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Allogeneic Hematopoietic Stem Cell Transplant For Epidermolysis Bullosa

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ClinicalTrials.gov Identifier: NCT00478244
Recruitment Status : Terminated (Competing studies)
First Posted : May 24, 2007
Results First Posted : February 11, 2013
Last Update Posted : December 28, 2017
Sponsor:
Information provided by (Responsible Party):
Masonic Cancer Center, University of Minnesota

Tracking Information
First Submitted Date  ICMJE May 23, 2007
First Posted Date  ICMJE May 24, 2007
Results First Submitted Date  ICMJE July 17, 2012
Results First Posted Date  ICMJE February 11, 2013
Last Update Posted Date December 28, 2017
Study Start Date  ICMJE April 2007
Actual Primary Completion Date August 2011   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 4, 2013)
Number of Patients With Detectable Collagen Type VII [ Time Frame: Day 100 Post Transplant ]
Number of patients with epidermolysis bullosa who had collagen type VII. Type VII collagen defects cause recessive dystrophic epidermolysis bullosa (RDEB), a blistering skin disorder often accompanied by epidermal cancers.
Original Primary Outcome Measures  ICMJE
 (submitted: May 23, 2007)
Incidence of detectable donor-derived collagen type VII by day 100
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: January 4, 2013)
  • Number of Patients With >70% Donor Chimerism [ Time Frame: Days 21, 100, 180, 365 and 730 Post Transplant ]
    Number of patients with donor chimerism - percentage of donor cells in the patient via the peripheral blood or bone marrow.
  • Number of Patients With Transplant-Related Mortality [ Time Frame: Day 180 Post Transplant ]
    Number of patients who died due to complications of the transplant (includes all deaths without previous relapse or progression).
  • Number of Patients With Platelet Engraftment [ Time Frame: Day 180 Post Transplant ]
    Number of patients with a platelet count >5 x 10^10 cells/liter for 3 consecutive measurements.
  • Number of Patients With Acute Graft-Versus-Host Disease (GVHD) [ Time Frame: Day 100 Post Transplant ]
    Number of patients with GVHD. Acute Graft-Versus-Host Disease is a severe short-term complication created by infusion of donor cells into a foreign host.
  • Number of Patients With Chronic Graft-Versus-Host Disease (cGVHD) [ Time Frame: Day 365 Post Transplant ]
    Number of patients with cGVHD; a severe long-term complication created by infusion of donor cells into a foreign host.
  • Overall Survival [ Time Frame: 1 year and 2 years Post Transplant ]
    Survival is defined as the number of patients that were alive post transplant.
  • Number of Patients With Donor Derived Cells in Skin [ Time Frame: Day 90 Post Transplant ]
    Number of patients who had donor skin chimerism - donor cells in the patient's epidermis (a state in bone marrow transplantation in which bone marrow and host cells exist compatibly without signs of graft-versus-host rejection disease).
  • Number of Patients With Resistance to Blister Formation [ Time Frame: Month 1 through Month 24 Inclusive ]
    Resistance to Blister Formation demonstrated by response to negative pressure.
  • Number of Patients With Neutrophil Engraftment [ Time Frame: Day 42 Post Transplant ]
    Number of patients with an absolute neutrophil count >5 x 10^8 cells/liter for 3 consecutive days.
Original Secondary Outcome Measures  ICMJE
 (submitted: May 23, 2007)
  • Incidence of transplant-related mortality at 180 days
  • Incidence of chimerism at 21, 100, 180, 365, and 730 days
  • Incidence of neutrophil recovery at day 42 and platelet recovery at 180 days
  • Incidence of acute graft-versus-host disease (GVHD) at day 100
  • Incidence of chronic GVHD at 1 year
  • Probability of survival and disease-free survival at 1 and 2 years
  • Incidence of donor skin-derived epidermal cell survival 90 days after epidermal cell transplantation
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Allogeneic Hematopoietic Stem Cell Transplant For Epidermolysis Bullosa
Official Title  ICMJE Allogeneic Hematopoietic Cell Transplantation to Correct the Biochemical Defect and Create Tolerance to Donor Tissue in Subjects With Epidermolysis Bullosa
Brief Summary

RATIONALE: In animal models, stem cells have been shown to home to the skin and repair the biochemical and structural abnormalities associated with recessive dystrophic epidermolysis bullosa (RDEB) (collagen 7 deficiency).

PURPOSE: To determine the safety and effectiveness of stem cell infusion in the treatment of RDEB.

Detailed Description

OBJECTIVES:

Primary

  • Estimate the incidence of detectable donor-derived collagen type VII at day 100 in patients with epidermolysis bullosa by donor.

Secondary

  • Determine the incidence of transplant-related mortality at day 180
  • Determine the incidence of blood chimerism at days 21, 100, 180, 365, and 730
  • Determine the incidence of neutrophil recovery at day 42 and platelet recovery at day 180
  • Determine the incidence of acute graft-versus-host disease (GVHD) grade II-IV and grade III-IV at day 100
  • Determine the incidence of chronic GVHD at 1 year
  • Determine the probability of survival at 1 and 2 years
  • Determine the incidence of donor derived cells in the skin
  • Determine resistance to blister formation OUTLINE: This is an open-label, pilot study.
  • Conditioning regimen: Busulfan intravenously (IV) over 2 hours every 6 hours on days -9 to -4, fludarabine phosphate IV over 1 hour on days -5 to -3, and high-dose cyclophosphamide IV over 1 hour on days -5 to -2.
  • Stem cell transplantation on day 0.

After completion of study treatment, patients are followed periodically for at least 5 years.

PROJECTED ACCRUAL: 30 patients

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Epidermolysis Bullosa
Intervention  ICMJE
  • Drug: busulfan
    Day -9 through Day -6: 1.1 mg/kg if < 12 kg IV every 6 hours; 0.8 mg/kg if > 12 kg.
    Other Name: Bulsulfex
  • Drug: cyclophosphamide
    Day -5 through Day -2: 50 mg/kg IV over 120 min.
    Other Name: Cytoxan
  • Drug: fludarabine phosphate
    Day -5 through Day -3: 25 mg/m2 IV over 60 min.
    Other Names:
    • Fludarabine
    • Fludara
  • Procedure: hematopoietic bone marrow transplantation
    allogeneic bone marrow, peripheral stem cell or umbilical cord blood transplantation
    Other Name: Bone marrow transplant
Study Arms  ICMJE Experimental: Epidermolysis Bullosa (EB) Patients
Epidermolysis bullosa patients treated per study regimen with chemotherapy and stem cell transplant.
Interventions:
  • Drug: busulfan
  • Drug: cyclophosphamide
  • Drug: fludarabine phosphate
  • Procedure: hematopoietic bone marrow transplantation
Publications * Wagner JE, Ishida-Yamamoto A, McGrath JA, Hordinsky M, Keene DR, Woodley DT, Chen M, Riddle MJ, Osborn MJ, Lund T, Dolan M, Blazar BR, Tolar J. Bone marrow transplantation for recessive dystrophic epidermolysis bullosa. N Engl J Med. 2010 Aug 12;363(7):629-39. doi: 10.1056/NEJMoa0910501. Erratum in: N Engl J Med. 2010 Sep 30;363(14):1383. Woodley, David T [added]; Chen, Mei [added].

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Terminated
Actual Enrollment  ICMJE
 (submitted: January 31, 2012)
7
Original Enrollment  ICMJE
 (submitted: May 23, 2007)
10
Actual Study Completion Date  ICMJE August 2011
Actual Primary Completion Date August 2011   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion criteria:

  • Diagnosis of epidermolysis bullosa (EB)

    • Documented collagen type VII deficiency by:

      • Antigenic mapping (LH7.2 antibody)
      • Ultrastructure analysis of anchoring fibrils
      • DNA mutation analysis
  • Performance status: >50% Lansky; >50% Karnofsky
  • Adequate organ function

    • Renal: glomerular filtration rate > 60ml/min/1.73m2 patients aged ≤ 10 years
    • Hepatic: bilirubin, aspartate aminotransferase/alanine aminotransferase (AST/ALT), Alkaline phosphatase (ALP) < 5 x upper limit of normal 4.2.3 Pulmonary: oxygen saturation >92% 4.2.4 Cardiac: left ventricular ejection fraction > 45%.
  • Healthy related hematopoietic stem cell donor available and meeting 1 of the following criteria:

    • HLA-A, B, DRB1-identical sibling bone marrow and/or umbilical cord blood donor (first priority)
    • HLA-A, B, DRB1-matched or partially matched related donor (second priority)
    • Donor may be a carrier but must be unaffected by EB
    • 8/8 HLA A, B, C, DRB1 allele level matched unrelated marrow donor (third priority)
    • 7/8 HLA-A, B, C, DRB1 allele level matched unrelated marrow donor or 4/6 HLA-A, B (antigen level), DRB1 (allele level) matched unrelated cord blood donor (fourth priority)

Exclusion criteria:

  • Active infection at time of transplantation (including active infection with Aspergillus or other mold within 30 days)
  • Squamous cell carcinoma of the skin
  • History of human immunodeficiency virus (HIV) infection
  • Prior transplantation with donor skin
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE up to 25 Years   (Child, Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT00478244
Other Study ID Numbers  ICMJE MT2006-15
CDR0000546620 ( Other Identifier: PDQ )
UMN-0702M01504 ( Other Identifier: IRB, University of Minnesota )
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Masonic Cancer Center, University of Minnesota
Study Sponsor  ICMJE Masonic Cancer Center, University of Minnesota
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Study Chair: John E. Wagner, MD Masonic Cancer Center, University of Minnesota
PRS Account Masonic Cancer Center, University of Minnesota
Verification Date December 2017

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