Hematopoietic Stem Cell Transplant, Poor Marrow Graft Function
Conditions
Keywords
T-cell Depleted Hematopoietic Stem Cell, Allogeneic Hematopoietic Stem Cell Transplantation, CliniMACS Cell Selection System, 14-228, HSCT
Brief summary
The purpose of this study is to see if giving the patient stem cells their original donor (boost) after removing the T cells (T cell depleted- TCD boost) without further chemotherapy. The investigators want to see if this can improve bone marrow function. This would also improve the patients white blood counts, red blood counts and platelets. This may make the patients chances of improving and surviving better. The investigators will also be looking at the short term side effects and risks of the TCD boost.
Interventions
PROCEDUREDonor peripheral blood progenitor cells: stimulation, harvesting, isolation and T-cell depletion
For related donors, beginning 5-6 days before the day of HPC(A) or HPC (M) TCD boost infusion, the normal donor will receive GCSF per institutional guidelines. On the fifth and sixth days of this course of G-CSF, the donor will undergo daily leukapheresis designed to provide a minimum of 5x10\^6 CD34+ cells/kg of the transplant recipient's weight. For unrelated donors, the G-CSF will be administered and the leukapheresis obtained according to the National Marrow Donor Program protocol IND, and institutional guidelines. Mononuclear cell fractions (i.e., CD34+ cells) collected on the fourth and fifth days will be pooled.
Sponsors
Memorial Sloan Kettering Cancer Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients who are diagnosed with PGF are candidates for this trial. * Patients who underwent transplant at another facility and suffer from PGF will be eligible as well as long as a donor is available. PGF can be primary (no counts recovery after the preparative regimen) or secondary (cytopenia after engraftment has occurred). * Patients with auto-immune cytopenia with auto antibodies to neutrophils or platelets or positive Coombs test that did not respond to immunosuppressive agents within 3 months from initiation of therapy are eligible as well. * Persistent cytopenia requiring growth factors and/or blood products AND evidence of hypocellular BM (\<25%). Persistent cytopenia (at least 4 weeks period) is defined by presence of TWO of the following: 1. ANC \<1.0x10\^9/L without filgrastim support or any ANC value that requires recurrent support by filgrastim (administered at least once a week). 2. Plt\<50x10\^9/L 3. Hb\<8 or PRBC transfusion dependent (once every 2 weeks or more) with reticulocyte count of \< 40x10\^9/L. This criteria for persistent cytopenia and hypocellular bone marrow does not apply to patients with auto-immune cytopenia, ONLY PGF patients * Full donor myeloid chimerism. Patients after T cell depletion transplant can have a significant mixed T cell chimerism and this can affect the testing of marrow chimerism. In this case, the neutrophil chimerism will be used to determine eligibility for this trial. Patients will be excluded if neutrophils are less than 90% donor cells; a higher percentage of host cells could be due to relapse or impending relapse. * Age: pediatrics and adults patients. No age exclusion. * Each patient must be willing to participate as a research subject and must sign an informed consent form. * For infections and end organs related criteria (at time of TCD boost administration) see table in protocol.
Exclusion criteria
Patients will be excluded from the trial if at time of enrollment: * Evidence of relapsed disease by morphologic, cytogenetic or molecular diagnostic tools. * Hypersplenism documented by imaging study (US or CT) * Pregnant women * Patient who underwent TCD boost without counts recovery and are considered for another TCD boost will be treated off protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Peripheral Blood Counts Recovery (Response Will be Defined by Stable Blood Counts (ANC>1000, Hb>8 With Absolute Reticulocyte Count>20x10^9/L ,and Plt>50,000) Without Support of Blood Product Transfusions and/or Growth Factors. | 1 year | will be documented by CBC checks every 2 weeks. Response will be defined by stable blood counts (ANC\>1000, Hb\>8 with absolute reticulocyte count\>20x10\^9/L ,and Plt\>50,000) without support of blood product transfusions and/or growth factors. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| No Active Infection and/or Organ Compromise or GVHD. This protocol includes two single-arm phase II trials to assess the efficacy and confirm the safety of administration of TCD stem cell boost or bone marrow (BM) HPC (M) boost from the original donor for patients with poor graft function after allogeneic hematopoietic stem cell transplantation. | 2 |
| Active Infection, Active or Controlled GVHD &/or Organ Compro This protocol includes two single-arm phase II trials to assess the efficacy and confirm the safety of administration of TCD stem cell boost or bone marrow (BM) HPC (M) boost from the original donor for patients with poor graft function after allogeneic hematopoietic stem cell transplantation. | 2 |
| Total | 4 |
Baseline characteristics
| Characteristic | No Active Infection and/or Organ Compromise or GVHD. | Total | Active Infection, Active or Controlled GVHD &/or Organ Compro |
|---|---|---|---|
| Age, Continuous | 54 years | 52 years | 50 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2 Participants | 4 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 2 Participants | 3 Participants | 1 Participants |
| Region of Enrollment United States | 2 Participants | 4 Participants | 2 Participants |
| Sex: Female, Male Female | 1 Participants | 2 Participants | 1 Participants |
| Sex: Female, Male Male | 1 Participants | 2 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 2 | 1 / 2 |
| other Total, other adverse events | 2 / 2 | 1 / 2 |
| serious Total, serious adverse events | 2 / 2 | 1 / 2 |
Outcome results
Primary
Peripheral Blood Counts Recovery (Response Will be Defined by Stable Blood Counts (ANC>1000, Hb>8 With Absolute Reticulocyte Count>20x10^9/L ,and Plt>50,000) Without Support of Blood Product Transfusions and/or Growth Factors.
will be documented by CBC checks every 2 weeks. Response will be defined by stable blood counts (ANC\>1000, Hb\>8 with absolute reticulocyte count\>20x10\^9/L ,and Plt\>50,000) without support of blood product transfusions and/or growth factors.
Time frame: 1 year
Population: No data were collected