Nonmyeloablative Allogeneic Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation For Severe Congenital Anemias Including Sickle Cell Disease (SCD) and Beta-Thalassemia

Study point of contact

John F Tisdale, M.D.
(301) 402-6497
[email protected]
Priscilla S Pollack, R.N.
(301) 496-1781
[email protected]

Locations

1 United States site

Age

2 to 65 Years

Phase

Phase 1/Phase 2

Study type

Interventional

Gender

All

Interventions

Procedure

Drug

Compensation

Unknown

About the study

People with severe congenital anemias, such as sickle cell anemia and beta-thalassemia, have
been cured with bone marrow transplantation (BMT). The procedure, however, is limited to
children younger than the age of 16 because the risks are lower for children than for adults.

The purpose of this study is to explore the use of a BMT regimen that, instead of
chemotherapy, uses a low dose of radiation, combined with two immunosuppressive drugs. This
type BMT procedure is described as nonmyeloablative, meaning that it does not destroy the
patient s bone marrow. It is hoped that this type of BMT will be safe for patients normally
excluded from the procedure because of their age and other reasons.

To participate in this study, patients must be between the ages of 18 and 65 and have a
sibling who is a well-matched stem-cell donor. Beyond the standard BMT protocol, study
participants will undergo additional procedures. The donor will receive G-CSF by injection
for five days; then his or her stem cells will be collected and frozen one month prior to
BMT. Approximately one month later, the patient will be given two immune-suppressing drugs,
Campath 1-H and Sirolimus, as well as a single low dose of total body irradiation and then
the cells from the donor will be infused.

Prior to their participation in this study, patients will undergo the following evaluations:
a physical exam, blood work, breathing tests, heart-function tests, chest and sinus x-rays,
and bone-marrow sampling.

participation requirements

RECIPIENTS:

Must fulfill one disease category from below:

DISEASE SPECIFIC:

Patients with sickle cell disease at high risk for disease related morbidity or mortality,
defined by having irreversible end organ damage (A, B, C, D or E) or potentially reversible
complication(s) not ameliorated by hydroxyurea (F):

A. Stroke defined as a clinically significant neurologic event that is accompanied by and
infarct on cerebral MRI

OR

an abnormal trans-cranial Doppler examination ( greater than or equal to 200m/s);

OR

B. 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 nephritic syndrome OR creatinine clearance less than 60mL/min/1.73m(2) for
patients less than or equal to 16 years of age or less than 50mL/min for patients greater
than or equal to 16 years of age OR requiring peritoneal or hemodialysis

OR

Age is less than or equal to 5 years of age with the upper limit of normal serum creatinine
0.8mg/dl

Age is greater than 5 years or less than or equal to 10 years of age with the upper limit
of normal serum creatinine 1.0mg/dl

Age is greater than 10 years and less than or equal to 15 years of agethe the upper limit
of normal serum creatinine 1.2mg/dl

Age greater than 15 years of age with the upper limit of normal serum creatinine 1.3mg/dl

C. Tricuspid regurgitant jet velocity (TRV) of greater than or equal to 2.5m/s in patients
greater than or equal to 18 years of age at least 3 weeks after a vaso- occlusive crisis,
OR

D. Recurrent tricorporal praipism defined as at least two episodes of an erection lasting
greater than or equal to 4 hours involving the corpora cavernosa and corpus spongiosa, OR

E. Sickle hepatopathy defined as EITHER ferritin greater than 100mcg/L OR direct bilirubin
greater than 0.4 mg/dL at baseline in patients greater than or equal to 18 years of age; OR

F. Any one of the below complications:

1. Vaso-occlusive crisis:

– 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

2. Acute Chest Syndrome (ACS):

– Eligible for hydroxyurea: 2 prior ACS while greater than 3 years of age and
adequately treated for asthma

– Eligible for HSCT: any ACS while on hydroxyurea*

3. Osteonecrosis of 2 or more joints:

– Eligible for hydroxyurea: And significantly affecting their quality of life by
Karnofsky score 50-60

– Eligible for HSCT: And on hydroxyurea* where total hemoglobin increase less than
1g/dL or fetal hemoglobin increases less than 2.5 time the baseline level

4. Red cell alloimmunization:

– Eligible for hydroxyurea: Transfusion dependent

– Eligible for HSCT: Total hemoglobin increase less htan 1 g/dL while on
hydroxyurea*

– hydroxyurea at maximum tolerated dose

Patients with beta-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 desferoxamine 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 2 cm below the costochondral margin

NON-DISEASE SPECIFIC:

– Ages greater than or equal to 4 years

– 6/6 HLA matched family donor available

– Ability to comprehend and willing to sign an informed consent, assent obtained
from minors

– Negative serum beta-HCG

– Pediatric patients less than 16 years of age must decline myeloablative bone
marrow transplantation

DONOR:

Donor deemed suitable and eligible, and willing to donate per clinical evaluations,
who are additionally willing to donate blood for research and undergo a
neuropsychological test. Donors will be evaluated in accordance with existing Standard
NIH Policies and Procedures for determination of eligibility and suitability for
clinical donation under a separate NHLBI protocol. Note that participation in this
study is offered to all donors, but is not required for a donor to make a stem cell
donation, so it is possible that not all donors will enroll onto this study.

participation restrictions

RECIPIENT:

(Any of the following would exclude the subject from participating)

ECOG performance status of 3 or more or Lansky performance status of less than 40.

Diffusion capacity of carbon monoxide (DLCO) less than 35% predicted. (corrected for
hemoglobin and alveolar volume)

Baseline oxygen saturation or less than 85 % or PaOa2 less than 70

Left ventricular ejection fraction: less than 35% estimated by ECHO.

Transaminases greater than 5 times the upper limit of normal for age

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

Major anticipated illness or organ failure incompatible with survival from PBSC
transplant.

Pregnant or lactating

Major ABO mismatch

DONOR:

None

Locations

  • Bethesda, Maryland, United States, National Institutes of Health Clinical Center, 9000 Rockville Pike, 20892 [Recruiting]
Last updated 2021-07-22 Enroll Now