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The main ailm of this phase I-II study is to evaluate toxicity and efficacy of allogenic mesenchymal stem cell therapy to treat severe systemic sclerosis. In practice this treatment will be given to patients with a rapidly evolutive disease or refractory to cyclophosphamide.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| INJECTION OF ALLOGENEIC MESENCHYMAL STEM CELLS | Experimental | Administration of allogeneic MSCs in the treatment of severe diffuse SSc or rapidly progressive and refractory to conventional treatments by prior cyclophosphamide |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| INJECTION OF ALLOGENEIC MESENCHYMAL STEM CELLS | Biological |
|
| Measure | Description | Time Frame |
|---|---|---|
| Immediate Toxicity | Immediate Toxicity/tolerance defined as grade 3 or above toxicity base on the CTCAE - Cancer Therapy Evaluation Program (CTEP), observed during the first 10 days (http://ctep.cancer.gov/protocolDevelopment/electronic\_applications/docs/ctcaev3.pdf) | 10 days |
| Measure | Description | Time Frame |
|---|---|---|
| Medium-term tolerance | Treatment-related event-free survival at 2 years. Treatment-related event (morbidity) being defined by the onset of clinical events induced by the procedure and not explained by the natural or expected course of the scleroderma disease. | 2 years |
| Survival |
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Inclusion Criteria:
These forms of severe and serious SSc WITH at least 6 months follow-up after completion of prior immunosuppressive therapy by high doses of iv cyclophosphamide when they were made, combine to varying degrees : rapidly progressive skin lesions with a score of Rodnan> 15 and one or more of the major visceral lesions defined as follows :
Respiratory disease :
DLCO <60% or FVC ≤70% of the theoretical value and the presence of interstitial lung disease (abnormalities on chest radiograph and / or lung HRCT with thin sections). It is necessary to ensure that non-related etiologies to scleroderma were eliminated; example: obstructive lung disease (chronic obstructive pulmonary disease or pulmonary emphysema). If the fibrosing lung disease threatens the vital prognosis, we will ensure of the exclusion of a possible lung transplant.
And/or
Heart disease:
congestive heart failure reversible, ventricular or atrial rhythm disturbances defined as recurrent episodes of atrial fibrillation or atrial flutter, recurrent paroxysmal atrial tachycardia or ventricular tachycardia, atrioventricular block of second or third degree, pericardial effusion with high abundance needing specific treatment of medical type (introduction of steroids) or surgical type (drainage). It is necessary to ensure that non-related etiologies to scleroderma were removed.
Exclusion Criteria:
Renal Disease:
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| Name | Affiliation | Role |
|---|---|---|
| dominique farges, MDPHD | APHP | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Saint-Louis Hospital | Paris | 75010 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38288741 | Background | Farge D, Loisel S, Resche-Rigon M, Lansiaux P, Colmegna I, Langlais D, Charles C, Pugnet G, Maria ATJ, Chatelus E, Martin T, Hachulla E, Kheav VD, Lambert NC, Wang H, Michonneau D, Martinaud C, Sensebe L, Cras A, Tarte K. Safety and preliminary efficacy of allogeneic bone marrow-derived multipotent mesenchymal stromal cells for systemic sclerosis: a single-centre, open-label, dose-escalation, proof-of-concept, phase 1/2 study. Lancet Rheumatol. 2022 Feb;4(2):e91-e104. doi: 10.1016/S2665-9913(21)00326-X. Epub 2022 Jan 5. | |
| 36928395 |
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Time from inclusion to death |
| 2 years |
| Progression free survival | Defined as the time in days from the day of inclusion until the occurrence of changes compared to the initial assessment, documented and re-evaluated at two successive examinations 3 months | 2 years |
| CBC | complete blood count (CBC) | 1, 2, 3, 4, 8, 12, 16, 20, 24 weeks |
| Platelet | Platelet blood count | 1, 2, 3, 4, 8, 12, 16, 20, 24 weeks |
| Lymphocyte | Lymphocyte subpopulation blood count measured by flow cytometry | 3, 6, 9, 12, 15, 18, 24 months |
| Antibody | Antibody response | 3, 6, 9, 12, 15, 18, 24 months |
| Rodnan score | modified Rodnan Score | 3, 6, 9, 12, 15, 18, 24 months |
| SHAQ | Scleroderma Health Assessment Questionnaire (SHAQ) | 3, 6, 9, 12, 15, 18, 24 months |
| Clinical progression | Occurence of visceral involvement, defined as any of the following:
| 3, 6, 9, 12, 15, 18, 24 months |
| Clinical response | Defined by a 25% improvement in modified Rodnan Score and/or ≥10% in DLCO or FVC compared to baseline state without the need to reintroduce other immunosuppressants. | 3, 6, 9, 12, 15, 18, 24 months |
| Derived |
| Loisel S, Lansiaux P, Rossille D, Menard C, Dulong J, Monvoisin C, Bescher N, Bezier I, Latour M, Cras A, Farge D, Tarte K. Regulatory B Cells Contribute to the Clinical Response After Bone Marrow-Derived Mesenchymal Stromal Cell Infusion in Patients With Systemic Sclerosis. Stem Cells Transl Med. 2023 Apr 17;12(4):194-206. doi: 10.1093/stcltm/szad010. |
| ID | Term |
|---|---|
| D012595 | Scleroderma, Systemic |
| ID | Term |
|---|---|
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D012871 | Skin Diseases |
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