Sickle Cell Anemia Clinical Trial
Official title:
Allogeneic Mixed Chimerism Stem Cell Transplantation Utilizing In Vivo and In Vitro Campath for Hemoglobinopathies and Bone Marrow Failure Syndromes
RATIONALE: Although used primarily to treat malignant disorders of the blood, allogeneic stem cell transplantation can also cure a variety of non-cancerous, inherited or acquired disorders of the blood. Unfortunately, the conventional approach to allogeneic stem cell transplantation is a risky procedure. For some non-cancerous conditions, the risks of this procedure outweigh the potential benefits. This protocol is designed to test a new approach to allogeneic stem cell transplantation. It is hoped that this approach will be better suited for patients with non-cancerous blood and bone marrow disorders.
Status | Completed |
Enrollment | 2 |
Est. completion date | June 2009 |
Est. primary completion date | May 2008 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Patients must have their clinical material reviewed at the transplanting institution and the diagnosis confirmed - Performance status must be Cancer and Leukemia Group B (CALGB) Performance Status (PS) 0, 1, or 2. - Patients must have a 5/6 to 6/6 HLA matched family member donor who is evaluated and deemed able to provide PBSCs and/or marrow by the transplant team. Donor must have < 50% Hemoglobin S (HgS) on hemoglobin electrophoresis. Cytomegalovirus (CMV) status of the donor will be assessed, but not used as an exclusion criterion. - Patients must meet the following laboratory parameters unless due to disease status as determined by the treating physician: 1. bilirubin and hepatic transaminases and creatinine must be reviewed by the transplantation center and deemed acceptable. 2. HIV antibody negative. 3. hematocrit, white cell count, platelet counts and hematologic status will be reviewed by the treating physician before patient is deemed acceptable. - Patient must agree to use some form of adequate birth control during the periods that they receive chemotherapy and any post-chemotherapy medications related to the transplant. - Patients must also have a resting multiple gated acquisition scan (MUGA) or echocardiogram and Pulmonary Function Tests (PFTs) with Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) performed before transplant. Recommended minimum standards include an Ejection Fraction (EF) greater than 40% and DLCO greater than 40% for this less toxic regimen. - Appropriate cardiology or pulmonary consultations should be considered if the patient has severe cardiac or lung disease at the initiation of therapy. I) Hemoglobinopathies: (a)Sickle Cell Anemia having history of one or more of the following despite treatment with standard therapies such as hydroxyurea: i) 2 or more episodes of acute chest syndrome since age 13 years ii) pulmonary hypertension as measured by tricuspid regurgitant jet velocity of greater than 2.5m/s iii) 2 or more painful crisis per year requiring medical care and analgesia in excess of what is needed at baseline. iv) history of cerebrovascular accident (b)Thalassemia major: Those eligible will have either cardiac or hepatic sequela of thalassemia as documented by biopsy or functional studies. For those with hepatic damage, this would be an increase in size by 50% of the liver or a doubling of the total bilirubin, aspartate transaminase (AST), alanine aminotransferase (ALT), or alkaline phosphatase. To be eligible for transplant due to cardiac damage, there must be evidence of left ventricular dysfunction as measured by MUGA scan or echocardiography. II) Bone marrow failure Disorders 1. Severe Aplastic Anemia: Cytopenia consisting of at least 2 of the following 3: absolute neutrophil count less than 500/µL, platelet count less than 20,000/µL, and reticulocyte count less than 50,000/µL. 2. Paroxysmal nocturnal hemoglobinuria (PNH): Patients must have a history of either life-threatening thrombosis, cytopenia, transfusion dependence or recurrent, debilitating hemolytic crisis 3. Pure red cell aplasia: Patients must be transfusion dependent. Exclusion Criteria: - pregnant or lactating women, - patients with other major medical or psychiatric illnesses which the treating or transplant physician feels could seriously compromise compliance to this protocol - patients with known history of allergies to murine protein |
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
United States | Duke Cancer Institute | Durham | North Carolina |
United States | Florida Hospital Cancer Institute | Orlando | Florida |
Lead Sponsor | Collaborator |
---|---|
David Rizzieri, MD |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of Patients With Neutrophil Engraftment | Number of patients with neutrophil engraftment: Absolute Neutrophil Count (ANC) > 500/µL and hemoglobin level remaining above 10 g/dL without transfusion support, with tests showing at least 2.5% donor cells present. Primary graft failure is defined as absence of establishment of adequate donor hematopoiesis by day 42 with bone marrow cellularity < 5%, peripheral White Blood Count (WBC) < 500/µL, peripheral ANC < 100/µL, and/or platelets < 10,000/µL by day 120 with absence of megakaryocytes in the bone marrow (in the absence of disease relapse). | 1 year post transplant | No |
Primary | Number of Patients With Platelet Engraftment | Number of patients with platelet engraftment - Platelets > 20,000/µL and hemoglobin level remaining above 10 g/dL without transfusion support, with tests showing at least 2.5% donor cells present. Primary graft failure is defined as absence of establishment of adequate donor hematopoiesis by day 42 with bone marrow cellularity < 5%, peripheral White Blood Count (WBC) < 500/µL, peripheral ANC < 100/µL, and/or platelets < 10,000/µL by day 120 with absence of megakaryocytes in the bone marrow (in the absence of disease relapse). | 1 year post transplant | No |
Primary | Number of Patients With Grade 3-4 Acute Graft Versus Host Disease (GVHD) | Number of patients with Grade 3-4 acute Graft Versus Host Disease (GVHD). GVHD will be monitored at least two times per week through day 45, then weekly through day 60 and graded by 2 persons at each institution, to ensure internal consistency in grading. | 60 days post transplant | Yes |
Primary | Number of Participants With Grade 3-4 Unexpected Adverse Events | An unexpected adverse event is one that differs in the nature, severity, or frequency from (a) the research procedures that are described in the protocol-related documents, (such as the IRB-approved research protocol and informed consent document) as expected, and/or (b) the characteristics of the subject population being studied. | 45 days post transplant | Yes |
Primary | Number of Participants With Transplant-related Mortality | Number of patients who died due to transplant-related complications | 100 days | No |
Secondary | Overall Survival | Number of patients alive 2 years after transplant | 2 years | No |
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT04134299 -
To Assess Safety, Tolerability and Physiological Effects on Structure and Function of AXA4010 in Subjects With Sickle Cell Disease
|
N/A | |
Completed |
NCT04581356 -
Voxelotor Sickle Cell Exercise Study
|
Phase 4 | |
Completed |
NCT02712346 -
The Role of Endothelin-1 in Sickle Cell Disease
|
Phase 1 | |
Withdrawn |
NCT02162225 -
Study of Beet Juice for Patients With Sickle Cell Anemia
|
Phase 2 | |
Completed |
NCT01976416 -
Novel Use Of Hydroxyurea in an African Region With Malaria
|
Phase 3 | |
Completed |
NCT01137721 -
State Of The Art Functional Imaging In Sickle Cell Disease
|
||
Terminated |
NCT01350232 -
Treatment of Sickle Cell Anemia With Stem Cell Transplant
|
N/A | |
Withdrawn |
NCT00937144 -
Endothelial Function in Patients With Sickle Cell Anemia Before and After Sildenafil
|
Phase 4 | |
Completed |
NCT00512564 -
Clinical and Laboratory Assessment of Iron Overload in Sickle Cell Anemia and Sickle Cell Thalassemia
|
N/A | |
Completed |
NCT00512226 -
Iron Overload Assesment in Sickle Cell Anemia and Sickle Cell Thalassemia
|
N/A | |
Completed |
NCT00004412 -
Phase II Randomized Trial:Arginine Butyrate Plus Standard Local Therapy in Patients With Refractory Sickle Cell Ulcers
|
Phase 2 | |
Withdrawn |
NCT01925001 -
Phase 2 Study of MP4CO to Treat Vaso-occlusive Sickle Crisis
|
Phase 2 | |
Completed |
NCT01783990 -
Pediatric Hydroxyurea Phase III Clinical Trial (BABY HUG) Follow-up Observational Study II Protocol
|
||
Completed |
NCT01848691 -
Carbon Monoxide Monitor for the Measurement of End-Tidal Carbon Monoxide Levels in Children With or Without Hemolysis
|
N/A | |
Completed |
NCT01000155 -
Efficacy of Vorinostat to Induce Fetal Hemoglobin in Sickle Cell Disease
|
Phase 2 | |
Completed |
NCT00874172 -
Effectiveness of New Analgesic Strategy Compared to the Usal Antalgic Strategy
|
N/A | |
Completed |
NCT00236093 -
Extension Study of ACTIQ Treatment for Children and Adolescents With Breakthrough Pain
|
Phase 2 | |
Completed |
NCT00399074 -
Sulfadoxine- Pyrimethamine Versus Weekly Chloroquine for Malaria Prevention in Children With Sickle Cell Anemia
|
Phase 3 | |
Completed |
NCT00004492 -
Phase I/II Randomized Study of Hydroxyurea With or Without Clotrimazole in Patients With Sickle Cell Anemia
|
Phase 1/Phase 2 | |
Completed |
NCT02065596 -
Hematopoietic Stem Cell Transplant for Sickle Cell Disease
|
Phase 1 |