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Rituximab hos nyreallograftmodtagere, der udvikler tidlige De Novo Anti-HLA Alloantistoffer

22. september 2026 opdateret af: National Institute of Allergy and Infectious Diseases (NIAID)

B-celle-depletering af anti-CD20 (Rituximab) hos nyreallograft-recipienter, der udvikler tidlige De Novo Anti-HLA-alloantistoffer, vil resultere i hæmning af alloantistofproduktion og svækkelse af kronisk humoral afstødning

The purpose of this study is to determine whether treatment with rituximab (anti-CD20, Rituxan®, MabThera®) in individuals who develop new anti-HLA antibodies after renal (kidney) transplant will promote longer-term survival of the transplanted kidney.The pilot study compares the use of rituximab (Rituxan®) + site-specific standard immunosuppression to placebo + site-specific standard immunosuppression in the treatment of circulating anti-HLA antibodies in subjects who develop de novo anti-HLA antibodies between 3-36 months after transplant.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Organ rejection occurs when a patient's body does not recognize the new organ and attacks it. Data suggest that the development of anti-human leukocyte antigen (HLA) antibodies is an early clinical indication that organ rejection may occur. Rituximab is a genetically engineered monoclonal antibody directed against the CD20 antigen on B cells and is known to deplete B cells when administered intravenously; it is FDA-approved for the treatment of non-Hodgkin's lymphoma; Chronic Lymphocytic Leukemia (CLL); and Rheumatoid Arthritis (RA) in combination with methotrexate in adult patients with moderately-to severely-active RA who have inadequate response to one or more TNF antagonist therapies.

In a previous small study, kidney transplant patients with either acute humoral rejection (AHR) or chronic humoral rejection (CHR) were given rituximab and other antilymphocyte therapy. Patients with AHR had lower or undetectable levels of circulating anti-HLA antibodies after study treatment, and patients with CHR had a sustained decrease of anti-HLA antibodies to undetectable after 6 to 9 months.

This study will evaluate the safety and efficacy of rituximab in 1.)preventing organ rejection and 2.)promoting long-term survival of donor kidneys in people who undergo kidney transplantation.

This study involves two stages:

  1. Stage 1 begins 3 to 36 months after transplant. During Stage 1, blood collection will occur every 3 months for up to 36 months after transplant to test for anti-HLA antibodies. When these antibodies are detected twice within 1 month, the patient will undergo a baseline kidney biopsy and have his or her glomerular filtration rate (GFR) measured to determine kidney function. If a patient meets certain study criteria, he or she will enter Stage 2 (Pilot Treatment Study).

    If anti-HLA antibodies are not detected in a patient's blood during Stage 1, the patient's participation will be complete.

  2. In Stage 2, patients will receive site-specific standard immunosuppression plus randomization to either rituximab or placebo:

    • Adult dosing (>18 years of age), will receive an intravenous infusion of 1000mg of rituximab on Days 0 and 14.
    • Pediatric dosing (<\= than 18 years of age) will receive an intravenous infusion of 375 mg/m^2/dose (maximum 500 mg/dose) in 4 doses of rituximab on Days 0, 8, 15 and 22.

Adult participants will have 7-9 study visits over 12-24 months. Pediatric participants will have 9-11 study visits over 12-24 months. A physical exam, medication history, adverse events assessment, and blood and urine collection will occur at all visits. A biopsy of the kidney transplant will occur at Stage 2 entry and Month 12.

Note: Prior to January 2010, Stage 2 of this was a double-blind (double-masked) randomized pilot treatment study. As of January 2010 and beyond:

  • subjects were no longer being recruited in the placebo treatment arm
  • all treatment assignments were unblinded and an open-label design commenced; therefore, medication assignments were open to the study participants as well as to the site clinical team.
  • all study subjects who participated in the study prior to this change were informed of the change
  • all subjects who were randomized to the placebo-controlled arm and continued to meet the pilot study eligibility criteria were provided the option to participate in the pilot treatment study.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

757

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Alabama
      • Birmingham, Alabama, Forenede Stater, 35294
        • University of Alabama
      • Birmingham, Alabama, Forenede Stater, 35294
        • University of Alabama, Pediatric Nephrology
    • California
      • San Francisco, California, Forenede Stater, 94143
        • University of California, San Francisco
    • Florida
      • Gainesville, Florida, Forenede Stater, 32601
        • University of Florida
    • Illinois
      • Chicago, Illinois, Forenede Stater, 60611
        • Northwestern University
      • Chicago, Illinois, Forenede Stater, 60607
        • University of Illinois
    • Maryland
      • Baltimore, Maryland, Forenede Stater, 21201
        • University of Maryland
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02215
        • Beth Israel Deaconess Medical Center
      • Boston, Massachusetts, Forenede Stater, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Forenede Stater, 02114
        • Massachusetts General Hospital
      • Boston, Massachusetts, Forenede Stater, 02115
        • Children's Hospital Boston
    • New Jersey
      • Livingston, New Jersey, Forenede Stater, 07039
        • Saint Barnabas Medical Center
    • Oregon
      • Portland, Oregon, Forenede Stater, 97210
        • Legacy Transplant Services
      • Portland, Oregon, Forenede Stater, 97219
        • Oregon Health Science University
    • Pennsylvania
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • Children's Hospital of Philadelphia
    • Texas
      • Houston, Texas, Forenede Stater, 77030
        • The Methodist Hospital
    • Washington
      • Seattle, Washington, Forenede Stater, 98105
        • Children's Hospital and Regional Medical Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

5 år til 70 år (Barn, Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Stage 1 Inclusion Criteria for All Participants:

  • Willing to provide informed consent
  • Previously diagnosed end stage renal disease (ESRD)
  • Received kidney transplant within 3 and 36 months of study entry
  • Willing to comply with the study protocol
  • Willing to use acceptable forms of contraception during the study and for 12 months following rituximab/placebo therapy
  • Willing to refrain from breastfeeding during the study and for 12 months following rituximab therapy

Stage 1 Inclusion Criteria for Pediatric Participants (<\=18 Years of Age):

  • Parent or guardian willing to provide informed consent
  • Have received all childhood vaccinations prior to study entry

Stage 2 Inclusion Criteria for Pilot Treatment Study:

  • Three to 39 months post-transplant
  • Developed new antibodies detected at two time points within 1 month between 3 to 36 months post-transplant
  • Negative pregnancy test

Stage 1 Exclusion Criteria for All Participants:

  • Recipient of a kidney from a donor older than 70 years of age
  • Multi-organ transplant
  • History of organ transplantation other than current kidney transplantation
  • Previous treatment with rituximab
  • History of severe allergic reactions to monoclonal antibodies
  • History of allergic reaction to iodine glomerular filtration rate (GFR) assay
  • Lack of intravenous (IV) access
  • Sensitized to greater than 5% Panel Reactive Antibody (PRA) within 12 weeks prior to transplant
  • History of recurrent bacterial or other significant infections
  • Known active bacterial, viral, fungal, mycobacterial, or other infection (including tuberculosis [TB] or atypical mycobacterial disease) or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of study entry. Patients with fungal infections of nail beds are not excluded.
  • HIV infected
  • Surface antigen positive for hepatitis B virus (HBV)
  • Antibody positive for hepatitis C virus (HCV)
  • History of drug, alcohol, or chemical abuse within 6 months prior to study entry
  • History of cancer. Patients with adequately treated in situ cervical carcinoma or adequately treated basal or squamous cell carcinoma of the skin are not excluded.
  • Clinically significant cardiovascular or pulmonary disease
  • Evidence of urinary tract obstruction causing decreased kidney function, unless corrected by study entry
  • Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that would contraindicate use of an investigational drug, may affect interpretation of study results, or put the patient at high risk for treatment complications
  • History of psychiatric disorder that may interfere with participation in the study
  • History of nonadherence to prescribed regimens
  • Use of other investigational drugs within 4 weeks of study entry
  • Received any licensed or investigational live attenuated vaccine within 2 months of study entry.

Stage 2 Exclusion Criteria for All Participants:

  • Previous treatment with rituximab
  • Immunoglobulin Levels <500mg/dL (Combined IgM, IgG, IgA, IgE, IgD)
  • History of severe allergic reactions to monoclonal antibodies
  • History of cancer. Patients with adequately treated in situ cervical carcinoma or adequately treated basal or squamous cell carcinoma of the skin are not excluded.
  • Active systemic infection at the time of entry into Stage 2
  • Recurrent or de novo glomerular disease or Banff Grade III chronic rejection other than chronic humoral rejection (CHR) indicated in baseline kidney biopsy post-transplant
  • History of post-transplant lymphoproliferative disease (PTLD)
  • Serum creatinine of 3.0 mg/dl or greater OR GFR less than 25 ml/min at the time of entry into Stage 2
  • Hemoglobin less than 8.5 g/dl
  • Platelets less than 80,000 cells/mm^3
  • White blood cell count less than 3,000 cells/mm^3
  • AST or ALT 2.5 times the upper limit of normal at study entry
  • Pregnant or breast-feeding
  • Absolute neutrophil count less than 1000/mm^3

Stage 2 Exclusion Criteria for Pediatric Participants (<\=18 Years of Age):

  • Positive test for parvovirus (B19) by PCR in the blood.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Pilot Phase-Rituximab plus immunosuppression

Enrollment into a Stage 2 pilot treatment study will occur after Stage 1. Adult Rituximab Dosing (Subjects > 18 years): 1000 mg on days 0 and 14; Pediatric Rituximab Dosing (Subjects <\=18 years): 375 mg/m^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22).

Standard immunosuppression is site-specific.
Medicin: Rituximab plus immunosuppression

Genetically engineered monoclonal antibody directed against the CD20 antigen on B cells and is known to deplete B cells when administered intravenously. Generally used in the treatment of non-Hodgkin's lymphoma

Standard immunosuppression is site-specific.

Andre navne:
  • Rituxan®
  • MabThera®
  • anti-CD20
Placebo komparator: Pilot Phase-Placebo plus immunosuppression

Adult Placebo Dosing (Subjects >18 years): 1000 mg on days 0 and 14; Pediatric Placebo Dosing (Subject <\=18 years): 375 mg/m^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22).

Standard immunosuppression is site-specific.
Medicin: Placebo plus immunosuppression

Placebo dosing: Adult Dosing (Subjects >18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject <\=18 years): 375 mg/m^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22).

Standard immunosuppression is site-specific.

Andre navne:
  • Placebo for rituximab

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
During Screening Phase: Incidence of Alloantibody Development
Tidsramme: During screening window of 3-60 months post kidney transplant

Data were analyzed for 653 participants from the screening phase of the study. This outcome looked at the number of kidney transplant recipients that developed de novo HLA antibodies (anti-HLA Ab) post-transplant. Alloantibody is defined as an antibody produced following the introduction of an alloantigen into the system of an individual lacking that particular antigen. Alloantibodies are important mediators of acute and chronic rejection.
During screening window of 3-60 months post kidney transplant
During Screening Phase: Timing of Alloantibody Development
Tidsramme: During screening window of 3-60 months post kidney transplant

Data were analyzed for 653 participants from the screening phase of the study. Of these, 79 (12%) developed de novo HLA-antibodies (anti-HLA Ab). This outcome looks at the average length of time (interval) from post kidney transplant until development of alloantibody. Alloantibody is defined as an antibody produced following the introduction of an alloantigen into the system of an individual lacking that particular antigen. Alloantibodies are important mediators of acute and chronic rejection
During screening window of 3-60 months post kidney transplant
Number of Participants With 50 Percent (%) Decrease in Circulating Anti-Human Leukocyte Antigen (HLA) Antibodies
Tidsramme: 1 year post treatment initiation

Number of participants with 50% decrease in circulating anti-HLA antibodies at any time within the first 12 months post kidney transplant by LuminexTM Beads Method. Luminex assays for quantitation and detection of cytokine and signal transduction proteins. Presence of circulating antibodies is indicative of the transplant recipient's immune system responding to the transplanted organ as a foreign object or infection.
1 year post treatment initiation

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Number of Deaths 12 Months Post Treatment Initiation
Tidsramme: 12 months post treatment initiation

Number of participant deaths within 12 months post treatment initiation
12 months post treatment initiation
Number of Participants Experiencing Graft Loss 12 Months Post Treatment Initiation
Tidsramme: 1 year post treatment initiation

Number of participants with graft loss, defined as the need for dialysis for greater than 30 days duration, allograft nephrectomy, or the decision to withdraw immunosuppression due to graft failure within 12 month post treatment initiation
1 year post treatment initiation
Number of Participants Experiencing Biopsy-proven Post-Transplant Lymphoproliferative Disease (PTLD)
Tidsramme: 1 year post treatment initiation

Number of participants with PTLD within 12 month post treatment initiation. Diagnosis of PTLD was made by B cell proliferation after therapeutic immunosuppression.
1 year post treatment initiation
Number of Participants Experiencing Loss of Peritubular Capillary (PTC) C4d Staining on Kidney Biopsy
Tidsramme: 1 year post treatment initiation

Number of participants with loss of PTC C4d staining on kidney (renal) biopsy within 12 months post treatment initiation. PTC C4d staining on biopsy indicates organ rejection.
1 year post treatment initiation
Number of Participants With Viral Replication of Cytomegalovirus (CMV)
Tidsramme: 1 year post treatment initiation

Number of participants with viral replication of CMV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of viral replication is indicative of active CMV infection.
1 year post treatment initiation
Number of Participants With Evidence of Viral Replication of Epstein-Barr Virus (EBV)
Tidsramme: 1 year post treatment initiation

Number of participants with positive viral replication of EBV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of EBV viral replication is indicative of active infection.
1 year post treatment initiation
Number of Participants With Viral Replication of Polyomavirus (BKV)
Tidsramme: 1 year post treatment initiation

Number of participants with viral replication of BKV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of viral replication is indicative of a BKV infection. Polyomavirus BK is a significant pathogen in transplant recipients.
1 year post treatment initiation

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

Samarbejdspartnere

Cooperative Clinical Trials in Pediatric Transplantation
Clinical Trials in Organ Transplantation

Efterforskere

  • Ledende efterforsker: Mohamed H. Sayegh, MD, Brigham and Women's Hospital
  • Ledende efterforsker: William Harmon, MD, Boston Children's Hospital
  • Studiestol: Anil Chandraker, MD, Brigham and Women's Hospital

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. marts 2006

Primær færdiggørelse (Faktiske)

1. december 2012

Studieafslutning (Faktiske)

1. december 2012

Datoer for studieregistrering

Først indsendt

23. marts 2006

Først indsendt, der opfyldte QC-kriterier

23. marts 2006

Først opslået (Anslået)

27. marts 2006

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

24. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

22. september 2026

Sidst verificeret

1. september 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • DAIT CTOT-02
  • CCTPT-02 (Anden identifikator: NIAID)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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