Allogeneic Stem Cell Transplantation for the Treatment of Multiple Sclerosis

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Duke University
Information provided by (Responsible Party):
University of Louisville
ClinicalTrials.gov Identifier:
NCT00497952
First received: July 6, 2007
Last updated: April 21, 2014
Last verified: April 2014
  Purpose

The goal of this research study is to establish chimerism in hopes to halt disease progression in patients with Multiple Sclerosis.


Condition Intervention Phase
Multiple Sclerosis
Biological: Enriched Hematopoetic Stem Cell Transplant
Phase 1
Phase 2

Access to an investigational treatment associated with this study is no longer available outside the clinical trial.   More info ...

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Allogeneic Stem Cell Transplantation for the Treatment of Multiple Sclerosis

Resource links provided by NLM:


Further study details as provided by University of Louisville:

Primary Outcome Measures:
  • Stem cell engraftment [ Time Frame: One month to three years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Disease remission [ Time Frame: 3 Years ] [ Designated as safety issue: No ]

Enrollment: 3
Study Start Date: July 2007
Estimated Study Completion Date: December 2020
Estimated Primary Completion Date: December 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Enriched Hematopoetic Stem Cell Transplant Biological: Enriched Hematopoetic Stem Cell Transplant
Bone marrow will be processed via a new technology which will enrich hematopoietic stem cells and graft facilitating cells. Monitoring for chimerism will be done at key time points.

Detailed Description:

While the cause of MS in not known, there is an autoimmune component that destroys nerve cells. Autoimmunity is a condition where an individual's immune system attacks his/her own cells. Bone marrow stem cell transplantation has been shown to halt autoimmunity. Stem cell transplant can be performed using the patient's own cells, or donor cells. The general consensus in the field is that donor transplant is most likely to halt disease progression. This study is designed to evaluate the safety of a donor transplant procedure as a therapy for relapsing remitting multiple sclerosis (RRMS).

Two factors limit the widespread application of traditional donor stem cell transplant: 1) preparing the patient for transplant (conditioning); and 2) graft-versus-host disease (GVHD). Traditional conditioning destroys the recipient's immune system and requires that the marrow transplant be successful because the patient is unable to fight off infection if the donor cells do not survive. GVHD occurs when donor immune cells recognize the recipient's cells as foreign tissue and attack them. Severe GVHD can result in death. This study utilizes a new approach to conditioning which leaves the patient's immune system intact. The transplant product is depleted of GVHD-producing cells but retains tolerance-promoting cells, called facilitating cells, which are intended to ensure the donor and recipient cells coexists peacefully. The toxicity of conditioning and transplantation is significantly reduced. The end result is a marrow system that contains recipient and donor cells, a state called mixed chimerism.

In this study, we will determine the appropriate cell dose to safely establish mixed chimerism following partial conditioning in patients with RRMS. The study takes a gradual approach to increasing the cell dose to achieve mixed chimerism. Each patient will receive a cell dose one unit above the dose received by the most recent safely transplanted patient. We believe this study will provide a breakthrough in the treatment of MS. The goal of this study is to evaluate the potential of safely establishing mixed chimerism to interrupt the autoimmune process and end the devastating effects of MS.

  Eligibility

Ages Eligible for Study:   18 Years to 55 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Clinically definite MS according to the McDonald criteria
  • Confirmed diagnosis of relapsing-remitting MS.
  • Age between 18 and 55 years
  • Extended Disability Status Score (EDSS) between 0 and 5.0
  • Independently ambulatory (eligible for inclusion if subject was acutely non-ambulatory within the previous year and return of function is substantiated with EDSS score.)
  • Relapse within the last year or sustained disability progression of 1.0 for six months
  • Treatment with high dose, high frequency Interferon-β therapy, or failure to tolerate Interferon-β therapy
  • Diffusing capacity of the lung for carbon monoxide (DLCO)> 50% (unless cleared by physician)
  • Ejection fraction (EF) > 40% (unless cleared by cardiologist)
  • Required initial laboratory data (obtained within 30 days prior to transplant, unless otherwise specified)

    • HIV-1,2 antigen and antibody negative
    • HBsAg negative (chronic hepatitis B carriers without clinical evidence of liver disease can be considered on an individual basis if it is determined that the added risk is justified by the prognosis and lack of treatment alternatives)
    • Hepatitis C antibody negative (positive antibody allowed if antigen (RNA)-negative and no clinical evidence of cirrhosis)
    • Cytomegalovirus (CMV), hepatitis B, Human T-lymphotropic virus (HTLV)-1,2, Epstein-Barr virus (EBV), and Herpes antibody status known
    • Pregnancy test negative (women of childbearing potential only)
  • No life-threatening organ dysfunction.

    • Uncontrolled or severe cardiovascular disease, including recent (<6 months) myocardial infarction, angina (symptomatic despite optimal medical management), life-threatening arrhythmia or hypertension
  • Able to give informed consent

Exclusion Criteria:

  • Women who are of child bearing potential must have a negative pregnancy test (serum pregnancy test - human chorionic gonadotrophin (HCG)) within 48 hours of initiating total body irradiation and agree to use reliable contraception for 1 year following transplant.
  • Concomitant severe diseases (respiratory, renal, liver, cardiac failures, psychiatric disorders, neoplasms)
  • Recurrent urinary, pulmonary infections.
  • Active bacterial, viral, or fungal infection
  • Active peptic ulcer disease
  • Previous treatments with total lymphoid irradiation or total body irradiation
  • Interferon-neutralizing antibody positive with a titer greater than 20
  • Relapse in the month preceding enrollment
  • Poor compliance
  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: NCT00497952

Locations
United States, Kentucky
Institute for Cellular Therapeutics, University of Louisville
Louisville, Kentucky, United States, 40202
United States, North Carolina
Duke University
Durham, North Carolina, United States, 27705
Sponsors and Collaborators
University of Louisville
Duke University
Investigators
Study Director: Suzanne T. Ildstad, M.D. Institute for Cellular Therapeutics, University of Louisville
Principal Investigator: Joanne Kurtzberg, MD Duke University
  More Information

No publications provided

Responsible Party: University of Louisville
ClinicalTrials.gov Identifier: NCT00497952     History of Changes
Other Study ID Numbers: ICT-13080-122206
Study First Received: July 6, 2007
Last Updated: April 21, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Louisville:
Relapsing-remitting multiple sclerosis
Marrow/Stem cell transplant

Additional relevant MeSH terms:
Multiple Sclerosis
Sclerosis
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Pathologic Processes

ClinicalTrials.gov processed this record on July 31, 2014