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)
調査の概要
状態
状態
条件
条件
介入・治療
介入・治療
詳細な説明
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.
研究の種類
研究の種類
入学 (推定)
入学
段階
段階
- フェーズ2
連絡先と場所
研究連絡先
研究連絡先
- 名前:Madhavi Lakkaraja, MD, MPH
- 電話番号:206-667-7166
- メール:mlakkara@fredhutch.org
研究場所
-
-
Washington
-
Seattle、Washington、アメリカ、98105
- Seattle Children's Hospital
-
Seattle、Washington、アメリカ、98109
- Fred Hutchinson Cancer Center
-
-
参加基準
適格基準
適格基準
就学可能な年齢
- 子
- 大人
健康ボランティアの受け入れ
説明
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
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:非ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
アーム数
武器と介入
参加者グループ / アーム参加者グループ / アーム |
介入・治療介入・治療 |
|---|---|
|
他の: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.
|
CD34-selected graft with CD45RA- depleted peripheral blood stem cells given to patients with Non-Malignant Diseases
|
|
他の: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.
|
CD34-selected graft with CD45RA- depleted peripheral blood stem cells given to patients with Non-Malignant Diseases
|
この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
GVHD-free Survival
時間枠:1 year post-transplant
|
Free of grade III-IV acute and NIH chronic (moderate-severe) GVHD requiring systemic immunosuppression
|
1 year post-transplant
|
二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Overall survival
時間枠:1 year post-transplant
|
1 year post-transplant
|
|
|
Transplant related mortality
時間枠:Day 100 post-transplant and 1 year post-transplant
|
Day 100 post-transplant and 1 year post-transplant
|
|
|
Graft failure
時間枠:Day 42 post-transplant
|
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.
|
Day 42 post-transplant
|
|
Graft rejection
時間枠:Day 100 post-transplant
|
Graft rejection defined as <5% donor CD3 T cell and CD33 myeloid chimerism
|
Day 100 post-transplant
|
|
Incidence of chronic GVHD
時間枠:At 1 year and 2 years post transplant
|
Defined and graded based on NIH criteria and graded operationally as the occurrence of compatible symptoms
|
At 1 year and 2 years post transplant
|
|
Prednisone for GVHD
時間枠:Every 3 months post-transplant for the first 2 years
|
Number of participants alive and off prednisone (or equivalent systemic corticosteroid) for the treatment of GVHD
|
Every 3 months post-transplant for the first 2 years
|
|
Incidence of opportunistic infections requiring treatment
時間枠:First year post-transplant
|
Proportion of participants who experience viral infections/reactivations.
|
First year post-transplant
|
|
Peripheral blood donor chimerism
時間枠:2 years post-transplant
|
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
|
2 years post-transplant
|
協力者と研究者
捜査官
捜査官
- 主任研究者:Madhavi Lakkaraja, MD, MPH、Fred Hutch Cancer Center
研究記録日
主要日程の研究
研究開始 (推定)
研究開始
一次修了 (推定)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
その他の研究ID番号
- 20798
- RG1126016 (その他の識別子:Fred Hutch Cancer Center)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。