Low-Dose Conditioning Followed by Donor Stem Cell Transplant in Treating Patients With Severe Systemic Sclerosis

This study has been withdrawn prior to enrollment.
Sponsor:
Collaborator:
Information provided by:
Fred Hutchinson Cancer Research Center
ClinicalTrials.gov Identifier:
NCT01047072
First received: January 11, 2010
Last updated: October 29, 2012
Last verified: October 2012
  Purpose

The purpose of the study is to see how well reduced intensity conditioning followed by a stem cell transplant from a donor (allogeneic) works in treating patients with severe systemic sclerosis. In an allogeneic stem cell transplant procedure, stem cells are taken from a healthy donor and transplanted into the patient. Stem cells can be donated by a family member or an unrelated donor who is a complete tissue type match.


Condition Intervention Phase
Systemic Scleroderma
Drug: fludarabine phosphate
Radiation: total-body irradiation
Drug: tacrolimus
Drug: mycophenolate mofetil
Biological: rituximab
Drug: cyclophosphamide
Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation
Procedure: peripheral blood stem cell transplantation
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Clinical Trial of Allogeneic Hematopoietic Cell Transplantation After Nonmyeloablative Conditioning for Patients With Severe Systemic Sclerosis

Resource links provided by NLM:


Further study details as provided by Fred Hutchinson Cancer Research Center:

Primary Outcome Measures:
  • Event-free survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Event-free survival [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Overall survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Overall survival [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Time to progression [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Time to progression [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Incidence of initiation of any SSC disease-modifying therapy other than that specified in the protocol treatment arms [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  • Incidence of definite and probable viral, fungal, and bacterial infections [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  • Median time to engraftment as defined as having greater than or equal to 5% donor T cells in the peripheral blood (donor T cell chimerism) [ Time Frame: From date of transplant to time of engraftment ] [ Designated as safety issue: No ]
  • Rate of primary graft failure [ Time Frame: Day 56 ] [ Designated as safety issue: No ]
  • Rate of secondary graft failure [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  • Probability of acute and chronic GVHD [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]

Enrollment: 0
Estimated Primary Completion Date: September 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I (transplant)
Patients receive fludarabine IV on days -4 to -2. Patients undergo total-body irradiation on day 0. Patients then undergo peripheral blood stem cell transplantation on day 0. Patients receive GVHD prophylaxis comprising tacrolimus PO twice daily on days -3 to 180 and taper and mycophenolate mofetil PO three times daily on days 0-28 and then twice daily until day 180 and taper.
Drug: fludarabine phosphate
Given IV
Other Names:
  • 2-F-ara-AMP
  • Beneflur
  • Fludara
Radiation: total-body irradiation
Undergo total-body irradiation
Other Name: TBI
Drug: tacrolimus
Given orally
Other Names:
  • FK 506
  • Prograf
Drug: mycophenolate mofetil
Given orally
Other Names:
  • Cellcept
  • MMF
Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation
Undergo transplantation
Procedure: peripheral blood stem cell transplantation
Undergo transplantation
Other Names:
  • PBPC transplantation
  • PBSC transplantation
  • peripheral blood progenitor cell transplantation
  • transplantation, peripheral blood stem cell
Active Comparator: Arm II (nontransplant)
Patients receive mycophenolate mofetil PO twice daily for 16 months, rituximab IV on days 1 and 15 and then repeated at 6 months, and cyclophosphamide IV at 28-32 day intervals or orally once daily for 16 months.
Drug: mycophenolate mofetil
Given orally
Other Names:
  • Cellcept
  • MMF
Biological: rituximab
Given IV
Other Names:
  • IDEC-C2B8
  • IDEC-C2B8 monoclonal antibody
  • Mabthera
  • MOAB IDEC-C2B8
  • Rituxan
Drug: cyclophosphamide
Given orally
Other Names:
  • CPM
  • CTX
  • Cytoxan
  • Endoxan
  • Endoxana

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients with severe SSc as defined by the American College of Rheumatology and at high-risk for a fatal outcome based on the following prognostic factors from groups 1-5:

    • Group 1: Patients with 1) both a. and b. below; and 2) at least one of c., d. or e:

      • a. Diffuse cutaneous scleroderma with skin score of >= 16 (modified Rodnan skin scale)
      • b. Duration of systemic sclerosis =< 5 years from the onset of first non-Raynaud's symptom
      • c. Presence of interstitial lung disease with FVC or DLCOcorr =< 70% of predicted and evidence of alveolitis (abnormal bronchoalveolar lavage [BAL] or high resolution chest computed tomography [CT] scan)
      • d. Left heart failure with left ventricular ejection Fraction (LVEF) < 50% or pericardial effusion (mild-moderate) or 2nd or 3rd Atrial-Ventricular (AV) block; Myocardial disease not secondary to SSc must be excluded by a cardiologist
      • e. History of SSc-related renal disease that is not active at the time of screening; History of scleroderma hypertensive renal crisis is included in this criterion
    • Group 2: Patients will have progressive pulmonary disease as the primary indication for transplant as defined by a decrease in the FVC or DLCO by 15 percent or greater in the previous 12-month period. In addition, patients may have either less skin involvement than group 1 (mRSS < 16) if they have a history of diffuse cutaneous disease and the FVC or DLCOcorr is < 70% or both FVC and DLCOcorr >= 70% if they have diffuse cutaneous disease (mRSS > 16) at screening for the study; Patients must also have evidence of alveolitis as defined by abnormal chest CT or BAL
    • Group 3: Have progressive active SSc after prior autologous HCT based on the presence of progressive pulmonary disease; This will be defined by a decrease in the FVC since prior autologous transplant by 10 percent or greater, or DLCO since prior autologous transplant by 15 percent or greater in addition to evidence of alveolitis as defined by chest CT changes or BAL; If patients had prior autologous HCT on the SCOT clinical trial, they must have failed based on the defined study endpoints and be approved by the protocol principal investigator (PI)
    • Group 4: Patients who meet group 1 inclusion criteria but have FVC or DLCO < 70% plus have had an adverse event to cyclophosphamide preventing its further use (i.e., hemorrhagic cystitis, leucopenia with WBC, 2000 or ANC < 1000 or platelet count < 100,000 and other adverse events)
    • Group 5: Diffuse scleroderma with disease duration =< 2 years since development of first sign of skin thickening plus modified Rodnan skin score >= 25 plus ESR > 25 mm/1st hour and/or Hb < 11 g/dL not explained by causes other than active scleroderma.
  2. Unless patients have a DLCOcorr less than 45%, patients must have failed either oral or intravenous cyclophosphamide regimen defined as:

    • IV cyclophosphamide administration for > 6 months or a total cumulative IV dose of 6 g/m^2, or
    • oral cyclophosphamide administration for > 6 months regardless of dose, or
    • combination of oral and IV cyclophosphamide for > 6 months independent of dose
  3. Patient must have a sibling who is a) HLA-identical and b) could serve as a donor of a peripheral blood stem cell graft to be placed on the transplant arm or an unrelated donor matched at HLA-A, B, C, DRB1 and DQB1. Patients without an HLA-identical sibling or an HLA-matched unrelated donor that meet the above criteria will be placed on the non-transplant arm

DONOR:

  • The donor must be an HLA-identical sibling of the patient or an HLA-matched unrelated donor.
  • If the donor has reached the age of assent, then they must have completed the local institutional review board (IRB) assent process.
  • Donor must consent to G-CSF administration and to leukapheresis for HSC collection.
  • Donor must have adequate veins for leukapheresis or agree to placement of central venous catheter (femoral, subclavian).
  • Age 12-75 years; Pediatric donors must be > 50 kg body weight.

Exclusion Criteria:

  • Eligible for the NIH-sponsored randomized clinical trial (SCOT)
  • Fertile men or women unwilling to use contraceptive techniques during and for 12 months or until immunosuppression is discontinued following transplantation
  • Evidence of ongoing active infection
  • Pregnancy
  • Subjects with pulmonary, cardiac, hepatic, or renal impairment that would limit their ability to receive therapy and compromise their survival. This includes but is not restricted to, subjects with any of the following:

    • Severe pulmonary dysfunction defined as:

      1. A hemoglobin corrected DLCOcorr < 30% or FVC < 40% of predicted; or
      2. O2 saturation < 92% at rest without supplemental oxygen; or
      3. PO2 < 70 mmHg or pCO2 > 50 mmHg without supplemental oxygen
    • Significant uncontrolled pulmonary hypertension defined as:

      1. Pulmonary artery peak systolic pressure > 45 mmHg by echocardiogram and mean pulmonary artery pressure by right heart catheterization exceeding 32 mmHg at rest or 42 mm Hg during exercise; or
      2. New York Heart Association (NYHA)/World Health Organization (WHO) classification for pulmonary hypertension, Class III or IV
    • Cardiac: Uncontrolled clinically significant arrhythmias; clinical evidence of significant cardiac disease (NYHA Class III or IV); LVEF < 40% by echocardiogram
    • Significant renal pathology, defined as:

      1. Estimated CrCl < 60 mL/min (using Cockcroft-Gault formula based on actual body weight) or serum creatinine > 2.0 mg/dL OR
      2. Active, untreated SSc renal crisis at the time of enrollment
    • Active hepatitis or liver biopsy evidence of cirrhosis or periportal fibrosis. Total bilirubin > 2.5 x the upper limit of normal (and not related to Gilbert's syndrome) and/or Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) > 4 x the upper limit of normal
    • Patients with poorly controlled hypertension
    • Patients whose life expectancy is severely limited by illness other than autoimmune disease
  • DONOR:

    • Identical twin of patient
    • Female donors who are pregnant (positive B-HCG) or breastfeeding
    • Infection with human immunodeficiency virus (HIV) or active viral hepatitis (B or C)
    • Known allergy to G-CSF
    • Current serious systemic illness
    • Uncontrolled bacterial, viral or fungal infection (currently taking medication and progression of clinical symptoms)
    • Donors receiving experimental therapy or investigational agents
    • Donors with cancer other than treated basal cell or carcinoma in situ of cervix; Cancer treated with curative intent > 2 years previous will be reviewed on a case-by-case basis by a Protocol Chair or Medical Monitor
  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: NCT01047072

Locations
United States, Washington
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States, 98109
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Investigators
Principal Investigator: George Georges Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
  More Information

No publications provided

Responsible Party: Georges, George, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
ClinicalTrials.gov Identifier: NCT01047072     History of Changes
Other Study ID Numbers: 2363.00, NCI-2012-00139
Study First Received: January 11, 2010
Last Updated: October 29, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by Fred Hutchinson Cancer Research Center:
Scleroderma, systemic sclerosis, allogeneic hematopoietic stem cell transplantation

Additional relevant MeSH terms:
Sclerosis
Scleroderma, Systemic
Scleroderma, Diffuse
Pathologic Processes
Connective Tissue Diseases
Skin Diseases
Cyclophosphamide
Tacrolimus
Fludarabine phosphate
Mycophenolate mofetil
Rituximab
Fludarabine
Mycophenolic Acid
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
Antimetabolites, Antineoplastic
Antimetabolites
Antibiotics, Antineoplastic
Enzyme Inhibitors

ClinicalTrials.gov processed this record on September 16, 2014