Umbilical Cord Derived Mesenchymal Stem Cells for Treatment-induced Myelosuppression in Hematologic Malignancies

Phase 1

Not yet recruiting

• Conditions: Bleeding; Hematologic Neoplasms; Neutropenia; Anemia; Infections; Thrombocytopenia
• Interventions: Biological: umbilical cord derived mesenchymal stem cells

• Registration Number: NCT05672420
• Lead Sponsor: Wuhan Union Hospital, China

Brief Summary

The purpose of the study is to explore the safety and efficacy of umbilical cord derived mesenchymal stem cells in treatment-induced myelosuppression in patients with hematologic malignancies.

Detailed Description

Despite the improved prognosis of patients with hematologic malignancies, almost all patients will experience severe myelosuppression induced by anti-cancer treatment, leading to a series of complications such as infection due to neutropenia, bleeding due to thrombocytopenia and/or impaired major organ function such as cardiac function due to anemia, which are the main reasons for dose reduction, dose interrruptions of anti-cancer treatment, failure of hematopoietic stem cell transplantation, and also patients' treatment-related death. It is of significant clinical importance and an urgent need to promote early recovery of myelosuppression and reduce risks of related complications as well as medical burdens. Umbilical cord derived mesenchymal stem cells (UC-MSCs), as a kind of stem cells with multipotential, can widely act on the functional cell units of bone marrow microenvironment and promote the repairment and regeneration of key cells such as hematopoietic stem cells, mesenchymal stem cells and endothelial cells, thus making it an ideal means for effectively promoting recovery of myelosuppression. Patients with hematologic malignancies and treatment-induced myelosuppression will be invited to participate in the Phase Ib/II study, to receive UC-MSCs intravenous infusion and follow-up visits of up to 2 years after enrollment.

Study Timeline

• Status Verified: 2023-01
• Study Start: 2023-01-01
• Study First Submitted: 2023-01-01
• Study First Submitted QC: 2023-01-03
• Last Update Submitted: 2023-01-03
• Study First Posted: 2023-01-05
• Last Update Posted: 2023-01-05
• Primary Completion: 2023-12-31
• Study Completion: 2025-01-31

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 181

Inclusion Criteria

1. Aged between 18 and 75 years old;

2. Either type of primary hematologic malignancies listed below:

   1. Acute myeloid leukemia (AML, AML subtype M3 excluded) or acute lymphoblastic leukemia (ALL) diagosed according to the 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia, either treatment naive participants who are going to receive first induction therapy, or participants who failed first induction therapy and are going to receive re-inducton therapy;
   2. AML or ALL participants who achieved remission and are going to receive consolidation therapy;
   3. Relapsed/refractory AML or ALL participants who are going to receive first re-induction therapy;
   4. Phase II trial will also include: participants with primary hematological maligancies who are going to receive autologous hematopoietic stem cell transplantation (allo-HSCT) whereas are poor mobilizers (CD34+cell count in peripheral blood was below 11-19/μL before collection, or the amount of CD34+ cells transfused was below 2×10^6/kg in allo-HSCT), and the participants' peripheral superficial veins have smooth blood flow which can meet the demand for intravenous drip;

3. The participant or his/her legal guardian is adequately informed of the nature and risks of the study, voluntarily participates in the study with signed informed consent;

4. Male or female;

5. Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 to 2 (by the day anti-cancer therapy is initiated)

6. Estimated survival of at least 3 months;

7. Adequate major organ function:

   1. Respiratory function: indoor oxygen saturation of at least 95%;
   2. Cardiac function: ejection fraction of left ventricular of at least 45%;
   3. Hepatic function: alanine aminotransferase/aspartate aminotransferase of at most 2.5 times/upper limit of normal value and serum total bilirubin of at most 1.5 times/upper limit of normal value;
   4. Renal function: Serum creatinine of at most 1.5 times/upper limit of normal value;

8. Participants who do not receive any type of anti-cancer therapy within 2 weeks before enrollment (radiation therapy, chemotherapy and/or immune therapy, et al.), and treatment-associated toxicities induced by previous therapy has recovered to Grade 1 or below (except for low grade toxities such as alopecia).

Exclusion Criteria

1. Overt central nervous system manifestations of hematologic malignancies at diagnosis;

2. Secondary hematological maligancies;

3. Body mass index (BMI) of more than 30 kg/m^2;

4. Myelosuppression induced by conditions other than anti-cancer therapy;

5. Previous radiation therapy performed on sternum or pelvis;

6. Specifically diagnosed and uncontrolled infection at enrollment (Uncontrolled is defined as exhibiting ongoing signs and symptoms of infection without improvement despite anti-infective agents) ;

7. Uncontrolled active bleeding at enrollment;

8. Severe underlying comorbidities affecting survival, including cachexia, severe malnutrition, etc;

9. Estimated survival of at most 48 hours;

10. Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection;

11. History of or current human immunodeficiency virus (HIV) infection;

12. Continuous usage of immunosuppressants or received organ transplantation in the last 6 months;

13. Participation in clinical trials of other drugs within 6 weeks before enrollment;

14. Previous participation in clinical stem cell research;

15. Receiving any agent concurrently with UC-MSCs infusion which inhibits cell division (hydroxyurea, low-dose cytarabine or methotrexate, etc) ;

16. Severe allergic constitution, or known or suspected allergy to the study drug and its components;

17. Known contraindication to receiving hematopoietic growth factors, transfusion of blood components, anti-infective agents;

18. Female participants who are pregnant or breast feeding;

19. Participants with fertility plan;

    Note: For female participants, they should be surgical sterilized or post-menopausal, or agree to utilize a medically recognised method of contraception (such as intrauterine device, condom) during treatment period of the study and within 6 months after the end of treatment period of the study; For male participants, they should be surgical sterilized or agree to utilize a medically recognised method of contraception (such as intrauterine device, condom) during treatment period of the study and within 6 months after the end of treatment period of the study;

20. Participants suffering from mental illness;

21. Presence of drug abuse/addiction;

22. History of other malignancies other than hematological malignancies within 3 years;

23. Participants without signed informed consent;

24. Participants with poor compliance and are unable to complete the whole course of the study;

25. Participants with circumstances that, in the opinion of the investigator, may increase the risk of the participants or interfere with conduct of the clinical trial and the judgment of results (excessive tension, sensitivity or cognitive impairment, etc) ;

26. Participants with other circumstances that are ineligible for enrollment in this study, in the opinion of the investigator.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
umbilical cord derived mesenchymal stem cells (UC-MSCs)	umbilical cord derived mesenchymal stem cells	In the Phase Ib study, participants will be those with treatment-induced myelosuppression and acute myeloid leukemia/acute lymphoblastic leukemia, UC-MSCs will be preset with 5 escalation dose levels: dose A , dose B, dose C ,dose D and dose E, frequency of infusion will be preset with 3 escalation levels: frequency 1, frequency 2, frequency 3, total course of treatment: 2 weeks; In the Phase II study, participants will be those with treatment-induced myelosuppression and acute myeloid leukemia/acute lymphoblastic leukemia/primary hematological maligancies who are going to receive hematopoietic stem cell transplantation, UC-MSCs will be preset according to the recommended phase II dose (RP2D) from the Phase Ib study, total course of treatment: 2 weeks.

Primary Outcome Measures

Name	Time	Method
Dose-limiting toxicities（DLT)	4 days after the last UC-MSCs dose, up to 12 days	During the DLT observation period, the subject has an adverse event that is reasonably related to UC-MSCs infusion (possibly, likely or definitely related).
Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)	From the day that the last UC-MSCs dose is used to up to 21 days	To investigate the safety characteristics, percentages will be calculated and grade will be evaluated.
Maximum tolerated dose (MTD)	From the day that the last UC-MSCs dose is used to up to 4 days	During the dose-escalation phase, the highest dose of dose-limiting toxicity for subjects less than or equal to 1/3 in the dose group of at least 6 evaluble subjects of the study drug after the last UC-MSCs dose.

Secondary Outcome Measures

Name	Time	Method
Incidence of febrile neutropenia	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Duration of febrile neutropenia	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, the duration will be measured in days.
Duration of infetion	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, the duration will be measured in days.
Duration of bleeding	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, the duration will be measured in days.
Time to absolute neutrophil count recovery	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, time will be measured in days.
Time to severe anemia recovery	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, time will be measured in days.
Incidence of bleeding	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Application rate of blood transfusion	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Time to achievement of complete remission	From enrollment to up to 28 days	To investigate the efficacy characteristics, time will be measured in days.
Incidence of secondary tumor in 2 years	2 years since the last UC-MSCs infusion	To investigate the safety characteristics, percentages will be calculated.
Incidence of severe thrombocytopenia	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Time to severe thrombocytopenia recovery	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, time will be measured in days.
Incidence of severe anemia	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Overall survival	From enrollment to maximun up to 2 years	From enrollment to the day of death caused by any reason.
Incidence of infetion	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Incidence of infusion reactions in 2 years	2 years since the last UC-MSCs infusion	To investigate the safety characteristics, percentages will be calculated.
Cumulative incidence of relapse of primary disease in 2 years	2 years since the last UC-MSCs infusion	To investigate the safety characteristics, percentages will be calculated.
Event free survival	From enrollment to maximun up to 2 years	From enrollment to the day of any event.
Application rate of anti-infective agents	From the start of anti-cancer therapy or completion of hematopoietic stem cell transplantation to up to 42 days	To investigate the efficacy characteristics, percentages will be calculated.
Duration of complete remission	From enrollment to maximun up to 2 years	To investigate the safety characteristics, the duration will be measured in days or months.

Trial Locations

Locations (3)

Wuhan Central Hospital; 🇨🇳 Wuhan, Hubei, China

Wuhan Union Hospital; 🇨🇳 Wuhan, Hubei, China

Wuhan Tongji Hospital; 🇨🇳 Wuhan, Hubei, China