Transplantation for Patients With Sickle Cell Disease From Mismatched Family Donors of Bone Marrow

NCT02757885 | Completed Phase 2 Results DMC FDA Drug

• 1 other identifier: IRB00080955
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to learn if it is possible and safe to treat persons with severe sickle cell disease (SCD) by bone marrow transplant (BMT) from human leukocyte antigen (HLA) half-matched related donors. Preparation before transplant includes the chemotherapy drugs hydroxyurea, fludarabine, thiotepa, anti-thymocyte globulin, and cyclophosphamide. It also includes radiation.

Conditions

Sickle Cell Disease

Keywords

bone marrow transplant

Outcome Measures

Primary Outcomes (4)

• Event-free Survival (EFS) Rate

  Event-free Survival (EFS) is defined as the survival with stable donor erythropoiesis with no new clinical evidence of sickle cell disease (SCD). Primary or late graft rejection with disease recurrence or death will count as events for this endpoint.

  Up to One Year

• Primary Graft Rejection Rate

  Primary graft rejection is defined as the absence of donor cells assessed by peripheral blood chimerism assays on day 42. Primary graft rejection can be accompanied by pancytopenia and marrow aplasia or by autologous hematopoietic reconstitution without aplasia.

  Day 42

• Late Graft Rejection Rate

  The absence of donor hematopoietic cells in peripheral blood beyond day 42 up to 1 year in a patient who had initial evidence of hematopoietic recovery with \> 20% donor cells will be considered a late graft rejection.

  Day 42 Post transplant up to 1 year

• Rate of Disease Recurrence

  Disease recurrence is defined as the return of sickle erythropoiesis (HbS level \> 70%) and the absence of donor cell representation.

  Up to One Year

Secondary Outcomes (8)

• Overall Survival Rate

  Up to One Year

• Cumulative Incidence of Neutrophil Engraftment and Platelet Engraftment.

  Up to One Year

• Chimerism Rate Following Hematopoietic Cell Transplantation for Sickle Cell Disease

  Up to One Year

• Frequency of Idiopathic Pneumonia Syndrome (IPS)

  Up to One Year

• Veno-occlusive Disease (VOD) Rate

  Up to One Year

Study Arms (1)

Bone Marrow Recipient

EXPERIMENTAL

Single arm open label study: Participants with sickle cell disease (SCD) will receive bone marrow from a human leukocyte antigen (HLA) mismatched donor.

Procedure: Bone Marrow Transplant (BMT); Drug: Hydroxyurea; Drug: Thiotepa; Drug: Fludarabine monophosphate; Drug: Cyclophosphamide; Other: Rabbit Anti-thymocyte Globulin; Radiation: Total Body Irradiation

Interventions

Bone Marrow Transplant (BMT) PROCEDURE

Participants will receive a bone marrow infusion from a human leukocyte antigen (HLA) mismatched donor through a central venous catheter.

Bone Marrow Recipient

Hydroxyurea DRUG

Hydroxyurea is part of the bone marrow transplant preparative regimen. Hydroxyurea will be administered at a dose of 30 mg/kg orally as a single daily dose for 90 days (from day -100 to day-10). Hydroxyurea dosing will be based on adjusted body weight in participants weighing \>125% ideal body weight.

Bone Marrow Recipient

Thiotepa DRUG

Thiotepa is part of the bone marrow transplant preparative regimen. Thiotepa will be administered at a dose of 10mg/kg intravenously (IV) over 2 hours or per institutional guidelines on day -7. Thiotepa dosing will be based on adjusted body weight in patients weighing \>125% ideal body weight.

Bone Marrow Recipient

Fludarabine monophosphate DRUG

Fludarabine is part of the bone marrow transplant preparative regimen. Fludarabine 30 mg/m2/day will be administered from day -7 to day -3 (for a total of 150 mg/m2 over 5 consecutive days) and administered intravenously (IV) over a minimum of 30 minutes. In participants weighing \> 125% ideal body weight, fludarabine will be dose based upon adjusted body weight.

Bone Marrow Recipient

Cyclophosphamide DRUG

Cyclophosphamide is part of the bone marrow transplant preparative regimen. Cyclophosphamide will be administered on days -6 and -5 prior to bone marrow infusion at a dose of 14.5 mg/kg intravenously (IV) infused over 1-2 hours. Post bone marrow infusion cyclophosphamide will be infused on days +3 (between 60 and 72 hours post marrow infusion) and +4 (approximately 24 hours after day +3 dose) at a dose of 50 mg/kg IV infused over 1-2 hours. For participants weighing more than 125% of their ideal body weight, dosing will be based on adjusted ideal body weight.

Bone Marrow Recipient

Rabbit Anti-thymocyte Globulin OTHER

Rabbit anti-thymocyte globulin (ATG) is part of the bone marrow transplant preparative regimen. It is an infusion of rabbit-derived antibodies against human T cells used for prevention of acute rejection in organ transplantation. Rabbit ATG will be administered on day -9 at 0.5 mg/kg and on days -8 and -7 at 2 mg/kg (for a total dose 4.5 mg/kg).

Bone Marrow Recipient

Total Body Irradiation RADIATION

Participants will receive 200 cGy of TBI in a single fraction.

Bone Marrow Recipient

Eligibility Criteria

• Age: 15 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Disease severity: Participants with SCD who have 1 or more of the following (i-v).
• Clinically significant neurologic event (stroke) or any neurological deficit lasting \> 24 hours;
• History of two or more episodes of acute chest syndrome (ACS) in the 2-year period preceding enrollment despite the institution of supportive care measures (i.e. asthma therapy and/or hydroxyurea);
• History of three or more severe pain crises per year in the 2-year period preceding enrollment despite the institution of supportive care measures (i.e. a pain management plan and/or treatment with hydroxyurea);
• Administration of regular red blood cell (RBC) transfusion therapy, defined as receiving 8 or more transfusions per year for ≥ 1 year to prevent vaso-occlusive clinical complications (i.e. pain, stroke, and ACS). Patients on chronic transfusion who have to discontinue transfusion because of allo-sensitization will be eligible.
• An echocardiographic finding of tricuspid valve regurgitant jet (TRJ) velocity ≥ 2.7 m/sec. Patients under the age of 18 years must have cardiac catheterization proven pulmonary arterial hypertension to qualify on this eligibility criterion.
• Age: Patients must be 15 - 40 years of age inclusive OR if younger than 15 years must be pubertal
• Adequate physical function as measured by:
• Karnofsky/Lansky performance score ≥ 60
• Cardiac function: Left ventricular ejection fraction (LVEF) \> 40% or LV shortening fraction \> 26% by cardiac echocardiogram or by MUGA scan.
• Pulmonary function: Pulse oximetry with a baseline O2 saturation of ≥ 85% and DLCO \> 40% (corrected for hemoglobin).
• Renal function: Serum creatinine ≤ 1.5 x the upper limit of normal for age as per local laboratory and 24 hour urine creatinine clearance \> 70 mL/min/1.73 m2 or GFR \> 70 mL/min/1.73 m2 by radionuclide GFR.
• Hepatic function: Serum conjugated (direct) bilirubin \< 2 x upper limit of normal for age as per local laboratory and ALT and AST \< 5 x upper limit of normal as per local laboratory. Patients with hyperbilirubinemia as a consequence of hyperhemolysis, or who experience a sudden, profound change in the serum hemoglobin after a RBC transfusion, are not excluded.
• For participants with a suitable donor who meet eligibility criteria and are willing to proceed to HCT, if they have received chronic transfusion therapy for ≥ 1 year and have clinical evidence of iron overload by serum ferritin or MRI, an evaluation by liver biopsy is required. Histological examination of the liver must document the absence of cirrhosis, bridging fibrosis, and active hepatitis. The absence of bridging fibrosis will be determined using the histological grading and staging scale
• Suitable Donor: To undergo transplantation on this study, participants must have an adult first degree relative who shares at least 1 human leukocyte antigen (HLA) haplotype with the participant, does not have SCD or other hemoglobinopathy, and is in good health; if these criteria are met, they will be allowed to serve as donors. Relatives with sickle cell trait are not excluded as donors. When more than 1 donor is available, the donor with the fewest HLA allele mismatches will be chosen, unless the patient had donor anti-HLA antibodies or there was a medical reason to exclude the donor. If donor anti-HLA antibodies are detected, the next best related match will be chosen. Umbilical cord blood or peripheral blood stem cell donors will not be accepted.

You may not qualify if:

• Availability of HLA matched sibling or 8 of 8 HLA-A, B, C and DRB1 matched unrelated donor
• Presence of donor specific antibodies in the patient
• Uncontrolled bacterial, viral or fungal infection in the 6 weeks before enrollment
• Seropositivity for HIV
• Previous hematopoietic cell transplantation (HCT)
• Participation in a clinical trial in which the patient received an investigational drug or device or off-label use of a drug or device within 3 months of enrollment
• Demonstrated lack of compliance with prior medical care
• Unwilling to use approved contraception for at least 6 months after transplant
• A history of substance abuse in the last 5 years that interferes with care
• Pregnant or breast-feeding females at the time of consideration for HCT
• Donor Selection Criteria:
• Preference will be given to related marrow donors who are 2-4 (out of 8) HLA antigen mismatched and towards whom the recipient does not have donor specific antibodies. Donors will sign an informed consent disclosing that the marrow donation will be used by a patient participating in this study. The donor must be matched with the recipient for at least 4 of 8 HLA alleles (HLA -A, -B, -C and -DRB1 by allele-level DNA methodology). The target total nucleated cell count (TNC) is 3.5-8.0 x 108/kg of recipient weight. Marrow will be collected without mobilization. Mobilized peripheral blood stem cell (HPC-A) collections will not be permitted. Donors must undergo hemoglobinopathy screening by electrophoresis; donors who have a hemoglobinopathy will be excluded but trait condition is acceptable.

Sponsors & Collaborators

• Emory University: lead

Study Sites (1)

Children's Healthcare of Atlanta

Atlanta, Georgia, 30033, United States

Location

MeSH Terms

Conditions

Anemia, Sickle Cell

Interventions

Bone Marrow Transplantation; Hydroxyurea; Thiotepa; fludarabine phosphate; Cyclophosphamide; Antilymphocyte Serum; Whole-Body Irradiation

Condition Hierarchy (Ancestors)

Anemia, Hemolytic, Congenital; Anemia, Hemolytic; Anemia; Hematologic Diseases; Hemic and Lymphatic Diseases; Hemoglobinopathies; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Intervention Hierarchy (Ancestors)

Tissue Transplantation; Cell- and Tissue-Based Therapy; Biological Therapy; Therapeutics; Transplantation; Surgical Procedures, Operative; Urea; Amides; Organic Chemicals; Phosphoramides; Organophosphorus Compounds; Triethylenephosphoramide; Aziridines; Azirines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Phosphoramide Mustards; Nitrogen Mustard Compounds; Mustard Compounds; Hydrocarbons, Halogenated; Hydrocarbons; Immune Sera; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins; Biological Products; Complex Mixtures; Radiotherapy; Investigative Techniques

Results Point of Contact

• Title: Professor of Pediatrics, Dr. Suhag H. Parikh
• Organization: Emory University

suhag.parikh@emory.edu

4047853240

Study Officials

• Lakshmanan Krishnamurti, MD

  Emory University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Pediatrics

Study Record Dates

• First Submitted: April 28, 2016
• First Posted: May 2, 2016
• Study Start: July 10, 2019
• Primary Completion: December 12, 2021
• Study Completion: December 14, 2021
• Last Updated: October 12, 2023
• Results First Posted: October 12, 2023

Record last verified: 2023-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)