HSCT For Patients With High Risk Hemoglobinopathies Using Reduced Intensity
|ClinicalTrials.gov Identifier: NCT02435901|
Recruitment Status : Completed
First Posted : May 6, 2015
Last Update Posted : April 26, 2018
|Condition or disease||Intervention/treatment||Phase|
|Sickle Cell Disease Beta Thalassemia-Major||Drug: alemtuzumab (Campath IH) Drug: Fludarabine Drug: Melphalan Drug: Cyclosporine Drug: Mycophenolate mofetil Drug: Tacrolimus Biological: Hematopoietic Stem Cell Transplantation||Phase 1 Phase 2|
Standard myeloablative regimens are toxic to non-hematopoietic tissue and are associated with treatment related mortality and morbidity (TRM). Preparative regimens that are not myeloablative are associated with a greatly decreased incidence of TRM. In addition to providing a less toxic regimen, the reduced intensity chemotherapy preparative regimen also remains immunosuppressive enough to allow donor engraftment. Recent report of non-myeloablative regimens which resulted in engraftment of allogeneic stem cell in hematological malignancies raises the possibility that this conditioning regimen might be useful in achieving engraftment in non hematological disorder.
In an effort to achieve stable engraftment with any suitable donor stem cell source and to minimize toxicity the investigators have developed a new reduced intensity conditioning regimen for high risk hemoglobinopathies with the main aim of significantly suppressing the recipient's immune system and facilitate engraftment.
Non-myeloablative or reduced-intensity immunosuppressive preparative regimens have achieved a stable, mixed chimerism engraftment and successful allogeneic bone marrow transplants.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||29 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN PATIENTS WITH HIGH RISK HEMOGLOBINOPATHIES LIKE SICKLE CELL DISEASE AND β-THALESSEMIA-MAJOR USING REDUCED INTENSITY CONDITIONING REGIMEN|
|Study Start Date :||December 2008|
|Actual Primary Completion Date :||January 2018|
|Actual Study Completion Date :||January 2018|
Experimental: Reduced Intensity Regimen
Administration of reduced doses of alemtuzumab (Campath-IH) IV 3mg test dose on Day -20 followed by daily dose of 10mg/dose on Day -19 to Day -17 for patients <10yrs or a daily dose of 15mg/dose on Day -19 to Day -17 for patients > 10yrs. Fludarabine 35mg/m2 daily for 4 days on Day -7 to Day -4. Melphalan 70mg/m2 daily for 2 days on Day -3 and Day -2. On Day -1 Cyclosporine OR Tacrolimus will be initiated along with Mycophenolate Mofetil as a graft vs host disease prophylaxis. On Day 0 the Human Leukocyte Antigen (HLA) matched or mismatched Hematopoietic Stem Cells from either the related or unrelated donor will be infused.
Drug: alemtuzumab (Campath IH)
Alemtuzumab (Campath IH) is given daily over first 4 days, Day -20 to Day -17
Other Name: Campath-IHDrug: Fludarabine
Fludarabine 35/m2 is given daily over 4 days on Day -7 to Day -4.Drug: Melphalan
Melphalan 70mg/m2 is given daily over 2 days on Day -3 to Day -2.Drug: Cyclosporine
Immunosuppressant to prevent graft vs host disease is given on Day -1 prior to stem cell infusionDrug: Mycophenolate mofetil
Immunosuppresant to prevent graft vs host disease is given on Day -1.Drug: Tacrolimus
Immunosuppresant to prevent graft vs host disease is given Day -1 prior to stem cell infusionBiological: Hematopoietic Stem Cell Transplantation
Human Leukocyte Antigen (HLA) matched or mismatched; related or unrelated hematopoietic stem cells to be transplanted on Day 0.
- Assessment of Stem Cell Engraftment [ Time Frame: 1 year ]Sustained stem cell engraftment of donor cells will be evaluated by chimerism (FISH fluorescence in situ hybridization OR VNTR (Variable Number of Tandem Repeats), based on recipient/donor gender, at 30 days, 100 days, 6 months and 1 year following the use of reduced intensity conditioning.
- Assessment of treatment related mortality and morbidity [ Time Frame: 2 years ]Patients will be evaluated for incidence and severity of graft versus host disease, infection, and cardiopulmonary complications.
- Event Free Survival [ Time Frame: 2 years ]
- Immunological Reconstitution [ Time Frame: 2 years ]Measure the rate of T and B cell immune reconstitution by laboratory studies at 8 weeks, 6 months, one year and two years post transplant.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02435901
|United States, New York|
|Cohen Children's Medical Center of New York|
|New Hyde Park, New York, United States, 11040|