Nonmyeloablative Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation for Sickle Cell Disease and Beta-Thalassemia in Individuals With Higher Risk of Transplant Failure

Study point of contact

Matthew M Hsieh, M.D.
(301) 402-7687
[email protected]
Wynona Coles
(301) 402-2104
[email protected]

Locations

1 United States site

Age

4 to 80 Years

Genotypes

SS, SC

Phase

Phase 2

Study type

Interventional

Gender

All

Interventions

Drug

Procedure

Compensation

Unknown

About the study

Background:

– Some sickle cell disease or beta-thalassemia can be cured with transplant. Researchers want
to test a variation of transplant that uses low dose radiation and a combination of
immunosuppressive drugs. They want to know if it helps a body to better accept donor stem
cells.

Objectives:

– To see if low dose radiation (300 rads), oral cyclophosphamide, pentostatin, and sirolimus
help a body to better accept donor stem cells.

Eligibility:

– People 4 and older with beta-thalassemia or sickle cell disease that can be cured with
transplant, and their donors.

Design:

– Participants and donors will be screened with medical history, physical exam, blood
test, tissue and blood typing, and bone marrow sampling. They will visit a social
worker.

– Donors:

– may receive an intravenous (IV) tube in their groin vein.

– will receive a drug injection daily for 5 or 6 days to move the blood stem cells from
the bone marrow into general blood circulation.

– will undergo apheresis: an IV is put into a vein in each arm. Blood is taken from one
arm, a machine removes the white blood cells that contain blood stem cells, and the rest
is returned through the other arm.

– Participants:

– may undergo red cell exchange procedure.

– will remain in the hospital for about 30 days.

– will receive a large IV line that can stay in their body from transplant through
recovery.

– will receive a dose of radiation, and transplant related drugs by mouth or IV.

– will receive blood stem cells over 8 hours by IV.

– will take neuropsychological tests and may complete questionnaires throughout the
transplant process.

– must stay near NIH for 4 months. They will visit the outpatient clinic weekly.

– will have 5 follow-up visits for 3 years after transplant, then annually.

participation requirements

– recipients (must fulfill one disease category in 1.0 and all of
2.0)

1.0 Disease specific

1.1 Patients with sickle cell disease (Hb SS, SC, or S beta-thal) at high risk for
disease-related morbidity or mortality, defined by having severe end-organ damage (A, B, C,
D, or E) or potentially modifiable complication(s) not ameliorated by hydroxyurea (F):

– A. 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

– 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 nephrotic syndrome OR creatinine clearance less than < 50mL/min OR requiring peritoneal or hemodialysis; OR - C. Tricuspid regurgitant jet velocity (TRV) of greater than or equal to 2.5 m/s 40, 41 at baseline; OR - D. Recurrent priapism defined as at least 2 episodes of an erection lasting >4 hours
involving the corpora cavernosa and corpus spongiosa; OR

– E. Sickle hepatopathy defined as EITHER ferritin >1000mcg/L OR direct bilirubin >0.4
mg/dL at baseline

– F. Any one of the below complications:

– Complication/ Eligible for hydroxyurea*/ Eligible for HSCT

– Vaso-occlusive crises/ At least 3 hospital admissions in the last year/ More
than one hospital admission in the last year while on maximal tolerated dose
of hydroxyurea (at MTD for at least 6 months)

– Acute chest syndrome/ 2 prior ACS/ any ACS while on hydroxyurea (at MTD for
at least 6 months)

– Osetonecrosis of 2 or more joints/ And significantly affecting their quality
of life by Karnofsky score 50-60/ And on hydroxyurea where total hemoglobuin
increases less than 1 g/dL or fetal hemoglobin increases less than 2.5 times
the baseline level

– Red cell alloimmunization/ Transfusion dependent/ Total hemoglobin increases
less than 1g/dL while on hydroxurea (hydroxurea for at least 6 months)

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

2.0 Non-disease specific:

2.1 Age greater than or equal to 4 years

2.2 6/6 HLA matched family donor available

2.3 Ability to comprehend and willing to sign an informed consent

2.4 Negative beta-HCG, when applicable

participation restrictions

– recipient (any of the following would exclude the subject from
participating)

1. ECOG performance status of 3 or more

2. 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.

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

4. Pregnant or lactating

5. We will measure anti-A, anti-B, and/or other red cell antibody titers from the first
cohort to determine the feasibility of transplanting patients with pre-existing
antibodies (major ABO mismatch or other anti-donor red cell antibody). The information
gathered from this cohort of patients will help to determine if the titer or antibody
to a specific antigen needs to be incorporated in the exclusion criteria.

Locations

  • Bethesda, Maryland, United States, National Institutes of Health Clinical Center, 9000 Rockville Pike, 20892 [Recruiting]