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Forsinket tolerance gennem blandet kimærisme

24. september 2026 opdateret af: Tatsuo Kawai, MD, PhD, Massachusetts General Hospital

This study will examine the safety and effectiveness of a bone marrow transplant after kidney transplant (from either a living or deceased donor). An investigational medication and other treatments will be given prior to and after the transplant to help protect the transplanted kidney from being attacked by the body's immune system

Studieoversigt

Detaljeret beskrivelse

Recipients of previous living donor (LD) or deceased donor (DD) kidney transplants that were maintained on conventional immunosuppression (I.S.), will receive a conditioning regimen that includes rituximab on study day -6, fludarabine 15 mg/m2/day on days -5 to -3 (3 doses), Cyclophosphamide (30 mg/kg/day) on days -5 and -4, followed by local thymic irradiation (7 Gy) on day -1 and Siplizumab (anti-CD2 mAb) on days, -2, -1, 0 and +1. Donor hematopoetic stem cells (HSCs) will be infused on study day 0. Methylprednisolone 250mg/day will be started on day 0 and tapered off by day 20 (Fig. 2). Prophylaxis will be provided for hemorrhagic cystitis, PCP, fungal infection, CMV, and perioperative infection. All patients who require any blood transfusion will receive only leukocyte-depleted and irradiated blood products for a period of at least 12 months following HSC Transplant. The recipients will undergo renal allograft biopsy at 6 months after HSCT. If the I.S. withdrawal criteria are met, I.S. will be slowly tapered off by 9-12 months

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

20

Fase

  • Fase 2
  • Fase 1

Kontakter og lokationer

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

Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02114
        • Rekruttering
        • Massachusetts General Hospital
        • Ledende efterforsker:
          • Tatsuo Kawai, MD, PhD
        • Kontakt:

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

18 år til 65 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Recipient Inclusion Criteria

  1. Male or female 18-65 years of age.
  2. Kidney transplant recipients from either LD or DD, with cryo-preserved HSCs available, good renal function (GFR>60 ml/min/1.73m2), normal current allograft biopsy, and no history of documented rejection episodes.
  3. First or second renal transplant.
  4. Use of FDA-approved methods of contraception (those with less than a 3% failure rate) by all recipients from the time that study treatment begins until 104 weeks (24 months) after renal transplantation. (For further information on FDA- approved methods of contraception, see https://www.fda.gov/media/150299/download
  5. Ability to understand and provide informed consent.
  6. Negative COVID-19 test during screening and two days prior to HSC transplantation (HSCT).

Deceased Donor (DD)

  1. Male or female 18-70 years of age.
  2. Consent to donate vertebral bones is obtained from the donor family.
  3. HSCs are successfully cryopreserved and saved >2X106/kg (CD34+ cells) of the recipient.
  4. Acceptable laboratory parameters (hematology in normal or near-normal range. Liver function <2 times the upper limit of normal, and normal creatinine)
  5. Negative for viral infection with HbsAg, HIV, HCV, or HTLV-1
  6. Negative COVID-19 test at the time of HSC procurement.

Living Donor (LD)

  1. Willingness to provide HSCs by leukapheresis or bone marrow aspiration.
  2. Negative serologic pregnancy test for females of childbearing potential
  3. Good general health as per conventional evaluation for kidney donation.
  4. Acceptable laboratory parameters (hematology in normal or near normal range. Liver function <2 times the upper limit of normal, and normal creatinine)
  5. Negative for viral infection with HbsAg, HIV, HCV, or HTLV-1.
  6. Cardiac/pulmonary function within normal limits (CXR, ECG).
  7. Ability to understand and provide informed consent.
  8. Meets standard institutional criteria for PBSC collection.
  9. Negative COVID-19 test during screening and two days prior to PBSC collection.

Recipient Exclusion Criteria

  1. ABO blood group-incompatible renal allograft.
  2. Evidence of anti-HLA antibody (donor specific with an MFI >1000) as assessed by routine methodology (Luminex)
  3. Previous history of biopsy proven rejection.
  4. Persistent Leukopenia (WBC less than 2,000/mm3) or thrombocytopenia (<100,000/mm3).
  5. Seropositivity for HIV-1, hepatitis B surface or core antigen, or hepatitis C virus (confirmed by hepatitis C virus RNA).
  6. Active infection
  7. Left ventricular ejection fraction < 40% as determined by TTE or clinical evidence of heart failure.
  8. Forced expiratory volume FEV1 or DLCO < 50% of predicted.
  9. Lactation or pregnancy.
  10. History of cancer (following the American Transplant Society Guidelines)
  11. Underlying renal disease etiology with high risk of disease recurrence in the transplanted kidney (such as focal segmental glomerulosclerosis). Autoimmune diseases such as Lupus and Thrombotic Thrombocytopenic Purpura.
  12. Enrollment in other investigational drug studies within 30 days prior to enrollment.
  13. Abnormal (>2 times lab normal) values for (a) liver function chemistries (ALT, AST, AP), (b) bilirubin, (c) coagulation studies (PT, PTT), or any patients on chronic anticoagulation therapy.
  14. Allergy or sensitivity to any component of Siplizumab, fludarabine, CP, tacrolimus, MMF or rituximab.
  15. Any medical condition that the investigator deems incompatible with participation in the trial. This includes a history of alcohol abuse or illicit drug use/dependence.
  16. Non-insulin dependent diabetes (NIDDM) without good blood glucose control (HbA1c<7). Severe retinopathy, gastroparesis, or severe neuropathy which prevent subject's normal independent daily activities.

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: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Kidney and Stem Cell Recipients

Months-Years after standard transplant, patients will undergo bone marrow transplant (either from prospective collection of stem cells from their living donor, or from bone marrow collected at the time of deceased donation)

Months-Years after standard transplant, patients will undergo bone marrow transplant (either from prospective collection of stem cells from their living donor, or from bone marrow collected at the time of deceased donation)

Fludarabine 15 mg/m2/day on days -5 to -3 (3 doses)

Cyclophosphamide (CP) 30 mg/kg/day on days -5 and -4

Rituximab on study day -6

Siplizumab (anti-CD2 mAb) on days, -2, -1, 0 and +1.

Eksperimentel: Kidney and Stem Cell Donors

PBSC will be collected from the LD via leukapheresis 1-4 weeks before the scheduled HSCT. The donor will first undergo standard GCSF mobilization: GCSF (can be TBO-GCSF) dosed at 10 mcg/kg/d (rounded to nearest pre-filled syringe) administered subcutaneously daily for 5 consecutive days. On the 5th day, the donor will undergo standard large volume leukapheresis. The target yield will be 2-3 x 106 CD34+ cells / kg of actual recipient body weight. A maximum of 3 days of pheresis will be allowed. A minimum of 2 x 106 CD34+ cells / kg of actual recipient body weight will be required to proceed

PBSC will be collected from the LD via leukapheresis 1-4 weeks before the scheduled HSCT. The donor will first undergo standard GCSF mobilization: GCSF (can be TBO-GCSF) dosed at 10 mcg/kg/d (rounded to nearest pre-filled syringe) administered subcutaneously daily for 5 consecutive days. On the 5th day, the donor will undergo standard large volume leukapheresis. The target yield will be 2-3 x 106 CD34+ cells / kg of actual recipient body weight. A maximum of 3 days of pheresis will be allowed. A minimum of 2 x 106 CD34+ cells / kg of actual recipient body weight will be required to proceed.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Forekomst af forbigående blandet kimærisme
Tidsramme: 3 måneder
3 måneder
Forekomst af renal allograft-tolerance
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Forekomst af deltageroverlevelse
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression
Forekomst af graftoverlevelse
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression
Forekomst af kimærisk overgangssyndrom
Tidsramme: 3 måneder
3 måneder
Forekomst af DSA
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression
Forekomst af GvHD
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression
Forekomst af thymusbestrålingstoksicitet
Tidsramme: 2 år efter ophør med immunsuppression
2 år efter ophør med immunsuppression
Incidence of Allograft Rejection
Tidsramme: 2 years after immunosuppression withdrawal

Measuring incidence of acute or chronic rejection free survival

2 years after immunosuppression withdrawal
Incidence of infections
Tidsramme: 2 years after immunosuppression withdrawal

Clinically significant, invasive or resistant opportunistic infection

2 years after immunosuppression withdrawal

Samarbejdspartnere og efterforskere

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

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Tatsuo Kawai, Massachusetts General Hospital

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 (Faktiske)

1. oktober 2023

Primær færdiggørelse (Anslået)

1. december 2031

Studieafslutning (Anslået)

1. december 2032

Datoer for studieregistrering

Først indsendt

18. maj 2023

Først indsendt, der opfyldte QC-kriterier

9. juni 2023

Først opslået (Faktiske)

12. juni 2023

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

24. september 2026

Sidst verificeret

1. september 2026

Mere information

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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