Preventing Acute Chest Syndrome by Transfusion Feasibility Study (PROACTIVE)
Preventing Acute Chest Syndrome by Transfusion Feasibility Study( PROACTIVE Feasibility Study)
調査の概要
詳細な説明
SCD is an inherited blood disorder, and symptoms include anemia, infections, organ damage, and intense episodes of pain, which are called "sickle cell crises." ACS, characterized by fever, respiratory distress, and lung tissue damage, is the second most common cause of hospitalization and the leading cause of death among people with SCD. Most people with SCD will experience at least one episode of ACS, and repeated episodes can result in progressive lung disease. ACS can appear suddenly and often requires immediate hospitalization and treatment, which can include blood transfusions. People with elevated blood levels of sPLA2 may be at risk for developing ACS, and this enzyme is often detectable before the onset of ACS symptoms. The purpose of this study is to examine the use of sPLA2 as a predictor of ACS and to determine whether subsequent blood transfusions can be administered early enough to prevent the onset of ACS in people with SCD who are at risk for ACS. Study researchers will also assess the feasibility of conducting a larger study that would further examine the effectiveness of using sPLA2 levels and blood transfusions to prevent ACS.
This study will involve two parts. In the first part of the study, participants with SCD who are admitted to the hospital with an acute sickle cell pain event will be randomly assigned to receive either a single blood transfusion or standard care for ACS and no blood transfusion. All participants will be closely monitored while in the hospital for the development of ACS, and study researchers will review participants' medical records. All participants will undergo daily blood collections, which will include testing for sPLA2 levels, and at least two chest x-rays. Twenty-eight days after hospital discharge, all participants will attend a follow-up study visit for blood collection, again to determine sPLA2 levels.
In the second part of the study, participants who are not eligible or who do not choose to participate in the first part of the study will be enrolled into an observational group. These participants will receive standard care for ACS, but will not receive a blood transfusion. They will undergo daily blood collection during their hospital stay and at least one chest x-ray. While participants are in the hospital and 28 days after discharge, study researchers will review participants' medical records.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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California
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Oakland、California、アメリカ
- Children's Hospital and Research Center
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Delaware
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Wilmington、Delaware、アメリカ
- A.I. Dupont Hospital for Children
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District of Columbia
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Washington、District of Columbia、アメリカ
- Children's National Medical Center
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Washington、District of Columbia、アメリカ
- Howard University Hospital
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Georgia
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Atlanta、Georgia、アメリカ
- Emory University School of Medicine
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Augusta、Georgia、アメリカ
- Medical College of Georgia
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Illinois
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Chicago、Illinois、アメリカ
- Children's Memorial Hospital
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Chicago、Illinois、アメリカ
- University of Illinois Sickle Cell Center
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Kentucky
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Louisville、Kentucky、アメリカ
- Kosair Children's Hospital
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Maryland
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Baltimore、Maryland、アメリカ
- Johns Hopkins
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Massachusetts
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Boston、Massachusetts、アメリカ
- Children's Hospital Boston
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Boston,、Massachusetts、アメリカ
- Boston Medical Center
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Boston,、Massachusetts、アメリカ
- Brigham & Women's Hospital
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Mississippi
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Jackson、Mississippi、アメリカ
- University of Mississippi Medical Center
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New York
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Brooklyn、New York、アメリカ
- Interfaith Medical Center
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Brooklyn、New York、アメリカ
- New York Methodist Hospital
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North Carolina
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Chapel Hill、North Carolina、アメリカ
- The University of North Carolina at Chapel Hill
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Durham、North Carolina、アメリカ
- Duke University Medical Center
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Ohio
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Cincinnati、Ohio、アメリカ
- Cincinnati Children's Hospital Medical Center
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Columbus、Ohio、アメリカ
- Ohio State University
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Columbus、Ohio、アメリカ
- Nationwide Children's Hospital
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Pennsylvania
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Philadelphia、Pennsylvania、アメリカ
- Children's Hospital of Philadelphia
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Philadelphia、Pennsylvania、アメリカ
- St. Christopher's Hospital for Children
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Virginia
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Richmond、Virginia、アメリカ
- Virginia Commonwealth University Health Systems
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria for the Observational and Trial Cohorts:
- Hemoglobin diagnosis of SS (two copies of the hemoglobin S gene), SC (one copy of the hemoglobin S gene and one copy of the hemoglobin C gene), or S-β thalassemia (β+ or β0)
- No clinically apparent ACS
- No prior participation in either part of the study
Inclusion Criteria for the Trial Cohort, in addition to the above criteria:
- sPLA2 level greater than 100 ng/mL within the same 24-hour window that coincides with fever and chest radiograph negative for new pulmonary infiltrate within the last 12 hours of the 24-hour window
- Fever greater than 38.0º C within the same 24-hour window that coincides with elevated sPLA2 level (greater than 100 ng/mL) and chest radiograph negative for new pulmonary infiltrate within the last 12 hours of the 24-hour window
- Chest radiograph negative for new pulmonary infiltrate within the last 12 hours of the 24-hour window of an abnormal sPLA2 level and fever
- Hemoglobin levels equal or less than 10 g/dL at time of study entry
- Informed consent of parent(s) or legal guardian; informed consent or assent of participant as applicable
Exclusion Criteria for Observational and Trial Cohorts:
- Existing diagnosis of a new pulmonary infiltrate diagnosed by chest radiography (pleural effusion not obscuring lung parenchyma will not exclude the person from the study)
- Any coexisting medical condition for which the physician feels that a transfusion may be needed within 24 hours (e.g., severe anemia, stroke)
- Red Blood Cell (RBC) transfusion in the 60 days before study entry
- Unwillingness to sign consent form, or if a minor, unwillingness of parent/guardian to sign consent form
- Treatment with any investigational drug or device in the 30 days before study entry (hydroxyurea is allowable)
- History of alloimmunization that would prevent the participant from receiving blood within 8 hours of eligibility for study entry or history of a life-threatening transfusion reaction
- Objection to transfusion for religious or other reasons from either the participant or guardian
- History of treatment with systemic steroids within 1 week of study entry (inhaled steroids are acceptable)
- Pregnant
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: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)
武器と介入
参加者グループ / アーム |
介入・治療 |
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アクティブコンパレータ:Blood Transfusion Trial Cohort
Twenty participants will receive a blood transfusion while in the hospital.
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Participants will receive a single transfusion of 7-13cc/kg packed red blood cells (RBCs) while in the hospital.
他の名前:
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アクティブコンパレータ:Standard Care Trial Cohort
Twenty participants will not receive a blood transfusion and will receive standard care.
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Participants will receive standard care for ACS while in the hospital.
他の名前:
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アクティブコンパレータ:Standard Care Observational Cohort
Approximately 300 participants who are ineligible for or decline the blood transfusion part of the study will participate in the observational portion of the study and receive standard care.
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Participants will receive standard care for ACS while in the hospital.
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Acute Chest Syndrome
時間枠:Chest x-rays (CXR) were ordered for trial eligibility, as a result of clinical indications, or at discharge or 72 hours if no prior CXR.
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First occurence of positive infiltrate on chest x-ray
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Chest x-rays (CXR) were ordered for trial eligibility, as a result of clinical indications, or at discharge or 72 hours if no prior CXR.
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Sonja McKinlay, PhD、HealthCore-NERI
- スタディディレクター:Margaret C. Bell, MPH, MS、HealthCore-NERI
出版物と役立つリンク
一般刊行物
- Miller ST, Kim HY, Weiner D, Wager CG, Gallagher D, Styles L, Dampier CD; Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN). Inpatient management of sickle cell pain: a 'snapshot' of current practice. Am J Hematol. 2012 Mar;87(3):333-6. doi: 10.1002/ajh.22265. Epub 2012 Jan 9.
- Styles L, Wager CG, Labotka RJ, Smith-Whitley K, Thompson AA, Lane PA, McMahon LE, Miller R, Roseff SD, Iyer RV, Hsu LL, Castro OL, Ataga KI, Onyekwere O, Okam M, Bellevue R, Miller ST; Sickle Cell Disease Clinical Research Network (SCDCRN). Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE). Br J Haematol. 2012 Jun;157(5):627-36. doi: 10.1111/j.1365-2141.2012.09105.x. Epub 2012 Mar 30.
- Miller ST, Kim HY, Weiner DL, Wager CG, Gallagher D, Styles LA, Dampier CD, Roseff SD; Investigators of the Sickle Cell Disease Clinical Research Network (SCDCRN). Red blood cell alloimmunization in sickle cell disease: prevalence in 2010. Transfusion. 2013 Apr;53(4):704-9. doi: 10.1111/j.1537-2995.2012.03796.x. Epub 2012 Jul 13.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
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
詳しくは
本研究に関する用語
その他の研究ID番号
- 668
- U10HL083721 (米国 NIH グラント/契約)
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。
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