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The aim of the current study is to evaluate the efficacy of combined regimen of GVHD prophylaxis with thymoglobulin in conditioning regimen and PTCY with ruxolitinib used after HSCT in patients with inborn errors of immunity (IEI)
Hematopoietic stem cell transplantation (HSCT) is widely used in inborn errors of immunity (IEI), and risks of graft-versus-host disease (GVHD) remain high. Use of post-transplant cyclophosphamide (PTCY) for GVHD prophylaxis revolutionized the outcomes of HSCT from mismatched related donor (MMRD). Use of ruxolitinib for GVHD prophylaxis demonstrates promising results in adult patients. Another well-known option for GVHD prevention is antithymocyte globulin. To evaluate the efficacy of combination of thymoglobulin with PTCY and ruxolitinib for GVHD prophylaxis, conditioning regimen containing treosulfan 30-42 g/m2, fludarabine 150 mg/mg, and thiotepa 10 mg/kg or melphalan 140 mg/m2 and GVHD prophylaxis regimen containing cyclophosphamide 50 mg/kg for MMRD, 25 mg/kg for matched unrelated and related donors at days +3, 4 post-HSCT and ruxolitinib at dose 7 mg/m2 from day +5 after HSCT will be used in patients with IEI.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| intervention/treatment | Experimental | Conditioning regimen containing treosulfan 30-42 g/m2, fludarabine 150 mg/mg, thymoglobulin 5 mg/kg and thiotepa 10 mg/kg or melphalan 140 mg/m2 GVHD prophylaxis regimen for matched unrelated (MUD) and matched related donors (MRD): Cyclophosphamide (PTCY) 25 mg/kg/day (days +3, +4) Ruxolitinib 7 mg/m2 from day +5 GVHD prophylaxis regimen for mismatched related donor (MMRD): Cyclophosphamide (PTCY) 50 mg/kg/day (days +3, +4) Ruxolitinib 7 mg/m2 from day +5 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cyclophosphamide | Drug | Cyclophosphamide 25mg/kg (days +3, +4) after HSCT from MUD and MRD Cyclophosphamide 50mg/kg (days +3, +4) after HSCT from MMRD |
|
| Measure | Description | Time Frame |
|---|---|---|
| Event-free survival | Events: graft failure, death | 1 year after HSCT |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | 1 year after HSCT | |
| Cumulative incidence of acute graft versus host disease | 1 year after HSCT | |
| Cumulative incidence of chronic graft versus host disease |
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Inclusion Criteria:
Exclusion Criteria:
Concomitant severe somatic disease associated with an additional risk of severe complications
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dmitry Balashov, MD, PhD | Contact | +74956647091 | bala8@yandex.ru | |
| Alexandra Laberko, MD, PhD | Contact | 74952876570 | alexandra.laberko@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Dmitry Balashov, MD, PhD | National Research Center for Pediatric Hematology, Moscow, Russia | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HSCT department | Recruiting | Moscow | Russia |
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| Ruxolitinib | Drug | Ruxolitinib 7 mg/m2 from day +5 after HSCT |
|
| 1 year after HSCT |
| Cumulative incidence of engraftment | 100 days |
| Cumulative incidence of graft failure | 1 year after HSCT |
| Incidence of early organ toxicity | 100 days |
| Cumulative incidence of transplant related mortality | 1 year after HSCT |
| Cumulative incidence of viral infections | 1 year after HSCT |
| Investigation of the concentration of ruxolitinib in the blood To investigate the pharmacokinetics of ruxolitinib | The features of pharmacokinetics in children of different ages | 1 month after HSCT |
| ID | Term |
|---|---|
| D003520 | Cyclophosphamide |
| C540383 | ruxolitinib |
| ID | Term |
|---|---|
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
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