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Sickle Cell AnemiaPhase 1/2NCT00977691

Haploidentical PBMC Transplant for Severe Congenital Anemias

A Phase 1/2 study testing PBSC Transplant, Alemtuzumab and Sirolimus in people with Sickle Cell Anemia, run by National Heart, Lung, and Blood Institute (NHLBI) at 1 site in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Background: Bone marrow transplantation (BMT), which involves transplanting a donor's marrow stem cells, is capable of curing some congenital anemias. BMT usually involves high-intensity treatment with chemotherapy and radiation to kill abnormal cells, which affects all systems of the body. Read more about this study

Who is it for?
Ages 2 to 80 years
Conditions the study is for
Sickle Cell Anemia
What is being tested?
PBSC Transplant, Alemtuzumab and Sirolimus
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
23 participants
Where
1 siteUnited States
Study dates
14 Dec 2009to 10 Sep 2026
Phase
Phase 1/2
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 2 to 80 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Recipients (must fulfill one disease category in 5.1.1 and all of 5.1.2)
  • 5.1.1 Disease specific
  • 5.1.1.1 Patients with sickle cell disease (HB SS, SC, or SBeta(0)-thal) at high risk for disease-related morbidity or mortality, defined by having severe end-organ damage (A, B, C, or D) or potentially modifiable complication(s) not ameliorated by hydroxyurea (E):
  • Stroke defined as a clinically significant neurologic event that is accompanied by an infarct on cerebral MRI or cerebral arteriopathy requiring chronic transfusion therapy; OR
  • Sickle cell-related renal insufficiency defined by a creatinine level greater than or equal to 1.5 times the upper limit of normal and kidney biopsy consistent with sickle cell nephropathy OR nephrotic syndrome OR creatinine clearance less than 50mL/min OR requiring peritoneal or hemodialysis; OR
  • Pulmonary hypertension defined as tricuspid regurgitant jet velocity (TRV) of greater than or equal to 2.5 m/s at baseline (without vaso-occlusive crisis); OR
Show all 30Show fewer
  • Sickle hepatopathy defined as EITHER ferritin greater than 1000mcg/L OR direct bilirubin greater than 0.4 mg/dL AND platelet count less than 250,000/microL at baseline (without vaso-occlusive crisis)
  • Any one of the below complications:
  • -Complication: Vaso-occlusive crises;
  • Eligible for hydroxyurea: At least 3 hospital admissions in the last year.
  • Eligible for HSCT: More than 1 hospital admission per year while on maximal tolerated dose of hydroxyurea
  • -Complication: Acute chest syndrome
  • Eligible for hydroxyurea: 2 prior ACS
  • Eligible for HSCT: any ACS while on hydroxyurea
  • hydroxyurea at maximum tolerated dose for at least 6 months
  • 5.1.1.2 Patients with thalassemia who have grade 2 or 3 iron overload, determined by the presence of 2 or more of the following:
  • portal fibrosis by liver biopsy
  • inadequate chelation history (defined as failure to maintain adequate compliance with chelation with deferoxamine initiated within 18 months of the first transfusion and administered subcutaneously for 8-10 hours at least 5 days each week)
  • hepatomegaly of greater than 2cm below the costochondral margin
  • 5.1.2 Non-disease specific:
  • 5.1.2.1 Age greater than or equal to 18 years
  • 5.1.2.2 Haploidentical relative donor available
  • 5.1.2.3 Ability to comprehend and willing to sign an informed consent
  • 5.1.2.4 Negative Beta-HCG
  • Donor
  • 5.3.1 Haploidentical relative donor
  • 5.3.2 Weight greater than or equal to 20 kg (insofar that the weight difference between recipient and donor does not exceed a reasonable likelihood of being able to obtain an adequate cell dose from the donor within two aphereses)
  • 5.3.3 Fit to receive filgrastim (G-CSF) and to give peripheral blood stem cells (blood counts and blood pressure within DTM standards)
  • 5.3.4 No history of congestive heart failure or unstable angina, and no history of stroke)
  • 5.3.4 Ability to comprehend and willing to sign an informed consent; assent obtained from minors

Who cannot join

  • Recipient (any of the following would exclude the subject from participating)
  • 5.2.1 6/6 HLA-matched with or without an ABO minor mismatched sibling donor
  • 5.2.2 ECOG performance status of 3 or more
  • 5.2.3 Evidence of uncontrolled bacterial, viral, or fungal infections (currently taking medication and progression of clinical symptoms) within one month prior to starting the conditioning regimen. Patients with fever or suspected minor infection should await resolution of symptoms before starting the conditioning regimen.
  • 5.2.4 Major anticipated illness or organ failure incompatible with survival from PBSC transplant
  • 5.2.5 Pregnant or lactating
Show all 12Show fewer
  • 5.2.6 Major ABO mismatch
  • Donor: (any of the following would exclude the donor from participating)
  • 5.4.1 Pregnant or lactating
  • 5.4.2 HIV positive
  • 5.4.3 Hemoglobin S greater than or equal to 50 percent, or beta
  • thalassemia intermedia

Trial locations and contacts

1 site in 1 country.

United States1 site

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

    Bethesda, Maryland, 20892

Other trials in United States

About this study

Official title: Nonmyeloablative Haploidentical Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation for Severe Congenital Anemias Including Sickle Cell Disease and Beta-Thalassemia

Background:

Bone marrow transplantation (BMT), which involves transplanting a donor's marrow stem cells, is capable of curing some congenital anemias. BMT usually involves high-intensity treatment with chemotherapy and radiation to kill abnormal cells, which affects all systems of the body.

Read more

People with anemias often have damage to other organs such as the kidneys, which can be further damaged by the chemotherapy. Only approximately 20 percent of patients have a full-matched donor, making treatment for many people with anemias unavailable. However, 90 percent of patients may have a half-matched donor, but using a half-matched donor increases the toxicity of BMT.

Objectives:

To determine if a research BMT with half-matched donor cells, low-intensity radiation, immunosuppressant drugs, and no chemotherapy will be effective in patients with sickle cell disease and Beta-thalassemia.

To determine the effectiveness of cyclophosphamide, an immunosuppressant drug, in preventing rejection of the donor cells.

Eligibility:

Recipients are individuals at least 18 years of age who have been diagnosed with sickle cell disease and Beta-thalassemia, and who have a family member who is a haploidentical (i.e., half match) tissue match.

Donors are healthy individuals between the ages of 2 and 80 who are found to be suitable donors.

Design:

Donors will undergo apheresis, which involves withdrawing blood from one arm vein, passing it through a machine that removes bone marrow stem cells, and returning the remaining blood through the vein in the other arm. Donors will receive a drug that causes the stem cells to be released into the bloodstream prior to the apheresis procedure.

Recipients will undergo routine physical and laboratory examinations, including bone marrow sampling at the beginning of the study. After transplantation, physical and laboratory examinations will occur on a weekly or twice weekly basis at the outpatient clinic. Recipients will be examined every 6 months starting 100 days posttransplant for 5 years.

Recipients will receive low-dose radiation in two treatments 1 and 2 days before the transplant. They will also be given immunosuppressant therapy with alemtuzumab and sirolimus. Another immunosuppressant drug, cyclophosphamide, will be given in the future as needed to subsets of the recipients to prevent rejection of donor cells.

Recipients will receive the donor stem cells through a previously inserted central line. The process takes up to 8 hours.

Recipients will receive blood transfusions as necessary to prevent anemia and bleeding during the posttransplant period. They may also receive intravenous antibiotics to prevent infection.

Read the detailed description

Nonmyeloablative allogeneic peripheral blood stem cell (PBSC) transplants are currently being investigated in phase I/II trials assessing engraftment, efficacy, and toxicity at a number of transplant centers. Our ongoing protocol for patients with severe congenital anemias, particularly sickle cell disease (SCD), and an HLA-matched sibling donor has had excellent preliminary results. None of the patients who engrafted had sickle-related events or any evidence of graft versus host disease (GVHD). There was no significant toxicity associated with the conditioning regimen.

Our main limitation has been a lack of HLA-matched sibling donors in the majority of patients. We performed a study in which patients with severe SCD who lacked a suitable donor underwent a search for a matched unrelated donor or umbilical cord donor. The vast majority of patients were not found to have an appropriate alternative donor. We therefore seek to develop a safe nonmyeloablative regimen to be applied to the haploidentical setting so that family members can serve as donors and greatly expand the donor pool.

In this protocol, we propose PBSC transplantation in patients with SCD and thalassemia, considered at high risk for complications from or ineligible for standard bone marrow transplantation, with allogeneic peripheral blood stem cells from a haploidentical donor using a novel immunosuppressive regimen without myeloablation in an attempt to further decrease the transplant-related morbidity/mortality. The low intensity nonmyeloablative conditioning regimen will consist of a relatively low radiation dose for therapeutic radiation, Alemtuzumab (Campath ), Sirolimus (Rapamune ), and Cyclophosphamide (Cytoxan ) as a strategy to provide adequate immunosuppression to allow sufficient engraftment for clinical remission with a lower risk of GVHD development. T-cell replete, donor-derived, granulocyte colony-stimulating factor (G-CSF)-mobilized PBSC will be used to establish hematopoietic and lymphoid reconstitution.

The primary endpoint of this study is the percentage of patients who have sustained donor type hemoglobin without significant GVHD for patients with SCD, or who are transfusion-independent and without significant GVHD for patients with thalassemia. Other endpoints include degree of donor-host chimerism necessary for long term graft survival and disease amelioration, incidence of acute and chronic GVHD, incidence of graft rejection, transplant-related morbidity, as well as disease-free and overall survival.

Being tested
PBSC Transplant, Alemtuzumab, Sirolimus, Cyclophosphamide, Low Dose Irradiation
Keywords
Sickle Cell Anemia, Peripheral Blood Stem Cell Transplantation, Graft-Versus-Host Disease, Sirolimus (Rapamune ), Alemtuzumab (Campath ), Thalassemia, Sickle Cell Disease
Medical subject headings
Anemia, Sickle Cell, Graft vs Host Disease, Thalassemia

What participants receive

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

  • PBSC TransplantProcedure or surgery

    PBSC transplant

  • AlemtuzumabDrug

    Also called Campath

    alemtuzumab

  • SirolimusDrug

    Also called Rapamune

    sirolimus

  • CyclophosphamideDrug

    Also called Cytoxan

    cyclophosphamide

  • Low Dose IrradiationProcedure or surgery

    low dose irradiation

Study groups in NCT00977691
Study groupRoleWhat they receive
Cohort 1ExperimentalPBSC transplant with no post-transplant cyclophosphamide (PT-Cy)
Receives: Procedure: PBSC Transplant; Drug: Alemtuzumab; Drug: Sirolimus; Procedure: Low Dose Irradiation
Cohort 2ExperimentalPBSC transplant with 50 mg/kg post-transplant cyclophosphamide (PT-Cy)
Receives: Procedure: PBSC Transplant; Drug: Alemtuzumab; Drug: Sirolimus; Drug: Cyclophosphamide; Procedure: Low Dose Irradiation
Cohort 3ExperimentalPBSC transplant with 100 mg/kg post-transplant cyclophosphamide (PT-Cy)
Receives: Procedure: PBSC Transplant; Drug: Alemtuzumab; Drug: Sirolimus; Drug: Cyclophosphamide; Procedure: Low Dose Irradiation

What is being measured

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

  1. Patients With Donor Type Hemoglobin

    Percentage of patients post transplant with sustained donor type hemoglobin on hemoglobin electrophoresis

    Measured: 1 year

Secondary outcomes (10)

  1. Chimeric Value That is Required to Maintain Graft Survival and Hematologic Normalcy.

    Define the level of chimerism required to maintain graft survival and hematologic normalcy. Hematologic normalcy may be defined as: being free from sickle cell disease.

    The chimeric status of patients will be measured on days +14 (or when subject starts to engraft), +30, +60 and +100, and periodically after day +100, by microsatellite analysis of the peripheral blood.

    Engraftment of donor cells was assessed with the use of methods that detect informative polymorphisms in regions known to contain short tandem repeats. Peripheral-blood CD3+ T cells and CD14+CD15+ myeloid cells were selected for analysis with the use of immunomagnetic beads (Dynal).

    Measured: Up to Year 5

  2. Number of Participants Who Developed Acute GVHD Grades I, II, III, IV

    Number of participants who developed Acute Graft vs Host Disease (GVHD) Grades I, II, III, IV as defined by CIMBTR criteria for Organ Stages of Acute GVHD.

    Grades are defined as:

    Grade I: Skin = Maculopapular rash< 25% of body surface area (BSA); Liver = Total Bilirubin 2-3 mg/dL; Lower GI = stool output/day is 500-999 mL/day.

    Grade II: Skin = rash on 25-50 percent body surface area; Liver = Total Bilirubin 3.1-6.0 mg/dL; Lower GI = Diarrhea 1001-1500 mL/day.

    Grade III: Skin = Rash on >50% of body surface; Liver = Total Bilirubin 6.1 - 15.0 mg/dL; Lower GI = Diarrhea > 1500 mL/day.

    Grade IV: Skin = Generalized erythroderma plus bullous formation; Liver = Total Bilirubin >15 mg/dL; Lower GI = Severe abdominal pain with or without ileus.

    Grade I GVHD is characterized as mild disease, grade II GVHD as moderate, grade III as severe, and grade IV life-threatening.

    Measured: Day100

  3. Number of Participants Who Developed Limited Chronic GVHD

    Number of incidences of participants who developed Limited Chronic Graft vs Host Disease (GVHD).

    Limited disease is characterized by localized skin involvement and/or evidence of hepatic dysfunction.

    Limited disease is associated with a favorable outcome without systemic therapy, while extensive disease patients have an unfavorable outcome.

    Measured: Year 5

  4. Number of Participants Who Develop Extensive GVHD

    Number of participants with extensive, Chronic Graft vs Host Disease (GVHD). Extensive chronic GVHD is defined as GVHD occurring after day 100 that did not meet the definition of limited chronic GVHD.

    Extensive disease presents either with generalized skin involvement, or with localized skin involvement or hepatic dysfunction plus at least one of the following:

    • Liver histology showing chronic progressive hepatitis, bridging necrosis, or cirrhosis
    • Involvement of the eye (Schirmer's test with less than 5 mm wetting) (see "Diagnosis and classification of Sjögren's syndrome")
    • Involvement of minor salivary glands or oral mucosa (as demonstrated on labial or mucosal biopsy specimen)
    • Involvement of any other target organ

    Measured: Year 5

  5. Number of Participants With Disease-free Survival

    Number of participants with disease-free survival, as defined by: alive and free acute complications related to sickle cell disease.

    Measured: Year 5

  6. Number of Participants Overall Survival

    Number of participants overall survival by year 5

    Measured: Up to Year 5

  7. Number of Participants With Graft Failure

    Number of participants with graft failure by year 5. Graft failure is defined by return of sickle cell disease.

    Measured: Up to Year 5

  8. Number of Participants That Experienced a Transplant-related Mortality

    Number of participants that experienced a transplant related mortality, as defined as death from causes other than relapse (GVHD, toxicity, infection, other and unknown causes).

    Measured: Year 1

  9. Number of Stem Cell Transplant Participants That Experienced Rejection at Each Dose of Post-transplant Cyclophosphamide

    Number of stem cell transplant participants that experienced rejection at each dose of post-transplant cyclophosphamide. Determine whether post-transplant cyclophosphamide is required and will reduce the incidence and severity of regimen failure.

    Measured: Year 5

  10. Participants Who Engrafted or Rejected and Type of Haploidentical Donors

    Determine whether specific haploidentical donors (i.e. parent versus sibling versus child) will decrease the incidence of regimen failure

    Measured: Up to Year 5

Timeline

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

  1. First posted16 Sep 2009 (estimated)
  2. Study start14 Dec 2009
  3. Primary completion1 Aug 2018
  4. Study completion10 Sep 2026 (estimated)

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 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Sequential
Masking
None (open label)
Enrolment
23 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00977691
Sponsor's protocol ID
090225
Other IDs
09-H-0225
Status last verified
Apr 2026
First submitted
15 Sep 2009
Last updated
23 Apr 2026
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Fitzhugh CD, Hsieh MM, Taylor T, Coles W, Roskom K, Wilson D, Wright E, Jeffries N, Gamper CJ, Powell J, Luznik L, Tisdale JF. Cyclophosphamide improves engraftment in patients with SCD and severe organ damage who undergo haploidentical PBSCT. Blood Adv. 2017 Apr 19;1(11):652-661. doi: 10.1182/bloodadvances.2016002972. eCollection 2017 Apr 25.

    PubMed 29296707

  • Kern KC, Inam Z, Hsieh MM, Tisdale JF, Fitzhugh CD, Limerick EM, Gebremeskel ASK, White T, Jordan LC, Lynch JK. Hematopoietic Stem Cell Transplant and Brain Volume Changes in Adults With Sickle Cell Disease. Neurology. 2026 Jun 9;106(11):e218050. doi: 10.1212/WNL.0000000000218050. Epub 2026 May 14.

    PubMed 42133908

  • Limerick E, Hsieh M, Queen J, Grecco ML, Varga J, Brooks J, Coles W, Jeffries N, Fitzhugh CD. Nonmyeloablative pentostatin-cyclophosphamide preconditioning improves rates of engraftment in adults undergoing haploidentical HCT for sickle cell disease. PLoS One. 2026 Mar 23;21(3):e0332282. doi: 10.1371/journal.pone.0332282. eCollection 2026.

    PubMed 41871072

  • Leonard A, Furstenau D, Abraham A, Darbari DS, Nickel RS, Limerick E, Fitzhugh C, Hsieh M, Tisdale JF. Reduction in vaso-occlusive events following stem cell transplantation in patients with sickle cell disease. Blood Adv. 2023 Jan 24;7(2):227-234. doi: 10.1182/bloodadvances.2022008137.

    PubMed 36240296

  • Bhat DK, Olkhanud PB, Gangaplara A, Seifuddin F, Pirooznia M, Biancotto A, Fantoni G, Pittman C, Francis B, Dagur PK, Saxena A, McCoy JP, Pfeiffer RM, Fitzhugh CD. Early Myeloid Derived Suppressor Cells (eMDSCs) Are Associated With High Donor Myeloid Chimerism Following Haploidentical HSCT for Sickle Cell Disease. Front Immunol. 2021 Nov 30;12:757279. doi: 10.3389/fimmu.2021.757279. eCollection 2021.

    PubMed 34917079

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing PBSC Transplant, Alemtuzumab and Sirolimus in people with Sickle Cell Anemia, run by National Heart, Lung, and Blood Institute (NHLBI) 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 30 inclusion and 12 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: under way, not looking for participants, as of the sponsor's last update on 23 Apr 2026. 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 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

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

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 14 Oct 2019). 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?

Patients With Donor Type Hemoglobin (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00977691, which also lists 5 linked publications.

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 23 Apr 2026.

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