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Unrelated Hematopoietic Stem Cell Transplantation(HSCT) for Genetic Diseases of Blood Cells

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00730314
Recruitment Status : Completed
First Posted : August 8, 2008
Last Update Posted : June 23, 2016
Sponsor:
Information provided by (Responsible Party):
Hisham Abdel-Azim, Children's Hospital Los Angeles

Study Description
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Brief Summary:

This is a clinical trial of bone marrow transplantation for patients with the diagnosis of a genetic disease of blood cells that do not have an HLA-matched sibling donor. Genetic diseases of blood cell include: Red blood cell defects e.g. hemoglobinopathies (sickle cell disease and thalassemia), Blackfan-Diamond anemia and congenital or chronic hemolytic anemias; White blood cells defects/immune deficiencies e.g. chronic granulomatous disease, Wiskott-Aldrich syndrome,Osteopetrosis, Kostmann's syndrome (congenital neutropenia), Hereditary Lymphohistiocytosis (HLH); Platelets defects e.g.Congenital amegakaryocytic thrombocytopenia; Metabolic/storage disorders e.g. leukodystrophies,mucopolysaccharidoses as Hurler disease;Stem cell defects e.g.reticular agenesis, among many other rare similar conditions.

The study treatment plan uses a new transplant treatment regimen that aims to try to decrease the acute toxicities and complications associated with the standard treatment plans and to improve outcome

The blood stem cells will be derived from either unrelated donor or unrelated umbilical cord blood.


Condition or disease Intervention/treatment Phase
Sickle Cell Disease Thalassemia Anemia Granuloma Wiskott-Aldrich Syndrome Chediak Higashi Syndrome Osteopetrosis Neutropenia Thrombocytopenia Hurler Disease Niemann-Pick Disease Fucosidosis Procedure: Hematopoietic stem cell transplantation Phase 1 Phase 2

Detailed Description:

This is a pilot clinical trial of hematopoietic stem cell transplantation for patients with the diagnosis of a genetic disease of blood cells that do not have an HLA-matched sibling donor. The stem cells will be derived from a 1) matched unrelated donor (MUD) or 2) unrelated umbilical cord blood (UCB). Patients will receive a novel conditioning regimen with Busulfan, Cytoxan and Fludarabine (Bu/Cy/Flu) and either Alemtuzumab (Campath 1H) for recipients of a MUD or rabbit Antithymocyte Globulin (rATG) for recipients of unrelated UCB prior to hematopoietic stem cell transplant (HSCT).

It is hypothesized that reduced dosages of Cytoxan will decrease the acute toxicities associated with the standard chemotherapies of Busulfan and Cytoxan (i.e. sinusoidal obstructive syndrome (SOS), hemorrhagic cystitis and mucositis). And the addition of fludarabine to a conditioning regimen with myeloablative doses of Busulfan and reduced dosages of Cytoxan prior to HSCT will overcome the engraftment barrier posed by an intact immune system, which is seen in patients with a genetic disease.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 25 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Trial Of Hematopoietic Stem Cell Transplant (HSCT) For Children With A Genetic Disease Of Blood Cells Without An HLA-Matched Sibling Donor
Study Start Date : August 2008
Actual Primary Completion Date : August 2015
Actual Study Completion Date : August 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Organ Donation
Genetic and Rare Diseases Information Center resources: Sickle Cell Anemia Thalassemia Frontotemporal Dementia Frontotemporal Dementia, Ubiquitin-positive Primary Progressive Aphasia Semantic Dementia Chronic Graft Versus Host Disease Granulocytopenia Diamond-Blackfan Anemia Niemann-Pick Disease Niemann-Pick Disease Type A Leukodystrophy Behavioral Variant of Frontotemporal Dementia Chronic Granulomatous Disease Wiskott Aldrich Syndrome Severe Congenital Neutropenia Chediak-Higashi Syndrome Hurler Syndrome Congenital Amegakaryocytic Thrombocytopenia Osteopetrosis X-linked Lymphoproliferative Syndrome Fucosidosis Immunodeficiency With Hyper IgM Type 1 Niemann-Pick Disease Type C1 Mucopolysaccharidosis Mucopolysaccharidosis Type I Sphingolipidosis Non-Langerhans-Cell Histiocytosis Mucopolysaccharidosis Type IV Albinism

Arms and Interventions
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Arm Intervention/treatment
Experimental: 1
Unrelated donor
 Procedure: Hematopoietic stem cell transplantation
hematopoietic stem cell transplantation conditioning regimen depending on graft source
Experimental: 2
Cord Blood
 Procedure: Hematopoietic stem cell transplantation
hematopoietic stem cell transplantation conditioning regimen depending on graft source


Outcome Measures
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Primary Outcome Measures :
  1. toxicities [ Time Frame: 3 years ]
  2. adverse events [ Time Frame: 3 years ]
  3. engraftment [ Time Frame: 1 year ]
  4. immune reconstitution [ Time Frame: 3 years ]
  5. overall and event free survival survival [ Time Frame: 3 years ]

Eligibility Criteria
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Ages Eligible for Study:   up to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Lethal or sublethal genetic disease of blood cells, who lack a fully histocompatible sibling or other family donor
  • Genetic diseases that would be candidates for this protocol includes those that have been shown to benefit from allogeneic HSCT: Red blood cell defects, Leukocyte defects/ Primary immune deficiencies, Platelets defects, Metabolic/storage disorders and Stem cell defects.
  • Renal: creatinine clearance or glomerular filtration rate (GFR) ≥50 ml/min/1.73m2 and not requiring dialysis.
  • Pulmonary: FEV1, FVC and DLCO (corrected for hemoglobin) ≥ 50% predicted. if unable to perform pulmonary function tests, then O2 saturation ≥ 92% in room air.
  • Cardiac: Left ventricular ejection fraction at rest must be ≥ 40%, or shortening fraction ≥ 26%
  • Hepatic: Bilirubin ≤3x upper limit of normal (ULN) and ALT and AST ≤ 5x for age (with the exception of isolated hyperbilirubinemia due to Gilbert's syndrome).
  • Patients will be 0-21 years of age.
  • Disease specific inclusion criteria (as applicable per protocol).

Exclusion Criteria:

  • Recipients should not have any of the general exclusion criteria, and disease specific exclusion criteria when applicable.
  • Patient with histocompatible sibling
  • End-organ failure that precludes the ability to tolerate the transplant procedure, including the conditioning regimen.
  • Creatinine clearance or GFR < 50 ml/min/1.73m2 or renal failure requiring dialysis.
  • Congenital heart disease resulting in congestive heart failure.
  • Severe residual CNS disease/impairment [(other than hemiplegia alone) e.g. coma or intractable seizures]
  • Ventilatory failure
  • Major congenital anomalies that adversely affect survival, e.g. CNS malformations
  • Lansky score < 40% or Karnofsky score < 60%
  • HIV seropositivity
  • Diagnosis of Fanconi's anemia, Severe Combined Immunodeficiency (SCID)
  • Positive pregnancy test (For female patients in child bearing period)
  • Uncontrolled bacterial, viral, or fungal infections (currently taking medication yet clinical symptoms progress)
  • Disease specific exclusion criteria (as applicable per protocol).
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): NCT00730314


Locations
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United States, California
Children Hospital Los Angeles
Los Angeles, California, United States, 90027
Sponsors and Collaborators
Children's Hospital Los Angeles
Investigators
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Principal Investigator: Hisham Abdel-Azim, MD Childrens Hospital Los Angeles, University of Southern California
More Information
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Additional Information:

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Responsible Party: Hisham Abdel-Azim, Principle Investigator, Children's Hospital Los Angeles
ClinicalTrials.gov Identifier: NCT00730314    
Other Study ID Numbers: CCI #07-00119
CHLA-#07-00119
First Posted: August 8, 2008    Key Record Dates
Last Update Posted: June 23, 2016
Last Verified: June 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Hisham Abdel-Azim, Children's Hospital Los Angeles:
unrelated
BMT
HSCT
bone marrow transplantation
sickle cell disease
thalassemia
CGD
HLH
Blackfan-Diamond anemia
Hurler
leukodystrophy
LAD I
Genetic diseases
Red blood cell defects
Leukocyte defects and immune deficiencies
 Hereditary Lymphohistiocytosis
chronic granulomatous disease
Wiskott-Aldrich syndrome
Chediak Higashi syndrome
CD40 ligand deficiency
Hyper IgM syndrome
leucocytes adhesion defect type 1
Osteopetrosis
congenital neutropenia
X-linked lymphoproliferative disease
Platelets defects
Congenital amegakaryocytic thrombocytopenia
Metabolic and storage disorders
Hurler disease
leukodystrophies
Additional relevant MeSH terms:
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Osteopetrosis
Pick Disease of the Brain
Aphasia, Primary Progressive
Frontotemporal Dementia
Niemann-Pick Diseases
Niemann-Pick Disease, Type A
Niemann-Pick Disease, Type C
Fucosidosis
Chediak-Higashi Syndrome
Anemia, Sickle Cell
Thrombocytopenia
Thalassemia
Neutropenia
Granuloma
Wiskott-Aldrich Syndrome
 Genetic Diseases, Inborn
Mucopolysaccharidosis I
Syndrome
Disease
Pathologic Processes
Anemia
Hematologic Diseases
Anemia, Hemolytic, Congenital
Anemia, Hemolytic
Hemoglobinopathies
Blood Platelet Disorders
Agranulocytosis
Leukopenia
Leukocyte Disorders
Lymphoproliferative Disorders