Clinical Trial Phase II Multicenter Open Randomized Trial of the Therapeutic Use of Cells Intraportal Infusion of Autologous Bone Marrow Mononuclear as Enhancing Liver Regeneration Prior to Performing Extended Hepatic Resection.
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 13
- 试验地点
- 2
- 主要终点
- Number of adverse events and serious adverse events
研究概览
简要总结
This is a randomized controlled trial in which the safety and feasibility of cell therapy medicinal product shall be measured by comparing the variables of the response after treatment compared to baseline prior to implementation. Secondarily the results obtained are compared with each of the study groups.
Patients will receive concomitant basic pharmacological treatment for maintaining liver function.
All patients will be equally medically treated. The hypothetic test is to propose mononuclear cells from the bone marrow infused in the territory hepatic portal remaining segments (II and III) to be performed while contralateral portal embolization provides progenitor cells hepatic regenerative capacity that would shorten the time of liver regeneration and increase residual volume, facilitating the realization of an extended hepatectomy with greater assurance of maintaining proper residual function and adequate surgical margins.
详细描述
The study population corresponds to patients with hepatic space occupying lesion that require extended hepatic resection and in which the residual liver volume is insufficient to ensure liver function as well as required safety margins after resection.
The study population will consist of a total of 65 patients divided into two groups:
Study group: patients with hepatic space occupying lesion requiring an extended hepatic resection to those who are undergoing preoperative embolization segments portal intraportal affections and application of bone marrow cells.
Control group: patients with hepatic space occupying lesion that require an extended liver resection and who were performed preoperatively embolization portal of the affected segments.
The distribution of cases / controls will be 1/1. Patients in study group before surgery as well as portal embolization of the affected by the injury, will receive the experimental treatment being tested. Autologous bone marrow will be extracted by aspiration of the iliac crest under local anesthesia, and then the mononuclear cells (mo-MNCs) will be separated by density gradient centrifugation on Ficoll by an automatic procedure in the Laboratory for Cell Therapy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients of both sexes aged ≥ 18 years.
- •Standard analytical parameters, defined by:
- •Leukocytes ≥ 3000
- •Neutrophils ≥ 1500
- •Platelets ≥ 100,000
- •Aspartate aminotransferase (AST) / Alanine aminotransferase (ALT) ≤ 1.5 standard range institution
- •creatinine ≤ 1.5 mg / dl
- •Patients with liver space occupying lesion (LOE) that require extended hepatic resection.
- •Patient selection should be cautious, covering basically 5 types of liver damage which must be submitted prior to liver volumetry:
- •Metastatic Disease subsidiary right hepatectomy extended to segment IV
- •Metastatic Disease subsidiary right hepatectomy with suspected diseased liver (neoadjuvant chemotherapy) (in cases of doubt may be used liver function test "indocyanine green")
- •Bilobar liver metastases with multiple nodules in the right lobe and more than 3 nodules greater than 30 mm in the left hepatic lobe (LHI) will perform lumpectomies the LHI + right portal branch ligation (or postoperative percutaneous embolization) in order to make right hepatectomy 4-6 weeks ("two stage" surgery)
- •Subsidiary Hepatocarcinoma extended right hepatectomy
- •Liver Injury benign / malignant (Hemangiomas, hydatid cysts or liver tumors / primary bile hepatoblastoma), which by extension threatens the viability of the remaining liver tissue.
- •4 - Patients give their written informed consent for participation in the study and provide sufficient guarantees adherence to protocol according to the opinion of the investigator in charge of the patient care.
排除标准
- •Different tumor records current disease or any disease hematologic.
- •Patients with uncontrolled hypertension.
- •Severe heart failure (NYHA IV).
- •Patients with malignant ventricular arrhythmias or unstable angina.
- •Diagnosis of deep vein thrombosis in the previous 3 months.
- •Adjunctive therapy including hyperbaric oxygen, vasoactive substances, agents or angiogenesis inhibitors against Cox-II.
- •BMI> 40 kg/m
- •Patients with alcoholic with active alcoholism.
- •Proliferative retinopathy.
- •Concomitant disease that reduces life expectancy to less than a year.
- •Difficulty in monitoring.
- •Heart failure or ejection fraction (EF) <30%.
- •Stroke or myocardial infarction within the last 3 months.
- •Pregnant women or women of childbearing age who do not have adequate contraception.
结局指标
主要结局
Number of adverse events and serious adverse events
时间窗: 6 after drug administration of cell therapy.
First 24 hours after administration of the mo-MNC, and monitoring at weeks 2,4 and 6 after drug administration of cell therapy.
次要结局
- Changes in volume hepatic after application of hepatic regeneration procedures before surgery.(12 months)