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Sickle Cell DiseasePhase 2/3NCT00176852

Stem Cell Transplant for Hemoglobinopathy

A Phase 2/3 study testing Busulfan, Fludarabine, ATG, TLI, Busulfan, Cyclophosphamide, ATG, GCSF and Campath, Fludarabine, Cyclophosphamide in people with Sickle Cell Disease and Thalassemia, run by Masonic Cancer Center, University of Minnesota at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study tests the clinical outcomes of one of two preparative regimens (determined by available donor source) in patients with non-malignant hemoglobinopathies. The researchers hypothesize that these regimens will have a positive effect on post transplant engraftment and the incidence of graft-versus-host-disease. Read more about this study

Who is it for?
Ages Up to 50 years
What is being tested?
Busulfan, Fludarabine, ATG, TLI, Busulfan, Cyclophosphamide, ATG, GCSF and Campath, Fludarabine, Cyclophosphamide
Could I receive a placebo?
No, everyone receives an active treatment
How many people
22 participants
Where
1 siteUnited States
Study dates
Jun 2002to Jan 2020
Phase
Phase 2/3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 50 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Patients with Sickle Cell Disease/Thalassemia (SCD/THAL) 0-50 years of age with an acceptable stem cell donor and disease characteristic defined by the following:
  • Stroke, central nervous system (CNS) hemorrhage or a neurologic event lasting longer than 24 hours, or abnormal cerebral magnetic resonance imaging (MRI) or cerebral arteriogram or MRI angiographic study and impaired neuropsychological testing
  • Acute chest syndrome with a history of recurrent hospitalizations or exchange transfusions
  • Recurrent vaso-occlusive pain 3 or more episodes per year for 3 years or more years or recurrent priapism,
  • Impaired neuropsychological function and abnormal cerebral MRI scan
  • Stage I or II sickle lung disease,
Show all 20Show fewer
  • Sickle nephropathy (moderate or severe proteinuria or a glomerular filtration rate [GFR] 30-50% of the predicted normal value)
  • Bilateral proliferative retinopathy and major visual impairment in at least one eye
  • Osteonecrosis of multiple joints with documented destructive changes
  • Requirement for chronic transfusions but with red blood cell (RBC) alloimmunization >2 antibodies during long term transfusion therapy
  • Patients with transfusion dependent alpha- or beta-thalassemia 0-35 years of age with an acceptable stem cell donor as defined in the criteria in section above.
  • Patients with other non-malignant hematologic disorders that are transfusion-dependent or involve other potentially life-threatening cytopenias (including but not limited to Severe Congenital Neutropenia, Diamond-Blackfan Anemia and Shwachman-Diamond Syndrome) who are 0-35 years of age with an acceptable stem cell donor
  • Second Transplants
  • Patients with sickle cell disease or thalassemia who have failed to engraft or have autologous recovery after a myeloablative SCT regimen or non-myeloablative regimen are eligible for this protocol.
  • Regimen A2 will be utilized for patients with sickle cell disease or thalassemia who do not have an HLA-identical sibling donor or for any patient who has pre-existing organ dysfunction making them ineligible for a myeloablative preparative regimen.
  • Regimen B will be utilized for patients with sickle cell disease or thalassemia who have an HLA-identical sibling donor.
  • Patients must meet above criteria.
  • If the patient has received prior radiation therapy, eligibility to receive additional radiation therapy must be determined by Dr. Dusenbery
  • If first transplant was a non-myeloablative regimen, the second transplant can occur at any time
  • If the first transplant was a myeloablative regimen, then the second transplant must be > 6 months from the first transplant

Who cannot join

  • Patients with one or more of the following:
  • Karnofsky or Lansky performance score <70
  • Acute hepatitis or evidence of moderate or severe portal fibrosis or cirrhosis on biopsy
  • Stage III-IV lung disease
  • GFR<30% predicted
  • Pregnant or lactating females
Show all 9Show fewer
  • Active serious infection whereby patient has been on intravenous antibiotics for one week prior to study entry. Any patient with AIDS or ARC or HIV seropositivity
  • Psychologically incapable of undergoing bone marrow transplant (BMT) with associated strict isolation or documented history of medical non-compliance
  • Patients not able to receive total lymphocytic irradiation (TLI) due to prior radiation therapy

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Masonic Cancer Center, University of Minnesota

    Minneapolis, Minnesota, 55455

Other trials in United States

About this study

Official title: Allogeneic Hematopoietic Stem Cell Transplant for Patients With High Risk Hemoglobinopathy Using a Preparative Regimen to Achieve Stable Mixed Chimerism

This study tests the clinical outcomes of one of two preparative regimens (determined by available donor source) in patients with non-malignant hemoglobinopathies. The researchers hypothesize that these regimens will have a positive effect on post transplant engraftment and the incidence of graft-versus-host-disease.

Regimen A2 has replaced Regimen A in this study. Two patients were treated on Regimen A but did not have evidence of initial engraftment thus triggering the stopping rule for that arm of this study.

Read the detailed description

Prior to transplantation, subjects will receive either:

Cyclophosphamide, Fludarabine, Campath, Total body irradiation (TBI)

Or

Busulfan, Cyclophosphamide, antithymocyte globulin (ATG), granulocyte colony-stimulating factor (GSCF)

These drugs (and the radiation) are being given to help the new stem cells take and grow. On the day of transplantation, subjects will receive stem cells transfused via intravenous (IV) catheter.

After stem cell transplantation, subjects will be given cyclosporine-A and mycophenolate (MMF)/or Methylprednisone/or Methotrexate to reduce the risk of graft-versus-host disease, the complication that occurs when the donor's stem cells react against the patient.

Being tested
Busulfan, Fludarabine, ATG, TLI, Busulfan, Cyclophosphamide, ATG, GCSF, Campath, Fludarabine, Cyclophosphamide, Total Body Irradiation, Stem cell infusion
Keywords
high risk hemoglobinopathy, stem cell transplant, donor lymphocyte infusion, transfusion dependent, stem cell donor, cord blood, marrow, transfusion dependent non-malignant hematologic disorders
Medical subject headings
Anemia, Sickle Cell, Thalassemia, Neutropenia, Severe Congenital, Autosomal Recessive 3, Anemia, Diamond-Blackfan, Shwachman-Diamond Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Busulfan, Fludarabine, ATG, TLIDrug

    Also called Busulfex, Fludara, ATG, Total lymphoid Irradiation

    Busulfan 0.8 mg/kg/dose intravenous (IV) Days -8 and -7 Fludarabine 35 mg/m2 IV Days -6 through -2 Antithymocyte globulin (ATG) 30 mg/kg IV Days -2 and -1 Total lymphoid radiation 300 cGy

  • Busulfan, Cyclophosphamide, ATG, GCSFDrug

    Also called Busulfex, Cytoxan, antithymocyte globulin, granulocyte colony-stimulating factor

    Busulfan 0.8 mg/kg/dose intravenous (IV) Days -9 through -6 Cyclophosphamide 50 mg/kg IV Days -5 through -2 ATG 30 mg/kg IV Day -1 GCSF 5 mcg/kg/day IV until ANC >2500 x 2 days.

  • Campath, Fludarabine, CyclophosphamideDrug

    Also called Fludara, alemtuzumab, Cytoxan

    Receives Campath-1H 0.2 mg/kg Days -10 through -6, Fludarabine 35 mg/m2 intravenous (IV) Days -6 through -2, total body irradiation (TBI) 300 cGy Day -1.

  • Total Body IrradiationRadiation

    Also called TBI

    300 cGY Day -1

  • Stem cell infusionProcedure or surgery

    Also called bone marrow transplant

    Given Day 0

Study groups in NCT00176852
Study groupRoleWhat they receive
RIC Bu/Flu (A) (discontinued)OtherFull Preparative Regimen for subjects with matched donors using Busulfan on Day -8 and -7, Fludarabine on Day -6 through -2, antithymocyte globulin (ATG) on Day -2 through -1, total lymphoid radiation (TLI) on Day -1, stem cell infusion on Day 0.
Receives: Drug: Busulfan, Fludarabine, ATG, TLI
MA Bu/Cy (B)ExperimentalMyeloablative Preparative Regimen for subjects with HLA identical sibling donors consists of Busulfan on day -9 through -6, Cyclophosphamide on day -5 through -2, ATG on day -3 through -1, stem cell infusion on Day 0 and Granulocyte Colony Stimulating Factor on day -3 until ANC >2500 x 2 days.
Receives: Drug: Busulfan, Cyclophosphamide, ATG, GCSF; Radiation: Total Body Irradiation; Procedure: Stem cell infusion
RIC Cy/Flu/TBI (A2)ExperimentalPatients with sickle cell disease or thalassemia who do not have an HLA-identical sibling donor or who has pre-existing organ dysfunction making myeloablative condition ineligible will receive Campath on day -10 through -6, Cyclophosphamide on day -7, Fludarabine on day -6 through -2, total body irradiation (TBI) on day -1, stem cell infusion on Day 0.
Receives: Drug: Campath, Fludarabine, Cyclophosphamide; Radiation: Total Body Irradiation; Procedure: Stem cell infusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Patients Who Experienced Grade 3-5 Treatment Related Toxicity

    In general, grade 3 equates to moderate, grade 4 to severe and grade 5 to death.

    Measured: 1 year

Secondary outcomes (16)
  1. The Incidence of Chimerism at 100 Days

    The number of patients whose blood and/or bone marrow contains > 10% donor cells.

    Measured: 100 days

  2. The Incidence of Chimerism at 6 Months

    The number of patients whose blood and/or bone marrow contains > 10% donor cells.

    Measured: 6 months

  3. The Incidence of Chimerism at 1 Year

    The number of patients whose blood and/or bone marrow contains > 10% donor cells.

    Measured: 1 year

  4. The Incidence of Grade 2-4 Acute Graft Versus Host Disease (Acute GVHD)

    The number of patients who experienced grades 2-4 Acute GVHD. Acute GVHD is when the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body. Grades 2-4 equate to mild to severe disease. Symptoms typically appear within weeks after transplant.

    Measured: 100 days

  5. The Incidence of Grade 3-4 Acute Graft Versus Host Disease (Acute GVHD)

    The number of patients who experienced grades 3-4 Acute GVHD. Acute GVHD is when the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body. IGrades 3-4 equate to moderate to severe disease. Symptoms typically appear within weeks after transplant.

    Measured: 100 days

  6. The Incidence of Chronic Graft Versus Host Disease (Chronic GVHD)

    The number of patients who experienced Chronic GVHD. Chronic GVHD is when the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body. Chronic GVHD can appear at any time after allogeneic transplant or several years after transplant.

    Measured: 6 months

  7. The Incidence of Chronic Graft Versus Host Disease (Chronic GVHD)

    The number of patients who experienced Chronic GVHD. Chronic GVHD is when the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body. Chronic GVHD can appear at any time after allogeneic transplant or several years after transplant.

    Measured: 1 year

  8. Change in the Patient's Quality of Life as Compared to the Pre-Transplant Assessment

    The measure for quality of life used in this study is the Karnofsky Performance Score. The Karnofsky Performance Score runs from 100 to 0, where 100 is "perfect" health and 0 is death.

    Measured: pre-transplant

  9. Change in the Patient's Quality of Life as Compared to the Pre-Transplant Assessment

    The measure for quality of life used in this study is the Karnofsky Performance Score. The Karnofsky Performance Score runs from 100 to 0, where 100 is "perfect" health and 0 is death.

    Measured: 1 year

  10. Change in the Patient's Quality of Life as Compared to the Pre-Transplant Assessment

    The measure for quality of life used in this study is the Karnofsky Performance Score. The Karnofsky Performance Score runs from 100 to 0, where 100 is "perfect" health and 0 is death.

    Measured: 2 years

  11. Determine Physical Characteristics and Biologic Effects of Mixed Populations of Donor and Host Red Blood Cells

    Measured: During study

  12. Determine the Concentration of Campath in the Serum

    Measured: Day 0

  13. Overall Survival

    Number of patients alive 100 days after transplant.

    Measured: 100 days

  14. Overall Survival

    Number of patients alive 1 year after transplant.

    Measured: 1 year

  15. Disease Free Survival

    Number of patients alive without disease 100 days after transplant.

    Measured: 100 days

  16. Disease Free Survival

    Number of patients alive without disease 1 year after transplant.

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Sep 2005 (estimated)
  2. Study startJun 2002
  3. Primary completionMar 2014
  4. Study completionJan 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
22 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00176852
Sponsor's protocol ID
MT2002-07
Other IDs
0206M26241
Status last verified
Feb 2020
First submitted
12 Sep 2005
Last updated
27 Feb 2020
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Busulfan, Fludarabine, ATG, TLI, Busulfan, Cyclophosphamide, ATG, GCSF and Campath, Fludarabine, Cyclophosphamide in people with Sickle Cell Disease and Thalassemia, run by Masonic Cancer Center, University of Minnesota at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 20 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 9 May 2017). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Patients Who Experienced Grade 3-5 Treatment Related Toxicity (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Feb 2020.

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