Reduced Intensity Conditioning (RIC) Regimen for Patients With Non-malignant Disorders

This study is currently recruiting participants. (see Contacts and Locations)
Verified January 2014 by Children's Hospital of Philadelphia
Sponsor:
Information provided by (Responsible Party):
Children's Hospital of Philadelphia
ClinicalTrials.gov Identifier:
NCT01050855
First received: January 15, 2010
Last updated: January 14, 2014
Last verified: January 2014
  Purpose

The purpose of this study is to see if we can engraft (grow) donor cells and cure the underlying disease by using Reduced Intensity Conditioning (RIC) before receiving the donor blood or marrow cells. RIC involves giving medicines that suppress the immune system before giving the donor stem cells. It does not completely eliminate blood making cells in bone marrow. This is in contrast to standard myeloablative conditioning that would completely "wipe out" bone marrow with high doses of chemotherapy and radiation. The possible benefits of a reduced intensity conditioning regimen are fewer short-term toxicities of lungs, liver and heart, and less long-term side effects. The hospital stay is usually shorter than after conditioning that completely destroys the bone marrow, and blood counts may recover more quickly. In general, the benefits of undertaking this transplant include possible cure of primary disease.


Condition Intervention Phase
Non Malignant Diseases
Immunodeficiencies
Hemoglobinopathies
Other: Hematopoetic Stem Cell Transplant using Reduced Intensity Conditioning Regimen
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: Reduced Intensity Conditioning (RIC) Regimen for Patients With Non-malignant Disorders

Further study details as provided by Children's Hospital of Philadelphia:

Primary Outcome Measures:
  • Engraftment and Survival [ Time Frame: Post Transplant -100 days ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 50
Study Start Date: January 2008
Estimated Study Completion Date: November 2014
Estimated Primary Completion Date: November 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Reduced Instensity Conditioning

There are two conditioning regimens in this protocol for children >6 months. They differ by the timing and dosing of Alemtuzumab (Campath). The "distal" Campath regimen proposed is identical to the regimen proposed by the Clinical Trials Network for patients with sickle cell disease with unrelated donors and has been used successfully in patients with IPEX. The "proximal" Campath regimen protocol is used extensively in the UK for immune deficiencies, and is currently in use internationally for HLH and LCH.

The conditioning regimen for children with immunodeficiencies <6 months omits melphalan, and substitutes two days of busulfan. This regimen is successfully used in the UK, and has been successful in a 3 month old infant at CHOP who engrafted with a haploidentical donor.

Other: Hematopoetic Stem Cell Transplant using Reduced Intensity Conditioning Regimen
Campath, Fludarabine, Melphalan, Cyclosporine, Cellcept (MMF)
Other Names:
  • Hematopoetic Stem Cell Transplant
  • Reduced Intensity Conditioning Regimen

Detailed Description:

Allogeneic hematopoietic stem cell transplant (HSCT) is curative for many non-malignant diseases, including immunodeficiencies and hemoglobinopathies. Standard myeloablative therapy to establish complete donor chimerism usually includes busulfan, cyclophosphamide +/- thymoglobulin. This approach may result in full donor engraftment with complete immune reconstitution. However, this approach has been associated with a poor outcome in patients with significant organ dysfunction, and is associated with significant organ morbidities including veno-occlusive disease. Late complications include gonadal failure and secondary malignancies.

Recently, reduced intensity conditioning (RIC) regimens have been used for both adult patients with leukemias and pediatric patients with non-malignant diseases. These regimens are better tolerated, resulting in less transplant related morbidity and mortality. Stable mixed chimerism, while insufficient for eradication of leukemias, may be sufficient to cure patients with non-malignant diseases.

There are two conditioning regimens in this protocol for children >6 months. They differ by the timing and dosing of Alemtuzumab (Campath). The "distal" Campath regimen proposed is identical to the regimen proposed by the Clinical Trials Network for patients with sickle cell disease with unrelated donors and has been used successfully in patients with immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX). The "proximal" Campath regimen protocol is used extensively in the UK for immune deficiencies, and is currently in use internationally for hemophagocytic lymphohistiocytosis (HLH) and Langerhans cell histiocytosis (LCH). Autologous reconstitution (graft loss) may be increased with RIC, but life-threatening aplasia from graft failure is rare.

The conditioning regimen for children with immunodeficiencies <6 months omits melphalan, and substitutes two days of busulfan. This regimen is successfully used in the United Kingdom (UK), and has been successful in a 3 month old infant at the Children's Hospital of Philadelphia (CHOP) who engrafted with a haploidentical donor.

  Eligibility

Ages Eligible for Study:   6 Months to 25 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age >6 months- 25 years
  2. IPEX syndrome
  3. Sickle cell disease
  4. Thalassemia major
  5. Bone marrow failure, including Kostmann's, amegakaryocytic thrombocytopenia, Blackfan-Diamond syndrome
  6. Hemophagocytic lymphohistiocytosis other macrophage activation syndromes, severe Langerhans histiocytosis
  7. Severe combined immune deficiency, adenosine deaminase deficiency, common variable immunodeficiency
  8. Wiskott-Aldrich syndrome
  9. Age <6 months with immunodeficiencies: Eligible for "mini" busulfan, fludarabine, alemtuzumab
  10. Organ criteria:

    • Cardiac: Echocardiogram shortening fraction >27%
    • Pulmonary: for those with pulmonary function tests: DLCO >40%
    • Renal: Serum creatinine <1.5 x upper limit of normal for age
    • Hepatic:; ALT and AST <5 x upper limit of normal
  11. Infection: No active infections

Exclusion criteria

  1. Uncontrolled bacterial, fungal or viral infections
  2. Bare lymphocyte syndrome (MHC class II deficiency)
  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: NCT01050855

Contacts
Contact: Patricia T Hankins, RN 215-590-5168 hankinsp@email.chop.edu

Locations
United States, Pennsylvania
The Children's Hospital of Philadelphia Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Patricia T Hankins, RN    215-590-5168    hankinsp@email.chop.edu   
Contact: Margaret R Tartaglione, RN    215 590-2209    tartaglione@email.chop.edu   
Principal Investigator: Nancy J Bunin, MD         
Sponsors and Collaborators
Children's Hospital of Philadelphia
Investigators
Principal Investigator: Nancy J Bunin, MD Children's Hospital of Philadelphia
  More Information

No publications provided

Responsible Party: Children's Hospital of Philadelphia
ClinicalTrials.gov Identifier: NCT01050855     History of Changes
Other Study ID Numbers: 2008-1-5658 (CHP 894)
Study First Received: January 15, 2010
Last Updated: January 14, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Children's Hospital of Philadelphia:
non-malignant diseases
immune deficiencies
hemoglobinopathies
Reduced Intensity Conditioning(RIC)

Additional relevant MeSH terms:
Immunologic Deficiency Syndromes
Hemoglobinopathies
Immune System Diseases
Hematologic Diseases
Genetic Diseases, Inborn

ClinicalTrials.gov processed this record on September 18, 2014