Chronic Graft-versus-host Disease
Conditions
Keywords
Children, Chronic graft-versus-host disease
Brief summary
In this study we will combine mycophenolate mofetil and imatinib mesylate to treat steroid-refractory sclerotic/fibrotic type chronic graft-versus-host disease (GVHD) to see the response rate and to find the safety of combination.
Detailed description
Sclerotic/fibrotic type chronic GVHD is one of the most severe forms of the disease and is frequently refractory to standard treatment approaches. Imatinib mesylate, a tyrosine kinase inhibitor, has been shown to be effective in patients with sclerotic/fibrotic type chronic GVHD by strongly inhibiting both PDGF (Platelet-derived growth factor) and TGF-β (transforming growth factor-β) intracellular signaling, which is responsible for the expression of extracellular matrix genes. Mycophenolate mofetil (MMF) is one of effective agent for the treatment of chronic graft-versus-host disease. MMF is rapidly absorbed after oral administration and hydrolyzed to the active metabolite, MPA (mycophenolic acid). MPA selectively inhibits inosine monophosphate dehydrogenase, blocking the pathway of purine synthesis in T and B lymphocytes. In this study we will combine MMF and imatinib mesylate to treat steroid-refractory sclerotic/fibrotic type chronic GVHD to see the response rate and to find the safety of combination.
Interventions
DRUGImatinib mesylate, Mycophenolate mofetil
Sponsors
Seoul National University 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
* Patients must have a diagnosis of chronic GVHD with fibrotic/scleroderma-like features. This diagnosis can be made clinically or by histopathology. * Patients must have active disease with at least one of the following manifestations: skin sclerosis, symptomatic bronchiolitis obliterans, extensive lung fibrosis, pathologically demonstrated visceral fibrotic involvement of the gut. * Patients with corticosteroid refractory or dependant cGVHD are eligible. Steroid-refractory chronic GVHD is defined as chronic GVHD of sustained severity during the last full month during which the patients received the equivalent of prednisone 0.5 mg/kg or more per day or 1 mg/kg or more every other day. * Age under 21 years old
Exclusion criteria
* Patients who have had chemotherapy, radiotherapy within 4 weeks prior to entering the study. * Patients who have not recovered from adverse events. * Prior treatment with imatinib mesylate or other tyrosine kinase inhibitor after the date of transplant. * Patients on pregnancy or lactating
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall (complete and partial) response rate | 1 year | Response evaluation will be performed every 3 months during the treatment by comprehensive response criteria based on NIH criteria. The complete and partial response categories apply only to organs that have measurable and reversible GVHD-related abnormalities at baseline. * Complete response (CR): Resolution of all signs and symptoms of chronic GVHD * Partial response (PR) : Improvement (at least 1 clinical score reduction, see Appendix 2) in 1 or more organs of involvement and no evidence of worsening in any organ * Objective response (OR): Either CR or PR |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate the safety profile of MMF plus imatinib mesylate | 1 year | All adverse events will be recorded on the Adverse Events CRF with the following information * Severity grade (NCI CTCAE ver. 4.0) * Relationship to the study drug * Duration (start and end dates or if continuing at final exam) * Whether it constitutes a serious adverse event (SAE) |
| Evaluate the quality of life (QOL) | 1 year | The assessment of QOL will be performed at baseline and every 3 months till 1 year with Lee cGVHD Symptom Scale. |
| Discontinuation of steroid | 1 year | * Based on the response during study period, investigators could modify the dosage of concomitant immunosuppressive agents in the same manner as corticosteroid. * The rate of discontinuation among patients and the dose change from baseline of each patient. |
| Overall survival rate | 1 year | For survival outcome, Kaplan-Meier method will be used for estimation. |
Countries
South Korea
Outcome results
None listed