Clinical Trials /

Expanded Access Protocol (EAP) Using the CliniMACS® Device for Pediatric Haplocompatible Donor Stem Cell Transplant

NCT01200017

Description:

This protocol provides expanded access to bone marrow transplants for children who lack a histocompatible (tissue matched) stem cell or bone marrow donor when an alternative donor (unrelated donor or half-matched related donor) is available to donate. In this procedure, some of the blood forming cells (the stem cells) are collected from the blood of a partially human leukocyte antigen (HLA) matched (haploidentical) donor and are transplanted into the patient (the recipient) after administration of a "conditioning regimen". A conditioning regimen consists of chemotherapy and sometimes radiation to the entire body (total body irradiation, or TBI), which is meant to destroy the cancer cells and suppress the recipient's immune system to allow the transplanted cells to take (grow). A major problem after a transplant from an alternative donor is increased risk of Graft-versus-Host Disease (GVHD), which occurs when donor T cells (white blood cells that are involved with the body's immune response) attack other tissues or organs like the skin, liver and intestines of the transplant recipient. In this study, stem cells that are obtained from a partially-matched donor will be highly purified using the investigational CliniMACS® stem cell selection device in an effort to achieve specific T cell target values. The primary aim of the study is to help improve overall survival with haploidentical stem cell transplant in a high risk patient population by limiting the complication of GVHD.

Related Conditions:
  • Chronic Myeloid Leukemia
Recruiting Status:

No longer available

Trial Eligibility

Document

Title

  • Brief Title: Expanded Access Protocol (EAP) Using the CliniMACS® Device for Pediatric Haplocompatible Donor Stem Cell Transplant
  • Official Title: An Expanded Access Study of the Feasibility of Using the CliniMACS® Device for CD34+ Cell Selection and T Cell Depletion for Graft-versus-Host Disease Prophylaxis in Alternative Donor Stem Cell Transplant Recipients

Clinical Trial IDs

  • ORG STUDY ID: 10082
  • SECONDARY ID: NCI-2020-02478
  • NCT ID: NCT01200017

Conditions

  • Acute Lymphoblastic Leukemia
  • Acute Myeloid Leukemia
  • Chronic Myeloid Leukemia
  • Myelodysplastic Syndrome
  • Lymphomas
  • Bone Marrow Failure
  • Hemoglobinopathy
  • Immune Deficiency
  • Osteopetrosis
  • Cytopenias
  • Leukocyte Disorders
  • Anemia Due to Intrinsic Red Cell Abnormality

Interventions

DrugSynonymsArms
CD34+ enriched, T Cell Depleted donor stem cell productbone marrow transplant

Purpose

This protocol provides expanded access to bone marrow transplants for children who lack a histocompatible (tissue matched) stem cell or bone marrow donor when an alternative donor (unrelated donor or half-matched related donor) is available to donate. In this procedure, some of the blood forming cells (the stem cells) are collected from the blood of a partially human leukocyte antigen (HLA) matched (haploidentical) donor and are transplanted into the patient (the recipient) after administration of a "conditioning regimen". A conditioning regimen consists of chemotherapy and sometimes radiation to the entire body (total body irradiation, or TBI), which is meant to destroy the cancer cells and suppress the recipient's immune system to allow the transplanted cells to take (grow). A major problem after a transplant from an alternative donor is increased risk of Graft-versus-Host Disease (GVHD), which occurs when donor T cells (white blood cells that are involved with the body's immune response) attack other tissues or organs like the skin, liver and intestines of the transplant recipient. In this study, stem cells that are obtained from a partially-matched donor will be highly purified using the investigational CliniMACS® stem cell selection device in an effort to achieve specific T cell target values. The primary aim of the study is to help improve overall survival with haploidentical stem cell transplant in a high risk patient population by limiting the complication of GVHD.

Detailed Description

      Patients will be enrolled with alternative (mismatched/haplocompatible) related donors or
      unrelated donors either for an initial transplant or as a rescue following rejection of a
      previous graft or relapse following a previous transplant. For patients with mismatched
      related donors, the majority of clinical experience has been with a T cell-depleted PBSC
      product. Currently, no FDA-approved method for T cell depletion exists. Recent experience
      with the CliniMACS® device has produced excellent results with a 70-75% survival in children,
      many of whom were high risk patients.

      Patients that receive transplants from unrelated donors usually receive stem cells that are
      not T cell-depleted. However, this is associated with a high risk of GVHD. The excellent
      results with mismatched related donor transplants justify expanding this approach to
      unrelated donor transplant recipients if the HLA mismatch is sufficiently great. It is
      anticipated that the use of the CliniMACS® device will result in a very low risk of GVHD
      without the need for post-transplant immunosuppression. The outcomes in relatively small
      studies for children receiving unrelated donor transplants using the CliniMACS® have been
      comparable to or better than those receiving T replete transplants with post-transplant
      immunosuppression.

      This protocol will allow the use of patient-specific conditioning regimens. Some patients
      have contraindications to certain components of the conditioning regimen used for our ongoing
      study under BB-IND 8817 (CC# 01151). An example is a patient with pre-existing organ
      dysfunction that would be better served by the use of a reduced intensity conditioning
      regimen. Another example is a patient for whom total body irradiation is contraindicated due
      to very young age or prior radiation therapy. Finally, patients who would be otherwise
      eligible for the predecessor study but who do not have an eligible related donor or a closely
      matched unrelated donor would be eligible for this study. The target CD3+ T cell dose that
      will be given will be 3 x 10^4/kg. The University of California, San Francisco Protocol
      CC#01151 uses a dose of 3 x 10^4/kg. The T cell dose in the graft is usually < 1 x 10^4/kg
      after processing and T cells are added to the product.
    

Trial Arms

NameTypeDescriptionInterventions

Eligibility Criteria

        Inclusion Criteria:

          -  >2 months - 30 years

          -  Patient must have a malignant or non-malignant disease that can benefit from
             alternative stem cell transplantation according to standard practice guidelines for
             including patients for transplant as outlined in UCSF Pediatric Bone Marrow Transplant
             (BMT) Standard Operating Procedure (SOP) #206.04. Examples include acute and chronic
             leukemias, myelodysplastic syndrome, lymphoma, severe acquired and congenital
             cytopenias, white and red blood cell abnormalities, inborn errors of metabolism and
             immunodeficiencies. Patient with Fanconi's Anemia will be eligible regardless of match
             with donor.

          -  Patients with acute leukemia (AML excepted) or lymphoma must be in remission at the
             time of transplant.

          -  Patients must lack a healthy human leukocyte antigen (HLA)-identical related donor.

          -  Recipient or authorized guardian must sign informed consent for this study.

          -  If recipient is female and of child-bearing age, negative pregnancy test.

          -  Patient must have a healthy, willing mismatched related or an unrelated donor who is:

               -  Able to receive Granulocyte colony-stimulating factor (G-CSF) +/- Plerixafor and
                  undergo apheresis either through placement of catheters in antecubital veins or a
                  temporary central venous catheter,

               -  For Related donor: sibling, half-sibling, parent, cousin, aunt, uncle or
                  grandparent will all be considered eligible.

               -  For Related donor: HLA antigen genotypic match ≥ 4/8 and ≤ 7/8 (haplocompatible).

               -  For unrelated donor: 6/8 or 7/8 HLA antigen match (if two mismatches, they must
                  be at different loci).

               -  Complete medical history, physical and screening for infectious diseases that are
                  acceptable for donation.

               -  If donor is female and of child-bearing age, negative pregnancy test.

               -  Absence of anti-HLA antibodies in recipient directed against donor antigens.

               -  Donor must be willing to sign informed consent for this study. If donor is < 18
                  years of age, donor must be willing to give assent and parents willing to sign
                  informed consent.

          -  Be suitable for an autologous gene-modified transplant:

               -  Using either bone marrow or cytokine-mobilized peripheral blood stem cells
                  (PBSC).

               -  Patient or authorized guardian must sign informed consent for this study.

          -  For unrelated donors: Per New Algorithm, Jan. 14, 2016, effective immediately,
             National Marrow Donor Program (NMDP) "Be The Match" is adopting a revised algorithm
             for determining if a donor is a research subject on their recipient's research
             protocol: The NMDP will inform the donor of the activities and the use of donor's
             apheresis product to be used in this study and obtain written consent from the donor.
             Transplant centers are sent documentation of the donor consent to participate in the
             research support activities. (The revised algorithm can be found on the "Be the Match
             Clinical Network")

          -  Criteria to consider when choosing among related haplo donors:

               -  CMV positive donor is preferred over other factors. CMV negative donor can be
                  used only if recipient is CMV negative.

               -  HLA disparity i.e. 2 Ag mismatch preferred over 3 Ag mismatch; Drβ1 match
                  preferred over class I match; HLA-C matched preferred over A and B match.

               -  killer immunoglobulin-like receptor (KIR) mismatch in GVH direction is preferred
                  for patients with malignant disorders

               -  ABO compatibility

          -  Age ≥ 2 months

        Exclusion Criteria:

          -  Patient with an anticipated life expectancy of < 1 month

          -  Active infectious hepatitis or cytomegalovirus (CMV) disease (organ involvement)

          -  Human immunodeficiency virus (HIV) or Human T-lymphotropic virus (HTLV-I/II) infection

          -  Cardiac ejection fraction < 45%; can be lower if patient is not in clinical cardiac
             failure and a reduced intensity conditioning regimen is used.

          -  Creatinine clearance <60 ml/min/1.72 m2; can be lower if a reduced intensity
             conditioning regimen is used.

          -  Pulmonary diffusion capacity (corrected for hemoglobin), forced expiratory volume in
             one second (FEV1), or forced vital capacity (FVC) <60% of predicted or oxygen
             saturation (O2 sat) > 94% on room air if unable to perform pulmonary function tests
             (PFTs); can be lower if a reduced intensity conditioning regimen is used.

          -  Serum alanine aminotransferase (ALT) > 5 x upper limit of normal (can be up to 10x
             upper limit of normal if a reduced intensity conditioning regimen is used) or
             bilirubin > 2.

          -  Performance score (Lansky/Karnofsky) < 50

          -  Any condition that compromises compliance with the procedures of this protocol, as
             judged by the principal investigator.
      
Maximum Eligible Age:30 Years
Minimum Eligible Age:2 Months
Eligible Gender:All
Healthy Volunteers:No

Details

Phase:
Primary Purpose:Expanded Access
Overall Status:No longer available
Lead Sponsor:Christopher Dvorak

Trial Keywords

  • T cell depleted
  • Matched unrelated donors
  • Haplocompatible donors
  • Graft vs Host Disease
  • Hemoglobinopathies
  • Leukemia
  • Leukemia, Lymphoid
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Leukemia, Myeloid, Acute
  • Leukemia, Myeloid
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive
  • Lymphoma
  • Myelodysplastic Syndromes
  • Preleukemia
  • Osteopetrosis
  • Pancytopenia
  • Immune System Diseases
  • Hematologic Diseases
  • Genetic Diseases, Inborn
  • Neoplasms by Histologic Type
  • Neoplasms
  • Lymphoproliferative Disorders
  • Lymphatic Diseases
  • Immunoproliferative Disorders
  • Myeloproliferative Disorders
  • Bone Marrow Diseases
  • Precancerous Conditions
  • Osteosclerosis
  • Osteochondrodysplasias
  • Bone Diseases, Developmental
  • Bone Diseases
  • Musculoskeletal Diseases
  • Severe acquired and congenital cytopenias
  • White and red blood cell abnormalities

Last Updated

May 27, 2021