Amegakaryocytic Thrombocytopenia, Anemia, Aplastic, Diamond-Blackfan Anemia, Kostmann Syndrome
Conditions
Keywords
Aplastic anemia, Amegakaryocytic thrombocytopenia, Diamond-Blackfan Anemia, Kostmann syndrome, Allogeneic stem cell transplantation, Haploidentical stem cell transplant, T-cell depletion, Partially matched family member donor transplant, Refractory cytopenia
Brief summary
Due to an overall and disease free survival of 85% to 100%, allogeneic blood or bone marrow stem cell transplantation using an HLA matched sibling donor is the therapy of choice for patients with severe aplastic anemia (SAA). Unfortunately, only about 25% of patients have such a donor. For patients with SAA lacking a matched sibling donor, immunosuppressive therapy is the current treatment of choice. Approximately 70% of these patients have a complete or partial response to immunosuppressive therapy, achieving transfusion independence and/or growth factor independence. For the approximately 30% of patients who do not respond to immunosuppressive therapy or experience recurrence, alternative donor (matched unrelated, partially matched family member) transplantation is a treatment option. However, graft rejection and graft-versus-host-disease (GVHD) are significant barriers to success, decreasing event-free survival to 30% to 50%. This study offers stem cell transplantation using a partially matched family member (haploidentical) donor to those patients with no available HLA-matched sibling or matched unrelated donor. In an attempt to reduce GVHD and regimen-related toxicity while maintaining adequate engraftment, we plan to infuse a highly purified stem cell graft. The Miltenyi Biotec CliniMACS CD3 depletion system will be used to derive a defined allogeneic graft highly enriched for CD34+ hematopoietic cells and depleted of CD3+ T-lymphocytes from G-CSF mobilized, donor-derived peripheral blood stem cells. Patients 21 years of age and younger with refractory cytopenias are also eligible for this protocol as there are no other potentially curative therapies currently available for these conditions. The primary objective of this study is to evaluate the safety of transplantation using a haploidentical donor product engineered to targeted cell counts using the investigational CliniMACS device for patients with refractory severe aplastic anemia (SAA) or refractory cytopenias. The treatment plan would be considered unsafe if we can find this type of procedure is associated with a significantly higher treatment failure rate. Treatment failure is defined as any occurrence of the following events, overall grade III-IV acute GVHD, graft failure or death due to any cause within 100 days after transplant.
Detailed description
Secondary objectives for this protocol include the following: * To observe the degree of hematopoietic chimerism in T-cells during the first year posttransplant. * To observe the relative proportions of donor/host T-regulatory cells during the first year posttransplant. * To monitor rates of acute and chronic GVHD during the first year posttransplant.
Interventions
DEVICEAllogeneic stem cell transplant
Participants will receive a reduced intensity conditioning regimen consisting of fludarabine, thiotepa, melphalan, and OKT3 followed by an infusion of haploidentical stem cells. Rituximab will be administered within 24 hours of the infusion in an effort to prevent posttransplant lymphoproliferative disorder LPD. In addition to T-cell depletion of the donor product, participant will receive mycophenolate mofetil for prophylaxis of GVHD.
Sponsors
St. Jude Children's Research Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 21 Years
Healthy volunteers
No
Inclusion criteria
* One of the following diagnoses: * Refractory severe aplastic anemia * Refractory Kostmann syndrome * Refractory Diamond-Blackfan anemia * Refractory amegakaryocytic thrombocytopenia * Absence of a suitable HLA-matched sibling donor and absence of a 10/10 allele matched unrelated donor. * Life expectancy of greater than six weeks as per the judgment of the principal investigator. * Karnofsky or Lansky Performance Status score of greater than or equal to 70%. * Creatinine clearance is greater than or equal to 40 cc/min/1.73 m2. * FVC greater than or equal to 40% of predicted or pulse oximetry greater than or equal to 92% on room air. * Does not have a known allergy to murine products.
Exclusion criteria
* Ejection fraction or shortening fraction below the lower limit of normal for age. * Lactating (female patient). * Pregnant or lactating * Diagnosis of Fanconi Anemia. * Positive HLA crossmatch with donor
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treatment Failures | 100 days post transplant | The primary objective of this study is to evaluate the safety of HAPLO HSCT for patients with refractory severe aplastic anemia (SAA) or refractory cytopenias. The treatment plan would be considered unsafe if we can demonstrate that it is associated with a significantly higher treatment failure rate. The treatment failure is defined as any occurrence of the following events, overall grade III-IV acute GVHD, graft failure or death due to any cause within 100 days post HSCT or after the last cellular product infusion, if required. |
Countries
United States
Participant flow
Recruitment details
Two patients and two donors were enrolled between 10/24/2005 and 2/24/2009 when the study was closed. The study was terminated due to the PI leaving St. Jude.
Participants by arm
| Arm | Count |
|---|---|
| Patients Patients were enrolled to treat refractory severe aplastic anemia. | 2 |
| Donors Parents of patients were enrolled onto the SAAHAP study to provide hematopoietic stem cells. | 2 |
| Total | 4 |
Baseline characteristics
| Characteristic | Patients | Donors | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 2 Participants | 0 Participants | 2 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 2 Participants | 2 Participants |
| Sex: Female, Male Female | 2 Participants | 1 Participants | 3 Participants |
| Sex: Female, Male Male | 0 Participants | 1 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 2 / 2 | 0 / 0 |
| serious Total, serious adverse events | 2 / 2 | 0 / 0 |
Outcome results
Primary
Treatment Failures
The primary objective of this study is to evaluate the safety of HAPLO HSCT for patients with refractory severe aplastic anemia (SAA) or refractory cytopenias. The treatment plan would be considered unsafe if we can demonstrate that it is associated with a significantly higher treatment failure rate. The treatment failure is defined as any occurrence of the following events, overall grade III-IV acute GVHD, graft failure or death due to any cause within 100 days post HSCT or after the last cellular product infusion, if required.
Time frame: 100 days post transplant
Population: Enrollment was terminated due to the PI leaving the institution. Insufficient data was generated to answer the objective.