Mesenchymal Stem Cell Infusion as Treatment for Steroid-Resistant Acute Graft Versus Host Disease (GVHD) or Poor Graft Function

Graft-versus-host Disease Clinical Trial

Official title:

Infusion of Mesenchymal Stem Cells as Treatment for Steroid-Resistant Grade II to IV Acute GVHD or Poor Graft Function: a Multicenter Phase II Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT00603330
• Other study ID #: TJB0703P1
• Status: Recruiting
• Phase: Phase 2
• Start date: January 2008
• Est. completion date: August 2024

Study information

• Verified date: May 2024
• Source: University of Liege
• Contact: Yves Beguin, MD, PhD
• Phone: 32-4-366 72 01
• Email: yves.beguin[@]chu.ulg.ac.be
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The present project aims at investigating the role of MSC for the treatment of patients with

Part 1: Steroid-refractory grade II-IV acute GVHD.

Part 2: Poor graft function (PGF)

Part 3: Low or falling donor T-cell chimerism after allogeneic HCT.

This is a multicenter phase II study examining the feasibility and efficacy of this approach.

Description:

Part 1: complete recruitment Part 2: complete recruitment Part 3: recruiting

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: August 2024
• Est. primary completion date: August 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

Patient eligibility criteria

1. Male or female of any age.

2. Previous allogeneic transplantation (related or unrelated donor, any degree of HLA matching) or autologous transplantation (for part 2 only) of HSC at any time before.

3. Any source of HSC (marrow, PBSC, cord blood) and any conditioning regimen.

4. Informed consent given by donor or his/her guardian if of minor age.

5. Additional criteria for each part of the protocol:

Part 1: MSC for steroid-refractory grade II-IV acute GVHD

1. Allogeneic transplantation.

2. Grade II-IV acute GVHD (see appendix A for acute GVHD grading) de novo or following DLI.

3. Acute GVHD refractory to mPDN 2 mg/kg/day or equivalent, defined as

• progression of GVHD on day 3 after initiation of steroids

• no improvement of GVHD on day 7 after initiation of steroids

• absence of complete resolution of acute GVHD on day 14 after initiation of steroids

• relapse of acute GVHD during or after steroid taper.

4. Ongoing therapy with Ciclosporine or Tacrolimus at therapeutic doses.

5. Patient may have received previously any other form of treatment for acute GVHD, but no new treatment started within 1 month of study entry.

Part 2: MSC for poor graft function (PGF)

1. Allogeneic or autologous transplantation.

2. Cytopenia in 2 or 3 lineages:

• Hb < 8.0 g/dL and reticulocytes < 1%, with or without transfusion

• Plt < 20,000/µL without transfusion

• Neutrophils < 500/µL, without G-CSF administration

OR severe cytopenia in 1 lineage:

• RBC transfusion dependent (if autologous transplantation; despite EPO administration if allogeneic transplantation)

• Plt transfusion dependent

• Neutrophils < 500/µL despite G-CSF administration

3. Cytopenia duration = 2 weeks beyond day 28 after autologous HCT, or day 42 (day 60 for cord blood transplantation) after allogeneic HCT.

4. Cytopenia is not related to CMV or other infection, myelosuppressive/toxic drugs, renal failure, peripheral cell destruction or other identifiable cause.

5. In case of HLA-identical related donor and full donor chimerism, patient can only be included if a boost of donor CD34+ cells has been unsuccessful or is not feasible.

Part 3: MSC + DLI for poor donor T-cell chimerism

1. Nonmyeloablative allogeneic transplantation.

2. Donor T-cell chimerism < 50% for at least 2 consecutive weeks beyond day 21 after HCT OR

• 20% decrease in donor T-cell chimerism with the second value < 50%.

MSC donor inclusion criteria

1. Related to the recipient (sibling, parent or child) or unrelated.

2. Male or female.

3. Age > 16 yrs (no age limit if same as HSC donor).

4. No HLA matching required.

5. Fulfills generally accepted criteria for allogeneic HSC donation.

6. Informed consent given by donor or his/her guardian if of minor age.

Exclusion Criteria:

Patient exclusion criteria

1. HIV positive.

2. Active uncontrolled infection at time of scheduled MSC infusion.

3. Relapsing or progressing malignancy.

MSC donor exclusion criteria

1. HIV positive

2. Known allergy to Lidocaine

3. If donor other than HSC donor : any risk factor for transmissible infectious diseases.

Related Conditions & MeSH terms

• Graft vs Host Disease
• Graft-versus-host Disease
• Low Donor T-cell Chimerism
• Poor Graft Function

Intervention

Biological:
• Mesenchymal stem cells
Mesenchymal Stem Cell infusion

Locations

Country	Name	City	State
Belgium	Hôpital Stuyvenberg	Antwerpen
Belgium	AZ St Jan	Brugge	West Flanders
Belgium	AZ VUB Jette	Brussels	Brabant
Belgium	Cliniques universitaires Saint-Luc- Université Catholique de Louvain	Brussels	Brabant
Belgium	Hôpital des enfants Reine Fabiola	Brussels	Brabant
Belgium	UZA	Edeghem	Antwerpen
Belgium	UZ Gent	Gent	Flanders Ost
Belgium	Hôpital de Jolimont	Haine St Paul	Hainaut
Belgium	AZ Gasthuisberg Leuven	Leuven	Flamish Brabant
Belgium	CHU Sart Tilman	Liege
Belgium	Cliniques Universitaires Mont-Godinne	Yvoir	Namur
Netherlands	University Hospital Maastricht	Maastricht	Limburg

Sponsors (12)

Lead Sponsor	Collaborator
University of Liege	AZ Sint-Jan AV, AZ-VUB, Cliniques universitaires Saint-Luc- Université Catholique de Louvain, Jolimont Hospital Haine Saint Paul, KU Leuven, Maastricht University Medical Center, Queen Fabiola Children's University Hospital, University Hospital of Mont-Godinne, University Hospital, Antwerp, University Hospital, Ghent, Ziekenhuis Netwerk Antwerpen (ZNA)

Countries where clinical trial is conducted

Belgium,  Netherlands, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Arm 1. Efficacy of MSC infusion as treatment for steroid-resistant grade II - IV acute GVHD.		30 days
Primary	Arm 2. Efficacy of MSC infusion as treatment for poor graft function		180 days
Primary	Arm 3. Efficacy of MSC infusion followed by donor lymphocyte infusion for preventing graft rejection in patients with low or failing donor T-cell chimerism after allogeneic HCT		180 days
Secondary	Toxicity of MSC infusion		180 days