Allogeneic Stem Cell Transplant for Patients With Severe Aplastic Anemia
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Purpose
Patients have been diagnosed with severe Aplastic Anemia that have not responded to treatment with immunosuppressive therapy (drugs that suppress the immune system, for example Steroids). The immune system is the system in the body that helps protect the body and fights bacterial, viral and fungal infections.
Research studies have shown that patients with Aplastic Anemia have improved survival (may live longer) after receiving a HLA (Human Leukocyte Antigen) identical sibling (brother and sister) stem cell transplants. Patients who do not have matched siblings can undergo immunosuppressive therapy, which has also shown to improve outcome. Unfortunately patients who do not respond to immunosuppressive therapy usually die. The best chance of survival for these patients is an HLA matched unrelated or mismatched related stem cell transplant as described below.
Stem cells are created in the bone marrow. They mature into different types of blood cells that people need including red blood cells which carry oxygen around the body, white blood cells which help fight infections, and platelets which help the blood to clot and prevent bleeding. For a matched unrelated stem cell transplant, stem cells are collected from a person (donor) who is not related to the patient but who has the same type of stem cells. For a mismatched related stem cell transplant, stem cells are collected from a donor who is related to the patient and whose stem cells are almost the same as those of the patient but not exactly. The patient then receives high dose chemotherapy. This chemotherapy kills the stem cells in the patient's bone marrow. Stem cells that have been collected from the donor are then given to the patient to replace the stem cells that have been killed.
The major problems associated with these types of stem cell transplants are graft rejection (where the patient's immune system rejects the donor stem cells) and severe graft versus host disease (GVHD), where the donors stem cell reacts against the patient's tissues in the body.
| Condition | Intervention | Phase |
|---|---|---|
|
Aplastic Anemia |
Drug: Cytoxan Drug: Campath Radiation: Total Body Irradiation (TBI) Drug: FK-506 Drug: Methotrexate Procedure: Stem cell infusion |
Phase 2 |
| 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 Patients With Severe Aplastic Anemia, Using Matched Unrelated Donors and Mismatched Related Donors (SAA MUD) |
- Number of subjects alive at 100 days post transplant [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
- Engraftment rate at 100 days post transplant [ Time Frame: 100 days post transplant ] [ Designated as safety issue: Yes ]Absolute neutrophil count greater than 0.5 X 109/ml for at least 3 days
- Number of patients with acute GVHD at 100 days post transplant [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
- Toxicity rate at 100 days post transplant [ Time Frame: 100 days ] [ Designated as safety issue: Yes ]
- Number of patients with chronic GVHD at 1 year post transplant [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]
| Enrollment: | 22 |
| Study Start Date: | February 2002 |
| Study Completion Date: | July 2012 |
| Primary Completion Date: | July 2012 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Patients
Patients with a diagnosis of severe aplastic anemia who require an allogeneic stem cell transplant but lack an Human Leukocyte Antigen (HLA) identical family member.
|
Drug: Cytoxan
Cytoxan will be given at 50 mg/kg per dose for 4 successive days.
Other Name: Cyclophosphamide
Drug: Campath
Campath will be given at a dose of 3 mg for patients whose weight is between 5 and 15 kg; at a dose of 5 mg for patients whose weight is between 16 and 30 kg; and at a dose of 10 mg for patients whose weight is greater than 30 kg. The last dose of Campath should be 24 hours or more before stem cell infusion.
Other Name: alemtuzumab
Radiation: Total Body Irradiation (TBI)
TBI will be given at a dose of 200 cGy for 6/6 HLA match and at a dose of 400 cGy in two fractions of 200 cGy each for 5/6 HLA matched donor.
Other Name: Irradiation
Drug: FK-506
FK-506 will be given at a dose of 0.03 mg/kg/day via continuous infusion over 24 hours from 4pm on day -2 until engraftment or when patient is able to take by mouth (PO), then 0.03 mg/kg PO every 12 hours.
Other Name: Tacrolimus
Drug: Methotrexate
Methotrexate will be administered on day +1, day +3, day +6 and day +11 at a dose of 5 mg/m2. The day +11 dose may be omitted at the discretion of the bone marrow transplant (BMT) in-patient attending physician.
Other Name: Methotrexate
Procedure: Stem cell infusion
Where possible patients will receive bone marrow. Marrow will be collected as per National Marrow Donor Program (NMDP) guidelines to provide a volume of 15-20 ml/kg of marrow and/or 2-4 X 10^8 nucleated cells/kg. In case marrow cannot be collected, peripheral blood stem cell (PBSC) will be substituted. A minimum of 5-6 X 10^6 CD 34+ cells/kg should be collected, with a target of 10 X 10^6/kg.
Other Name: Stem Cell Infusion
|
Show Detailed Description Eligibility| Ages Eligible for Study: | up to 60 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Diagnosis of Severe Aplastic Anemia (SAA) based on bone marrow aspirate and biopsy results.
- Failure to respond to immunosuppressive therapy.
- Lack of an Human Leukocyte Antigen (HLA) identical family member.
- A 6/6 or 5/6 HLA matched unrelated donor or a 5/6 matched related donor available after high resolution HLA typing.
- Age from birth to 60 years.
Exclusion Criteria:
- Severe disease other than aplastic anemia that would limit the probability of survival during the graft procedure. Patients who present with active infection must be treated to maximally resolve this problem before beginning the conditioning regimen.
- Human immunodeficiency virus (HIV) seropositive patients
- Patients who have clonal cytogenetic abnormalities or a myelodysplastic syndrome.
- Patient greater than 60 years of age.
- Women who are pregnant or nursing.
- Patients with active hepatitis
- Patients with severe cardiac dysfunction defined as shortening fraction < 25%.
- Patients with severe renal dysfunction defined as creatinine clearance < 40 ml/mim/1.73m2.
- Patient with severe pulmonary dysfunction with forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) 40% of predicted or 3 standard deviations (SD) below normal.
Contacts and Locations| United States, Texas | |
| Texas Children's Hospital | |
| Houston, Texas, United States, 77030 | |
| The Methodist Hospital | |
| Houston, Texas, United States, 77030 | |
| Principal Investigator: | Kathryn Leung, MD | Baylor College of Medicine |
More Information
No publications provided
| Responsible Party: | Kathryn Leung, Principal Investigator, Baylor College of Medicine |
| ClinicalTrials.gov Identifier: | NCT00578903 History of Changes |
| Obsolete Identifiers: | NCT00598221 |
| Other Study ID Numbers: | 10915-SAA MUD, SAA MUD |
| Study First Received: | December 19, 2007 |
| Last Updated: | August 10, 2012 |
| Health Authority: | United States: Institutional Review Board United States: Food and Drug Administration |
Keywords provided by Baylor College of Medicine:
|
Severe Aplastic Anemia Severe |
Additional relevant MeSH terms:
|
Anemia Anemia, Aplastic Hematologic Diseases Bone Marrow Diseases Cyclophosphamide Methotrexate Tacrolimus Alemtuzumab 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 Abortifacient Agents, Nonsteroidal Abortifacient Agents Reproductive Control Agents Antimetabolites, Antineoplastic Antimetabolites Dermatologic Agents Enzyme Inhibitors Folic Acid Antagonists Nucleic Acid Synthesis Inhibitors |
ClinicalTrials.gov processed this record on May 16, 2013