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Cord Blood-Derived Mesenchymal Stem Cells for the Treatment of COVID-19 Related Acute Respiratory Distress Syndrome

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04565665
Recruitment Status : Recruiting
First Posted : September 25, 2020
Last Update Posted : October 7, 2022
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Tracking Information
First Submitted Date  ICMJE September 22, 2020
First Posted Date  ICMJE September 25, 2020
Last Update Posted Date October 7, 2022
Actual Study Start Date  ICMJE July 29, 2020
Estimated Primary Completion Date April 30, 2023   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: April 16, 2021)
  • Incidence of composite serious adverse events (Phase I) [ Time Frame: Within 30 days of the first mesenchymal stem cell (MSC) infusion ]
    Serious adverse events with be comprised of grade 3 or 4 graft versus host disease or death and will be estimated and reported overall and by group, along with 95% confidence intervals.
  • Patients alive without grade 3, 4 infusional toxicity (Phase II) [ Time Frame: At day 30 post MSC infusion ]
  • Patients alive with grade 3 or 4 infusional toxicity (Phase II) [ Time Frame: At day 30 post MSC infusion ]
  • Patients not alive (Phase II) [ Time Frame: At day 30 post MSC infusion ]
Original Primary Outcome Measures  ICMJE
 (submitted: September 24, 2020)
  • Incidence of composite serious adverse events (Pilot) [ Time Frame: Within 30 days of the first mesenchymal stem cell (MSC) infusion ]
    Serious adverse events with be comprised of grade 3 or 4 graft versus host disease or death and will be estimated and reported overall and by group, along with 95% confidence intervals.
  • Patients alive without grade 3, 4 infusional toxicity (Phase II) [ Time Frame: At day 30 post MSC infusion ]
  • Patients alive with grade 3 or 4 infusional toxicity (Phase II) [ Time Frame: At day 30 post MSC infusion ]
  • Patients not alive (Phase II) [ Time Frame: At day 30 post MSC infusion ]
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: April 16, 2021)
  • Proportion of successfully extubated patients who present intubated on ventilator support (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Rate of successful progression to intubation in patients who require supplemental oxygen but who are otherwise able to breathe without assistance (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Overall survival rate (Phase I) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Survival rate in patients who present intubated on ventilator support (Phase I) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Survival rate in patients who require supplemental oxygen but who are otherwise able to breathe without assistance (Phase I) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Clinical parameters (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    The effect of MSCs on clinical parameters will be assessed. Continuous clinical parameters will be summarized by means, medians, standard deviations, ranges, and quartiles. Categorical parameters will be summarized by frequency tables.
  • Oxygenation parameters (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    The effect of MSCs on oxygenation parameters will be assessed. Continuous oxygenation parameters will be summarized by means, medians, standard deviations, ranges, and quartiles. Categorical parameters will be summarized by frequency tables.
  • Respiratory parameters (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    The effect of MSCs on respiratory parameters will be assessed. Continuous respiratory parameters will be summarized by means, medians, standard deviations, ranges, and quartiles. Categorical parameters will be summarized by frequency tables.
  • Laboratory markers (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    The effect of MSCs on laboratory markers will be assessed. Continuous laboratory parameters will be summarized by means, medians, standard deviations, ranges, and quartiles. Categorical parameters will be summarized by frequency tables.
  • Hospitalization stay (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
  • Intensive care unit stay (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
  • Incidence of infusion-related adverse events (Phase I) [ Time Frame: Up to day 30 post MSC infusion ]
    All grades of infusion-related adverse events will be summarized by grade and type.
Original Secondary Outcome Measures  ICMJE
 (submitted: September 24, 2020)
  • Proportion of successfully extubated patients who present intubated on ventilator support (Pilot) [ Time Frame: Up to day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Rate of successful progression to intubation in patients who require supplemental oxygen but who are otherwise able to breathe without assistance (Pilot) [ Time Frame: Up to day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Overall survival rate (Pilot) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Survival rate in patients who present intubated on ventilator support (Pilot) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Survival rate in patients who require supplemental oxygen but who are otherwise able to breathe without assistance (Pilot) [ Time Frame: At day 30 post MSC infusion ]
    Will be estimated and reported with 95% confidence intervals.
  • Determine the treatment effect on clinical parameters, oxygenation and respiratory parameters [ Time Frame: Up to day 30 post MSC infusion ]
    Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
  • Hospitalization stay (Pilot) [ Time Frame: Up to day 30 post MSC infusion ]
  • Intensive care unit stay (Pilot) [ Time Frame: Up to day 30 post MSC infusion ]
  • Incidence of infusion-related adverse events (Pilot) [ Time Frame: Up to day 30 post MSC infusion ]
    All grades of infusion-related adverse events will be summarized by grade and type.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Cord Blood-Derived Mesenchymal Stem Cells for the Treatment of COVID-19 Related Acute Respiratory Distress Syndrome
Official Title  ICMJE Study of Cord Blood Derived Mesenchymal Stem Cells for Treatment Acute Respiratory Distress Syndrome
Brief Summary This is a phase I trial followed by a phase II randomized trial. The purpose of phase I study is the feasibility of treating patients with acute respiratory distress syndrome (ARDS) related to COVID-19 infection (COVID-19) with cord blood-derived mesenchymal stem cells (MSC). The purpose of the phase II trial is to compare the effect of MSC with standard of care in these patients. MSCs are a type of stem cells that can be taken from umbilical cord blood and grown into many different cell types that can be used to treat cancer and other diseases. The MSCs being used for infusion in this trial are collected from healthy, unrelated donors and are stored and grown in a laboratory. Giving MSC infusions may help control the symptoms of COVID-19 related ARDS.
Detailed Description

PRIMARY OBJECTIVE:

I. To assess the safety of administering cord blood derived mesenchymal stem cell (CB-MSC) infusions for treatment of COVID-19 acute respiratory distress syndrome (ARDS).

SECONDARY OBJECTIVES:

I. In the group of patients who present intubated on ventilator support, assess the proportion that are able to be successfully extubated.

II. In the group of patients who present requiring supplemental oxygen but otherwise breathing without assistance, assess the rate of progression to intubation.

III. Estimate the survival rate at day 30 post treatment separately by group.

IV. Determine the treatment effect on clinical parameters, oxygenation and respiratory parameters:

IVa. Resolution of fever. IVb. Changes in oxygen demand (increased oxygen saturation at similar fraction of inspired oxygen [FiO2] or decreased FiO2 requirement).

IVc. Progression to mechanical ventilation. IVd. Length of mechanical ventilation. IVe. Decrease in positive end-expiratory pressure (PEEP) in intubated patients. IVf. Decrease in FiO2 in intubated patients.

V. Determine the treatment effect on laboratory markers:

Va. Complete blood count. Vb. C-reactive protein (CRP). Vc. Ferritin. Vd. D dimer. Ve. Procalcitonin. Vf. Cytokine levels. VI. Estimate hospitalization and intensive care unit (ICU) stay. VII. Report on study related adverse events.

OUTLINE:

Currently not shipping cells outside of MD Anderson Cancer Center in Houston.

PILOT STUDY: Patients receive MSCs intravenously (IV) over 1-2 hours on day 1. Patients may receive a second infusion of MSCs within 7 days after the first infusion per physician discretion.

PHASE II STUDY: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive MSCs IV over 1-2 hours on day 1. Patients may receive a second infusion of MSCs within 7 days after the first infusion per physician discretion.

ARM II: Patients receive standard of care.

After completion of study treatment, patients are followed up at days 7, 14, 30, 60, and months 6 and 12.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Phase 2
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • COVID-19 Infection
  • COVID-19-Associated Acute Respiratory Distress Syndrome
  • Hematopoietic and Lymphoid Cell Neoplasm
  • Malignant Solid Neoplasm
  • Symptomatic COVID-19 Infection Laboratory-Confirmed
Intervention  ICMJE
  • Other: Best Practice
    Receive standard of care
    Other Names:
    • standard of care
    • standard therapy
  • Biological: Mesenchymal Stem Cell
    Given IV
    Other Names:
    • Mesenchymal Progenitor Cell
    • MPC
Study Arms  ICMJE
  • Experimental: Phase II Arm I (mesenchymal stem cells)
    Patients receive MSCs as in the Pilot study.
    Intervention: Biological: Mesenchymal Stem Cell
  • Active Comparator: Phase II Arm II (standard of care)
    Patients receive standard of care.
    Intervention: Other: Best Practice
  • Experimental: Pilot study (mesenchymal stem cells)
    Patients receive MSCs IV over 1-2 hours on day 1. Patients may receive a second infusion of MSCs within 7 days after the first infusion per physician discretion.
    Intervention: Biological: Mesenchymal Stem Cell
Publications * Not Provided

*   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 Recruiting
Estimated Enrollment  ICMJE
 (submitted: September 24, 2020)
70
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE April 30, 2023
Estimated Primary Completion Date April 30, 2023   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Patients with moderate to severe ARDS per Berlin criteria secondary to COVID-19. Moderate to severe is defined in appendix as the following: moderate partial pressure of arterial oxygen (PaO2)/FiO2 of 100-200 mm Hg, severe PaO2/FiO2 of less than 100 mm Hg
  • Negative pregnancy test in a woman with childbearing potential defined as not post-menopausal for 12 months or no previous surgical sterilization
  • Patient or legally authorized representative consent
  • Because of the nature of COVID-19, patients enrolled on this study with COVID-19 associated ARDS may have been previously enrolled in other Investigational New Drug (IND) trials for their cancer diagnosis or COVID-19. These enrollments will not exclude them from enrollment to this study

Exclusion Criteria:

  • Moribund patients not expected to survive up to 48 hours
  • Patients with severe chronic liver disease (Childs-Pugh score > 10)
  • Pregnant and/or lactating women
  • Patients on extracorporeal membrane oxygenation
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Bethany Overman 713-745-4567 BJSpears@mdanderson.org
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04565665
Other Study ID Numbers  ICMJE 2020-0365
NCI-2020-06741 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2020-0365 ( Other Identifier: M D Anderson Cancer Center )
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Current Responsible Party M.D. Anderson Cancer Center
Original Responsible Party Same as current
Current Study Sponsor  ICMJE M.D. Anderson Cancer Center
Original Study Sponsor  ICMJE Same as current
Collaborators  ICMJE National Cancer Institute (NCI)
Investigators  ICMJE
Principal Investigator: Amanda Olson M.D. Anderson Cancer Center
PRS Account M.D. Anderson Cancer Center
Verification Date October 2022

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