Feasibility Study of CD34 Selection for GVHD Prophylaxis Using the Automated CliniMACS
试验速览
- 阶段
- 1 期
- 状态
- 招募中
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Severe acute GVHD
研究概览
简要总结
Patients with graft failure or delayed engraftment may benefit from a hematopoietic stem cell boost or an additional hematopoietic stem cell transplantation procedure. In such settings standard immune suppression strategies are avoided due to their myelosuppressive nature. Therefore those patients are at increased risk of graft versus host disease, and the infusion of a CD34 selected graft would reduce such a risk. The infusion of CD34 selected graft using CliniMACS plus is currently FDA FDA-approved indication for acute myeloid leukemia. However, the use of the Prodigy would streamline the processing, in terms of hands-off procedure, allowing to provision of this product to the patients without strains on the cell therapy lab team. This procedure has been demonstrated safe and effective in several single-center studies and is currently in advanced phase investigation in several studies for malignant and non-malignant conditions.
详细描述
Patients eligible to be treated on this status are status post allogeneic hematopoietic stem cell transplantation for a neoplastic hematologic disorder with the need of a CD34 selected stem cell boost for graft failure or low graft function (e.g. marrow cellularity reduced per age and/or dropping donor chimerism with cytopenias and/or platelets or red blood cells transfusion requirement).
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
- 年龄范围
- 4 Weeks 至 75 Years（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •AML in morphologic remission with intermediate/high-risk features or relapsed disease 1 or 2
- •ALL in morphologic remission with high-risk features or relapsed disease 1 or 2
- •Lymphoid malignancies in CR or PR (e.g. non-Hodgkin's lymphoma, prolymphocytic leukemia, CLL)
- •Myelodysplastic syndromes with <=10% blasts
- •CML in morphologic remission after blast phase or accelerated phase
- •Primary myelofibrosis with <=10% blasts ^morphologic remission is defined as <5% blasts on the bone marrow biopsy. Negative test for donor-specific antibody within 28 days of starting conditioning regimen, or adequate for standard desensitization protocol.
排除标准
- •Non-compliant patients.
- •No appropriate caregivers identified.
- •Uncontrolled medical or psychiatric disorders which may preclude patients to undergo clinical studies (Discretion of the attending physician).
- •Patients with known allergy to DMSO.
- •Pregnant or breastfeeding women
研究组 & 干预措施
Treatment population
Patients status post allogeneic hematopoietic stem cell transplantation for a neoplastic hematologic disorder with the need of a CD34 selected stem cell boost for graft failure or low graft function will receive a CD34 selected hematopoietic stem cell infusion with or without preceding conditioning.
Fludarabine 25 mg/mq day 1 - 5 + 2 Gray Total body irradiation depending on clinician's discretion (with the addition of cyclophosphamide 14.5 mg/kg for two doses for haploidentical or matched unrelated donor with at least one major HLA mismatch). Recommendation to use a conditioning regimen include complete loss of donor chimerism, trilineage cytopenias.
干预措施: Infusion of CD34 selected hematopoietic stem cells (Drug)
结局指标
主要结局
Severe acute GVHD
时间窗: 6 years
Incidence of severe (grade III-IV) acute GVHD \<=25% at 100 days
donor chimerism
时间窗: 6 years
Improvement of donor chimerism by \>=15%
extensive chronic GVHD
时间窗: 6 years
Incidence of extensive chronic GVHD \<=10% at one year.
Clinical improvement
时间窗: 6 years
Clinical improvement, defined as an increase of blood counts with transfusion independence if anemia or thrombocytopenia or freedom for infections if reduced leukocytes
次要结局
- Absolute neutrophil count(6 years)
- Non-relapse mortality(6 years)
- Disease relapse(6 years)
- overall survival(6 years)
研究者
Antonio Di Stasi
Associate Professor
University of Alabama at Birmingham