A Prospective Multicenter Trial Comparing Allogeneic Matched Related Haematopoietic Stem Cell Transplantation After a Reduced Intensity Conditioning Regimen, With Standard of Care in Adolescents and Adults With Severe Sickle Cell Disease

Study point of contact

Sylvie Chevret
+33142499742
[email protected]
Nathalie Dhedin
+33142385127
[email protected]

Age

15 to 45 Years

Phase

Phase 3

Study type

Interventional

Gender

All

Interventions

Procedure

Other

Compensation


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About the study

Although the survival of children with sickle cell disease (SCD) has dramatically improved
over the last decades in the US and Europe, mortality remains high in adults. Moreover, many
children and most adults develop a chronic debilitating condition due to organ damage.
Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the unique curative
approach; it allows the cure of more than 95% of children transplanted from a matched related
donor (MRD) after a myeloablative conditioning regimen.To date, few studies have addressed
the role of HSCT in SCD adults, due to the risk of graft versus host disease (GVHD) and to
the toxicity expected in older patients with a higher risk of organ damage. The development
of safe, non-myeloablative conditioning regimens that allow stable mixed chimerism and avoid
GVHD appears as an attractive option for HSCT to cure adults with severe SCD. The
investigators design a prospective multicenter trial targeting patients over 15 years with
severe SCD, and compare non-myeloablative transplant (when a matched related donor (MRD) is
identified) versus no HSCT (for patients lacking MRD). The main objective is to assess the
benefit of HSCT on the 2-year event free survival compared to standard care. The primary
endpoint is the 2-year event free survival.

study participation requirements

– SCD patients (SS/Sβ0)

– Aged :15 to 45 years

– With at least one non-SCD sibling > 18 years from the same parental couple

– Who presented at least one of the following criteria:

– 3 VOC requiring hospitalization over one year within the past 2 years and at least a
past history of an ACS

– At least 1 ACS within the past 2 years requiring transfusions

– History of ischemic stroke or cerebral/cervical arterial stenosis > 50%

– Pulmonary hypertension defined by mean pulmonary artery pressure ≥ 25 mmHg at rest,
determined by right heart catherization

– Requiring treatment with Hydroxyurea or chronic transfusion, or already treated by
Hydroxyurea or transfusion program (TP) at inclusion.

– Patients already receiving chronic transfusions for VOC or ACS not responding to
hydroxyurea, will be eligible, provided at least 3 VOC requiring hospitalization/year
within the 2 years before initiation of chronic transfusions, and at least past
history of an ACS.

– Contraception during all the study period by sirolimus for women of child bearing
potential

– Signed informed consent

– Amenable to HLA typing, HSCT if an HLA-identical sibling is available.

– Patients affiliated to the French health care insurance

study participation exclusions

– Performance status: ECOG scale>1

– Pulmonary function: FEV1 et CVF < 50% of the theorical value - Post capillary and severe pre-capillary pulmonary hypertension with measured mean pulmonary artery pressure at rest >35 mmHg

– Cardiac ejection fraction < 45% - Estimated glomerular fraction rate (GFR) <50ml/mn /1.73m2 - Conjugate bilirubin >50 µmole/L, cirrhosis, ALT>4N

– Uncontrolled infection

– Known hypersensitivity of alemtuzumab

– Known hypersensitivity to murine proteins and to the following excepients: disodium
edetate, polysorbate 80, potassium chloride, potassium phosphate monobasic, sodium
chloride, dibasic sodium phosphate, water for injections

– Positivity for HIV

– Pregnancy or breast-feeding women

– Alloimmunization or Delayed Hemolytic Transfusion Reaction precluding red cell
transfusions

More info

View on ClinicalTrials.gov
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