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Autologous Stem Cell Transplantation for Progressive Systemic Sclerosis (AST-MOMA)

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: NCT01895244
Recruitment Status : Active, not recruiting
First Posted : July 10, 2013
Last Update Posted : May 23, 2022
Sponsor:
Information provided by (Responsible Party):
Joerg Henes, University Hospital Tuebingen

Study Description
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Brief Summary:

Autologous stem cell therapy has been shown to be effective in patients with systemic sclerosis. Nevertheless treatment is associated with treatment related mortality and patients die during follow up despite successful transplantation.

Intention of this trial is to improve overall survival by modifying the existing protocol used for the ASTIS trial.

To reduce treatment toxicity we reduce the dose of Cyclophosphamide (CYC) for mobilisation to 2x1g.

Especially in patients with cardiac manifestations we also modify the conditioning regimen by adding thiotepa and reducing CYC; as CYC has known cardiotoxic side effects.


Condition or disease Intervention/treatment Phase
Scleroderma Cardiac Involvement Autologous Stem Cell Transplantation Drug: Autologous stemcell transplantation with CD (cluster of differentiation) 34 selected stem cells Phase 2

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 44 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Highdose Chemotherapy and Transplantation of 34+ Selected Stem Cell for Progressive Systemic Sclerosis - Modification According to Manifestation
Actual Study Start Date : September 2012
Actual Primary Completion Date : September 2021
Estimated Study Completion Date : September 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Scleroderma

Arms and Interventions
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Arm Intervention/treatment
Experimental: Conditioning with CYC/ antithymocyte globulin (ATG)
Each patient receives stem cell transplantation open label with cluster of differentiation (CD)34 selected stem cells mobilisation and conditioning depending on manifestation If cardiac manifestation: Conditioning with CYC 2 x 50mg + thiotepa 2x5mg + ATG If no cardiac manifestation: Conditioning with 4 x 50mg CYC + ATG
 Drug: Autologous stemcell transplantation with CD (cluster of differentiation) 34 selected stem cells
If no active alveolitis: mobilisation with 2x1g Cyclophosphamide If active alveolitis: mobilisation with 2x1.5g Cyclophosphamid If cardiac manifestation: Conditioning with CYC 2 x 50mg + thiotepa 2x5mg + ATG If no cardiac manifestation: Conditioning with 4 x 50mg CYC + ATG
Experimental: Conditioning with CYC/Thiotepa/ATG
In patients with cardiac manifestations as defined in the protocol the conditioning for stem cell transplantation is changed to Cyclophosphamide (CYC), thiotepa and ATG
 Drug: Autologous stemcell transplantation with CD (cluster of differentiation) 34 selected stem cells
If no active alveolitis: mobilisation with 2x1g Cyclophosphamide If active alveolitis: mobilisation with 2x1.5g Cyclophosphamid If cardiac manifestation: Conditioning with CYC 2 x 50mg + thiotepa 2x5mg + ATG If no cardiac manifestation: Conditioning with 4 x 50mg CYC + ATG


Outcome Measures
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Primary Outcome Measures :
  1. Efficay - Overall survival [ Time Frame: 3 years ]
    Number of patients that are alive after 3 years


Secondary Outcome Measures :
  1. Safety - Treatment related mortality [ Time Frame: 100 days ]
    Treatment related mortality: number of patients who die during the first 100 days after transplantation

  2. Time to engraftment [ Time Frame: 2 months ]
    Time in days from day 0 to platelet count > 20.000 and granulocytes >500/µl

  3. Progression free survival [ Time Frame: 3 years ]
    Time after transplantation without symptoms of disease activity

  4. Efficacy - Lung function test and Skin [ Time Frame: 3 years ]
    Number of patients that achieve either improvement of >25% in mRSS or > 10% in FVC or DLCO


Other Outcome Measures:
  1. Efficacy - Patient reported outcome [ Time Frame: 3 years ]
    Differences in Health Assessment Questionnaire (HAQ)


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of progressive systemic sclerosis <7 years
  • Progressive course despite cyclophosphamide pretreatment
  • Cyclophosphamide i.v.: at least 3 x with 500-1000 mg/m² every 3-4 weeks or
  • Cyclophosphamide p.o. with at least 100mg/day for at least 2 months or
  • Contraindication to treatment with cyclophosphamide

  • Progress defined as at least one of the following criteria:

    • Increase in the mRSS
    • Worsening of the lung function
    • Increase in fibrosis/alveolitis in thorax CT
    • Worsening kidney function through manifestation of systemic sclerosis
  • Limited or diffuse cutaneous progressive form of Ssc with organ manifestation in the lungs/heart or kidneys

Exclusion Criteria:

  • Age <18 years
  • Pregnancy or inadequate contraception
  • Severe heart failure with ejection fraction (EF) < 30% in echo
  • Pulmonary arterial hypertension with systolic pulmonary arterial pressure (PAPsys) >50mm Hg
  • Kidney insufficiency: creatinine clearance <30 ml/min
  • Reduced lung function
  • Inspiratory vital capacity (IVC) < 50% of normal
  • Carbon monoxide (CO)-Diffusion capacity SB < 40%
  • Previously damaged bone marrow
  • Leukopenia < 2,000/µl
  • Thrombopenia < 100,000/µl
  • Previous myelotoxic treatment:
  • Cyclophosphamide > 50g cumulative (relative)
  • Infection (Hepatitis B/C, HIV, Salmonella carrier, syphilis, relative: history of tuberculosis)
  • Severe concomitant psychiatric illness (depression, psychosis)
  • Substance dependence
  • Continued nicotine abuse
  • Continued alcohol abuse
  • Continued drug abuse
  • Consent not given
  • Poor 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): NCT01895244


Locations
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Germany
University Hospital Tuebingen; Department of oncology, hematology, rheumatology, immunology and pulmology
Tuebingen, Germany, 72076
Sponsors and Collaborators
University Hospital Tuebingen
Investigators
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Principal Investigator: Joerg C Henes, MD University Hospital Tuebingen, Department of oncology, hematology, rheumatology
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Joerg Henes, Dr. med. Joerg Henes, University Hospital Tuebingen
ClinicalTrials.gov Identifier: NCT01895244    
Other Study ID Numbers: AST MOMA
First Posted: July 10, 2013    Key Record Dates
Last Update Posted: May 23, 2022
Last Verified: May 2022
Keywords provided by Joerg Henes, University Hospital Tuebingen:
scleroderma
autologous stem cell transplantation
thiotepa
cluster of differentiation (CD) 34 selection
Additional relevant MeSH terms:
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Scleroderma, Systemic
Scleroderma, Diffuse
Connective Tissue Diseases
Skin Diseases