Pre-Transplant Immunosuppression and Related Haploidentical Hematopoietic Cell Transplantation for Patients With Severe Hemoglobinopathies

Study point of contact

Kris M Mahadeo
713-729-2873
[email protected]

Locations

1 United States site

Age

2 to 30 Years

Phase

Early Phase 1

Study type

Interventional

Gender

All

Interventions

Biological

Drug

Procedure

Compensation

Unknown

About the study

This clinical trial studies the effect of pre-transplant immunosuppression (PTIS) and donor
stem cell transplant in treating patients with severe blood diseases (hemoglobinopathies).
PTIS helps prepare the body for the transplant and lowers the risk of developing graft versus
host disease (GVHD). Hematopoietic cells are found in the bone marrow and produce blood
cells. Hematopoietic cell transplantation (HCT) injects healthy hematopoietic cells into the
body to support blood cell production. PTIS and HCT may help to control severe
hemoglobinopathies.

participation requirements

– Patients 2-30 years-of-age with confirmed sickle cell disease (SCD) (SS & sickle beta
[SB]-thalassemia, both sickle beta 0 [SB0] and sickle beta plus [SB+]) or severe
B-thalassemia major are potentially eligible

– Patients with SCD should also meet the following eligibility criteria as outlined by
the Center for Medicaid and Medicare Services: sickle cell disease and at least one of
the following:

– Stroke or neurological deficit lasting > 24 hours

– Recurrent acute chest syndrome (ACS): 2 or more episodes of ACS in 2-year period
preceding enrollment

– Recurrent vaso-occlusive pain crises: 3 or more episodes per year in 2-year
period preceding enrollment or recurrent priapism (3 or more episodes in the 2
years preceding enrollment)

– Chronic transfusion program defined as 8 or more packed red blood cells (PRBC)
transfusions per year to prevent central nervous system and/or vaso-occlusive
complications in 1-year period preceding enrollment

– Impaired neuropsychological function and abnormal cerebral magnetic resonance
imaging (MRI) scan (silent strokes)

– Stage I or II sickle lung disease

– Sickle nephropathy (moderate or severe proteinuria or a glomerular filtration
rate 30-50% of predicted normal value)

– Bilateral proliferative retinopathy and major visual impairment in at least one
eye

– Osteonecrosis of multiple joints

– Echocardiographic finding of tricuspid valve regurgitant jet velocity (TRJV) >=
2.7 m/sec

– Patients with B-thalassemia are considered as severe if they are/have any of the
following:

– Transfusion-dependent

– Evidence of extra-medullary hematopoiesis

– Pesaro Class III

– Patients shall not proceed to HCT without confirmation of primary diagnosis by review
of available newborn screening results or hemoglobin electrophoresis and/or genetic
testing

– DONOR: High resolution HLA typing will be performed on all willing and available
biologic parents and siblings without clinically significant hemoglobinopathy.
Preference will be given to donors with the lowest number of HLA-allele mismatches

– DONOR: Donor-specific anti-HLA antibodies will be obtained and analyzed from all
patients. Preference will be given to donors with absent or low titer anti HLA-donor
specific antibody levels when possible

participation restrictions

– Uncontrolled infection

– Females who are pregnant and/or unwilling to cease breastfeeding

– Seropositivity for human immunodeficiency virus (HIV)

– Lansky or Karnofsky performance status < 70% - Life expectancy severely limited by concomitant illness - Uncontrolled arrhythmias or symptomatic cardiac disease - Uncontrolled symptomatic pulmonary disease - Evidence of chronic active hepatitis or cirrhosis - Serum conjugated (direct) bilirubin > 2 x upper limit of normal for age. Participants
are not excluded if the serum conjugated (direct) bilirubin is > 2 x the upper limit
of normal for age as per local laboratory and:

– There is evidence of a hyperhemolytic reaction after a recent red blood cell
(RBC) transfusion, OR

– There is evidence of moderate direct hyperbilirubinemia defined as direct serum
bilirubin < 5 times upper limit of normal (ULN) and not caused by underlying hepatic disease - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) > 5 x upper limit
of normal for age

– Serum creatinine > 1.5 x upper limit of normal for age AND estimated or measure
creatinine clearance < 70 mL/min/1.72 m^2 - Patient, parent or guardian unable/unwilling to provide consent and when indicated, assent - Patients with available HLA-matched related donor - Prior receipt of gene therapy - DONOR: All potential donors shall be tested by hemoglobin electrophoresis. Any potential donor with a clinically significant hemoglobinopathy will be deemed ineligible. Donors with sickle cell trait and beta thalassemia trait are eligible to donate

Locations

  • Houston, Texas, United States, M D Anderson Cancer Center, 77030 [Recruiting]
Last updated 2021-03-10 Enroll Now