Fecal Microbiota Transplantation (FMT) in for the Treatment of High-Risk Acute Graft-Versus-Host Disease (GVHD) After Allogeneic Hematopoietic Cell Transplantation (HCT)
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Acute Graft-Versus-Host Disease (Gvhd) Grade
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 10
- Locations
- 1
- Primary Endpoint
- Proportion of patients who are able to swallow ≥ 40 capsules (out of 75)
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The purpose of this study is to evaluate the effectiveness of Fecal Microbiota Transplant (FMT) treatment in high-risk acute graft-versus-host disease (GVHD).
This research study involves an experimental intervention called FMT.
Detailed Description
In this research study, the investigators are evaluating the effectiveness of Fecal Microbiota Transplant (FMT) treatment in high-risk acute GVHD. The investigators are evaluating the effectiveness of FMT (also known as 'stool transplantation' or 'fecal transplant') in being able to transfer gut organisms from a healthy donor to the patient. The investigators are also evaluating the ability of this treatment to improve or completely resolve the clinical symptoms (diarrhea, abdominal pain, rash, liver inflammation) that can occur with acute GVHD.This research study is a Pilot Study, which is the first time investigators are examining this intervention for treatment of acute GVHD. The FDA (the U.S. Food and Drug Administration) has not approved FMT for this use. The FDA has classified human stool as a biological agent and determined that its use in FMT therapy should be regulated to ensure patient safety. To use FMT to treat recurrent Clostridium difficile infection, the most common indication for FMT, does not require an investigation new drug permit. To use FMT for research or to treat any condition other than recurrent Clostridium difficile infection requires an investigation new drug permit. An investigation new drug permit has been obtained for this study. * After HCT, the body's microbiome (the natural existence of various bacteria and organisms) in the intestinal tract may be affected, in that the number and types of good bacteria is reduced (also called a reduction in microbial flora diversity). Studies have shown that the number and types of good bacteria in the gut can impact whether or not graft-versus-host disease (GVHD) is developed. GVHD occurs when donated bone marrow cells attack the body with an immune response. * FMT is a process utilizing microbial components which are the good, healthy bacteria that would otherwise naturally occur the body. Since may have decreased microbial flora diversity after HCT, these microbial components are taken from a stool donor. They are extracted from fecal matter (stool) and put into a capsule to ingest.
Investigators
Zachariah Michael DeFilipp
Principal Investigator
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •Men or women ≥ 18 years old
- •Patient has undergone allogeneic hematopoietic cell transplantation from any donor (related or unrelated with any degree of HLA matching) and any donor source (bone marrow, peripheral blood stem cells, or cord blood) for a hematologic malignancy or disorder. Recipients of myeloablative and reduced-intensity conditioning regimens are eligible.
- •Evidence of myeloid engraftment (eg, absolute neutrophil count ≥ 0.5 × 109/L for 3 consecutive assessments if ablative therapy was previously used). Use of growth factor supplementation is allowed.
- •Patient must have clinically suspected Grade II to IV aGVHD as per MAGIC criteria. Clinical suspicion of aGVHD by the treating physician is sufficient and biopsies are not required to pathologically confirm aGVHD. However, in situations where alternative diagnoses of drug effects or infection are not adequately ruled out on clinical suspicion alone, biopsies are recommended. - Patients must have a diagnosis of high-risk acute GVHD, defined as either:
- •- Steroid-refractory GVHD:
- •Progressive GVHD after at least 3 days of systemic corticosteroids (≥ 1 mg/kg/day of prednisone equivalent), OR
- •No improvement in GVHD after at least 7 days on ≥ 1 mg/kg/day of prednisone equivalent or insufficient improvement which warrants the addition of another agent, OR
- •Flare of GVHD symptoms during taper.
- •High-risk, treatment-naïve GVHD
- •AA3 risk by Ann Arbor GVHD scoring risk system
Exclusion Criteria
- •Participants who have initiated a new systemic treatment for steroid-refractory GVHD (institutional standard or investigational agent) within the 2 weeks prior to first dose of FMT. Treatment with FMT is allowed once the time since initiation of newest systemic therapy is 2 weeks or longer.
- •Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- •Delayed gastric emptying syndrome or large hiatal hernia
- •Known chronic aspiration
- •Participants with a history of significant allergy to foods not excluded from the donor diet (excluded foods are tree nuts, peanuts, shellfish, eggs)
- •Pregnant and breast-feeding women are ineligible because they are not eligible for hematopoietic stem cell transplantation.
- •HIV-positive participants are ineligible.
- •Participants who are unable to swallow pills.
- •Participants with end-stage liver disease (cirrhosis)
- •Participants with acute, active gastrointestinal infection (e.g., typhlitis, diverticulitis, appendicitis)
Outcomes
Primary Outcomes
Proportion of patients who are able to swallow ≥ 40 capsules (out of 75)
Time Frame: 29 Days
Based on this information, FMT will be considered feasible if, among the 11 eligible patients, ≥8 patients are able to swallow ≥ 40 capsules.
Secondary Outcomes
- Response Rate-Acute GVHD(29 Days)
- Progression Free Survival(6 months, 12 Months)
- Non-relapse mortality (NRM)(6 month, 12 Months)
- Overall Survival(6 months, 12 Months)