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)
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Detaljert beskrivelse
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.
Studietype
Studietype
Registrering (Antatt)
Registrering
Fase
Fase
- Fase 2
Kontakter og plasseringer
Studiekontakt
Studiekontakt
- Navn: Madhavi Lakkaraja, MD, MPH
- Telefonnummer: 206-667-7166
- E-post: mlakkara@fredhutch.org
Studiesteder
-
-
Washington
-
Seattle, Washington, Forente stater, 98105
- Seattle Children's Hospital
-
Seattle, Washington, Forente stater, 98109
- Fred Hutchinson Cancer Center
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-
Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Barn
- Voksen
Tar imot friske frivillige
Beskrivelse
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
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Antall våpen
Våpen og intervensjoner
Deltakergruppe / ArmDeltakergruppe / Arm |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
|
Annen: 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
|
|
Annen: 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
|
Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
GVHD-free Survival
Tidsramme: 1 year post-transplant
|
Free of grade III-IV acute and NIH chronic (moderate-severe) GVHD requiring systemic immunosuppression
|
1 year post-transplant
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Overall survival
Tidsramme: 1 year post-transplant
|
1 year post-transplant
|
|
|
Transplant related mortality
Tidsramme: Day 100 post-transplant and 1 year post-transplant
|
Day 100 post-transplant and 1 year post-transplant
|
|
|
Graft failure
Tidsramme: 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
|
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Graft rejection
Tidsramme: 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
Tidsramme: At 1 year and 2 years post transplant
|
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
|
|
Prednisone for GVHD
Tidsramme: 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
Tidsramme: First year post-transplant
|
Proportion of participants who experience viral infections/reactivations.
|
First year post-transplant
|
|
Peripheral blood donor chimerism
Tidsramme: 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
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2 years post-transplant
|
Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Etterforskere
Etterforskere
- Hovedetterforsker: Madhavi Lakkaraja, MD, MPH, Fred Hutch Cancer Center
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Genetiske sykdommer, medfødte
- Sykdommer i immunsystemet
- Hematologiske sykdommer
- Immunologiske mangelsyndromer
- Lymfesykdommer
- Benmargssykdommer
- Histiocytose, ikke-Langerhans-celle
- Histiocytose
- Medfødte, arvelige og neonatale sykdommer og abnormiteter
- Hemic og lymfatiske sykdommer
- Primære immunsviktsykdommer
- Benmargssviktforstyrrelser
- Hemoglobinopatier
- Lymfohistiocytose, hemofagocytisk
Andre studie-ID-numre
Andre studie-ID-numre
- 20798
- RG1126016 (Annen identifikator: Fred Hutch Cancer Center)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
Legemiddel- og utstyrsinformasjon, studiedokumenter
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