- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04792294
Multicenter Analysis of Efficacy and Outcomes of Extracorporeal Photopheresis as Treatment of Chronic Lung Allograft Dysfunction
March 9, 2021 updated by: Alberto Benazzo, Medical University of Vienna
Lung transplantation is an established therapy for end-stage lung disease such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis and pulmonary hypertension.
However, Chronic Lung Allograft Dysfunction (CLAD) is a major cause of morbidity and mortality in long-term survivors.
The 5-year survival rate is reported to be 50%, which is considerably inferior compared to other solid organ transplantation.
In addition, the financial burden of CLAD (around 80.000 euro/year for a patient with CLAD) is considerable.
No curative therapy is available yet.
To date, the two most effective treatment are azithromycin and extracorporeal photopheresis.
Azithromycin is used as first-line treatment and it is effective in stopping FEV1 decline, however its effects are only limited to a set of patients.
ECP can be used as second-line treatment in patients unresponsive to azithromycin.
ECP has been firstly developed for treatment of cutaneous T cell lymphomas and later used in a variety of other indications including solid organ transplantation.
The process starts with leukapheresis, followed by incubation of the isolated cells with 8-methoxypsoralen (8-MOP) and subsequent activation of 8-MOP with ultraviolet A radiation.
At the end, the cells are reinfused into the patient.
8-MOP is a biologically inert substance, but in the presence of UVA light it cross-links DNA by forming covalent bonds with pyrimidine bases and causes apoptosis.
ECP is effective in the palliative treatment of cutaneous T-cell lymphoma but its effectiveness was also shown in several other T-cell-mediated diseases, particularly in the treatment and prevention of acute and chronic graft-versus-host disease.
In depth knowledge on the mechanisms whereby ECP manipulates the immune system are still unclear.
Most of the experimental studies have been performed in murine models of GvHD.
Apoptotic cells isolated during ECP treatment have the potential to induce IL-10 secretion, reduce dendritic cells activation and increase percentage of Tregs.
In addition, ECP reduces the production of IL-6 and TNF-α and increases TGF-β production.
In lung transplantation, ECP treatment is used as second-line treatment of CLAD and it has the potential to stabilize lung function decline and to improve long-term graft.
According to the published literature, however, approximately 30 to 40% of treated recipients did not profit from ECP. Greer and colleagues found that RAS patients as well as rapid lung function decliners showed lower rate of response and worse long-term outcomes.
On the contrary in a more recent analysis only BOS diagnosis was associated with better outcomes.
A single prospective interventional study was published by our group and it confirmed results from other previous retrospective analysis.
Up to now, no clear predictors for response have been identified yet.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Study Type
Observational
Enrollment (Anticipated)
800
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 70 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
Lung transplant recipients with chronic lung allograft dysfunction who received extracorporeal photopheresis as treatment
Description
Inclusion Criteria:
Diagnosis of CLAD Adult transplant recipients (>18 years)
Exclusion Criteria:
ECP for other diagnosis Recipients of multi-organ transplantation Recipients of single lung transplantation
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Lung transplant recipients with chronic lung allograft dysfunction
Lung transplant recipients with chronic lung allograft dysfunction, who underwent extracorporeal photopheresis
|
ECP can be used as second-line treatment in patients unresponsive to azithromycin.
ECP has been firstly developed for treatment of cutaneous T cell lymphomas and later used in a variety of other indications including solid organ transplantation.
The process starts with leukapheresis, followed by incubation of the isolated cells with 8-methoxypsoralen (8-MOP) and subsequent activation of 8-MOP with ultraviolet A radiation.
At the end, the cells are reinfused into the patient.
8-MOP is a biologically inert substance, but in the presence of UVA light it cross-links DNA by forming covalent bonds with pyrimidine bases and causes apoptosis.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in forced expiratory value in 1 second at 3 months after start of extracorporeal photopheresis
Time Frame: 3 months
|
Percentage change in FEV1 within 3 months after start of extracorporeal photopheresis
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in maximal expiratory flow (50%) at 3 months after start of extracorporeal photopheresis
Time Frame: 3 months
|
Percentage change in MEF50 within 3 months after start of extracorporeal photopheresis
|
3 months
|
Change in forced expiratory value in 1 second/dorced vital capacity ratio at 3 months after start of extracorporeal photopheresis
Time Frame: 3 months
|
Percentage change in FEV1/FVC within 3 months after start of extracorporeal photopheresis
|
3 months
|
Change in total lung capacity at 3 months after start of extracorporeal photopheresis
Time Frame: 3 months
|
Percentage change in TLC within 3 months after start of extracorporeal photopheresis
|
3 months
|
Patients' survival
Time Frame: Within 5 years from start of extracorporeal photopheresis
|
Patients' survival
|
Within 5 years from start of extracorporeal photopheresis
|
Graft survival
Time Frame: Within 5 years from start of extracorporeal photopheresis
|
Graft survival
|
Within 5 years from start of extracorporeal photopheresis
|
Adverse events on extracorporeal photopheresis
Time Frame: Within 5 years from start of extracorporeal photopheresis
|
Adverse events on extracorporeal photopheresis
|
Within 5 years from start of extracorporeal photopheresis
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 1, 2005
Primary Completion (Anticipated)
December 31, 2021
Study Completion (Anticipated)
December 31, 2021
Study Registration Dates
First Submitted
February 25, 2021
First Submitted That Met QC Criteria
March 9, 2021
First Posted (Actual)
March 10, 2021
Study Record Updates
Last Update Posted (Actual)
March 10, 2021
Last Update Submitted That Met QC Criteria
March 9, 2021
Last Verified
March 1, 2021
More Information
Terms related to this study
Other Study ID Numbers
- 1541/2020
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
product manufactured in and exported from the U.S.
No
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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