Bortezomib to Treat Significant Complication of HSCT

Allogeneic Stem Cell Transplantation Clinical Trial

— Bortezomib  

Official title:

Use of Bortezomib to Treat Refractory Autoimmune Cytopenia(s) in Allogeneic Stem Cell Transplantation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01929980
• Other study ID #: 2012:1089
• Status: Completed
• Phase: Phase 2
• First received: August 23, 2013
• Last updated: October 18, 2016
• Start date: July 2012
• Est. completion date: May 2014

Study information

• Verified date: October 2016
• Source: Children's Hospital Medical Center, Cincinnati
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug AdministrationUnited States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

The purpose of this trial is to study the safety and effectiveness of a drug called Bortezomib for the treatment of low blood cell counts after bone marrow transplant.

Description:

The purpose of this research study is to study the safety and effectiveness of a drug called bortezomib for the treatment of autoimmune cytopenia(s) (low blood cell counts) after bone marrow transplant that are not responding to standard treatments. Autoimmune cytopenias are low blood counts due to antibodies or proteins produced against an individual's own blood cells. Having a low red blood cell count (anemia) can make a person feel tired and require blood transfusions frequently. A low platelet count (blood cells that help blood to clot) can make a person bleed or bruise easily. A low neutrophil (white blood cell) count can make a person have infections.

All of these things can be a serious complication after bone marrow transplant and can cause prolonged hospital stay. Bortezomib is being used in children with certain types of blood cancer, however, bortezomib has not been used in children with autoimmune cytopenia(s) and its use in this study is investigational.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 4
• Est. completion date: May 2014
• Est. primary completion date: May 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 4 Months to 29 Years

Eligibility

Inclusion Criteria:

• All patients, having undergone allogeneic stem cell transplantation at our center.

• Should have failed at least 2 standard treatments for autoimmune cytopenias. Standard treatments include corticosteroids, rituximab, IVIG, plasmapheresis, withdrawal of cyclosporine, cyclophosphamide and MMF. Definition of "failed" treatment will be no response of cytopenia after 2 weeks of continued treatment OR requirement of daily GCSF at 10 mcgs/kg/day for autoimmune neutropenia despite 2 weeks of treatment, transfusions of packed red blood cells or platelets 3 times weekly for 2weeks despite continued treatment OR 5days/week plasmapheresis for 2 weeks and inability to wean the duration.

• Definition of autoimmune hemolytic anemia- development of anemia, where there is a hemoglobin drop of >2 g/dL/48 hours or an absolute value of hemoglobin < 8 g/dL, and evidence of hemolysis by positive direct Coombs test with compatible peripheral blood cell morphology, reticulocyte count and bilirubin level.

• Definition of autoimmune neutropenia - absolute neutrophil counts < 500 for 2 weeks and presence of anti-neutrophil antibodies.

• Definition of autoimmune thrombocytopenia- Platelet counts < 20,000 cells/uL for 2 weeks and presence of anti-platelet antibodies.

Exclusion Criteria:

• Ongoing life threatening infections

• Documented anaphylaxis to bortezomib

• Failed engraftment

• Relapse of primary malignancy

• =6/8 matched or haploidentical transplants

Study Design

Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Allogeneic Stem Cell Transplantation
• Refractory Autoimmune Cytopenia(s)

Intervention

Drug:
• Bortezomib

Locations

Country	Name	City	State
United States	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio

Sponsors (1)

Lead Sponsor	Collaborator
Children's Hospital Medical Center, Cincinnati

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Response	For Autoimmune Hemolytic Anemia- At least 3 of 5 criteria should be met.; Stabilization of hemoglobin without transfusions by 2 weeks; Conversion of DAT from + to - by 6 weeks; Normalization of serum haptoglobin levels by 6 weeks; Normalization of indirect bilirubin levels by 6 weeks; Reduction in the frequency of transfusions by 50% by 4 weeks; For Autoimmune Neutropenia- At least 2 of 3 criteria should be met.; Stabilization of absolute neutrophil count by 2 weeks; Undetectable antineutrophil antibodies by 6 weeks; Reduction in GCSF dose by 50% by 6 weeks; For Autoimmune Thrombocytopenia- At least 2 of 3 criteria should be met.; Stabilization of platelet count without platelet transfusions by 2 weeks; Undetectable antiplatelet antibodies by 6 weeks; Reduction in the frequency of platelet transfusions by 50% from pre-bortezomib values by 6 weeks	6 weeks	No