Haploidentical Hematopoietic Stem Cell Transplantation Patients With Wiskott-Aldrich Syndrome - Full Text View

Sponsor:	St. Jude Children's Research Hospital
Information provided by:	St. Jude Children's Research Hospital
ClinicalTrials.gov Identifier:	NCT00160355

Purpose

Wiskott - Aldrich syndrome (WAS) is a rare disorder curable only through allogeneic hematopoietic stem cell transplantation. A mismatched family member is an option when no human leukocyte antigen (HLA-immune system type) matched related or matched unrelated donor is available.

This study will evaluate a novel therapeutic strategy for patients with WAS who undergo haploidentical transplantation using a parental donor. To reduce the risk of transplant-related toxicities, participants will receive a reduced intensity chemotherapy and antibody regimen (conditioning treatment). Participants will then receive an infusion of donor stem cells depleted of certain white blood cells called T- and B-lymphocytes. The stem cell depletion processing will be done through the use of the investigational CliniMACS device. A certain number of T-lymphocytes will be added back to the processed stem cell graft prior to infusion into the recipient.

The primary objective of this study is to determine the safety of haploidentical transplantation in WAS patients using this specified conditioning regimen and engineered graft. Safety will be defined in terms of engraftment (meaning how well the graft grows and functions after infusion) and regimen-related toxicity within the first 100 days after transplant.

Condition	Intervention	Phase
Wiskott-Aldrich Syndrome	Procedure: Hematopoietic stem cell transplantation Device: Miltenyi CliniMACS selection system Drug: Fludarabine, Melphalan, Thiotepa	Phase I

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Haploidentical Hematopoietic Stem Cell Transplantation for Pediatric Patients With Wiskott-Aldrich Syndrome: A Pilot Study

Resource links provided by NLM:

Genetics Home Reference related topics: complement factor I deficiency hemophilia Wiskott-Aldrich syndrome Help Me Understand Genetics

Drug Information available for: Thiotepa Fludarabine Fludarabine monophosphate Melphalan Sarcolysin Melphalan hydrochloride

U.S. FDA Resources

Further study details as provided by St. Jude Children's Research Hospital:

Primary Outcome Measures:

To determine safety in regards to engraftment and toxicity within 100 days post-haploidentical T- and B-cell depleted hematopoietic stem cell transplantation for patients with Wiskott-Aldrich syndrome who received a reduced intensity conditioning [ Time Frame: March 2010 ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	12
Study Start Date:	May 2005
Study Completion Date:	February 2009
Primary Completion Date:	July 2008 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1	Procedure: Hematopoietic stem cell transplantation To determine the safety in regards to engraftment and toxicity within 100 days of infusing a haploidentical T- and B-cell depleted hematopoietic stem cell graft into patients with Wiskott-Aldrich syndrome who have received a reduced intensity conditioning regimen. Other Names: Haploidentical stem cell transplant Allogeneic stem cell transplant Mismatched family member donor transplant T and B cell depletion Device: Miltenyi CliniMACS selection system This system depletes the hematopoietic stem cell graft of T and B lymphocytes. Drug: Fludarabine, Melphalan, Thiotepa Participants will receive a reduced intensity conditioning regimen consisting of Fludarabine, Melphalan, Thiotepa, and OKT3 prior to receipt of the haploidentical stem cell graft. Rituximab will be given in an effort to prevent PTLPD. In addition to T-cell depletion of the donor product, cyclosporine will be given for GVHD prophylaxis.

Arms

Assigned Interventions

1

Procedure: Hematopoietic stem cell transplantation

To determine the safety in regards to engraftment and toxicity within 100 days of infusing a haploidentical T- and B-cell depleted hematopoietic stem cell graft into patients with Wiskott-Aldrich syndrome who have received a reduced intensity conditioning regimen.

Other Names:

Haploidentical stem cell transplant
Allogeneic stem cell transplant
Mismatched family member donor transplant
T and B cell depletion

Device: Miltenyi CliniMACS selection system

This system depletes the hematopoietic stem cell graft of T and B lymphocytes.

Drug: Fludarabine, Melphalan, Thiotepa

Participants will receive a reduced intensity conditioning regimen consisting of Fludarabine, Melphalan, Thiotepa, and OKT3 prior to receipt of the haploidentical stem cell graft. Rituximab will be given in an effort to prevent PTLPD. In addition to T-cell depletion of the donor product, cyclosporine will be given for GVHD prophylaxis.

Detailed Description:

Secondary Objectives in this trial include the following:

To estimate the survival of study recipients at one year after infusion of the T- and B-lymphocyte depleted stem cell graft.
To assess if the study treatment enables the recipient to generate normal donor-derived B-cell numbers and endogenous IgM, IgG, and IgA production, resulting in a reduction/elimination of the need for intravenous immunoglobulin infusions.
To determine if the study treatment results in the ability of the research participant to generate normal donor-derived T cell response and natural killer (NK) cell numbers and function.
To describe the incidence of Epstein-Barr virus-lymphoproliferative disease (EBV-LPD) in these transplant recipients.

Eligibility

Ages Eligible for Study:	up to 18 Years
Genders Eligible for Study:	Male
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Genotypical diagnosis of Wiskott-Aldrich Syndrome.
Less than 18 years of age at time of transplant.

Must meet two of the eight following clinical criteria:

Eczema that is refractory to standard therapy.
Thrombocytopenia as defined by a platelet count < 50,000/mm3.
Significant risk for or presence of opportunistic infection.
Autoimmune disease.
Malignancy or pre-malignant condition.
Family history as defined as a family member with WAS who died before 10 years of age.
Does not have a suitable, available 6/6 HLA-matched sibling donor available for donation.
Does not have a suitable, available 10/10 HLA-allele matched unrelated donor identified through the National Marrow Donor Program (NMDP).

Exclusion Criteria:

If any of the following clinical indicators are met within 45 days prior to transplant, the research participant will not be eligible for the study:

Symptomatic cardiac disease or evidence of significant cardiac dysfunction by echocardiogram (shortening fraction < 30%).
Creatinine clearance or Tc 99 less than or equal 40ml/min/1.73 m2.
SGPT greater than or equal 500 U/L.
Karnofsky or Lansky Performance Score of < 50.
Pulmonary function tests: FVC < 50% of predicted value if age appropriate to perform the testing adequately or an O2 saturation less than or equal to 92% on room air at rest.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00160355

Locations

United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105

Sponsors and Collaborators

St. Jude Children's Research Hospital

Investigators

Principal Investigator:

Kimberly Kasow, DO

St. Jude Children's Research Hospital

More Information

Additional Information:

St. Jude Children's Research Hospital This link exits the ClinicalTrials.gov site

No publications provided

Responsible Party:	Kimberly Kasow, DO / Principal Investigator, St. Jude Children's Research Hospital
ClinicalTrials.gov Identifier:	NCT00160355 History of Changes
Other Study ID Numbers:	WASHAP
Study First Received:	September 8, 2005
Last Updated:	February 12, 2009
Health Authority:	United States: Food and Drug Administration

Keywords provided by St. Jude Children's Research Hospital:

Wiskott-Aldrich Syndrome
Immunodeficiency
Haploidentical transplantation

Additional relevant MeSH terms:

Wiskott-Aldrich Syndrome
Blood Coagulation Disorders, Inherited
Blood Coagulation Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphopenia
Leukopenia
Leukocyte Disorders
Genetic Diseases, Inborn
Genetic Diseases, X-Linked
Immunologic Deficiency Syndromes
Immune System Diseases
Melphalan
Thiotepa

Fludarabine
Fludarabine monophosphate
Myeloablative Agonists
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antimetabolites

ClinicalTrials.gov processed this record on February 12, 2012