High Dose Cyclophosphamide for Treatment of Scleroderma

This study has been completed.
Information provided by (Responsible Party):
Fredrick M. Wigley, Johns Hopkins University
ClinicalTrials.gov Identifier:
First received: July 13, 2007
Last updated: March 29, 2012
Last verified: July 2008

Systemic Sclerosis (Scleroderma) varies greatly in clinical manifestations, mode of presentation, and course. The natural history of this chronic autoimmune disease ranges from benign to fatal. Patients are classified into limited and diffuse scleroderma defined by the degree of skin involvement. Patients with limited disease (e.g. the C.R.E.S.T. syndrome) generally have mild disease and normal survival. However, patients with diffuse cutaneous scleroderma often have severe multi-system disease that is not only devastating emotionally and physically but is associated with a 60-70% five year survival and a 40-50% 10 year survival. No therapies have proven effective in the treatment of scleroderma. Strategy to treat scleroderma have included attempts to prevent fibrosis with drugs that interfere with collagen metabolism, attempts to modify the disease process by immunosuppression and attempts to alter the disease by vasoactive drugs. High dose of corticosteroids and other immunosuppressive drugs (e.g. chlorambucil, 5-fluorouracil, methotrexate, cyclophosphamide, cyclosporine) used at conventional doses have not proven curative, but have shown some benefit for inflammatory features of the disease (e.g. arthritis, myositis, fibrosing alveolitis).

Both allogeneic and autologous bone marrow transplantation (BMT) have shown to modify and in some instances reverse a variety of animal models of autoimmune disease. This has prompted many investigators to propose the use of peripheral blood stem cell transplantation (PBSCT) for the treatment of autoimmune disease including scleroderma. Unfortunately, this approach risks infusing untreated autoreactive lymphocyte clones after the immunoablative preparative regimen. We have previously demonstrated that high-dose cyclophosphamide without BMT can induce durable and complete remissions in another autoimmune disease, severe aplastic anemia. Recent data with high dose cyclophosphamide show that it can induce complete remissions in other autoimmune hematologic disorders. The objective of this study is to determine whether high dose cyclophosphamide can induce a durable remission in scleroderma patients with life-threatening disease, and to determine toxicity of high dose cyclophosphamide in high risk scleroderma patients.

Condition Intervention Phase
Drug: High Dose Cyclophosphamide
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: High Dose Cyclophosphamide for Treatment of Systemic Sclerosis (Scleroderma)

Resource links provided by NLM:

Further study details as provided by Johns Hopkins University:

Primary Outcome Measures:
  • The primary endpoint will be the total skin score. A 25% improvement will be considered clinically important. The skin score is the accepted clinical measure of scleroderma activity. [ Time Frame: 3 months through 3 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Secondary endpoints will be changes in the total severity score (composite) and measures of severity in each specific organ (organ specific measures). [ Time Frame: 3 months through 3 years ] [ Designated as safety issue: No ]

Enrollment: 8
Study Start Date: February 2001
Study Completion Date: May 2010
Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: I
This is an open-labeled single arm study.
Drug: High Dose Cyclophosphamide
Cyclophosphamide (50 mg/kg) intravenously daily for 4 consecutive days (total 200 mg/kg) followed by granulocyte colony-stimulating factor (5 µg/kg/day)


Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Meet established criteria for a diagnosis of diffuse cutaneous scleroderma and have evidence of moderately severe organ damage and clinical evidence of active disease.
  • Patients with diffuse scleroderma who have evidence of active fibrosing alveolitis manifested by either a greater than 10% decline in the forced vital capacity or the diffusing capacity from the defined normal values or from baseline measurements.
  • Patients with severe deforming localized scleroderma (generalized morphea, liner morphea, keloid or bullous scleroderma) that threatens their capacity to function normally in society.

Exclusion Criteria:

  • Age less than 18 years and over 70 years
  • Any risk of pregnancy
  • Cardiac ejection fraction of < 45%
  • Serum creatinine > 3.0
  • Patients who are pre-terminal or moribund
  • Bilirubin > 2.0, transaminases > 2x normal
  • FVC, FEV1 (5/30/01) < 50% predicted
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00501995

Sponsors and Collaborators
Johns Hopkins University
Principal Investigator: Fredrick M Wigley, MD Johns Hopkins University
  More Information

No publications provided

Responsible Party: Fredrick M. Wigley, Professor of Medicine, Johns Hopkins University
ClinicalTrials.gov Identifier: NCT00501995     History of Changes
Other Study ID Numbers: 00-11-17-02
Study First Received: July 13, 2007
Last Updated: March 29, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by Johns Hopkins University:
High Dose Cyclophosphamide
Systemic Sclerosis

Additional relevant MeSH terms:
Scleroderma, Systemic
Scleroderma, Diffuse
Scleroderma, Localized
Connective Tissue Diseases
Skin Diseases
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists

ClinicalTrials.gov processed this record on April 23, 2014