Bone Marrow Transplant With Abatacept for Non-Malignant Diseases
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|ClinicalTrials.gov Identifier: NCT01917708|
Recruitment Status : Completed
First Posted : August 7, 2013
Last Update Posted : December 26, 2019
|Condition or disease||Intervention/treatment||Phase|
|Hurler Syndrome Fanconi Anemia Glanzmann Thrombasthenia Wiskott-Aldrich Syndrome Chronic Granulomatous Disease Severe Congenital Neutropenia Leukocyte Adhesion Deficiency Shwachman-Diamond Syndrome Diamond-Blackfan Anemia Dyskeratosis-congenita Chediak-Higashi Syndrome Severe Aplastic Anemia Thalassemia Major Hemophagocytic Lymphohistiocytosis Sickle Cell Disease||Drug: Abatacept||Phase 1|
Allogeneic hematopoietic stem cell transplantation (HSCT) represents the only viable cure for children who suffer from a wide variety of rare, serious non-malignant diseases, such as Fanconi Anemia, Hurler syndrome, and hemophagocytic lymphohistiocytosis. A major obstacle to the success of HSCT is morbidity and mortality from graft versus host disease (GVHD), driven by donor T cells recognizing and reacting against disparate host antigens. This trial is being conducted as a step toward testing the long-term hypothesis that the costimulation blockade agent abatacept can be added to a standard post-transplant GVHD prophylaxis regimen, cyclosporine and mycophenolate mofetil, to improve disease-free survival after unrelated hematopoietic stem cell transplantation (HSCT) using reduced intensity conditioning for children with non-malignant diseases (NMD). This study will have the following Specific Aims:
Specific Aim #1: To conduct a multicenter pilot assessing the tolerability of abatacept (n=10). Patients will receive four doses (10 mg/kg IV on days -1, +5, +14 and +28), a schedule well tolerated by adolescents and adults with hematologic malignancies in a previous pilot. Abatacept will be combined with cyclosporine and mycophenolate mofetil.
Specific Aim #2: To examine the immunological effects of abatacept in this setting.
Three reduced intensity conditioning regimens that have been shown to be effective in achieving sustained engraftment in patients with non-malignant diseases are available for use, depending on the patient's disease:
- Patients with Fanconi anemia will receive fludarabine, low dose cyclophosphamide, and anti-thymocyte globulin.
- Patients with severe aplastic anemia will receive low dose total body irradiation, fludarabine, cyclophosphamide, and anti-thymocyte globulin.
- Patients with other NMD will receive either the low dose total body irradiation regimen or an alemtuzumab, fludarabine, thiotepa, and melphalan regimen.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||10 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Supportive Care|
|Official Title:||Abatacept for Post-Transplant Immune Suppression in Children and Adolescents Receiving Allogeneic Hematopoietic Stem Cell Transplants for Non-Malignant Diseases|
|Study Start Date :||January 2014|
|Actual Primary Completion Date :||September 19, 2019|
|Actual Study Completion Date :||September 19, 2019|
4 doses of abatacept 10 mg/kg/dose will be given on days -1, +5, +14, and +28.
All patients will receive 4 doses of abatacept in addition to standard GVHD prophylaxis with cyclosporine and mycophenolate mofetil.
Other Name: Orencia
- Tolerability of Abatacept [ Time Frame: 1 year post-transplant ]
The primary endpoint for this trial will be tolerability, defined in terms of the success in administering all prescribed doses of abatacept.
Abatacept will be deemed to be poorly tolerated if any of the following conditions are met:
- More than one dose is withheld.
- Death from an infection that occurs within 30 days of receiving the last prescribed dose of abatacept, but that is not preceded by systemic immunosuppressive therapy for GVHD
- Post-transplant lymphoproliferative disorder (PTLD) that occurs within 100 days of receiving the last prescribed dose, but that is not preceded by systemic immunosuppressive therapy for GVHD.
If less than 4 patients (of at least 18 evaluable patients) tolerate abatacept poorly, abatacept will be deemed tolerable. If there are fewer than 18 evaluable patients, if 3 of the first 10 patients treated tolerate abatacept poorly, abatacept will be deemed tolerable.
- Proportion of Participants Experiencing Regimen-related Toxicity (RRT) [ Time Frame: Day 42 post-transplant ]Regimen-related toxicity is scored according to the Bearman scale. Major RRT, defined as grade 4 (causing death) in any organ system or grade 3 for pulmonary, cardiac, renal, oral mucosal, neurologic or hepatic, will be recorded.
- Days until Neutrophil Recovery [ Time Frame: 1 year post-transplant ]Neutrophil recovery is defined as the first of 3 consecutive days following the nadir that the absolute neutrophil count is at least 500/µl.
- Days until Platelet Recovery [ Time Frame: 1 year post-transplant ]Platelet recovery is defined as the first day that the platelet count is at least 20 thousand/µl without a transfusion in the preceding 7 days.
- Number of Participants with Non-engraftment [ Time Frame: 1 year post-transplant ]Non-engraftment is defined as lack of neutrophil recovery (defined as absolute neutrophil count (ANC )>0.5 *109/L for three consecutive days) by 28 days post-transplant or neutrophil recovery with lack of myeloid donor chimerism.
- Number of Participants with Secondary Graft Failure [ Time Frame: 1 year post-transplant ]Secondary graft failure is defined by initial engraftment but subsequent development of an ANC <0.5*109/L for fourteen consecutive days.
- Number of Participants with Graft Loss [ Time Frame: 1 year post-transplant ]Graft loss is defined by initial engraftment (assessed by neutrophil recovery and donor chimerism) with the subsequent loss of donor myeloid chimerism (regardless whether persistent neutropenia develops).
- Number of Participants Experiencing Cytomegalovirus (CMV) Viremia [ Time Frame: Up to Day 180 ]Cytomegalovirus (CMV) viremia is defined as positive blood antigen or polymerase chain reaction (PCR) test.
- Number of Participants Experiencing CMV Invasive Disease [ Time Frame: 1 year post-transplant ]CMV invasive disease is defined in accordance with the Blood and Marrow Transplant Clinical Trials Network Manual of Procedures.
- Number of Participants Experiencing Post-transplant Lymphoproliferative Disorder (PTLD) [ Time Frame: 1 year post-transplant ]Post-transplant lymphoproliferative disorder (PTLD) is defined in accordance with the Blood and Marrow Transplant Clinical Trials Network Manual of Procedures and the World Health Organization's Classification of Tumours of Haematopoietic and Lymphoid Tissues.
- Number of Participants Experiencing Other Infections [ Time Frame: 1 year post-transplant ]Infections other than CMV viremia, CMV invasive disease, and PTLD is defined in accordance with the Blood and Marrow Transplant Clinical Trials Network Manual of Procedures.
- Number of Participants Experiencing Immune Reconstitution [ Time Frame: 1 year post-transplant ]Immune reconstitution is assessed by the day 100 cluster of differentiation 4 (CD4+) T cell count and by the reaccumulation of natural killer (NK) cells, B cells, total T cells, and cluster of differentiation 8 (CD8+) T cells as assessed by multicolor flow cytometry.
- Number of Participants Experiencing Acute Graft Versus Host Disease (GVHD) [ Time Frame: Up to 1 year post-transplant ]Early onset (before day 100) and late onset (after day 100) acute GVHD is assessed according to the Blood and Marrow Transplant Clinical Trials Network Manual of Procedures using the NIH consensus criteria.
- Number of Participants Experiencing Chronic GVHD [ Time Frame: 2 years post-transplant ]Chronic GVHD, including overlap syndrome, is assessed according to the Blood and Marrow Transplant Clinical Trials Network Manual of Procedures using the NIH consensus criteria.
- Immune Suppression-Free Survival Rate [ Time Frame: 1 year post-transplant ]Participant survival while off of immunosuppressive agents.
- Immune Suppression-Free and Disease-Free Survival Rate [ Time Frame: 1 year post-transplant ]Participant disease-free survival while off of immunosuppressive agents.
- Disease-free Survival Rate [ Time Frame: 1 year post-transplant ]Disease-free survival is defined as survival without recurrence of underlying disease.
- Overall Survival Rate [ Time Frame: 1 year post-transplant ]Overall-survival is defined as survival with or without relapse of underlying disease
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01917708
|United States, Georgia|
|Children's Healthcare of Atlanta|
|Atlanta, Georgia, United States, 30322|
|Principal Investigator:||John T Horan, MD||Children's Healthcare of Atlanta/Emory University|