T-Cell Depletion and Stem Cell Transplant for Immune Deficiencies and Histiocytic Disorders

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Masonic Cancer Center, University of Minnesota
ClinicalTrials.gov Identifier:
NCT00176826
First received: September 12, 2005
Last updated: March 27, 2014
Last verified: March 2014
  Purpose

The hypothesis is to determine if a preparative regimen of busulfan, cyclophosphamide, and antithymocyte globulin (ATG) plus allogeneic stem cell transplantation will be effective in the treatment of immune deficiencies and histiocytic disorders.


Condition Intervention Phase
Hemophagocytic Lymphohistiocytosis
X-Linked Lymphoproliferative Disorders
Chediak-Higashi Syndrome
Griscelli Syndrome
Immunologic Diseases
Langerhans-Cell Histiocytosis
Hematologic Diseases
Procedure: Stem Cell Transplant
Drug: Myeloablative conditioning regimen
Phase 2
Phase 3

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: In-vivo T-cell Depletion and Hematopoietic Stem Cell Transplantation for Life-Threatening Immune Deficiencies and Histiocytic Disorders

Resource links provided by NLM:


Further study details as provided by Masonic Cancer Center, University of Minnesota:

Primary Outcome Measures:
  • Time to Transplant Engraftment [ Time Frame: Day 100 Post Transplant ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Number of Patients With Treatment Related Mortality. [ Time Frame: Day 100 Post Transplant ] [ Designated as safety issue: Yes ]
  • Number of Patients Surviving (Disease-free) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  • Number of Patients With Grade II-IV Graft-Versus-Host Disease (GVHD) [ Time Frame: Day 100 Post Transplant ] [ Designated as safety issue: Yes ]
  • Number of Patients With Graft Failure [ Time Frame: Day 100 Post transplant ] [ Designated as safety issue: No ]
  • Number of Patients With III-IV Graft-Versus-Host Disease (GVHD) [ Time Frame: Day 100 Post Transplant ] [ Designated as safety issue: Yes ]
  • Number of Patients Surviving (Disease-free) [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]

Enrollment: 22
Study Start Date: September 2000
Estimated Study Completion Date: July 2015
Primary Completion Date: August 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Intent-To-Treat
Patients who were treated with chemotherapies (myeloablative conditioning regimen) and stem cell transplant. Busulfan intravenously for 4 days followed by cyclophosphamide intravenously for 4 days. Rabbit ATG is given intravenously for 4 doses pre-transplant.
Procedure: Stem Cell Transplant
Infusion of hematopoietic stem cells (bone marrow, cord blood, peripheral blood stem cells) following myeloablative conditioning regimen.
Other Name: HSCT
Drug: Myeloablative conditioning regimen
Busulfan intravenously for 4 days followed by cyclophosphamide intravenously for 4 days. Rabbit ATG is given intravenously for 4 doses pre-transplant.
Other Names:
  • Busulfex
  • Cytoxan
  • ATG

Detailed Description:

Subjects will begin chemotherapy as a preparative regimen, which is intended to completely eliminate their defective immune system and bone marrow. The preparative regimen consists of the chemotherapy drugs (busulfan, cyclophosphamide, and antithymocyte globulin (ATG)).

Transplantation: subjects will then have a source of blood stem cells (bone marrow) from their donor administered into their catheter. Medication will be given to help prevent Graft-Versus Host Disease (GVHD). The ATG will help to deplete the donor stem cells of the type of cells that can cause GVHD and will also help to promote engraftment of the new stem cells.

Recovery Phase: The second phase of treatment consists of a period after transplantation during which we wait for the return of bone marrow function. This usually takes two to four weeks. Subjects will be given a blood cell growth factor, G-CSF, to help speed recovery of the white blood cells and potentially decrease the risk of infection and decrease the time until the bone marrow recovers.

  Eligibility

Ages Eligible for Study:   up to 55 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Any patient from birth to < 55 years of age fulfilling the following criteria will be eligible for this study.
  • Patients meeting clinical diagnostic criteria for Hemophagocytic Lymphohistiocytosis (HLH)
  • Patients meeting clinical diagnostic criteria or genetic diagnosis of X-linked lymphoproliferative disorder (XLP) and whose disease is ACTIVE but STABLE, or NON-ACTIVE/QUIESCENT.
  • Patients with Chediak-Higashi Syndrome who meet the following diagnostic criteria and whose disease is ACTIVE but STABLE, or NON-ACTIVE/QUIESCENT as defined in Appendix V of the study protocol.
  • Patients with Viral Associated Hemophagocytic Syndrome (VAHS) - if relapsed after other therapy or supportive care. Diagnostic criteria as above for HLH. Disease status must be ACTIVE but STABLE, or NON-ACTIVE/QUIESCENT as defined in Appendix V. It is cautioned that many patients with HLH or familial hemophagocytic lymphohistiocytosis (FHL) will have a viral infection at time of initial presentation and may therefore be misdiagnosed as having VAHS.
  • Griscelli Syndrome
  • Primary immune deficiencies with non-genotypic identical donors only.
  • Progressive Langerhans cell histiocytosis unresponsive to standard therapy.
  • Other non-malignant hematological disorders in which stem cell transplant with a myeloablative regimen is indicated.
  • Diamond Blackfan Anemia if transfusion dependent
  • Schwachman Diamond Syndrome: with cytopenias or transformation to myelodysplastic syndrome (MDS)
  • Kostman's Syndrome (if ANC <500 without GCSF support, or transformation to MDS)
  • Congenital dyserythropoietic anemia if transfusion dependent
  • Amegakaryocytic thrombocytopenia if baseline platelet counts <20,000 or requiring transfusions.
  • Cardiac, hepatic, renal and pulmonary function deemed adequate for high dose chemotherapy with stem cell rescue as per institutional standards. General guidelines are as follows:

    • Cardiac: Asymptomatic or, if symptomatic, then left ventricular ejection fraction at rest must be > 40% and must improve with exercise, or shortening fraction by echocardiogram must be within institutional normals
    • Hepatic: < 3 x normal SGOT and < 2.5 mg/dL serum bilirubin
    • Renal: Serum creatinine within normal range, or if serum creatinine outside normal range then creatinine clearance or glomerular filtration study should be > 50% of normal.
    • Pulmonary: Asymptomatic or, if symptomatic, diffusing capacity of the lung for carbon monoxide (DLCO) > 45% of predicted (corrected for hemoglobin). For children unable to perform pulmonary function testing, then oxygen saturation should be >95%.
  • Availability of a suitable allogeneic bone marrow donor as per current institutional guidelines for non-T cell depleted hematopoietic stem cell transplant (HSCT).
  • Patients who have undergone previous stem cell transplant (SCT) and failed engraftment or who had relapse of their disease are considered eligible if they meet other eligibility criteria and if the second SCT would occur 6 months or more after the first. If the first SCT preparative regimen was of a non-myeloablative intensity then the second SCT could be performed earlier when the acute toxicity from that procedure was resolved.

Exclusion Criteria:

  • Patients who are moribund or whose life expectancy is severely limited by disease other than their underlying disorder. Karnofsky performance status < 70% or Lansky < 50% for patients < 16 years.
  • Patients with hemophagocytic disorders secondary to underlying malignancy.
  • Patients who have ACTIVE/UNSTABLE disease as defined in Appendix V.
  • Significant active infections, including Human Immunodeficiency Virus (HIV).
  • Age > 55 years.
  • Not providing informed consent.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00176826

Locations
United States, Minnesota
Masonic Cancer Center, University of Minnesota
Minneapolis, Minnesota, United States, 55455
Sponsors and Collaborators
Masonic Cancer Center, University of Minnesota
Investigators
Principal Investigator: Angela Smith, MD University of Minnesota Medical Center
  More Information

No publications provided

Responsible Party: Masonic Cancer Center, University of Minnesota
ClinicalTrials.gov Identifier: NCT00176826     History of Changes
Obsolete Identifiers: NCT00973843
Other Study ID Numbers: UMN-MT2000-21, 0010M66781
Study First Received: September 12, 2005
Results First Received: March 27, 2014
Last Updated: March 27, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Masonic Cancer Center, University of Minnesota:
Stem Cell Transplant
T-cell depletion
immune deficiencies
Busulfan pharmacokinetics
Non-Malignant Hematological Disorders

Additional relevant MeSH terms:
Chediak-Higashi Syndrome
Hematologic Diseases
Histiocytosis
Histiocytosis, Langerhans-Cell
Immune System Diseases
Lymphohistiocytosis, Hemophagocytic
Lymphoproliferative Disorders
Phagocyte Bactericidal Dysfunction
Leukocyte Disorders
Immunologic Deficiency Syndromes
Lymphatic Diseases
Lung Diseases, Interstitial
Lung Diseases
Respiratory Tract Diseases
Histiocytosis, Non-Langerhans-Cell
Immunoproliferative Disorders

ClinicalTrials.gov processed this record on August 27, 2014