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Allo-HCT MUD for Non-malignant Red Blood Cell (RBC) Disorders: Sickle Cell, Thal, and DBA: Reduced Intensity Conditioning, Co-tx MSCs

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ClinicalTrials.gov Identifier: NCT00957931
Recruitment Status : Completed
First Posted : August 13, 2009
Results First Posted : August 6, 2018
Last Update Posted : August 6, 2018
Sponsor:
Collaborators:
University of Minnesota
University of Alabama at Birmingham
Information provided by (Responsible Party):
Sandhya Kharbanda, Stanford University

Study Description
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Brief Summary:

The main purpose of this project is to cure patients with high risk Sickle cell disease and other red cell disorders including thalassemia and diamond-blackfan anemia by bone marrow transplantation. The patients enrolled in this study will be those who lack matched sibling donors and therefore have no other option but to undergo bone marrow transplantation using matched but unrelated bone marrow or umbilical cord blood from the national marrow donor program registry. Since bone marrow transplantation for these disorders using matched unrelated donors has two major problems i.e. engraftment, or , the process of new marrow being accepted and allowed to grow in the the patient; and graft-versus-host disease, or the process where the new marrow "rejects" the host or the patient, this study has been devised with methods to overcome these two problems and thus make transplantation from unrelated donors both successful in terms of engraftment and safe in terms of side effects, both acute and long term.

In order to accomplish these two goals, two important things will be done. Firstly, patients will get three medicines which are considered reduced intensity because they are not known to cause the serious organ damage seen with conventional chemotherapy. These medicines, however, do cause intense immune suppression so these can cause increased infections. Secondly, in addition to transplantation of bone marrow from unrelated donors, patients will also transplanted with mesenchymal stromal cells derived from the bone marrow of their parents. Mesenchymal stromal cells are adult stem cells that are normally found in the bone marrow and are thought to create the right background for the blood cells to grow. They have been shown in many animal and human studies to improve engraftment. In addition, they have a special property by which they prevent and are now even considered to treat graft versus host disease. Therefore, by using a reduced intensity chemotherapy regimen before transplant and transplanting mesenchymal stromal cells, we hope to improve engraftment while at the same time decrease the potential for severe side effects associated with a conventional transplant which uses extremely high doses of chemotherapy.


Condition or disease Intervention/treatment Phase
Sickle Cell Disease Thalassemia Diamond-Blackfan Anemia Procedure: Bone marrow transplantation Biological: Mesenchymal Stromal Cells Phase 2

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pilot Study MUD HCT:Pts High Risk Sickle Cell,Other Non-Malignant RBC Disorders- Reduced Intensity Preparative Regimen, HAPLO-Identical Mesenchymal Stromal Cells
Actual Study Start Date : March 2009
Actual Primary Completion Date : August 2013
Actual Study Completion Date : August 2013

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Mesenchymal stromal cells Procedure: Bone marrow transplantation
Bone marrow transplantation using matched unrelated donors, reduced intensity conditioning regimen, and co-transplanting mesenchymal stromal cells derived from parental bone marrow.

Biological: Mesenchymal Stromal Cells


Outcome Measures
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Primary Outcome Measures :
  1. Count of Participants With Stable Engraftment Post Hematopoietic Cell Transplantation (HCT) [ Time Frame: Up to 1 year ]
    Stable engraftment was defined as absolute neutrophil count (ANC) >500 cells /µL for 3 consecutive days and platelet count >50,000 for one week without transfusion; subsequently stable engraftment was measured by percentage of donor cells.


Secondary Outcome Measures :
  1. Overall Survival 6 Months Following HCT [ Time Frame: 6 months ]
    Overall survival is reported at the count of participants alive 6 months following HCT.

  2. Overall Survival 1 Year Following HCT [ Time Frame: 1 year ]
    Overall survival is reported at the count of participants alive 1 year following HCT.

  3. Count of Participants With Disease-free Survival 6 Months Following HCT [ Time Frame: 6 months ]
    Disease-free survival is defined as alive without underlying disease.

  4. Count of Participants With Disease-free Survival 1 Year Following HCT [ Time Frame: 1 year ]
    Disease-free survival is defined as alive without underlying disease.


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   1 Year to 25 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with sickle cell disease (SCD) 1-25 years of age with an HLA-identical, but unrelated, donor or 1 human leukocyte antigen (HLA) allele mismatched bone marrow or up to 2 HLA antigen mismatched umbilical cord blood (UCB) donor with one or more of the following:

    • Stroke, central nervous system (CNS) hemorrhage or a neurologic event lasting longer than 24 hours.
    • Acute chest syndrome with a history of recurrent hospitalizations or exchange transfusions.
    • Recurrent vaso-occlusive pain, 3 or more episodes per year for 3 years or more years; or recurrent priapism.
    • Impaired neuropsychological function and/or abnormal cerebral MRI scan or abnormal transcranial Doppler (TCD).
    • Stage I or II sickle lung disease.
    • Sickle nephropathy (moderate or severe proteinuria or a glomerular filtration rate (GFR) 30-50% of the predicted normal value).
    • Bilateral proliferative retinopathy and major visual impairment in at least one eye.
    • Osteonecrosis of multiple joints with documented destructive changes.
    • Requirement for chronic transfusions but with RBC alloimmunization >2 antibodies during long term transfusion therapy.
    • Failure of hydroxyurea (HU) therapy.
  • Patients aged 0-21 years with transfusion dependent alpha- or beta-thalassemia who have an HLA-identical or 1 HLA allele mismatched bone marrow or up to 2 HLA mismatched UCB donor.
  • Patients aged 0-21 years with Diamond-Blackfan anemia who have an HLA-identical or 1 HLA allele mismatched bone marrow or up to 2 HLA mismatched UCB donor. Diamond- Blackfan anemia patients will only be eligible if they have failed steroid therapy.

Exclusion Criteria:

  • Patients with one or more of the following:

    • Karnofsky or Lansky performance score <70 (See Appendices I and II).
    • Stage III-IV lung disease (Appendix III).
    • GFR<30% predicted normal values.
    • Pregnant or lactating females.
    • Active serious infection whereby patient has been on intravenous antibiotics for one week prior to study entry.
    • Any patient with AIDS or HIV seropositivity.
    • Any patient with invasive aspergillus infection within one year of study entry.
    • Psychologically incapable of undergoing bone marrow transplant (BMT) with associated strict isolation or documented history of medical non-compliance.
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): NCT00957931


Locations
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United States, Alabama
Children's Hospital of Alabama
Birmingham, Alabama, United States, 35233
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55455
Sponsors and Collaborators
Stanford University
University of Minnesota
University of Alabama at Birmingham
Investigators
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Principal Investigator: Sandhya Kharbanda, M.D. Stanford University
More Information
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Publications of Results:

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Responsible Party: Sandhya Kharbanda, Principle Investigator, Stanford University
ClinicalTrials.gov Identifier: NCT00957931    
Other Study ID Numbers: MSC01
First Posted: August 13, 2009    Key Record Dates
Results First Posted: August 6, 2018
Last Update Posted: August 6, 2018
Last Verified: July 2018
Additional relevant MeSH terms:
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Anemia, Sickle Cell
Thalassemia
Anemia, Diamond-Blackfan
Anemia, Hemolytic, Congenital
Anemia, Hemolytic
Anemia
Hematologic Diseases
Hemoglobinopathies
 Genetic Diseases, Inborn
Anemia, Hypoplastic, Congenital
Anemia, Aplastic
Red-Cell Aplasia, Pure
Congenital Bone Marrow Failure Syndromes
Bone Marrow Failure Disorders
Bone Marrow Diseases