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Study of Human Umbilical Cord-derived Mesenchymal Stem Cells for Treatment of Refractory Immune Thrombocytopenia

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ClinicalTrials.gov Identifier: NCT04014166
Recruitment Status : Recruiting
First Posted : July 10, 2019
Last Update Posted : January 26, 2023
Sponsor:
Information provided by (Responsible Party):
Zhang Lei, MD, Institute of Hematology & Blood Diseases Hospital

Study Description
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Brief Summary:

Primary Objective: To evaluate the safety and efficacy of human umbilical cord-derived mesenchymal stem cells（hUC-MSCs） to treat refractory immune thrombocytopenia（ITP）.

Secondary Objective: To observe the changes of immune function in refractory ITP patients with human umbilical cord-derived mesenchymal stem cells（hUC-MSCs） after infusion, and to explore and reveal the mechanism of hUC-MSCs in treating ITP.


Condition or disease Intervention/treatment Phase
Thrombocytopenia Mesenchymal Stem Cells Other: Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) Not Applicable

Detailed Description:

Human umbilical cord (hUC)-derived mesenchymal stem cells (MSCs) have been shown to have marked therapeutic effects in a number of inflammatory diseases and autoimmune diseases in humans based on their potential for immunosuppression and their low immunogenicity. Currently, no more data is available on the safety and effectiveness of hUC-MSCs to treat immune thrombocytopenia patients.

This is a single-arm study to evaluate the safety and efficacy of hUC-MSCs to treat refractory immune thrombocytopenia（ITP）. In addition, it is the objective of this study to observe the changes of immune function in refractory ITP patients after hUC-MSCs infusion, and to explore and reveal the mechanism of hUC-MSCs in treating ITP.

The investigator will assess the changes of the platelet counts after hUC-MSCs infusion from week 1 to week 28, and observe incidence of adverse events during and after hUC-MSCs infusion.The investigator will complete virus detection( including HBV, HCV, HIV, Syphilis, etc) at week 4 and week 16 after hUC-MSCs infusion.

The dose of hUC-MSCs will be successively divided into three increasing dose(group A: hUC-MSCs 0.5×10^6/kg, weekly for 4 weeks, 3 patients; group B: hUC-MSCs 1.0×10^6/kg, weekly for 4 weeks, 3 patients; hUC-MSCs 2.0×10^6/kg, weekly for 4 weeks, 3 patients) with 3 patients in each group according to the dose.

The principle of increasing dose will be carried out successively from low dose to high dose group. According to the results of the safety and efficacy data from these 9 patients, the investigator will determine one of the doses and expand the sample size to 6 cases.

The investigator will observe the concentration of hUC-MSCs in peripheral blood from female patients after the first hUC-MSCs infusion at 10 time points, including 30 minutes before hUC-MSCs infusion, 30 minutes, 60 minutes, 2 hours, 4 hours, 8 hours, 16 hours, 24 hours,48 hours and 96 hours after the first hUC-MSCs infusion.

The investigator will detect antibody production of hUC-MSCs in peripheral blood from the first 9 patients at 2 time points, including 30 minutes before the first hUC-MSCs infusion and 48 hours after the last hUC-MSCs infusion.

The investigator will observe the changes of immune function in refractory ITP patients after hUC-MSCs infusion at 7 time points, including one day before hUC-MSCs infusion, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 16weeks and 28 weeks after hUC-MSCs infusion.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 15 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Study of Human Umbilical Cord-derived Mesenchymal Stem Cells for Treatment of Refractory Immune Thrombocytopenia
Actual Study Start Date : November 21, 2019
Estimated Primary Completion Date : February 28, 2023
Estimated Study Completion Date : June 30, 2023

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: 15 refractory ITP patients
15 enrolled refractory ITP patients will be picked up to infuse hUC-MSCs at the indicated dose.
 Other: Human umbilical cord-derived mesenchymal stem cells (hUC-MSCs)
This is a single-arm study to evaluate the safety and efficacy of hUC-MSCs to treat refractory immune thrombocytopenia. The dose of hUC-MSCs will be successively divided into three increasing dose(group A: hUC-MSCs 0.5×10^6/kg, weekly for 4 weeks, 3 patients; group B: hUC-MSCs 1.0×10^6/kg, weekly for 4 weeks, 3 patients; hUC-MSCs 2.0×10^6/kg, weekly for 4 weeks, 3 patients) with 3 patients in each group according to the dose. The principle of increasing dose will be carried out successively from low dose to high dose group. According to the results of the safety and efficacy data from these 9 patients, the investigator will determine one of the doses and expand the sample size to 6 cases.


Outcome Measures
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Primary Outcome Measures :
  1. Changes of the platelet counts after hUC-MSCs infusion [ Time Frame: 28 weeks ]
    The investigator will assess the changes of the platelet counts after hUC-MSCs infusion from week 1 to week 28.

  2. Incidence of adverse events after hUC-MSCs infusion [ Time Frame: 4 weeks ]
    The investigator will observe incidence of adverse events during and after hUC-MSCs infusion, including fever, thrombosis, diarrhea, skin rash and so on.

  3. Changes in virus safety indicators after hUC-MSCs infusion [ Time Frame: 16 weeks ]
    The investigator will complete virus detection( including HBV, HCV, HIV, Syphilis, EB, CMV, etc) at week 4 and week 16 after hUC-MSCs infusion.


Secondary Outcome Measures :
  1. Changes of concentration of hUC-MSCs in peripheral blood [ Time Frame: 96 hours ]
    The investigator will observe the concentration of hUC-MSCs in peripheral blood from female patients after the first hUC-MSCs infusion at 10 time points, including 30 minutes before hUC-MSCs infusion, 30 minutes, 60 minutes, 2 hours, 4 hours, 8 hours, 16 hours, 24 hours,48 hours and 96 hours after the first hUC-MSCs infusion.

  2. Changes of antibody production of hUC-MSCs in peripheral blood [ Time Frame: 24 days ]
    The investigator will detect antibody production of hUC-MSCs in peripheral blood from the first 9 patients at 2 time points, including 30 minutes before the first hUC-MSCs infusion and 48 hours after the last hUC-MSCs infusion.

  3. Changes of immune function in refractory ITP patients after hUC-MSCs infusion [ Time Frame: 28 weeks ]
    The investigator will observe the changes of immune function in refractory ITP patients after hUC-MSCs infusion at 7 time points, including one day before the first hUC-MSCs infusion, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 16weeks and 28 weeks after the first hUC-MSCs infusion. The changes of immune function will include the changes of the percentage of Th cell subsets， regulatory T cells (Treg)，supressor T cells（Ts）, activation and proliferation of B and T lymphocyte, apoptosis of platelets by cytotoxic T cells(CTLs) and function of dendritic cells in peripheral blood mononuclear cells（PBMCs）at the 7 time points, and to compare with the healthy controls. The investigator also will assess the changes of cytokines in the cell culture supernatants and plasma at the 7 time points, and to compare with the healthy controls.


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Aged 18 to 60 years old, male or female;
  • Conform to the diagnostic criteria of immune Thrombocytopenia (ITP);
  • Three months after splenectomy;
  • The first-line treatment drugs such as human immunoglobulin, glucocorticoid, and the second-line treatment of thrombopoietin drugs and rituximab were invalid, or there was no response or recurrence after splenectomy;
  • Diagnosis of ITP>6 months；
  • More than 3 months after rituximab treatment；
  • Platelet counts <30 ×10^9/L, and bleeding tendency;
  • People who are willing to sign the informed consent voluntarily and follow the research program.
  • Subject is practicing an acceptable method of contraception. Women of childbearing potential must have a negative serum pregnancy test in the whole study;

Exclusion Criteria:

  • ECOG score standard >1；
  • Secondary thrombocytopenic purpura;
  • Patients with poor compliance;
  • Positive serology for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and/or hepatitis D virus (HDV), Syphilis; Positive for Epstein-Barr Virus DNA, Cytomegalovirus DNA;
  • Pregnancy or lactation period;
  • History of thrombosis;
  • The serum chemistry results exceed the upper laboratory normal range by more than 20%, such as ALT, AST, TBIL, BUN, Cre etc;
  • Pre-existing cardiac disease, including congestive heart failure of New York Heart Association [NYHA] Grade III/IV, arrhythmia requiring treatment or myocardial infarction within the last 6 months. No arrhythmia known to increase the risk of thrombotic events (e.g. atrial fibrillation), or patients with a QT >450msec or QTc > 480 for patients with a Bundle Branch Block;
  • History of solid organ or bone marrow transplant;
  • Researchers believe that patients should not participate in the test of any other condition.
Contacts and Locations
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Information from the National Library of Medicine

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): NCT04014166


Contacts
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Contact: Yunfei Chen, MD +86-22-23909009 chenyunfei@ihcams.ac.cn
Contact: Lei Zhang, MD +86-22-23909240 zhanglei1@ihcams.ac.cn

Locations
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China, Tianjin
Yunfei Chen Recruiting
Tianjin, Tianjin, China, 300020
Contact: Yunfei Chen, MD    +86-22-23909009    chenyunfei@ihcams.ac.cn   
Contact: Lijun Liu, MD    +8613920927593    liulijun@ihcams.ac.cn   
Sponsors and Collaborators
Institute of Hematology & Blood Diseases Hospital
Investigators
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Principal Investigator: Lei Zhang, MD Chinese Academy of Medical Science and Blood Disease Hospital
More Information
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Publications of Results:

Other Publications:

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Responsible Party: Zhang Lei, MD, vice Director of Thrombosis and Hemostasis Center, Institute of Hematology & Blood Diseases Hospital
ClinicalTrials.gov Identifier: NCT04014166    
Other Study ID Numbers: SC2019002-EC-1
First Posted: July 10, 2019    Key Record Dates
Last Update Posted: January 26, 2023
Last Verified: January 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Researchers qualified can request the dataset, including de-identified individual subject data. Data may be requested from PI from 12 months 36 months after study completion.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Time Frame: From 12 months 36 months after study completion.
Access Criteria: Upon request to PI.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Zhang Lei, MD, Institute of Hematology & Blood Diseases Hospital:
Thrombocytopenia
Additional relevant MeSH terms:
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Thrombocytopenia
Immune System Diseases
Purpura, Thrombocytopenic, Idiopathic
Blood Platelet Disorders
Hematologic Diseases
Purpura, Thrombocytopenic
Purpura
 Blood Coagulation Disorders
Thrombotic Microangiopathies
Hemorrhagic Disorders
Autoimmune Diseases
Hemorrhage
Pathologic Processes
Skin Manifestations