A Prospective Natural History Study of Lymphatic Anomalies

Lymphatic Diseases Clinical Trial

Official title:

A Prospective Natural History Study of Lymphatic Anomalies

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05731141
• Other study ID #: 10001084
• Secondary ID: 001084-CH
• Status: Recruiting
• Start date: March 20, 2023
• Est. completion date: December 31, 2028

Study information

• Verified date: June 10, 2024
• Source: National Institutes of Health Clinical Center (CC)
• Contact: Andrea I Bowling, C.R.N.P.
• Phone: (301) 451-3824
• Email: nichd_lymphaticanoma[@]mail.nih.gov
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Background:

The lymphatic system is a network of vessels that carry a clear fluid called lymph through the body. Problems in the lymphatic system can cause pain, fluid buildup, and issues with immunity. There is much researchers do not understand about lymphatic anomalies. In this natural history study, they will collect data from a lot of people over a long time.

Objective:

To better understand why lymphatic anomalies develop. The goal is to improve future treatments.

Eligibility:

People aged 0 days and older with a suspected or confirmed lymphatic anomaly. Their unaffected parents or siblings aged 7 years or older are also needed.

Design:

Participants may remain in the study indefinitely. Affected participants may be evaluated every 10 months to 2 years. Some participants will be seen over telemedicine. Others will be seen at the NIH Clinical Center for 2-5 days.

All participants will have a physical exam. They may provide specimens including blood, saliva, hair follicles, stool, skin, and other tissues. Samples may be used for genetic testing.

Participants may undergo other tests depending on their medical conditions. The NIH Clinical Center visit may include:

Heart tests include placing stickers on the chest to measure electrical activity and using sound waves to capture pictures of the heart.

A lung test measures the muscle strength in the chest. Participants will blow into a tube.

Photographs may be taken of participants faces and other features.

Imaging scans will take pictures of the inside of the body. One scan will measure bone density.

One type of scan tracks how lymph fluid moves through the body. Participants will be under anesthesia, and they will be injected with a dye.

Description:

Study Description:

A natural history study for lymphatic anomalies to systematically evaluate the disease phenotypes and long-term outcomes to provide improved prognostication to families, establish screening/monitoring guidelines, determine best practices for genetic diagnosis, explore family opinions, and explore fertility for those on long term medication management. This study will allow us to identify novel end points for future clinical trials.

Objectives:

Primary objectives:

• To establish a longitudinal cohort of participants with lymphatic anomalies

• To longitudinally determine the age at presentation and incidence of clinical features

Secondary objectives:

• To establish a longitudinal biospecimen repository

• To determine the best practices for genetic diagnosis based on phenotype

• To determine the malignant potential of anomalies longitudinally

Endpoints:

Primary endpoints:

• The number of participants with lymphatic anomalies

• For each clinical feature or symptoms, the range of ages at the development of that feature/symptom and fraction of participants with that feature

• Quantification and identification of novel features associated with disease

Secondary endpoints:

• The number of specimens collected

• Diagnostic yields by phenotype and genetic test methodology

• Number of malignancies related to the primary lesion that have developed

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 1200
• Est. completion date: December 31, 2028
• Est. primary completion date: December 31, 2026
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 1 Day to 100 Years

Eligibility

• INCLUSION CRITERIA:

Affected (Proband)

In order to be eligible to participate in this study, an individual must meet one of the following criteria as determined after review of medical history:

• Current or history of lymphatic anomaly or symptoms suggestive of a lymphatic disorder Or

• An ill-defined vascular anomaly that is suspected to have an abnormal lymphatic component Or

• A pathogenic, likely pathogenic, or VUS in a genetic disorder with a known lymphatic component Or

• Clinical diagnosis of a syndrome with a known lymphatic component

Unaffected (First Degree Relatives: Parents and Siblings)

Genetic variants underlying complex lymphatic anomalies can be passed down through parents or be new in a child (de novo). Inclusion of first-degree relatives will assist in genetic analysis to delineate whether the variant is inherited or de novo.

To be eligible to participate as a first degree relative in this study, an individual must be a first-degree family member of an affected participants

EXCLUSION CRITERIA:

Affected Proband

An individual who meets any of the following criteria will be excluded from participation in this study after review of medical history, concomitant medication and allergy review, anthropometrics, and performance status:

• Any condition, in the opinion of the investigator, that would increase risk of participation or impair their ability to comply with protocol requirements.

• Lymphatic anomalies that are definitively determined to be secondary by the principal investigator will be excluded from this study. For example, participants who develop a lymphedema after breast cancer surgery.

Unaffected (First Degree Relatives)

-Any condition, in the opinion of the investigator, that would increase risk of participation or impair their ability to comply with protocol requirements.

Related Conditions & MeSH terms

• Congenital Abnormalities
• Lymphatic Abnormalities
• Lymphatic Diseases

Locations

Country	Name	City	State
United States	National Institutes of Health Clinical Center	Bethesda	Maryland
United States	Children's Hospital of Philadelphia	Philadelphia	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Country where clinical trial is conducted

United States, 

References & Publications (3)

Brouillard P, Witte MH, Erickson RP, Damstra RJ, Becker C, Quere I, Vikkula M. Primary lymphoedema. Nat Rev Dis Primers. 2021 Oct 21;7(1):77. doi: 10.1038/s41572-021-00309-7. — View Citation

Liu M, Smith CL, Biko DM, Li D, Pinto E, O'Connor N, Skraban C, Zackai EH, Hakonarson H, Dori Y, Sheppard SE. Genetics etiologies and genotype phenotype correlations in a cohort of individuals with central conducting lymphatic anomaly. Eur J Hum Genet. 2022 Sep;30(9):1022-1028. doi: 10.1038/s41431-022-01123-9. Epub 2022 May 24. Erratum In: Eur J Hum Genet. 2022 Jun 3;: — View Citation

Makinen T, Boon LM, Vikkula M, Alitalo K. Lymphatic Malformations: Genetics, Mechanisms and Therapeutic Strategies. Circ Res. 2021 Jun 25;129(1):136-154. doi: 10.1161/CIRCRESAHA.121.318142. Epub 2021 Jun 24. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To establish a longitudinal cohort of participants with lymphatic anomalies	We plan to enroll a group of participants willing to participate in the study over time.	12/31/2028
Primary	To longitudinally determine the age at presentation and incidence of clinical features	For each clinical feature or symptoms, the range of ages at the development of that feature/symptom and fraction of participants with that feature	12/31/2028
Secondary	To establish a longitudinal biospecimen repository	We plan to collect biospecimens including, but not limited to blood and stool from participants over time.	12/31/2028
Secondary	To determine the best practices for genetic diagnosis based on phenotype	We will analyze diagnostic yields by phenotype (how many participants are able to have a genetic diagnosis in proportion to the number of participants who receive genetic testing) and genetic test methodology (to determine which genetic test is most helpful in diagnosing lymphatic anomalies)	12/31/2028
Secondary	To determine the malignant potential of anomalies longitudinally	We will track the number of malignancies related to the primary lesion that have developed	12/31/2028

External Links

•   NIH Clinical Center Detailed Web Page