Kidney Failure, Chronic, Multiple Myeloma
Conditions
Keywords
Immune tolerance, Graft vs host disease, Kidney Failure, Kidney diseases, End Stage Renal Disease, Multiple Myeloma, Bone Marrow Transplant, Kidney Transplant, Renal Transplant, Tolerance, Chimerism, ESRD
Brief summary
The purpose of this study is to determine whether a combined bone marrow and kidney transplant will be effective in treating stage II or greater multiple myeloma and associated kidney failure. This study will determine whether transplant rejection and the need for immunosuppressive drugs are decreased with this combined transplant approach.
Detailed description
In very limited human testing, a combined kidney and bone marrow transplant appears to be safe and effective in treating multiple myeloma and associated kidney failure. This study will evaluate this approach in 10 patients with kidney failure due to or in association with stage II or greater multiple myeloma. Treatment prior to transplant will include cyclophosphamide, ATGAM (a lymphocyte-specific immunosuppressant), local radiation to the thymus, and cyclosporine (an immunosuppressive drug). An infusion of donor bone marrow and a kidney graft from a closely matched, related donor will be transplanted simultaneously. An additional infusion of donor white blood cells may be administered between day 45 and 74 after transplant in an effort to eliminate any remaining cancer cells. Patients will remain on cyclosporine for a defined period of time. The cyclosporine doses will be slowly decreased and stopped if graft rejection and graft-versus-host disease do not occur. Each participant will be involved in the study for 3 years; this includes the intervention phase (time from initial screening at approximately 7 days before transplant through 100 days after the transplant) and continued follow-up visits for at least 2 years following the transplant.
Interventions
Sponsors
Immune Tolerance Network (ITN)
National Institute of Allergy and Infectious Diseases (NIAID)
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* End-stage renal disease (ESRD) due to or in association with stage II or greater multiple myeloma * Participants in whom the development of ESRD is not due to the underlying myeloma will be included if they have evidence of active myeloma despite past treatment with standard therapies (e.g., prednisone, melphalan, high-dose radiation therapy with autologous stem cell transplantation) * On dialysis or have a creatinine clearance greater than 20 ml/min * HLA-matched or one of six HLA antigen-mismatched related donor
Exclusion criteria
* Compromised pulmonary, cardiac, or liver function * Active infection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Remission status of multiple myeloma | Throughout study |
| Renal allograft acceptance and ability to discontinue immunosuppressive therapy | Throughout study |
Secondary
| Measure | Time frame |
|---|---|
| Graft vs. host disease (GVHD) | Throughout study |
| Opportunistic infections | Throughouto study |
| T-cell recovery and immune reconstitution | Throughout study |
Countries
United States
Outcome results
None listed