A Blood Stem Cell Transplant for Sickle Cell Disease

NCT03249831 | Active Not Recruiting Phase 1 DMC FDA Drug

• 1 other identifier: 16453
• Study Type: interventional
• Target: 3
• Locations: 1 country
• Sites: 1

Brief Summary

Blood stem cells can produce red blood cells (which carry oxygen), white blood cells of the immune system (which fight infections) and platelets (which help the blood clot). Patients with sickle cell disease produce abnormal red blood cells. A blood stem cell transplant from a donor is a treatment option for patients with severe sickle cell disease. The donor can be healthy or have the sickle cell trait. The blood stem cell transplant will be given to the patient as an intravenous infusion (IV). The donor blood stem cells will then make normal red blood cells - as well as other types of blood cells - in the patient. When blood cells from two people co-exist in the patient, this is called mixed chimerism. Most children are successfully treated with blood stem cells from a sibling (brother/sister) who completely shares their tissue type (full-matched donor). However, transplant is not an option for patients who (1) have serious medical problems, and/or (2) do not have a full-matched donor. Most patients will have a relative who shares half of their tissue type (e.g. parent, child, and brother/sister) and can be a donor (half-matched or haploidentical donor). Adult patients with severe sickle cell disease were successfully treated with a half-matched transplant in a clinical study. Researchers would like to make half-matched transplant an option for more patients by (1) improving transplant success and (2) reducing transplanted-related complications. This research transplant is being tested in this Pilot study for the first time. It is different from a standard transplant because:

1. 1.Half-matched related donors will be used, and
2. 2.A new combination of drugs (chemotherapy) that does not completely wipe out the bone marrow cells (non-myeloablative treatment) will be used to prepare the patient for transplant, and
3. 3.Most of the donor CD4+ T cells (a type of immune cells) will be removed (depleted) before giving the blood stem cell transplant to the patient to improve transplant outcomes.
4. 4.Will reverse sickle cell disease and improve patient quality of life,
5. 5.Will reduce side effects and help the patient recover faster from the transplant,
6. 6.Help the patient keep the transplant longer and
7. 7.Reduce serious transplant-related complications.

Conditions

Sickle Cell Disease; Thalassemia; Anemia, Sickle Cell; Sickle Cell Disorder; Hemoglobinopathies

Keywords

Sickle Cell Disease; Sickle Cell Disorders; Hemoglobinopathies; Thalassemia; Anemia, Sickle Cell; Haploidentical Transplant; Nonmyeloablative Conditioning; CD4+ T cell; CD4+ T cell-depleted Hematopoietic Cell Transplant; Mixed Chimerism

Outcome Measures

Primary Outcomes (4)

• Toxicity per NCI-Common Terminology Criteria for Adverse Events version 4.0

  Day -22 to 2 years post-transplant

• Unacceptable Toxicity at least possibly related to COH-MC-17

  Day -22 to Day +60 post-transplant

• Mixed Chimerism defined as 30-90% donor cells

  Day +60 post-transplant

• Feasibility of producing an infusion ready CD4+ T-cell-depleted hematopoietic product

  From apheresis to Day 0

Secondary Outcomes (20)

• Adverse events of Grade 3 or higher

  Up to 2 years post-transplant

• Neutrophil count ≥ 500/mm3, time to recovery

  Up to 2 years post-transplant

• Platelet count ≥ 20,000/mm3, time to recovery

  Up to 2 years post-transplant

• Marrow failure

  Up to 2 years post-transplant

• Sickle cell disease related complications

  Up to 2 years post-transplant

Other Outcomes (3)

• Ratio donor: recipient de novo thymic T cells

  Up to 2 years post-transplant

• Ratio donor: recipient FoxP3+ regulatory T cells

  Up to 2 years post-transplant

• Tolerance status of donor: recipient type T cells

  Up to 2 years post-transplant

Study Arms (1)

COH-MC-17 and immunosuppressants

EXPERIMENTAL

Participants receive COH-MC-17: a 21-day nonmyeloablative conditioning regimen (cyclophosphamide, pentostatin and rabbit anti-thymocyte globulin), followed by CD4+ T-cell-depleted Haploidentical Hematopoietic Transplant on Day 0. Immunosuppressants (tacrolimus and mycophenolate mofetil) given on Day -1 onwards until discontinuation post-transplant. The minimally manipulated transplant product is manufactured using the CliniMACS device.

Drug: Cyclophosphamide; Drug: Pentostatin; Drug: Rabbit anti-thymocyte globulin; Drug: Tacrolimus; Drug: Mycophenolate mofetil; Biological: CD4+ T-cell-depleted Haploidentical Hematopoietic Transplant

Interventions

Cyclophosphamide DRUG

Orally daily

Also known as: Cytoxan

COH-MC-17 and immunosuppressants

Pentostatin DRUG

Intravenous

Also known as: NIPENT

COH-MC-17 and immunosuppressants

Rabbit anti-thymocyte globulin DRUG

Intravenous

Also known as: Rabbit ATG, Thymoglobulin

COH-MC-17 and immunosuppressants

Tacrolimus DRUG

Initially IV. If patient tolerates, convert to oral.

Also known as: PROGRAF®

COH-MC-17 and immunosuppressants

Mycophenolate mofetil DRUG

IV or oral

Also known as: MMF, CellCept®, Myfortic

COH-MC-17 and immunosuppressants

CD4+ T-cell-depleted Haploidentical Hematopoietic Transplant BIOLOGICAL

Infusion

Also known as: CD4+ T-cell depleted HaploHCT, CD4+ T-cell depleted hematopoietic progenitor cell (HPC) product

COH-MC-17 and immunosuppressants

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Confirmed diagnosis of hemoglobin SS or S-βº Thalassemia sickle cell disease
• Severe disease status as defined by presence of one or more of the following:
• Clinically significant neurologic event (stroke) or any neurological deficit lasting \> 24 hours; or increased transcranial Doppler velocity (\>200 m/s). A stroke is defined as a sudden neurologic change lasting more than 24 hours that is accompanied by cerebral magnetic resonance imaging (MRI) changes.
• History of ≥ 1 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 ≥ 2 severe vaso-occlusive pain crises (VOC) 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). A severe VOC is defined as an episode of pain lasting more than 2 hours severe enough to require care at a medical facility. Note that priapism that lasts more than 2 hours and requires care at a medical facility is also considered a VOC.
• Osteonecrosis of ≥ 2 joints despite the institution of supportive care measures.
• Prior treatment with regular RBC transfusion therapy, defined as receiving ≥ 8 transfusions per year for \> 1 year to prevent vaso-occlusive clinical complications (i.e. pain, stroke, and acute chest syndrome)
• No HLA matched sibling or 10/10 matched unrelated donor
• Related donor who:
• Is genotypically haploidentical on HLA-A, B, C and DRB1 loci AND
• Meets institutional criteria
• Failed prior hydroxyurea therapy or have intolerance to hydroxyurea
• Meets protocol specified organ function criteria
• Women of childbearing potential or sexually active male: Agreement to use adequate contraception prior to study entry and 6 months post-transplant.

You may not qualify if:

• Prior stem cell transplant
• Prior bone marrow transplant
• Concurrent other investigational agents, chemotherapy, biological therapy or radiation therapy
• Planned use of moderate and strong CYP3A4 inhibitors
• Active infection
• Major surgery within the last 30 days
• Clinically significant liver fibrosis or cirrhosis if on chronic transfusion therapy \> 6 months
• Active malignancy (other than non-melanoma skin cancers)
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to any in the pre- or post-transplant regimen.
• Women of childbearing potential: pregnant or breastfeeding

Sponsors & Collaborators

• City of Hope Medical Center: lead
• California Institute for Regenerative Medicine (CIRM): collaborator

Study Sites (1)

City of Hope Medical Center

Duarte, California, 91010, United States

Location

MeSH Terms

Conditions

Anemia, Sickle Cell; Hemoglobinopathies; Thalassemia

Interventions

Cyclophosphamide; Pentostatin; Antilymphocyte Serum; thymoglobulin; Tacrolimus; Mycophenolic Acid; Pharmaceutical Preparations

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Phosphoramide Mustards; Nitrogen Mustard Compounds; Mustard Compounds; Hydrocarbons, Halogenated; Hydrocarbons; Organic Chemicals; Phosphoramides; Organophosphorus Compounds; Coformycin; Formycins; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Deoxyribonucleosides; Nucleosides; Nucleic Acids, Nucleotides, and Nucleosides; Immune Sera; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins; Biological Products; Complex Mixtures; Macrolides; Lactones; Caproates; Acids, Acyclic; Carboxylic Acids; Fatty Acids; Lipids

Study Officials

• Joseph Rosenthal, MD

  City of Hope Medical 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: August 10, 2017
• First Posted: August 15, 2017
• Study Start: January 4, 2019
• Primary Completion (Estimated): January 25, 2027
• Study Completion (Estimated): January 25, 2027
• Last Updated: March 5, 2026

Record last verified: 2026-03

Locations

US (1)