Umbilical Cord Blood Transplant for Congenital Pediatric Disorders (UCB)
The purpose of this study is to determine the safety and effectiveness of Umbilical Cord Blood Transplant (UCBT) to treat the patient's disease, and to see if this treatment can decrease the incidence of GVHD.
This study is for patients that were born with a disease that affects their body's metabolism or immune system. The doctor plans to treat the patient for this illness with a stem cell transplant.
While improved medical care has allowed many people with these diseases to live longer, the only way to truly cure the diseases is by means of a stem cell transplant from a donor who does not have the disease. A stem cell transplant will replace sick cells with new healthy donor cells. Stem cells grow into different types of blood cells that people need, including red blood cells, white blood cells, and platelets. In a stem cell transplant, the patients own stem cells would be killed by chemotherapy drug and then replaced by stem cells from the donor. Stem cells can be collected from the bone marrow, peripheral blood or umbilical cords. In this study, umbilical cords will be the source of the stem cells.
Currently, large inventories of umbilical cord blood units are available in public banks for transplantation in those lacking bone marrow donors. UCB transplants offer several advantages over adult bone marrow or peripheral blood stem cell transplants, including:
- Rapid availability,
- Absence of donor risk,
- Low risk of transmissible infectious diseases,
- Low risk of acute GvHD (as compared to recipients of unrelated donor marrow and peripheral blood cells).
The two main causes of death after umbilical cord blood transplantation for disorders for these kinds of patients, are graft failure and infection.
In this study we are trying to address these two problems by using different drugs to prepare patients for the transplant.
To help improve engraftment (cells begin to grow), we will include the drug Fludarabine to the usually used Busulfan and Cytoxan that the study patients will receive before their transplant.
We will try to decrease the chance of developing graft-versus-host disease (GvHD) by using Cyclosporin A (CSA) and Mycophenolate Mofetil (MMF), instead of Anti-Thymocyte Globulin (ATG) which is normally used.
|Congenital Pediatric Disorders||Drug: Busulfan Drug: Cytoxan Drug: Fludarabine Procedure: Cord Blood Stem Cell Infusion|
|Study Design:||Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
|Official Title:||Umbilical Cord Blood Transplant for Congenital Pediatric Disorders|
- Overall survival at 100 days, 1 year, 3 years, and 5 years after umbilical cord blood transplant in pediatric patients with congenital diseases. [ Time Frame: 5 years ]
- Neutrophil and platelet count recovery at Day 42. [ Time Frame: Day 42 ]
- Incidence of severe Grade III-IV acute GvHD at Day 100. [ Time Frame: Day 100 ]
- Incidence of chronic GvHD at 1 year. [ Time Frame: 1 year ]
- Engraftment of donor cells at 100 days, 6 months, and 12 months after transplant. [ Time Frame: 100 days, 6 months and 12 months ]
|Study Start Date:||July 2009|
|Estimated Study Completion Date:||January 2025|
|Estimated Primary Completion Date:||January 2025 (Final data collection date for primary outcome measure)|
Experimental: Umbilical Cord Blood Transplant Treatment Plan
Busulfan, Cytoxan, Fludarabine, Cord Blood Stem Cell Infusion
Day -9, -8, -7 and -6
Patients less than or equal to 12 kg: 1.1 mg/kg/dose IV every 6 hours for 16 doses total; patients >12 kg: 0.8 mg/kg/dose IV every 6 hours for 16 doses.
Other Name: BusulfexDrug: Cytoxan
(50 mg/kg/dose) will be given IV on Days -5, - 4, -3, and -2 over 2 hours (can be given over 1 to 4 hours as determined by the treating physician). The total dose to be given over 4 days is 200 mg/kg.
Other Name: CyclophosphamideDrug: Fludarabine
40 mg/m2/day IV over 1 hour for patients greater than 10 kg, or 1.3 mg/kg/day for patients less than or equal to 10 kg.
Other Name: FluderaProcedure: Cord Blood Stem Cell Infusion
The cord blood stem cells will be infused on Day 0.
Patients will be examined to make sure that they meet the requirements of this study. There will be tests of the heart and of the lungs. X-rays will be taken of the lungs and other organs, depending on the disease. An MRI and consultations with different specialists will also be conducted.
Patients also must have a negative pregnancy test before entering this study if they are a woman of childbearing potential. The blood will be tested for viruses and to look at the functioning of the liver and kidneys. The examination also includes HIV testing. If the patient has HIV, they will not be able to be treated on this protocol.
After we have determined that the patient is eligible for treatment on this study and a suitable UCB stem donor has been found, they will have a central line placed.
After placement of the central line, the following chemotherapy will be given to after admission to the hospital:
- 9 days before the infusion through 6 days before the infusion: Busulfan every 6 hours for 16 total doses.
- 5 days before the infusion through 2 days before the infusion: Cytoxan given daily for 4 days over 2 hours. (It can be given over 1 to 4 hours if needed as decided by the physician). Mesna will be given per standards.
- 4 days before the infusion through 1 day before the infusion: Fludarabine given daily for 4 days over 1 hour.
Stem cell transplant (infusion of the UCB stem cells) - defined as Day 0 of the treatment. All other "numbered" days relate to this infusion date. For example, Day 1 is the first day after the stem cell transplant.
Standard Therapy: Phenytoin will be given according to the standards of the TCH formulary.
Cyclosporin A (CSA) will be given starting 2 days prior to the stem cell infusion. It will be given daily over 2 hours every 12 hours, and then tapered if no GvHD is present.
Administration of Mycophenolate Mofetil (MMF) will start on the day the stem cell infusion is completed, and will continue daily for 45 days unless the patient develops GvHD.
Intravenous Immunoglobulins (IVIG) will be given as per CAGT SOP for infections prophylaxis.
Granulocyte Colony-Stimulating Factor (GCSF) will be given daily starting at Day +7 until ANC is greater than 2,500 for three consecutive days.
Study Evaluation: Patients will have various study evaluations, including blood samples, before and after the transplant.
Follow-Up: After year 1, the patients will be asked to return to the clinic once a year for consultations. These consultations with specialists will be similar to the ones the patients had before their transplant.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00950846
|Contact: Caridad Martinez, MDfirstname.lastname@example.org|
|United States, Texas|
|Texas Children's Hospital||Recruiting|
|Houston, Texas, United States, 77030|
|Contact: Caridad A Martinez, MD 832-824-4692 email@example.com|
|Principal Investigator:||Caridad Martinez, MD||Baylor College of Medicine|