Naive T Cell Deplete Grafts for GVHD Prevention in Non-Malignant Diseases
A Phase II Prospective Study Evaluating Selective Depletion of CD45RA+ (Naïve) T Cells (TND) From Peripheral Blood Stem Cell (PBSC) Grafts for Prevention of Graft Versus Host Disease (GVHD) in Non-Malignant Diseases (NMDs)
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
OUTLINE: Patients will receive CD34+ enriched CD45RA-depleted donor T-lymphocytes IV on day 0. For conditioning, patients receive cyclophosphamide by IV on day -8, fludarabine by IV on day -7 to day -3, thiotepa IV on day -7 and day -6, and undergo total-body irradiation (TBI) for 2 doses on day -2 and day -1.
GVHD Prophylaxis:
All patients also receive tacrolimus IV continuously starting on day -1, and mycophenolate mofetil (MMF) starting day 0 through day 35. If there is no evidence of grade II-IV acute GVHD on or prior to day 100, tacrolimus is tapered.
All patients also undergo bone marrow aspiration/biopsy and collection of blood samples throughout the trial.
After completion of study treatment, patients are followed up at days 7, 14, 21, 28, 56, 80, 180, and 270 and at 1, 1.5, and 2 years.
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- Fase 2
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Madhavi Lakkaraja, MD, MPH
- Número de teléfono: 206-667-7166
- Correo electrónico: mlakkara@fredhutch.org
Ubicaciones de estudio
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Washington
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Seattle, Washington, Estados Unidos, 98105
- Seattle Children's Hospital
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Seattle, Washington, Estados Unidos, 98109
- Fred Hutchinson Cancer Center
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Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Niño
- Adulto
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Considered appropriate candidate for allogeneic HCT following low dose (4Gy) TBI containing-conditioning and have one of the following diagnoses: A) BMF B)Hemoglobinopathies C)PID D) Autoimmune cytopenias E) Immune dysregulation F) HLH G) Other NMD treatable by HCT and NMD that is not clearly defined (a patient with a NMD for whom genetic testing has been done and a genetic mutation responsible for their NMD phenotype has not been identified) are eligible for the study following discussion with and approval by the protocol PI
- Patients aged 6 months- 5 years old (inclusive) at the time of informed consent
- Patient with suitable HCT donor (see inclusion criteria below)
- Recipient informed consent/assent (13 years and older), and/or legal guardian permission must be obtained
Exclusion Criteria:
- Patient with aplastic anemia
- Patients with severe combined immunodeficiency (SCID)
- Fanconi anemia
- Dyskeratosis congenita
- Patient weight > 100 kg
- Patients who are positive for HIV-1, HIV-2
- Patients with current neoplastic disorders
- Patients with uncontrolled infections for whom HCT is considered contraindicated by the consulting infectious disease physician.
- Patients with organ dysfunction including A) Renal insufficiency B) Impaired cardiac function C)Impaired pulmonary function D) Liver dysfunction
- Patients who are pregnant or breast-feeding
- Patients on other experimental protocols for prevention of GVHD
- Patients of childbearing age who are presumed to be fertile and are unwilling to use an effective birth control method or refrain from sexual intercourse during and for 12 months post-HCT
- Patients with any other significant medical conditions that would make them unsuitable for transplantation, as determined by the PI
- Patients with a known hypersensitivity to tacrolimus or MMF
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: No aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
|---|---|
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Otro: Arm A (HLA-Haploidentical or mismatched unrelated donor)
Conditioning regimen for HLA-Haploidentical or mismatched unrelated donor consisting of Cyclophosphamide (50 mg/kg x1 day), Fludarabine 35 mg/m2/day x 5 days, Thiotepa (5 mg/kg/day x 2 days), TBI (200 cGy x 2).
Tacrolimus starting Day -1, MMF D0-35.
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CD34-selected graft with CD45RA- depleted peripheral blood stem cells given to patients with Non-Malignant Diseases
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Otro: Arm B (HLA-matched related or matched unrelated donor )
Conditioning regimen for HLA-matched related or matched unrelated donor consisting of Cyclophosphamide (50 mg/kg x1 day), Fludarabine (30 mg/m2/day x 5 days), Thiotepa (5 mg/kg/day x 2 days), TBI (200 cGy x 2).
Tacrolimus starting Day -1, MMF D0-35.
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CD34-selected graft with CD45RA- depleted peripheral blood stem cells given to patients with Non-Malignant Diseases
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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GVHD-free Survival
Periodo de tiempo: 1 year post-transplant
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Free of grade III-IV acute and NIH chronic (moderate-severe) GVHD requiring systemic immunosuppression
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1 year post-transplant
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Overall survival
Periodo de tiempo: 1 year post-transplant
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1 year post-transplant
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Transplant related mortality
Periodo de tiempo: Day 100 post-transplant and 1 year post-transplant
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Day 100 post-transplant and 1 year post-transplant
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Graft failure
Periodo de tiempo: Day 42 post-transplant
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Graft failure defined as failure to achieve an ANC ≥ 0.5 × 109/L before death or second HCT, or decrease to ANC <0.1 × 109/L for 14 consecutive days (date of graft failure defined as the 14th day) after an established donor graft despite daily administration of G-CSF (SC or IV) and ≤ average 20% bone marrow cellularity on bone marrow aspirate or biopsy any time in the first 2 years following HCT.
If a patient dies from organ toxicity and/or infection prior to day 28 without ANC ≥ 0.5 × 109/L this will not be considered graft failure.
If the graft failure is attributed to viral infection, multi-organ failure or drug effect it will still be considered graft failure if it meets the definition of graft failure specified above.
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Day 42 post-transplant
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Graft rejection
Periodo de tiempo: Day 100 post-transplant
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Graft rejection defined as <5% donor CD3 T cell and CD33 myeloid chimerism
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Day 100 post-transplant
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Incidence of chronic GVHD
Periodo de tiempo: At 1 year and 2 years post transplant
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Defined and graded based on NIH criteria and graded operationally as the occurrence of compatible symptoms
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At 1 year and 2 years post transplant
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Prednisone for GVHD
Periodo de tiempo: Every 3 months post-transplant for the first 2 years
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Number of participants alive and off prednisone (or equivalent systemic corticosteroid) for the treatment of GVHD
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Every 3 months post-transplant for the first 2 years
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Incidence of opportunistic infections requiring treatment
Periodo de tiempo: First year post-transplant
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Proportion of participants who experience viral infections/reactivations.
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First year post-transplant
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Peripheral blood donor chimerism
Periodo de tiempo: 2 years post-transplant
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Full donor chimerism will be defined as CD33 and CD3 ≥95%.
Mixed chimerism will be defined as CD33 OR CD3 <95% but >5%.
Actual chimerism values will be reported and summarized as well as dichotomized according to the 'full chimerism' and 'mixed chimerism' labels
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2 years post-transplant
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Investigadores
Investigadores
- Investigador principal: Madhavi Lakkaraja, MD, MPH, Fred Hutch Cancer Center
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Enfermedades Genéticas Congénitas
- Enfermedades del sistema inmunológico
- Enfermedades hematológicas
- Síndromes de deficiencia inmunológica
- Enfermedades linfáticas
- Enfermedades de la médula ósea
- Histiocitosis De Células No Langerhans
- Histiocitosis
- Enfermedades y anomalías congénitas, hereditarias y neonatales
- Enfermedades hemic y linfáticas
- Enfermedades de inmunodeficiencia primaria
- Trastornos de insuficiencia de la médula ósea
- Hemoglobinopatías
- Linfohistiocitosis Hemofagocítica
Otros números de identificación del estudio
Otros números de identificación del estudio
- 20798
- RG1126016 (Otro identificador: Fred Hutch Cancer Center)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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