Epidermolysis Bullosa
Conditions
Brief summary
Few but persistent wounds often remain even after successful hematopoietic cell transplantation for systemic genodermatosis epidermolysis bullosa (EB). The investigators propose local wound therapy using epidermal skin grafting from the same donor that provided the hematopoietic graft, or from the same EB individual with a mosaic (naturally gene corrected) skin. In both cases permissive immune system and skin chimerism is expected to enable long-term epidermal engraftment and wound healing. The investigators will use FDA approved vacuum device (CelluTome®, Regulation number 878.4820) that enables scar-free harvesting of epidermis and its transfer on a non-adherent silicone dressing (Adaptic) to the recipient as a wound dressing.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
Patient (Recipient) * Diagnosis of Dystrophic Epidermolysis Bullosa (DEB) or Junctional Epidermolysis Bullosa (JEB) with at least one wound, visibly free from infection (or previously treated) and meets the eligibility for Arm A or Arm B based on the skin graft source: * Cell harvest from previous hematopoietic cell transplantation (HCT) donor (Arm A) - not applicable if Arm B * At least 6 months after hematopoietic cell transplantation with donor chimerism * Peripheral blood donor chimerism should be measured within 21 days of grafting and be \>/= 5% and stable. Stability of chimerism will be determined by the protocol team and based on 3 peripheral blood chimerism values at least 1 month apart. * No history of pre-BMT autoimmune cytopenias * Off immune suppressive therapy * Original transplant donor is available and willing to be the epidermis donor * Self-donation (Arm B) - not applicable if Arm A * Proven somatic reversion * Site for skin grafting free of cellulitis and any other clinically evident abnormalities * Meets donor eligibility * Insurance pre-authorization for procedure, if applicable * Voluntary written consent (patient or parent/guardian for minors with assent) prior to any research related procedures or treatment. Skin Graft Donor (either hematopoietic cell transplantation donor for the EB patient \[Arm A\] or EB patient herself/himself \[Arm B\]) * Age \> 2 years (based on prior safety testing of the device) * Healthy on physical examination in the opinion of the evaluating provider * Negativity for Hepatitis B and C, HIV, and HTLV1/2 within 30 days of donation * Voluntary written consent (donor or parent/guardian for minors with assent) prior to any research related procedures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Grafts Successfully Treated | 12 weeks after grafting | If the body surface area affected by the wound is at least 50% lower at 12 weeks relative to baseline, the graft will be considered successful. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants With Lesion Free Skin | 1 year after grafting | Participants without Squamous cell carcinoma (SCC) at graft site. Wound reassessments will be performed via photographs and follow-up visits. |
| Longevity of Grafted Skin | 1 year after grafting | Percentage of patients who have had a 6 week period of lesion free skin by the time they are 1 year post grafting. Wound reassessments will be performed via photographs and follow-up visits. |
| Percentage Change of a Patient's IScorEB Assessment Score | Baseline and 6 weeks | Measure percent of changes in quality of life (QOL) through pain, itching, and general QOL IScorEB questionnaire. Scores can range from 16 to 112. The QOLS scores are summed so that a higher score indicates higher quality of life. |
| Percentage Change of a Patient's IScoreEB Assessment Score | Baseline and 12 weeks | Measure percent of changes in quality of life (QOL) through pain, itching, and general QOL IScorEB questionnaire. Scores can range from 16 to 112. The QOLS scores are summed so that a higher score indicates higher quality of life. |
| Scar-free Healing of the Body Sites of the Donor | 1 year after grafting | Percentage of donors with no evidence of non-healed skin. Wound reassessments will be performed via photographs and follow-up visits. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Graft From HCT Donor Cells are harvested from a donor using Cellutome, then transferred via Adaptic dressing to the recipient's wound with up to 3 donor harvest sites/treated wound sites on day 0.
Cellutome Epidermal Harvesting System | 17 |
| Donor Cells are harvested from a donor using Cellutome, then transferred via Adaptic dressing to the recipient's wound with up to 3 donor harvest sites/treated wound sites on day 0.
Cellutome Epidermal Harvesting System | 17 |
| Total | 34 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 2 | 0 | 0 |
Baseline characteristics
| Characteristic | Graft From HCT Donor | Donor | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 15 Participants | 10 Participants | 25 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 2 Participants | 7 Participants | 9 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 1 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 16 Participants | 16 Participants | 32 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 | 1 Participants | 1 Participants | 2 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 | 1 Participants | 4 Participants | 5 Participants |
| Race (NIH/OMB) White | 15 Participants | 12 Participants | 27 Participants |
| Region of Enrollment United States | 17 participants | 17 participants | 34 participants |
| Sex: Female, Male Female | 8 Participants | 15 Participants | 23 Participants |
| Sex: Female, Male Male | 9 Participants | 2 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 17 | 0 / 17 |
| other Total, other adverse events | 0 / 17 | 0 / 17 |
| serious Total, serious adverse events | 0 / 17 | 0 / 17 |
Outcome results
Percentage of Grafts Successfully Treated
If the body surface area affected by the wound is at least 50% lower at 12 weeks relative to baseline, the graft will be considered successful.
Time frame: 12 weeks after grafting
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Graft From HCT Donor | Percentage of Grafts Successfully Treated | 78 Percentage of grafts |
Longevity of Grafted Skin
Percentage of patients who have had a 6 week period of lesion free skin by the time they are 1 year post grafting. Wound reassessments will be performed via photographs and follow-up visits.
Time frame: 1 year after grafting
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Graft From HCT Donor | Longevity of Grafted Skin | 34 Percentage of participants |
Participants With Lesion Free Skin
Participants without Squamous cell carcinoma (SCC) at graft site. Wound reassessments will be performed via photographs and follow-up visits.
Time frame: 1 year after grafting
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Graft From HCT Donor | Participants With Lesion Free Skin | 100 Percentage of participants |
Percentage Change of a Patient's IScorEB Assessment Score
Measure percent of changes in quality of life (QOL) through pain, itching, and general QOL IScorEB questionnaire. Scores can range from 16 to 112. The QOLS scores are summed so that a higher score indicates higher quality of life.
Time frame: Baseline and 6 weeks
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Graft From HCT Donor | Percentage Change of a Patient's IScorEB Assessment Score | Change in pain QOL score | -2.1 Percent change |
| Graft From HCT Donor | Percentage Change of a Patient's IScorEB Assessment Score | Change in itch QOL score | -1.9 Percent change |
| Graft From HCT Donor | Percentage Change of a Patient's IScorEB Assessment Score | Change in General QOL score | 3.1 Percent change |
Percentage Change of a Patient's IScoreEB Assessment Score
Measure percent of changes in quality of life (QOL) through pain, itching, and general QOL IScorEB questionnaire. Scores can range from 16 to 112. The QOLS scores are summed so that a higher score indicates higher quality of life.
Time frame: Baseline and 12 weeks
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Graft From HCT Donor | Percentage Change of a Patient's IScoreEB Assessment Score | Change in general QOL score | -0.4 Percent change |
| Graft From HCT Donor | Percentage Change of a Patient's IScoreEB Assessment Score | Change in pain QOL score | -8.1 Percent change |
| Graft From HCT Donor | Percentage Change of a Patient's IScoreEB Assessment Score | Change in itch QOL score | -10.4 Percent change |
Scar-free Healing of the Body Sites of the Donor
Percentage of donors with no evidence of non-healed skin. Wound reassessments will be performed via photographs and follow-up visits.
Time frame: 1 year after grafting
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Graft From HCT Donor | Scar-free Healing of the Body Sites of the Donor | 100 Percentage of participants |