CD34+ Stem Cell Selection for Patients Receiving Allogeneic Stem Cell Transplantation for Non-Malignant Disease

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2013 by Columbia University
Sponsor:
Information provided by (Responsible Party):
Diane George, MD, Columbia University
ClinicalTrials.gov Identifier:
NCT01966367
First received: October 17, 2013
Last updated: NA
Last verified: October 2013
History: No changes posted

October 17, 2013
October 17, 2013
March 2013
March 2017   (final data collection date for primary outcome measure)
Incidence of acute graft versus host disease (GVHD) [ Time Frame: 100 days ] [ Designated as safety issue: No ]
Determine the incidence and severity of acute GVHD.
Same as current
No Changes Posted
  • Incidence of primary graft failure [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    Quantify the incidence of primary and secondary graft failure.
  • Survival Rate [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    To assess event free survival and overall survival
  • Time to neutrophil and platelet engraftment [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    To determine the time to neutrophil and platelet engraftment
  • Time to immune reconstitution [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    To determine the time to immune reconstitution (including normalization of T, B and NK cell repertoire and Immunoglobulin G production)
  • Incidence of infectious complications [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    To establish the incidence of infectious complications including bacterial, viral, fungal and atypical mycobacterial and other infections
  • Incidence of secondary graft failure [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    Quantify the incidence of primary and secondary graft failure.
Same as current
Not Provided
Not Provided
 
CD34+ Stem Cell Selection for Patients Receiving Allogeneic Stem Cell Transplantation for Non-Malignant Disease
CD34+ Stem Cell Selection for Patients Receiving a Matched or Partially Matched Family or Unrelated Adult Donor Allogeneic Stem Cell Transplantation for Non-Malignant Disease

This study's goal is to determine the frequency and severity of acute graft versus host disease, to evaluate incidence of primary and secondary graft rejection, to assess event free survival and overall survival, to determine the time to neutrophil and platelet engraftment, to determine the time to immune reconstitution (including normalization of T, B and natural killer (NK) cell repertoire and Immunoglobulin G production), and to establish the incidence of infectious complications including bacterial, viral, fungal and atypical mycobacterial and other infections following CD34+ selection in children, adolescents and young adults receiving an allogeneic peripheral blood stem cell transplant from a family member or unrelated adult donor for a non-malignant disease.

Graft-versus-host disease (GVHD) is a condition that results from a reaction of transplanted donor T-lymphocytes against the body and organs of the patient receiving the transplanted cells. There are two forms: acute (early) and chronic (late). Acute GVHD may produce skin rashes, liver disease,diarrhea, and an increased risk of infection. Chronic GVHD can appear in patients without prior acute GVHD. Chronic GVHD may also produce skin rashes, liver disease, diarrhea and an increased risk of infection. GVHD can make patients very sick, and having GVHD can make it more likely that patients will not survive their transplant. In this study the investigators are offering to treat the donor peripheral blood stem cells in the hope that it will make it less likely for the patient who receives them to have GVHD.

Patients on this study are being offered an experimental treatment involving the use of a Miltenyi CliniMacs CD34+ selection device to remove T-cells from the peripheral blood stem cell transplant in order to decrease the risk of acute and chronic GVHD. CD34+ stem cells are selected from the donor's peripheral blood stem cells. In doing this, T-cells are also removed. T-cells are the cells which are responsible for graft versus host disease (GVHD). This study is a clinical trial for patients diagnosed with a non-malignant disease who will receive a peripheral blood stem cell transplant. Patients with the following types of non-malignant diseases can participate in this study: Bone marrow failure syndromes (including Severe Aplastic Anemia, Severe Congenital Neutropenia, Amegakaryocytic Thrombocytopenia (Kostman's Syndrome), Diamond-Blackfan Anemia, Schwachman Diamond Syndrome, Primary Immunodeficiency Syndromes, Acquired Immunodeficiency Syndromes, and Histiocytic Disorders) and Hemoglobinopathies (including Sickle Cell Anemia and Sickle/Beta Thalassemia). Patients on this study will be given standard transplant therapy with either high doses of chemotherapy drugs or lower doses of chemotherapy drugs, depending on their disease. Diseases within each disease group will receive chemotherapy that is standard for that condition.

Some patients on this study will receive an allogeneic stem cell transplant (AlloSCT) from a matched related donor. If a patient does not have a matched related donor, a bone marrow search will be done at all of the bone marrow banks in the world. The patient will then go on to receive an AlloSCT from either a partially matched family member or an unrelated adult stem cell transplant donor. The transplanted cells will allow all the normal parts of the patient's blood system to recover. The experimental portion of this treatment involves the use of a Miltenyi CliniMacs CD34+ selection device to remove T-cells from the peripheral blood stem cell transplant in order to decrease the risk of acute and chronic GVHD. CD34+ stem cell selection AlloSCT has been studied in adults with malignant and non-malignant disease with successful engraftment and has shown some improvement in GVHD. It is unknown if CD34+ stem cell selection will work to prevent severe GVHD in children and adolescents.

Interventional
Not Provided
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Bone Marrow Failure Syndrome
  • Severe Aplastic Anemia
  • Severe Congenital Neutropenia
  • Amegakaryocytic Thrombocytopenia
  • Diamond-Blackfan Anemia
  • Schwachman Diamond Syndrome
  • Primary Immunodeficiency Syndromes
  • Acquired Immunodeficiency Syndromes
  • Histiocytic Syndrome
  • Familial Hemophagocytic Lymphocytosis
  • Lymphohistiocytosis
  • Macrophage Activation Syndrome
  • Langerhans Cell Histiocytosis (LCH)
  • Hemoglobinopathies
  • Sickle Cell Disease
  • Sickle Cell-beta-thalassemia
Biological: CliniMacs (PLUS) Reagent System
The CliniMacs (PLUS) Reagent System (Miltenyi CliniMacs CD34+ Cell Selection Device) will be used to remove T-cells from the peripheral blood stem cell transplant in order to decrease the risk of acute and chronic graft versus host disease (GVHD).
Other Name: Miltenyi Clinimacs CD34+ Cell Selection Device
Experimental: CliniMacs (PLUS) Reagent System
Patients will receive a pre-transplant conditioning regimen of Busulfan Fludarabine and Campath. For patients with pre-transplant hepatic dysfunction, Melphalan will be substituted for the Busulfan. The donor peripheral blood stem cells will undergo CD34+ selection. The CliniMacs (PLUS) Reagent System will be used to remove T-cells from the peripheral blood stem cell transplant in order to decrease the risk of acute and chronic graft versus host disease (GVHD).
Intervention: Biological: CliniMacs (PLUS) Reagent System
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
25
March 2017
March 2017   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Patient or the patient's legally authorized guardian must sign an informed consent.
  • HLA Matching donor: A matched unrelated adult donor (MUD),or a related donor will be required for study entry.
  • Adequate renal function as determined by the institutional normal range.
  • Adequate liver function.
  • Adequate cardiac function defined by radionucleotide angiogram or echocardiogram.
  • Adequate pulmonary function by pulmonary function test. For children who are uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry >92% on room air.

Eligibility for reduced liver toxicity regimen

  • Adequate renal function as determined by the institutional normal range.
  • Adequate liver function.
  • For patients with hemoglobinopathies, serum conjugated (direct) bilirubin < 2x upper limit of normal for and ALT and AST < 5 times upper limit of normal
  • Adequate cardiac function defined by radionuclide angiogram or echocardiogram.
  • Adequate pulmonary function defined by pulmonary function test. For children who are uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry >92% in room air.

For patients with sickle cell anemia

  • For patients with related donors: Any patient with a HLA matched sibling donor who is either sickle cell negative or sickle cell trait
  • For patients with unrelated donors:

    1. A clinically significant neurologic event (stroke) and accompanied by an infarct
    2. Minimum of two episodes of acute chest syndrome during the two years prior to enrollment
    3. History of 3 or more severe pain (if patients are receiving hydroxyurea and compliant with therapy, being symptomatic is an indication for transplantation)

Exclusion Criteria:

  • Patients with documented uncontrolled infection at the time of study entry are not eligible.
  • Pregnancy/Breast Feeding Females who are pregnant or breast feeding at the time of study entry are not eligible.
  • Uncontrolled bacterial, viral or fungal infection in the past month
  • Seropositivity for HIV
  • Patients who have received prior HCT within three months of enrollment for reduced toxicity regimen and within six months for myeloablative regimen
  • Females who are pregnant or breast feeding are excluded
  • For patients with sickle cell anemia the following exclusion criteria also apply
  • Patients with bridging fibrosis or cirrhosis of the liver
Both
2 Years to 21 Years
No
Contact: Diane George, MD 212-305-9806 dg2039@columbia.edu
Contact: Elana Smilow, CPNP 212-305-8443 eha9001@nyp.org
United States
 
NCT01966367
AAAL0156
Yes
Diane George, MD, Columbia University
Diane George, MD
Not Provided
Principal Investigator: Diane George, MD Columbia University
Columbia University
October 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP