousness; 3, 8R; Emotional Stability: 4R, 9; Openness to Experiences: 5, 10R.
("R" denotes reverse-scored items)
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Pre-BMT and Day 180 post transplant
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Change in optimism as assessed by the Life Orientation Scale-Revised
Time Frame: Pre-BMT and Day 180 post transplant
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5 point Likert scale, assessing optimism.
0= strongly disagree; 4 = strongly agree.
The total score is from 0 to 24; higher scores indicate more optimism.
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Pre-BMT and Day 180 post transplant
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Change in perceived loneliness as assessed by the Loneliness Scale
Time Frame: Pre-BMT and Day 180 post transplant
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Revised University of California, Los Angeles (UCLA) Loneliness Scale.
Each question is rated on a 4-point scale: 1 = never; 2 = Rarely; 3 = Sometimes 4 = Always.
All items are summed to give a total score.
Higher scores indicate more loneliness
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Pre-BMT and Day 180 post transplant
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Change in perceived socio-economic status as assessed by the US socioeconomic questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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10-rung ladder to assess a participant's perception of participant's status in society.
To score this measure, researchers simply note the number of the rung (1-10) on which the respondent placed their "X".
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Pre-BMT and Day 180 post transplant
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Change in perceived financial strain as assessed by Financial Strain questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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2 item measure evaluating difficulty and anxiety about money.
Higher scores equal higher financial strain.
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Pre-BMT and Day 180 post transplant
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Change in feeling of community inclusion as assessed by the Social Cohesion Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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Participants rate their community by rate of agreement.
Response is Agree a lot, a little, do not agree with 3 statements about their community.
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Pre-BMT and Day 180 post transplant
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Change in feeling of isolation as assessed by the Social Isolation/Engagement Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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7-item measure evaluating social isolation, participation and engagement with others.
Higher scores= greater sense of isolation.
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Pre-BMT and Day 180 post transplant
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Change in perceived confidence in spirituality as assessed by the Religion/Spirituality Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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5-Item measure for use in epidemiological studies regarding spirituality.
Score range from 5-27, with higher scores = more sense of spirituality
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Pre-BMT and Day 180 post transplant
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Change in feelings of depression as assessed by the Patient Health Questionnaire
Time Frame: Pre-BMT and Day 180 post transplant
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Measures depressive symptoms in the last 2 weeks (PHQ-8)
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Pre-BMT and Day 180 post transplant
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Change in perceived childhood trauma as assessed by the Adverse Childhood Events (ACE) Scale
Time Frame: Pre-BMT and Day 180 post transplant
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10-item measure to assess childhood abuse and household dysfunction.
Response is yes/no.
The ACE Scale is scored by summing the number of items for which respondents answered "yes."
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Pre-BMT and Day 180 post transplant
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Changes in perceived stress as assessed by the Perceived Stress Scale
Time Frame: Pre-BMT and Day 180 post transplant
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5-point Likert scale measures the cognitive appraisal and perceptions of stress in life.
Higher score= high level of perceived stress.
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Pre-BMT and Day 180 post transplant
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Change in bone marrow cell ratios as assessed by Bone Marrow Aspirate
Time Frame: pre-transplant and at Day 180 post-transplant
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aspirate will be collected during standard of care bone marrow biopsies and analyzed using JHU normal reference ranges.
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pre-transplant and at Day 180 post-transplant
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Change in hemoglobin tests.
Time Frame: pre-transplant and then at Day 30, Day 56 and Day 180 post-transplant
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160 mL of blood during evaluations, and 90mL of blood at the day 180 visit.
Assessment will be documents using Hopkins normal reference ranges
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pre-transplant and then at Day 30, Day 56 and Day 180 post-transplant
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changes in salivary plasma free cortisol collection
Time Frame: single 24 hour period before BMT and at Day 180 post-transplant
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Saliva collected at home by participants at 4 time points during a single 24 hour period.
The mean salivary cortisol concentration is 15.5 +/- 0.8 nmol/L (range, 10.2-27.3) at 0800 h and 3.9 +/- 0.2 nmol/L (range, 2.2-4.1) at 2000 h.
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single 24 hour period before BMT and at Day 180 post-transplant
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Change in cortisol level
Time Frame: pre-transplant and at Day 180 post-transplant
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This is part of the ACTH Stimulation test to assess the reactivity of hypothalamic-pituitary-adrenal (HPA) axis.
Test After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for cortisol levels (mcg/dL).
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pre-transplant and at Day 180 post-transplant
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Changes in interleukin (IL)-6 level
Time Frame: pre-transplant and at Day 180 post-transplant
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This is part of the ACTH Stimulation test to assess the reactivity of HPA axis.
After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for IL-6 levels (pg/ml).
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pre-transplant and at Day 180 post-transplant
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Change in dehydroepiandrosterone (DHEA) level
Time Frame: pre-transplant and at Day 180 post-transplant
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This is part of the ACTH Stimulation test to assess the reactivity of HPA axis.
After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for DHEA levels (µg/dL).
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pre-transplant and at Day 180 post-transplant
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Change in glucose tolerance as assessed by the Oral Glucose Tolerance Test (OGTT)
Time Frame: pre-transplant and at Day 180 post-transplant
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Participants will fast overnight and then be given the 75 gram glucose oral load followed by blood draws at 0, 30.
60 and 120 minutes.
At 120min, below 140mg/dL= normal blood sugar.
200mg/dL or higher= diabetes
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pre-transplant and at Day 180 post-transplant
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Change in heart rate variability as assessed by the "myPatch" Holter monitor
Time Frame: During clinic visits at pre-transplant, Day 30, Day 56 and Day 180
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lightweight digital device that records and stores electrocardiogram (ECG) data on a continuous basis during study visits.
A normal resting heart rate for adults ranges from 60 to 100 beats per minute.
Generally, a lower heart rate at rest implies more efficient heart function.
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During clinic visits at pre-transplant, Day 30, Day 56 and Day 180
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Change in attention as assessed by the Flanker Inhibitory Control and Attention Test score
Time Frame: pre-transplant, once a week from Day of transplant to Day 60 and at Day 180 post-transplant
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Measures attention and inhibitory control.
Scoring is 0-10.
Details and interpretations are available in the NIH toolbox scoring and interpretation guide.
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pre-transplant, once a week from Day of transplant to Day 60 and at Day 180 post-transplant
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Collaborators and Investigators
Investigators
- Principal Investigator: Philip Imus, MD, Johns Hopkins University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Neoplasms by Site
- Bone Marrow Diseases
- Hematologic Diseases
- Lymphoma
- Myelodysplastic Syndromes
- Hematologic Neoplasms
- Leukemia
- Leukemia, Myeloid
- Leukemia, Myeloid, Acute
Other Study ID Numbers
- J1849
- UH2AG056933 (U.S. NIH Grant/Contract)
- IRB00165139 (Other Identifier: Johns Hopkins School of Medicine)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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