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Study of HLA-Haploidentical Stem Cell Transplantation to Treat Clinically Aggressive Sickle Cell Disease

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ClinicalTrials.gov Identifier: NCT03121001
Recruitment Status : Recruiting
First Posted : April 19, 2017
Last Update Posted : May 19, 2017
Sponsor:
Information provided by (Responsible Party):
Damiano Rondelli, MD, University of Illinois at Chicago

Brief Summary:

The study is a Phase II clinical trial. Patients will receive intensity modulated total body irradiation (TBI) at a dose of 3 Gy with standard fludarabine/ i.v. cyclophosphamide conditioning prior to human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplant (HSCT).

The primary objective of the study is to determine the engraftment at Day +60 following HLA-haploidentical hematopoietic stem cell transplant protocol using immunosuppressive agents and low-dose total body irradiation (TBI) for conditioning and post-transplant cyclophosphamide in patients with sickle cell disease.


Condition or disease Intervention/treatment Phase
Sickle Cell Disease Drug: ATG Drug: fludarabine Drug: cyclophosphamide Radiation: Total body irradiation Procedure: Stem cell infusion Drug: Sirolimus Drug: mycophenolate mofetil Phase 2

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study of HLA-Haploidentical Stem Cell Transplantation to Treat Clinically Aggressive Sickle Cell Disease
Actual Study Start Date : April 28, 2017
Estimated Primary Completion Date : October 28, 2026
Estimated Study Completion Date : October 28, 2026

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Subject treatment
Patients will receive the following conditioning regimen: ATG, fludarabine (6 days before stem cell infusion), cyclophosphamide, and total body irradiation. The stem cell product will be infused according to BMT unit policy. Patients will also receive GVHD prophylaxis which will consist of cyclophosphamide, sirolimus, and mycophenolate mofetil according to the protocol. Post-transplant evaluation will be done as per standard care with study data collected at days 30, 60, 100, 180, 365, and annually thereafter.
Drug: ATG
0.5 mg/kg IV on day -9, and 2 mg/kg on days -8 and day -7
Other Name: Thymoglobulin®

Drug: fludarabine
30 mg/m2 IVPB daily for day -6 (6 days before stem cell infusion) through day -2

Drug: cyclophosphamide
14.5 mg/kg IV on days -6 and -5 and 50 mg/kg/d on days +3 and +4

Radiation: Total body irradiation
3 Gy on day -1

Procedure: Stem cell infusion
Stem cell product infused according to BMT unit policy on day 0.

Drug: Sirolimus
loading dose of 15 mg followed by 5 mg per day on day +5

Drug: mycophenolate mofetil
1 g every 8 h (until day 35) will be started on day 5




Primary Outcome Measures :
  1. Estimate the number of patients who engraft by Day +60 [ Time Frame: Up to Day +60 ]
    Patients who achieve < 5% peripheral blood donor chimerism by Day +30 and do not have a Day +60 measure will be regarded as failing to achieve full donor chimerism by Day +60; patients who achieve > 5% donor chimerism by Day +30 but do not have a Day +60 measure will be considered nonevaluable for the primary endpoint.


Secondary Outcome Measures :
  1. Disease free survival [ Time Frame: Up to Day +60 ]
    Using the Kaplan-Meier method, the probability of EFS will be estimated and reported with 90% confidence intervals. The proportion of patients who are alive will also be estimated with a 90% exact binomial confidence interval. Cumulative incidences of transplant related mortality will be estimated separately using Grey's method.

  2. Overall survival [ Time Frame: Up to Day +60 ]
    Using the Kaplan-Meier method, the probability of overall survival will be estimated and reported with 90% confidence intervals. The proportion of patients who are alive will also be estimated with a 90% exact binomial confidence interval. Cumulative incidences of transplant related mortality will be estimated separately using Grey's method.

  3. Adverse Effects [ Time Frame: Up to Day +60 ]
    The cumulative incidence of acute (grade II-IV, grade III-IV) and chronic GVHD will be estimated through competing-risk analysis using Grey's method, wherein graft failure, and death are competing risks for GVHD. Other selected toxicities (including rates of infection) will be reported descriptively.



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Ages Eligible for Study:   16 Years to 60 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Patient Eligibility:

  1. Patients with sickle cell disease are eligible if they have any of the following complications:

    1.1 Stroke or central nervous system event lasting longer than 24 hours 1.2 Frequent vaso-occlusive pain episodes, defined as ≥ 3 per year requiring emergency room, acute care center, hospital admissions, or home bedrest leading to absence from work or school. 1.3 Recurrent episodes of priapism, defined as ≥ 2 per year requiring emergency room visits 1.4 Acute chest syndrome with recurrent hospitalizations, defined as ≥ 2 lifetime events 1.5 Red-cell alloimmunization (≥ 2 antibodies) during long-term transfusion therapy 1.6 Bilateral proliferative retinopathy with major visual impairment in at least one eye 1.7 Osteonecrosis of 2 or more joints 1.8 Sickle cell nephropathy, defined by a GFR < 90mL/min/1.73m2 or the presence of macroalbuminuria (urine albumin > 300 mg/g creatinine) 1.9 Pulmonary hypertension, defined by a mean pulmonary arterypressure >25mmHg

  2. Age 16-60 years
  3. Karnofsky performance status of 60 or higher (Appendix A)
  4. Adequate cardiac function, defined as left ventricular ejection fraction ≥ 40%
  5. Adequate pulmonary function, defined as diffusion lung capacity of carbon monoxide ≥ 50% predicted (after adjustment for hemoglobin concentration)
  6. Estimated GFR ≥ 50mL/min/1.73m2 as calculated by the modified MDRD equation
  7. ALT ≤ 3x upper limit of normal
  8. HIV-negative
  9. Patient is not pregnant
  10. Patient is able and willing to sign informed consent
  11. Patient does not have a fully HLA-matched sibling donor
  12. Patient has an HLA-haploidentical relative

Donor Eligibility Relatives (parents, offspring, siblings, aunts/uncles, cousins) will be tested by molecular typing of HLA class I (A, B, and C) and class II (DRB1) at low resolution. Only those that are an HLA-haploidentical match (≥ 4/8) will be considered as a potential donor. NOTE: If during testing, a fully HLA-matched sibling donor is found and is willing to donate his/her stem cells, the potential subject will not be eligible for this protocol.

Donor consent will be obtained as per standard protocol of the bone marrow transplant unit.


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): NCT03121001


Contacts
Contact: Damiano Rondelli, MD 312 413-3547 drond@uic.edu

Locations
United States, Illinois
University of Illinois at Chicago Recruiting
Chicago, Illinois, United States, 60612
Contact: Damiano Rondelli, MD    312-413-3547    drond@uic.edu   
Sponsors and Collaborators
University of Illinois at Chicago
Investigators
Principal Investigator: Damiano Rondelli, MD University of Illinois at Chicago

Responsible Party: Damiano Rondelli, MD, Professor, Hematology, University of Illinois at Chicago
ClinicalTrials.gov Identifier: NCT03121001     History of Changes
Other Study ID Numbers: 2016-1152
First Posted: April 19, 2017    Key Record Dates
Last Update Posted: May 19, 2017
Last Verified: May 2017

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Anemia, Sickle Cell
Anemia, Hemolytic, Congenital
Anemia, Hemolytic
Anemia
Hematologic Diseases
Hemoglobinopathies
Genetic Diseases, Inborn
Cyclophosphamide
Fludarabine phosphate
Sirolimus
Everolimus
Thymoglobulin
Fludarabine
Mycophenolic Acid
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antimetabolites, Antineoplastic
Antimetabolites
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents
Antibiotics, Antitubercular