Probiotic Use in Children Undergoing Hematopoietic Stem Cell Transplantation (HSCT)

Hematopoietic Organs; Disorder Clinical Trial

Official title:

A Limited Institution Pilot Trial Evaluating the Safety of Administering the Probiotic, Lactobacillus Plantarum, to Children and Adolescents Undergoing Allogenic Hematopoietic Stem Cell Transplantation (HSCT) - A Pilot Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01010867
• Other study ID #: AAAE0846
• Status: Completed
• Phase: Phase 1
• First received: November 6, 2009
• Last updated: July 11, 2017
• Start date: February 2010
• Est. completion date: October 2014

Study information

• Verified date: July 2017
• Source: Columbia University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Primary Objective:

1. To evaluate the safety of orally administered Lactobacillus plantarum strains 299 and 299v, a probiotic, in patients undergoing allogeneic myeloablative HSCT, as measured by incidence of Lactobacillus plantarum bacteremia.

Secondary Objectives:

1. To investigate the feasibility of administering Lactobacillus plantarum 299 and 299v to children and adolescents undergoing HSCT.

2. To describe the overall incidence of bacteremia in HSCT patients who have been administered Lactobacillus plantarum.

3. To describe the overall incidence of acute graft versus host disease (GVHD) in HSCT patients who have been administered Lactobacillus plantarum.

Description:

Myeloablative regimens are the backbone of hematopoietic stem cell transplantation (HSCT) and are associated with prolonged periods of cachexia/anorexia, nausea/vomiting, mucositis, and compromised gut integrity (CGI). The toxicities associated with HSCT often lead to prolonged periods of poor oral intake and may result in overt malnutrition. CGI decreases oral tolerance to foods, reduces Quality of Life (QOL) and functional status, delays the transition from the hospital to home setting, and increases the risk of the development of gut-derived infections. Probiotics are nutritional supplements that contain a defined amount of viable microorganisms and upon administration confer a benefit to the host. Clinical trials in adults receiving organ transplants have found probiotics decrease the incidence of infection, the duration of antibiotic use, the incidence of multiorgan failure and systemic inflammation. Children and adolescents undergoing HSCT, experience similar clinical challenges suggesting probiotics may have a therapeutic value in the setting of HSCT. This study is to evaluate the safety and feasibility of administering probiotics to children and adolescents undergoing HSCT.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 31
• Est. completion date: October 2014
• Est. primary completion date: October 2014
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Years to 17 Years

Eligibility

Inclusion Criteria:

• All patients undergoing myeloablative allogeneic HSCT will be eligible. The source of stem cells can be from bone marrow, umbilical cord blood or cytokine mobilized peripheral blood. Donor can be human leukocyte antigen (HLA) matched sibling or parent, a related donor mismatched for a single HLA locus (class I or II), unrelated marrow or peripheral blood stem cell donor, or unrelated cord blood at least 4/6 antigen match (Class 1 or II).

• Patients of either gender and between 2 and 17.99 years of age

• Patients receiving any type of GVHD prophylaxis are eligible.

Exclusion Criteria:

• Patients who have self-prescribed probiotics within 3 months of starting the conditioning regimen for stem cell transplant (consumption of yogurt products is allowed).

• Patients with known allergy to oats.

• Patients who have had any type of gut damage within the past three months; such as, previous bowel perforations; previous episode of Grade 4 neutropenic colitis or typhlitis.

• Patients with inflammatory bowel syndrome, short small bowel syndrome, Crohns Disease, Ulcerative Colitis, and patients with a history of bowel resections.

• Patients who have undergone a previous allogeneic HSCT.

Related Conditions & MeSH terms

• Hematopoietic Organs; Disorder

Intervention

Drug:
• Lactobacillus plantarum strains 299 and 299v
Patients will receive a daily dose of Lactobacillus plantarum: 1 x10^8 CFU/kg/day. This supplement will be supplied in sachets of powder and will be mixed in water (certain water-based liquid) that is no warmer that 37o C. Colony forming units (CFU)

Locations

Country	Name	City	State
United States	Nemours Children's Clinic	Jacksonville	Florida
United States	Columbia Universtiy Medical Center	New York	New York
United States	All Children's Hospital	Saint Petersburg	Florida

Sponsors (3)

Lead Sponsor	Collaborator
Columbia University	Johns Hopkins All Children's Hospital, Nemours Children's Clinic

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Lactobacillus Plantarum Bacteremia Infections		36 days (day -7 to +28 of HSCT)
Secondary	Adherence With the Prescribed Dose, Measured as the Percentage of Prescribed Probiotic Doses	To determine the feasibility of administration of L. plantarum 299 and 299v. The treatment is considered feasible for a patient if he/she received at least 50% of the probiotic dose (>= 11 days of treatment).	22 days (day -7 to +14 of HSCT)
Secondary	Number of Non-lactobacillus Infections	To determine incidence of bacteremia in HSCT patients who have been administered lactobacillus plantarum.	36 days (day -7 to +28 of HSCT)
Secondary	Number of Acute Graft Versus Host Disease (GVHD) Events in HSCT Patients Who Have Been Administered Lactobacillus Plantarum		Up to Day +100 of HSCT