Fanconi Anemia Clinical Trial
Official title:
A Study of Total Body Irradiation, Cyclophosphamide and Fludarabine Followed by Alternated Donor Hematopoietic Cell Transplantation in Patients With Fanconi Anemia
The protocol is designed for the compassionate treatment of patients with Fanconi Anemia who do not have an HLA-matched sibling donor. The purpose of this study is to determine the likelihood of engraftment in Fanconi Anemia patients using total body irradiation (TBI), cyclophosphamide (CY), fludarabine (FLU) and antithymocyte globulin (ATG) followed by an unrelated donor hematopoietic cell transplant with T-cell depletion using the CliniMACS device.
The major obstacle to successful alternate donor HCT for patients with Fanconi Anemia is
graft failure. While T-cell depletion decreases the incidence of aGVHD, its effect on
improving long term survival is unproven. To potentially improve engraftment rate, we have
chosen a relatively new immunosuppressive agent, fludarabine (FLU), FLU is an antineoplastic
agent that has been shown to be an effective immunosuppressive agen in BMT conditioning
therapy. The addition of FLU to the commonly used preparative regimen of CY and TBU in
Fanconi Anemia patients may improve engraftment rates.
Based on all presented data and its outcome, hematopoietic stem cell transplantation with the
use of total body irradiation (450 cGy), cyclophosphamide (10 mg/kg IV) and fludarabine (35
mg/m2 IV) as preparative cytoreductive therapy has become the standard treatment for the
hematologic manifestations of Fanconi Anemia at CHLA. However, the use of Isolex 300i will be
replaced by CliniMACS in processing T-cell depletion.
The CliniMACS CD34 Reagent System is an investigational medical device that has not yet been
approved by the FDA. This device is used in vitro to select and enrich specific cell
populations. When using the CliniMACS CD34 Reagent, the system selects CD34+ cells from
heterogenous hematological cell populations for transplantation in cases where this is
clinically indicated. Based on the gathered data, CliniMACS has not been a contributing
factor in the toxicity of patients, although may have a potential of eliciting "antibody"
reactions in some patients, the process has been of significant life-saving benefit as
compared to the potential risks.
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