Pilot Study of Total Body Irradiation in Combination With Cyclophosphamide, Anti-thymocyte Globulin, and Autologous CD34-Selected Peripheral Blood Stem Cell Transplantation in Children With Refractory Autoimmune Disorders

NCT00010335 | Completed Phase 1 DMC

• 3 other identifiers: 1353.00FHCRC-1353.00199/15575
• Study Type: interventional
• Target: 6
• Locations: 1 country
• Sites: 1

Brief Summary

OBJECTIVES: I. Determine the safety and long term complications of total body irradiation in combination with cyclophosphamide, anti-thymocyte globulin, and autologous CD34-selected peripheral blood stem cell (PBSC) transplantation in children with refractory autoimmune disorders. II. Determine the efficacy of this treatment regimen in these patients. III. Determine the reconstitution of immunity after autologous CD34-selected PBSC transplantation in these patients. IV. Determine engraftment of autologous CD34-selected PBSC in these patients.

Conditions

Systemic Sclerosis; Systemic Lupus Erythematosus; Dermatomyositis; Juvenile Rheumatoid Arthritis; Autoimmune Diseases

Keywords

arthritis & connective tissue diseases; dermatomyositis; immunologic disorders and infectious disorders; juvenile rheumatoid arthritis; rare disease; systemic lupus erythematosus; systemic sclerosis

Outcome Measures

Primary Outcomes (1)

• Mortality

  Annually for 5 years and then every 5 years thereafter

Secondary Outcomes (1)

• Immune reconstitution, engraftment, efficacy, late-effects

  Annually for 5 years and then every 5 years thereafter

Study Arms (1)

1

EXPERIMENTAL

Participants will receive a stem cell transplant.

Procedure: Stem Cell Transplantation; Device: CD34 selection

Interventions

Stem Cell Transplantation PROCEDURE

Participants will receive a stem cell transplantation along with irradiation and the drugs anti-thymocyte globulin, cyclophosphamide, and filgrastim as noted in the text of this record.

1

CD34 selection DEVICE

CD34+ cells are separated from the rest of the peripheral blood stem cells.

1

Eligibility Criteria

• Age: 2 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

PROTOCOL ENTRY CRITERIA: --Disease Characteristics-- * Diagnosis of 1 of the following based on American College of Rheumatology (ACR) Criteria: Severe juvenile rheumatoid arthritis (systemic onset or polyarticular course) Juvenile systemic lupus erythematosus Systemic sclerosis Dermatomyositis * Refractory to standard or aggressive therapy OR unacceptable toxicity from standard therapy * Reasonable expectation of possible improvement as evidenced by a good potential for rehabilitation therapy and adequate social factors * No serious CNS damage that would preclude significant functional recovery --Prior/Concurrent Therapy-- * Chemotherapy: At least 4 weeks since prior methotrexate or cyclophosphamide * Endocrine therapy: At least 4 weeks since prior intra-arterial steroids Juvenile rheumatoid arthritis patients should continue steroids without taper throughout mobilization and harvest of stem cells If receiving corticosteroids, must be continued without taper Other: * At least 4 weeks since prior anti-inflammatory agents such as non-steroidal anti-inflammatory drugs (NSAIDs) or sulfasalazine * At least 4 weeks since prior cyclosporine, tacrolimus, mycophenolate mofetil, azathioprine, penicillamine, or etanercept --Patient Characteristics-- * Life expectancy: At least 30 days * Hematopoietic: Absolute neutrophil count at least 1,000/mm3 OR Platelet count at least 100,000/mm3 No bone marrow aspirate or biopsy consistent with production defect (depletion of neutrophil precursors or megakaryocytes) No myelodysplasia * Hepatic: Bilirubin no greater than 2.5 mg/dL AST no greater than 300 U/L on two sequential tests No severe liver dysfunction within past month No active hepatitis A, B, or C * Renal: No end-stage glomerulonephritis or renal disease Creatinine clearance at least 40 mL/min * Cardiovascular: No uncontrolled malignant arrhythmia No New York Heart Association class III or IV congestive heart failure Ejection fraction at least 50% * Pulmonary: DLCO at least 45% (DLCO at least 70% for patients with pulmonary disease caused by documented processes other than primary autoimmune disorder, such as infectious pneumonia or aspiration pneumonia) No severe pulmonary hypertension (PAP greater than 50) without potential for significant improvement Other: * No medical or psychosocial reasons that would make hematopoietic stem cell collection intolerable * No increased anesthetic risks * No fever higher than 39 degrees C * No positive serology for toxoplasmosis * No active life threatening infection not responsive to therapy * No other disease or organ dysfunction that would limit survival * No known hypersensitivity to murine or equine proteins * No known primary immunodeficiency disease HIV negative

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• Fred Hutchinson Cancer Center: lead

Study Sites (1)

Fred Hutchinson Cancer Research Center

Seattle, Washington, 98109, United States

Location

MeSH Terms

Conditions

Scleroderma, Systemic; Lupus Erythematosus, Systemic; Dermatomyositis; Arthritis, Juvenile; Autoimmune Diseases; Arthritis; Connective Tissue Diseases; Immune System Diseases; Communicable Diseases; Rare Diseases

Interventions

Stem Cell Transplantation

Condition Hierarchy (Ancestors)

Skin and Connective Tissue Diseases; Skin Diseases; Polymyositis; Myositis; Muscular Diseases; Musculoskeletal Diseases; Neuromuscular Diseases; Nervous System Diseases; Joint Diseases; Rheumatic Diseases; Infections; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Cell Transplantation; Cell- and Tissue-Based Therapy; Biological Therapy; Therapeutics; Transplantation; Surgical Procedures, Operative

Study Officials

• Ann Woolfrey

  Fred Hutchinson Cancer Center

  STUDY CHAIR

• Carol A. Wallace, MD

  Fred Hutchinson Cancer Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 2, 2001
• First Posted: February 2, 2001
• Study Start: November 1, 2000
• Primary Completion: July 1, 2010
• Study Completion: May 1, 2011
• Last Updated: March 6, 2015

Record last verified: 2015-03

Locations

US (1)