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Cyclophosphamide Therapy for Refractory Antibody-Mediated Rejection (AMR) in Kidney Transplants

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
University of Manitoba Identifier:
First received: June 25, 2012
Last updated: April 10, 2017
Last verified: April 2017
The study hypothesis is that short-term low dose cyclophosphamide therapy will be effective in resolving inflammation in patients with late phase antibody-mediated rejection refractory to current standard of care treatment.

Condition Intervention Phase
Antibody Mediated Rejection
Drug: Cyclophosphamide
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Phase II Pilot Study of Cyclophosphamide Therapy for Refractory Antibody-Mediated Rejection in Kidney Transplantation

Resource links provided by NLM:

Further study details as provided by University of Manitoba:

Primary Outcome Measures:
  • Microvascular inflammation [ Time Frame: month 6 ]
    Histologic resolution of acute antibody-mediated inflammation in a 6 month post-treatment biopsy (Banff histology scores: g, v, ptc, C4d +ve)

Secondary Outcome Measures:
  • titre of donor specific antibody (DSA) [ Time Frame: 6 and 12 months ]
    Change in the level of de novo DSA between enrolment and at 6 and 12 months post-enrollment

  • antibody-mediated tissue injury [ Time Frame: month 6 ]
    Change in antibody-mediated tissue injury between the enrollment and post-treatment kidney transplant biopsy samples

  • Urine Albumin/Creatinine ratios [ Time Frame: month 6 and 12 ]
    Change in urine albumin/creatinine ratio between enrolment and 6 and 12 month post-enrolment samples

  • Creatinine Clearance and estimated GFR [ Time Frame: month 6 and 12 ]
    Evaluation of Creatinine Clearance, and estimated GFR using the Chronic Kidney Disease Epidemiology (CKR-EPI) equation

  • Graft Survival [ Time Frame: month 6 and 12 ]
  • Patient Survival [ Time Frame: month 6 and 12 ]

Enrollment: 4
Study Start Date: June 2013
Estimated Study Completion Date: December 2018
Estimated Primary Completion Date: April 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cyclophosphamide
Cyclophosphamide 1.5 mg/kg orally daily for 180 days (26 weeks) adjusted for renal function.
Drug: Cyclophosphamide
Cyclophosphamide 1.5 mg/kg orally daily for 180 days adjusted for renal function
Other Name: Procytox

Detailed Description:
There is no consensus on the optimal treatment of de novo donor specific antibody-mediated rejection. Optimizing baseline immunosuppression (calcineurin inhibitor (CNI), anti-proliferative agent, and anti-inflammatory) is considered foundational but is insufficient. Pulse steroids are routinely used. A number of immunosuppressive approaches have been tried in uncontrolled trials. The strongest evidence, at least for early antibody-mediated rejection (< 6 months from transplant), exists for plasmapheresis, with or without low dose IVIg, or high dose IVIg alone. However, as noted in a recent FDA workshop, "while the literature suggests that [these agents] have evidence of efficacy for the management of acute antibody-mediated rejection, and could be considered as standard of care, treatment regimes have not been standardized or optimized." Moreover the evidence supporting efficacy of this approach in late, as opposed to early antibody-mediated rejection is distinctly lacking.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with a living or deceased donor kidney transplant
  • Failed current standard of care for late antibody-mediated rejection
  • Persistent de novo donor specific antibody and a concurrent biopsy with histologic evidence of acute antibody-mediated inflammation
  • Adults with reproductive potential must agree to use approved methods of birth control while in the study

Exclusion Criteria:

  • Leukopenia (WBC) < 3.0 x 109/L
  • Creatinine Clearance less than or equal to 25 ml/min/1.73m2
  • HCV or HBV positive
  • BKV or CMV viremia assessed by PCR
  • Any active infection
  • Use of other investigational drugs within 4 weeks of study
  • Pregnancy/breast feeding/unwilling or unable to take birth control
  • Active malignancy
  • de novo DSA occurring equal to or greater than15 years after kidney transplant
  • Screening biopsy with equal to or greater than cg2 on Banff criteria
  • Cumulative/lifetime dose of cyclophosphamide, including anticipated total study dose (calculated according to Creatinine Clearance and mg/kg/day) equal to or greater than 36 g.
  • Any condition that, in the opinion of the investigator, would pose risk to the subject's safe participation in the study
  Contacts and Locations
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Please refer to this study by its identifier: NCT01630538

Canada, Manitoba
Transplant Manitoba Adult Kidney Transplant Program, Health Sciences Centre
Winnipeg, Manitoba, Canada
Sponsors and Collaborators
University of Manitoba
Principal Investigator: Peter W Nickerson, MD University of Manitoba
Study Chair: David N Rush, MD University of Manitoba
  More Information

Responsible Party: University of Manitoba Identifier: NCT01630538     History of Changes
Other Study ID Numbers: TMCT-01
Study First Received: June 25, 2012
Last Updated: April 10, 2017
Individual Participant Data  
Plan to Share IPD: Undecided

Keywords provided by University of Manitoba:

Additional relevant MeSH terms:
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists processed this record on April 26, 2017