- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT00034528
Stem Cell Transplantation After Reduced-Dose Chemotherapy for Patients With Sickle Cell Disease or Thalassemia
Allogeneic Stem Cell Transplantation Following Nonmyeloablative Chemotherapy in Patients With Hemoglobinopathies
Studieoversigt
Status
Intervention / Behandling
Detaljeret beskrivelse
Hemoglobinopathies, such as sickle cell disease and thalassemia major, are genetic diseases associated with significant morbidity and premature death. Allogeneic bone marrow transplantation (BMT) is the only potential cure for severe hemoglobinopathies. Typical regimens have used high doses of chemotherapy or chemo-radiotherapy to ablate recipient hematopoiesis and to prevent graft rejection. The widespread use of this treatment has been limited by toxicity, risk of end-organ damage, and donor availability. This study will use a nonmyeloablative regimen of fludarabine and busulfan to attempt to generate consistent engraftment with donor hematopoietic stem cells in patients with severe hemoglobinopathy.
G-CSF mobilization of the donor's peripheral blood white blood cells will precede donor apheresis. A nonmyeloablative conditioning regimen of fludarabine and busulfan will be administered to patients prior to allogeneic peripheral blood stem cell infusions. FK506 and prednisone will be administered for graft versus host disease (GVHD) prophylaxis. Patients will be evaluated for engraftment, donor: host hematopoietic chimerism, toxicity, and hemoglobinopathy.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Fase 2
Kontakter og lokationer
Studiesteder
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Massachusetts
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Boston, Massachusetts, Forenede Stater, 02115
- Dana-Farber Cancer Institute/Harvard Cancer Center, Brigham and Women's Hospital and Massachusetts General Hospital
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion criteria:
All patients must:
- Have related donors who are identical at 6 human leukocyte antigens (HLA) loci (A, B and DR) by molecular typing
- Have a performance status from 0-2
- Give written informed consent
Patients with sickle cell disease should have 1 or more of the following:
- Acute chest syndrome requiring recurrent hospitalization or exchange transfusion
- Nonhemorrhagic stroke or central nervous system event lasting longer than 24 hours
- Recurrent vaso-occlusive pain (2 episodes or more per year) or recurrent priapism
- Sickle nephropathy (moderate or severe proteinuria or a glomerular filtration rate 30-50 percent of normal predicted value)
- Bilateral proliferative retinopathy and major visual impairment in at least 1 eye
- Osteonecrosis of multiple joints
Patients with thalassemia should have 1 or more of the following:
- Transfusion dependence, defined as a transfusion requirement of greater than or equal to 6 units of packed red blood cells over the past 12 months
- Iron overload, defined as serum ferritin greater than 500 mcg/L in the absence of infection or biopsy-proven iron overload
- Presence of 2 or more alloantibodies against red cell antigens
Exclusion criteria:
- Pregnancy
- Acute hepatitis (transaminases greater than 3 times the normal value)
- Cardiac ejection fraction less than 30 percent
- Severe renal impairment (glomerular filtration rate less than 30 percent of predicted normal value)
- Severe residual functional neurologic impairment (other than hemiplegia alone)
- Seropositivity for the human immunodeficiency virus (HIV)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Eksperimentel: Allogeneic stem cell transplantation
Participants will receive a nonmyeloablative conditioning regimen of fludarabine and busulfan prior to allogeneic peripheral blood stem cell (CD34+) infusions.
FK506 and prednisone will be administered for graft versus host disease (GVHD) prophylaxis.
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0.8 mg/kg/d administered as a single intravenous infusion over 3 hours for 4 days.
All infusions are anticipated to be given in the outpatient clinic.
Andre navne:
30 mg/m^2/d administered as a bolus infusion over 30 minutes for 4 days.
All infusions are anticipated to be given in the outpatient clinic.
Andre navne:
0.15 mg/kg taken orally daily for 12 to 14 weeks
Andre navne:
0.5 mg/kg taken orally four times daily on Day 7 and increase to 1 mg/kg taken orally four times daily on Day 14. Participants will continue regimen until Day 30 before a 20-25% taper per week.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
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Evidence of engraftment of donor hematopoietic cells following administration of low doses of busulfan and fludarabine
Tidsramme: Throughout study
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Throughout study
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Sekundære resultatmål
Resultatmål |
Tidsramme |
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Solid organ toxicity related to the conditioning regimen
Tidsramme: Throughout study
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Throughout study
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Incidence of grade II, III, or IV acute graft versus host disease (GVHD)
Tidsramme: Throughout study
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Throughout study
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Level of disease response
Tidsramme: Throughout study
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Throughout study
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Samarbejdspartnere og efterforskere
Efterforskere
- Ledende efterforsker: Catherine J. Wu, MD, Dana-Farber Cancer Institute
Publikationer og nyttige links
Generelle publikationer
- Walters MC, Storb R, Patience M, Leisenring W, Taylor T, Sanders JE, Buchanan GE, Rogers ZR, Dinndorf P, Davies SC, Roberts IA, Dickerhoff R, Yeager AM, Hsu L, Kurtzberg J, Ohene-Frempong K, Bunin N, Bernaudin F, Wong WY, Scott JP, Margolis D, Vichinsky E, Wall DA, Wayne AS, Pegelow C, Redding-Lallinger R, Wiley J, Klemperer M, Mentzer WC, Smith FO, Sullivan KM. Impact of bone marrow transplantation for symptomatic sickle cell disease: an interim report. Multicenter investigation of bone marrow transplantation for sickle cell disease. Blood. 2000 Mar 15;95(6):1918-24.
- Gomez-Almaguer D, Ruiz-Arguelles GJ, Ruiz-Arguelles A, Gonzalez-Llano O, Cantu OE, Hernandez NE. Hematopoietic stem cell allografts using a non-myeloablative conditioning regimen can be safely performed on an outpatient basis: report of four cases. Bone Marrow Transplant. 2000 Jan;25(2):131-3. doi: 10.1038/sj.bmt.1702100.
- Krishnamurti L, Blazar BR, Wagner JE. Bone marrow transplantation without myeloablation for sickle cell disease. N Engl J Med. 2001 Jan 4;344(1):68. doi: 10.1056/NEJM200101043440119. No abstract available.
- Andersson BS, Madden T, Tran HT, Hu WW, Blume KG, Chow DS, Champlin RE, Vaughan WP. Acute safety and pharmacokinetics of intravenous busulfan when used with oral busulfan and cyclophosphamide as pretransplantation conditioning therapy: a phase I study. Biol Blood Marrow Transplant. 2000;6(5A):548-54. doi: 10.1016/s1083-8791(00)70064-4.
- Wu CJ, Krishnamurti L, Kutok JL, Biernacki M, Rogers S, Zhang W, Antin JH, Ritz J. Evidence for ineffective erythropoiesis in severe sickle cell disease. Blood. 2005 Nov 15;106(10):3639-45. doi: 10.1182/blood-2005-04-1376. Epub 2005 Aug 9.
- Wu CJ, Gladwin M, Tisdale J, Hsieh M, Law T, Biernacki M, Rogers S, Wang X, Walters M, Zahrieh D, Antin JH, Ritz J, Krishnamurti L. Mixed haematopoietic chimerism for sickle cell disease prevents intravascular haemolysis. Br J Haematol. 2007 Nov;139(3):504-7. doi: 10.1111/j.1365-2141.2007.06803.x. No abstract available.
- Wu CJ, Hochberg EP, Rogers SA, Kutok JL, Biernacki M, Nascimento AF, Marks P, Bridges K, Ritz J. Molecular assessment of erythroid lineage chimerism following nonmyeloablative allogeneic stem cell transplantation. Exp Hematol. 2003 Oct;31(10):924-33. doi: 10.1016/s0301-472x(03)00227-3.
Datoer for undersøgelser
Studer store datoer
Studiestart
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Hæmatologiske sygdomme
- Genetiske sygdomme, medfødte
- Anæmi
- Anæmi, hæmolytisk, medfødt
- Anæmi, hæmolytisk
- Anæmi, seglcelle
- Thalassæmi
- beta-thalassæmi
- Hæmoglobinopatier
- Hæmoglobin SC sygdom
- Lægemidlers fysiologiske virkninger
- Molekylære mekanismer for farmakologisk virkning
- Anti-inflammatoriske midler
- Antineoplastiske midler
- Immunsuppressive midler
- Immunologiske faktorer
- Glukokortikoider
- Hormoner
- Hormoner, hormonsubstitutter og hormonantagonister
- Antineoplastiske midler, hormonelle
- Antineoplastiske midler, Alkylering
- Alkyleringsmidler
- Myeloablative agonister
- Prednison
- Fludarabin
- Busulfan
Andre undersøgelses-id-numre
- DAIT DF/HCC 01-098
- P01 A 129530
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Kliniske forsøg med Anæmi, seglcelle
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Universitaire Ziekenhuizen KU LeuvenUkendtLymfom | Hodgkin lymfom | Non-Hodgkin lymfom (follikulært, diffust B-cel lymfom, PTLD og Mantle Cel lymfom)Belgien
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University of BolognaNovartisUkendtMyeloproliferative lidelser | Hypereosinofilt syndrom | Kronisk eosinofil leukæmi (CEL)Italien
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AHS Cancer Control AlbertaCross Cancer InstituteAfsluttetOmfattende Stage Small Cel Lung CancerCanada
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Novartis PharmaceuticalsAfsluttetKronisk myeloid leukæmi (CML) | Philadelphia kromosom positiv akut lymfoblastisk leukæmi (Ph+ ALL) | Andre Glivec/Gleevec-indicerede hæmatologiske lidelser (HES, CEL, MDS/MPN)Den Russiske Føderation
Kliniske forsøg med Busulfan
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Hospital Israelita Albert EinsteinUkendtAkut leukæmi | Immundefekt | Kronisk leukæmi | Lymfoproliferativ sygdom | Myeloproliferativ sygdomBrasilien
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Institut Paoli-CalmettesUkendtAkut myeloid leukæmi | Myelodysplastisk syndromFrankrig
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Shanghai Public Health Clinical CenterR&D Kanglin BiotechUkendtHIV-infektioner | AIDSKina
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City of Hope Medical CenterSangamo Therapeutics; California Institute for Regenerative Medicine (CIRM)Aktiv, ikke rekrutterende
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Gruppo Italiano Trapianto di Midollo OsseoAfsluttet
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Pediatric Brain Tumor ConsortiumNational Cancer Institute (NCI)AfsluttetSarkom | Lymfom | Leukæmi | Tumorer i hjernen og centralnervesystemet | Metastatisk kræft | Retinoblastom | Kimcelletumor i barndommenForenede Stater
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Duke UniversityNational Cancer Institute (NCI)AfsluttetTumorer i hjernen og centralnervesystemetForenede Stater
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Alberta Health servicesUkendtHæmatologisk malignitetCanada
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Institut Paoli-CalmettesIkke rekrutterer endnuAkut leukæmi | Myeloproliferativ neoplasma | Mielodysplasisk syndrom
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Baylor Research InstituteGenzyme, a Sanofi CompanyAfsluttetLeukæmi | Myelodysplastisk syndromForenede Stater