A Phase II Trial of Non-Myeloablative (NMA) Conditioning and Transplantation of Partially HLA-Mismatched/Haploidentical Related or Matched Unrelated Donor (MUD) Bone Marrow for Newly Diagnosed Patients With Severe Aplastic Anemia
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 21
- 试验地点
- 1
- 主要终点
- Overall Survival and Engraftment at One Year
研究概览
简要总结
Our primary objective is to determine if it is feasible for previously untreated severe aplastic anemia (SAA) patients to be transplanted using non-myeloablative conditioning and post transplantation cyclophosphamide.
详细描述
This is a clinical trial of upfront bone marrow transplantation for patients with SAA who do not have a fully human leukocyte antigen (HLA) matched donor. The trial uses a conditioning regimen which has been successful in the refractory and relapsed setting to maximize engraftment and post transplant therapy to minimize graft versus host disease (GVHD). This would be used here in patients who have not yet undergone immunosuppressive therapy for their SAA or are thought to be unlikely to respond to immunosuppressive therapy for SAA.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Confirmed diagnosis of inherited or acquired severe aplastic anemia (SAA)
- •One of the following available donors:
- •HLA-haploidentical relative
- •If recipient is >= 40 years old, may use HLA-matched related donor
- •For recipients with inherited bone marrow failure syndromes (IBMFS) with clear evidence of same disorder in potential related donors, may use 10/10 matched unrelated donor
- •Recipient and/or legal guardian must sign protocol informed consent
- •Donor must be willing to donate bone marrow
- •Left ventricular ejection fraction (LVEF) >= 40%. For recipients < 13 years old, shortening fraction >= 26% may be used instead.
- •Bilirubin < 3 x upper limit of normal (ULN) for age, unless patient has Gilbert's disease
- •aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 5 x ULN for age
- •For patients >= 13 years old: estimated creatinine clearance > 50 mL/min using Cockcroft-Gault formula and actual body weight
- •For patients >= 1 but < 13 years old: glomerular filtration rate (GFR) estimated by updated Schwartz formula >= 90 mL/min/1.73 m^
- •If estimated GFR is < 90 mL/min/1.73 m^2, 24-hour measured creatinine clearance must be > 50 mL/min/1.73 m^
- •For patients >= 8 years old, diffusing capacity of the lung for carbon monoxide (DLCO) (corrected for hemoglobin) > 40%; forced expiratory volume at one second (FEV1) > 50%; forced vital capacity (FVC) > 50%
- •For patients < 8 years old or unable to undergo pulmonary function testing: no evidence of dyspnea at rest; no need for supplemental oxygen; oxygen saturation > 92% on room air
- •Karnofsky/Lansky status (depending on age) >= 70%
- •Females and males of childbearing potential must agree to practice 2 effective methods of contraception at the same time. If unwilling, they must agree to complete abstinence.
排除标准
- •Previous administration of immunosuppressive therapy for SAA.
- •Fanconi anemia. At minimum, this diagnosis must be excluded by diepoxybutane (DEB) or equivalent testing on peripheral blood or marrow in patients < 30 years old.
- •Clonal cytogenetic abnormalities consistent with pre-myelodysplastic syndrome (pre-MDS) or MDS on bone marrow examination
- •Presence of anti-donor antibodies
- •Prior allogeneic stem cell transplant
- •Prior solid organ transplant
- •Uncontrolled bacterial, viral, or fungal infection
- •HIV seropositivity
- •Active hepatitis B or C infection determined by serology and/or nucleic acid testing (NAT)
- •Pregnancy or active breastfeeding
- •Prior malignancies except: resected basal carcinoma or treated cervical carcinoma in situ; cancer treated with curative intent > 5 years previously. Other prior cancers will not be allowed unless approved by the PI.
研究组 & 干预措施
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Thymoglobulin (Drug)
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Fludarabine (Drug)
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Cyclophosphamide (Drug)
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Total body irradiation (Radiation)
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Tacrolimus (Drug)
Bone marrow transplant
Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.
干预措施: Mycophenolate mofetil (Drug)
结局指标
主要结局
Overall Survival and Engraftment at One Year
时间窗: 1 year
Number of enrolled participants who receive BMT, achieve engraftment, and are alive at one year post bone marrow transplant (BMT).
次要结局
- Number of Participants Who Experience Chronic GVHD(2 years)
- Overall Survival at One Year(1 year)
- Probability of Platelet Recovery as Assessed by Number of Participants Who Have Recovered Platelet Counts(1 year)
- Number of Participants Who Experience Primary Graft Failure(1 year)
- Number of Participants Who Experience Grades II-IV Acute GVHD(Day 100)
- Transplant-related Mortality(1 year)
- Probability of Neutrophil Recovery as Assessed by the Number of Participants Who Have Recovered Neutrophil Counts(1 year)
- GVHD-free Relapse-free Survival (GRFS)(1 year)
- Number of Participants With Full Donor Chimerism(Day 60)
- Number of Participants Who Experience Secondary Graft Failure(1 year)
- Number of Participants Who Experience Grades III-IV Acute GVHD(Day 100)