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Severe Aplastic AnemiaPhase 2NCT06412497

MT2023-20: Hematopoietic Cell Transplant With Reduced Intensity Conditioning and Post-transplant Cyclophosphamide for Severe Aplastic Anemia and Other Forms of Acquired Bone Marrow Failure.

A Phase 2 study testing Rituximab, Rabbit ATG and Cyclophosphamide in people with Severe Aplastic Anemia and Acquired Amegakaryocytic Thrombocytopenia, run by Masonic Cancer Center, University of Minnesota at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

A phase II trial of a reduced intensity conditioned (RIC) allogeneic hematopoietic cell transplant (HCT) with post-transplant cyclophosphamide (PTCy) for idiopathic severe aplastic anemia (SAA), paroxysmal nocturnal hemoglobinuria (PNH), acquired pure red cell aplasia (aPRCA), or acquired amegakaryocytic… Read more about this study

Who is it for?
Ages 0 to 75 years
What is being tested?
Rituximab, Rabbit ATG and Cyclophosphamide
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteUnited States
Study dates
5 Jun 2024to 1 May 2036
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 0 to 75 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Idiopathic Severe Aplastic Anemia (SAA), characterized by one of the following:
  • Refractory cytopenia(s), with 1+ of the following:
  • Platelets <20,000/uL or transfusion dependent
  • Absolute neutrophil count <500/uL without hematopoietic growth factor support
  • Absolute reticulocyte count <60,000/uL AND bone marrow cellularity <50% (with < 30% residual hematopoietic cells)
  • Early myelodysplastic features (bone marrow (BM) blasts <5%), without history of MDS/AML pre-treatment.
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  • Idiopathic SAA with post-HCT graft failure (blood/marrow donor chimerism <5%) requiring a 2nd allogeneic HCT
  • Paroxysmal Nocturnal Hemoglobinuria (PNH), including AA-PNH overlap syndrome, acquired pure red cell aplasia (aPRCA), or acquired amegakaryocytic thrombocytopenia (aAT), characterized by one of the following:
  • Refractory cytopenia(s), with 1+ of the following:
  • Platelets <20,000/uL or transfusion dependent
  • Absolute neutrophil count <500/uL without hematopoietic growth factor support
  • Absolute reticulocyte count <60,000/uL or red cell transfusion dependent AND Bone marrow evidence of 1 to 3-lineage aplasia OR peripheral blood PNH clone >/= 10%
  • Early myelodysplastic features (bone marrow (BM) blasts <5%) without history of MDS/AML pre-treatment.
  • Idiopathic PNH, aPRCA, or aAT with post-HCT graft failure (blood/marrow donor chimerism <5%) requiring a 2nd allogeneic HCT
  • Adequate organ function within 30 days of conditioning regimen

Who cannot join

  • Pregnant, breastfeeding or intending to become pregnant during the study. Persons of childbearing potential must have a negative pregnancy test (serum or urine) within 7 days of the start of treatment
  • Uncontrolled infection
  • Evidence of moderate or severe portal fibrosis or cirrhosis on biopsy
  • Known allergy to any of the study components
  • Prior radiation therapy deemed excessive by radiation therapist for proposed low dose TBI exposure on this protocol
  • Diagnosis of an inherited bone marrow failure disorder such as Fanconi anemia, Telomere biology disorder, or Schwachman-Diamond syndrome, unless reviewed by the principal investigator and deemed appropriate for this approach (e.g. GATA2 deficiency)
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  • Advanced myelodysplastic syndrome (MDS; BM blasts >5%) or acute myeloid leukemia
  • Psychiatric illness/social situations that, in the judgement of the enrolling Investigator, would limit compliance with study requirements
  • Other illness or a medical issue that, in the judgement of the enrolling Investigator, would exclude the patient from participating in this study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Meera Srikanthan, MD contact

(612) 626-2961

srika038@umn.edu

United States1 site, 1 recruiting
  • University of Minnesota Masonic Cancer Center

    Minneapolis, Minnesota, 55455

    Meera Srikanthan, MD, srika038@umn.edu

    Recruiting

Other trials in United States

About this study

A phase II trial of a reduced intensity conditioned (RIC) allogeneic hematopoietic cell transplant (HCT) with post-transplant cyclophosphamide (PTCy) for idiopathic severe aplastic anemia (SAA), paroxysmal nocturnal hemoglobinuria (PNH), acquired pure red cell aplasia (aPRCA), or acquired amegakaryocytic thrombocytopenia (aAT) utilizing population pharmacokinetic (popPK)-guided individual dosing of pre-transplant conditioning and differential dosing of low dose total body irradiation based on age, presence of myelodysplasia and/or clonal hematopoiesis.

Keywords
HCT, RIC, SAA, PTCy, aAT, aPRCA
Medical subject headings
Anemia, Aplastic, Acquired amegakaryocytic thrombocytopenia, Hemoglobinuria, Paroxysmal

What participants receive

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

  • RituximabDrug

    For patients with EBV IgG seropositivity or EBV PCR positivity on pre-transplant evaluations, Rituximab 375 mg/m2 is given IV once on day -14 (+/-2 day) in the outpatient setting. Pre-medicate 30 minutes prior to rituximab with methylprednisolone (1 mg/kg) IV, acetaminophen 15 mg/kg (maximum 650mg) IV or PO and diphenhydramine 1 mg/kg (maximum 50mg) IV or PO.

  • Rabbit ATGDrug

    Also called Thymoglobulin

    Rabbit ATG will be administered at doses and days indicated above, infused through a 0.22 micrometer filter over 4-6 hours. Pre-medicate 30 minutes prior to ATG infusion with methylprednisolone 1 mg/kg IV, (max dose = 125 mg), acetaminophen 15 mg/kg dose (max dose = 650 mg) enterally and diphenhydramine 1 mg/kg/dose (max dose = 50 mg) enterally or IV.

  • CyclophosphamideDrug

    Cyclophosphamide 14.5 mg/kg is be given as a 2-hour infusion on day -6. If the patient is obese (actual body weight (ABW) >/= 125% of the ideal body weight (IBW)), cyclophosphamide should be dosed using the adjusted body weight (AdjBW): 0.5(ABW-IBW) + IBW. Uroprotection with MESNA (14.5 mg/kg/day) in IV continuous infusion will be provided per institutional guidelines. Hyperhydration is not required for 14.5 mg/kg cyclophosphamide doses.

    Cyclophosphamide will be administered at 50 mg/kg using ABW over 2 hours on days +3 and +4. If the patient is obese (ABW >/= 125% of the ideal body weight (IBW)), cyclophosphamide should be dosed using the adjusted body weight (AdjBW): 0.5(ABW-IBW) + IBW. Uroprotection with MESNA (50 mg/kg/day) in IV continuous infusion as well as hyperhydration will be provided per institutional guidelines.

  • FludarabineDrug

    For all patients, fludarabine dosing will be model-based using Bayesian methodology IV every 24 hours on days -6 to -3 with a cumulative area under the curve (cAUC) of 20 mg*hr/L.

  • Total Body IrradiationRadiation

    Also called TBI

    For patients age >/= 25 years, with myelodysplasia, or clonal hematopoiesis, total body irradiation will be 4 Gy, provided in two fractions on day -1. For all other patients, total body irradiation will be 2 Gy provided in a single fraction on day -1.

    Each dose of 2 Gy will be given at a dose rate between 1 and 1.9 Gy/minute prescribed to the midplane of the patient at the level of the umbilicus.

  • Cell InfusionBiological

    On day 0 the cells will be infused per cell source specific institutional guidelines.

  • Post-Transplant G-CSFDrug

    Also called Filgrastim

    Beginning on day +5, patients will receive G-CSF SQ or IV 5 micrograms/kg once daily until post-nadir ANC > 1500/μL for 3 consecutive days or >3000/μL for 1 day.

  • TacrolimusDrug

    Tacrolimus will begin on day +5 at an initial dose of 0.03 mg/kg/day IV via continuous infusion. Goal trough levels will be 10-15 ug/mL until day +14 posttransplant, then decreased to a goal of 5-10 ng/mL thereafter. In the absence of GvHD, tacrolimus will discontinue at day +180 without a taper.

  • Mycophenolate MofetilDrug

    Also called MMF

    Mycophenolate mofetil (MMF) therapy will begin on day +5. For pediatric service patients dosing of MMF will be 15 mg/kg/dose (max = 1000 mg) three times daily. For adult service patients dosing of MMF will be 15 mg/kg/dose (max = 1500 mg) twice daily. The same dosage is used orally or intravenously. Consider dose modification and/or pharmacokinetic measurements if renal and/or hepatic impairment (GFR<25 mL/minute corrected). Stop MMF at Day +35 or 7 days after engraftment achieved (ANC>500 x 106 neutrophils/L x 3 days) if later than day +35. If sufficient acute GvHD is observed to require systemic therapy, MMF should be continued for 7 days after initiation of systemic therapy. Afterward, use of MMF is at the discretion of the treating physician.

Study groups in NCT06412497
Study groupRoleWhat they receive
Arm A: No clonal hematopoiesisExperimentalParticipants 25 years of age and younger with no clonal hematopoiesis. Active study treatment includes the conditioning regimen followed by the stem cell infusion and GvHD prophylaxis through day +180. Supportive care and follow up activities continue through two years post HCT.
Receives: Drug: Rituximab; Drug: Rabbit ATG; Drug: Cyclophosphamide; Drug: Fludarabine; Radiation: Total Body Irradiation; Biological: Cell Infusion; Drug: Post-Transplant G-CSF; Drug: Tacrolimus; Drug: Mycophenolate Mofetil
Arm B: Clonal hematopoiesisExperimentalParticipants 25-75 years old and/or with clonal hematopoiesis. Active study treatment includes the conditioning regimen followed by the stem cell infusion and GvHD prophylaxis through day +180. Supportive care and follow up activities continue through two years post HCT.
Receives: Drug: Rituximab; Drug: Rabbit ATG; Drug: Cyclophosphamide; Drug: Fludarabine; Radiation: Total Body Irradiation; Biological: Cell Infusion; Drug: Post-Transplant G-CSF; Drug: Tacrolimus; Drug: Mycophenolate Mofetil

What is being measured

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

  1. Incidence of grade 3-4 acute GvHD

    Incidence of grade 3-4 acute graft-versus host disease (GvHD) at 1 year post HCT.

    Measured: 1 year post HCT

  2. Incidence of chronic GvHD-free, failure-free survival (GFFS)

    Incidence of chronic GvHD-free, failure-free survival (GFFS) 1 year post HCT

    Measured: 1 year post HCT

  3. Incidence of chronic GvHD-free survival

    Incidence of chronic GvHD-free survival at 1 year post HCT

    Measured: 1 year post HCT

Secondary outcomes (7)
  1. Incidence of failure-free survival (GFFS)

    Incidence of chronic GvHD-free, failure-free survival (GFFS) 2 years post HC

    Measured: 2 years post HCT

  2. Incidence of neutrophil recovery

    Incidence of neutrophil recovery at day 42 post HCT

    Measured: Day 42 post HCT

  3. Incidence of platelet recovery

    Incidence of platelet recovery at 6 months post HCT

    Measured: 6 months post HCT

  4. Incidence of grade 3-4 acute GvHD

    Incidence of grade 3-4 acute GvHD at 100 days post HCT

    Measured: 100 days post HCT

  5. Incidence of any chronic GvHD

    Incidence of any chronic GvHD at 1 year post HCT

    Measured: 1 year post HCT

  6. Overall survival

    Overall survival at 1 and 2 years

    Measured: 1 and 2 years post HCT

  7. Incidence of chronic GvHD-free survival

    Incidence of chronic GvHD-free survival at 2 years post HCT

    Measured: 2 years post HCT

Timeline

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

  1. First posted14 May 2024
  2. Study start5 Jun 2024
  3. Primary completion1 May 2035 (estimated)
  4. Study completion1 May 2036 (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 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06412497
Sponsor's protocol ID
2023LS101
Status last verified
Jun 2026
First submitted
9 May 2024
Last updated
3 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Rituximab, Rabbit ATG and Cyclophosphamide in people with Severe Aplastic Anemia and Acquired Amegakaryocytic Thrombocytopenia, 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 15 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: looking for participants now, as of the sponsor's last update on 3 Jun 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 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.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Meera Srikanthan, MD ((612) 626-2961, srika038@umn.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of grade 3-4 acute GvHD (time frame: 1 year post HCT). The study lists 3 primary outcomes in all. 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 3 Jun 2026.

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