NCT01419704撤回1 期
Phase I/II Pilot Study of Mixed Chimerism to Treat Hemoglobinopathies
适应症
干预措施
试验速览
- 阶段
- 1 期
- 状态
- 撤回
- 试验地点
- 3
- 主要终点
- Proportion of Hemoglobin A and S
研究概览
简要总结
The goal of this research study is to establish chimerism and avoid graft-versus-host disease in patients with hemoglobinopathies.
详细描述
This proposal is a phase I/II feasibility study to demonstrate that mixed chimerism can be established with minimal risk in recipients with hemoglobinopathies treated with Campath-1H-based nonmyeloablative conditioning and graft engineering to reduce the risk of Graft Versus Host Disease (GVHD), but preserve engraftment of donor cells.
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
- — 至 45 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion Criteria
- •The following criteria are established to identify subjects with hemoglobinopathies, hematologic or bone marrow failure syndromes who have a high predicted morbidity and are at risk for early mortality:
- •Patients with alpha or beta thalassemia major.
- •Patients with Diamond-Blackfan anemia and other bone marrow failure syndromes, characterized by severe chronic anemia.
- •Patients with other complex and transfusion-dependent hemoglobinopathies, including sickle cell disease.
- •Patients with sickle disease who have one or more of the following:
- •Overt or silent stroke
- •Neurocognitive impairment
- •Pain crises 2 or more episodes per year for past year
- •One or more episodes of acute chest syndrome
- •Osteonecrosis involving 1 or more joints
- •Evidence of retinopathy
- •Microalbuminuria or evidence of sickle cell nephropathy
- •Alloimmunization
- •Subjects must also meet all of the following general inclusion criteria:
- •Subjects must have a related donor which can consist of Histocompatibility Leukocyte Antigen (HLA)-matched donor up to haploidentical match, mismatched for 1, 2 or 3 HLA-A, B or -DR loci.
- •Subjects must have adequate cardiopulmonary function as documented by echocardiogram or radionuclide scan. (Shortening fraction >26% or ejection fraction >40% or ≥ 80% of normal value for age).
- •Subjects must have adequate pulmonary function documented by Forced expiratory volume in 1 second (FEV1) of ≥ 50% of predicted for age and/or Diffusing capacity of the lung for carbon monoxide (DLCO) (corrected for hemoglobin) ≥50% of predicted for age for patients > 10 years of age.
- •Subjects must have adequate hepatic function as demonstrated by a serum albumin ≥ 3.0 mg/dL, and serum glutamic pyruvic transaminase (SGPT) or serum glutamic oxaloacetic transaminase (SGOT) less than or equal to 5 times the upper limit of normal. Liver biopsy or a liver MRI is necessary if the patient has received chronic transfusions for over a year and/or has a ferritin level of ≥
- •Subjects must have adequate renal function as demonstrated by a serum creatinine less than or equal to 2 mg/dL. If serum creatinine is ≥ 2 mg/dL, then a creatinine clearance test or nuclear medicine GFR should document GFR of ≥ 50 ml/min/1.73 m
- •Subjects or legal guardians must give written informed consent.
- •Female patients of childbearing potential cannot be pregnant or lactating/breast-feeding and must be either surgically sterile, postmenopausal (no menses for the previous 12 months), or must be practicing an effective method of birth control as determined by the investigator (e.g., oral contraceptives, double barrier methods, hormonal injectable or implanted contraceptives, tubal ligation, or partner with vasectomy).
- •Less than or equal to 45 years of age.
排除标准
- •Patients with cirrhosis, extensive bridging hepatic fibrosis, or active hepatitis are excluded from enrollment.
- •Uncontrolled infection or severe concomitant diseases, which in the judgment of the Principal Investigator, indicate that the patient could not tolerate reduced intensity transplantation.
- •Severe impairment of functional performance as evidenced by a Karnofsky score <70% (patients ≥16 years old) or Lansky (children <16 years old) score <70%
- •Renal insufficiency (GFR <50 ml/min/1.73 m2).
- •Subjects with a positive human immunodeficiency virus (HIV) antibody test result.
- •Subjects who are pregnant, as indicated by a positive serum human chorionic gonadotrophin (HCG) test.
- •Subjects whose only donor is pregnant at the time of intended transplant.
- •Subjects of childbearing potential who are not practicing adequate contraception as defined by the investigator at the site.
- •Allogeneic hematopoietic stem cell transplant within the previous 1 year.
- •Subjects must not have had previous radiation therapy that would preclude total body irradiation (TBI) (as determined by a radiation therapist).
- •Jehovah's Witness unwilling to be transfused .
- •Uncontrolled hypersplenism.
- •Severe alloimmunization with inability to guarantee a supply of adequate packed red blood cell (PRBC) donors.
- •Subjects with thalassemia who are Lucarelli Class 3
- •Fanconi anemia.
- •Insufficient funds for the bone marrow processing costs
研究组 & 干预措施
Hemoglobinopathies diagnosed patients
Experimental
Recipients diagnosed with Hemoglobinopathies are treated with an enriched hematopoetic stem cell infusion from living donor bone marrow
干预措施: Enriched Hematopoetic Stem Cell Infusion (Biological)
结局指标
主要结局
Proportion of Hemoglobin A and S
时间窗: one month to three years
Red blood cell contents by hemoglobin electrophoresis
次要结局
- Enriched Hematopoetic Stem Cell Engraftment(One month to three years)
研究者
研究点 (3)
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