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| ID | Type | Description | Link |
|---|---|---|---|
| RG1126016 | Other Identifier | Fred Hutch Cancer Center |
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This phase II trial investigates how well a naive T cell depleted graft work for the reduction of graft versus host disease in patients with non-malignant diseases requiring hematopoietic cell transplantation. Giving chemotherapy and total-body irradiation before a donor peripheral blood stem cell transplant helps stop the growth of cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient, they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. The donated stem cells may also replace the patient's immune cells and help destroy any remaining cancer cells.
OUTLINE: Patients will receive CD34+ enriched CD45RA-depleted donor T-lymphocytes IV on day 0. For conditioning, patients receive cyclophosphamide by IV on day -8, fludarabine by IV on day -7 to day -3, thiotepa IV on day -7 and day -6, and undergo total-body irradiation (TBI) for 2 doses on day -2 and day -1.
GVHD Prophylaxis:
All patients also receive tacrolimus IV continuously starting on day -1, and mycophenolate mofetil (MMF) starting day 0 through day 35. If there is no evidence of grade II-IV acute GVHD on or prior to day 100, tacrolimus is tapered.
All patients also undergo bone marrow aspiration/biopsy and collection of blood samples throughout the trial.
After completion of study treatment, patients are followed up at days 7, 14, 21, 28, 56, 80, 180, and 270 and at 1, 1.5, and 2 years.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm A (HLA-Haploidentical or mismatched unrelated donor) | Other | Conditioning regimen for HLA-Haploidentical or mismatched unrelated donor consisting of Cyclophosphamide (50 mg/kg x1 day), Fludarabine 35 mg/m2/day x 5 days, Thiotepa (5 mg/kg/day x 2 days), TBI (200 cGy x 2). Tacrolimus starting Day -1, MMF D0-35. |
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| Arm B (HLA-matched related or matched unrelated donor ) | Other | Conditioning regimen for HLA-matched related or matched unrelated donor consisting of Cyclophosphamide (50 mg/kg x1 day), Fludarabine (30 mg/m2/day x 5 days), Thiotepa (5 mg/kg/day x 2 days), TBI (200 cGy x 2). Tacrolimus starting Day -1, MMF D0-35. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ALLOGENEIC CD34+ ENRICHED AND CD45RA- DEPLETED PBSCs | Biological | CD34-selected graft with CD45RA- depleted peripheral blood stem cells given to patients with Non-Malignant Diseases |
| Measure | Description | Time Frame |
|---|---|---|
| GVHD-free Survival | Free of grade III-IV acute and NIH chronic (moderate-severe) GVHD requiring systemic immunosuppression | 1 year post-transplant |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | 1 year post-transplant | |
| Transplant related mortality | Day 100 post-transplant and 1 year post-transplant | |
| Graft failure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Madhavi Lakkaraja, MD, MPH | Contact | 206-667-7166 | mlakkara@fredhutch.org |
| Name | Affiliation | Role |
|---|---|---|
| Madhavi Lakkaraja, MD, MPH | Fred Hutch Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seattle Children's Hospital | Seattle | Washington | 98105 | United States | ||
| Fred Hutchinson Cancer Center |
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Graft failure defined as failure to achieve an ANC ≥ 0.5 × 109/L before death or second HCT, or decrease to ANC <0.1 × 109/L for 14 consecutive days (date of graft failure defined as the 14th day) after an established donor graft despite daily administration of G-CSF (SC or IV) and ≤ average 20% bone marrow cellularity on bone marrow aspirate or biopsy any time in the first 2 years following HCT. If a patient dies from organ toxicity and/or infection prior to day 28 without ANC ≥ 0.5 × 109/L this will not be considered graft failure. If the graft failure is attributed to viral infection, multi-organ failure or drug effect it will still be considered graft failure if it meets the definition of graft failure specified above. |
| Day 42 post-transplant |
| Graft rejection | Graft rejection defined as <5% donor CD3 T cell and CD33 myeloid chimerism | Day 100 post-transplant |
| Incidence of chronic GVHD | Defined and graded based on NIH criteria and graded operationally as the occurrence of compatible symptoms | At 1 year and 2 years post transplant |
| Prednisone for GVHD | Number of participants alive and off prednisone (or equivalent systemic corticosteroid) for the treatment of GVHD | Every 3 months post-transplant for the first 2 years |
| Incidence of opportunistic infections requiring treatment | Proportion of participants who experience viral infections/reactivations.
| First year post-transplant |
| Peripheral blood donor chimerism | Full donor chimerism will be defined as CD33 and CD3 ≥95%. Mixed chimerism will be defined as CD33 OR CD3 <95% but >5%. Actual chimerism values will be reported and summarized as well as dichotomized according to the 'full chimerism' and 'mixed chimerism' labels | 2 years post-transplant |
| Seattle |
| Washington |
| 98109 |
| United States |
| ID | Term |
|---|---|
| D000080983 | Bone Marrow Failure Disorders |
| D006453 | Hemoglobinopathies |
| D000081207 | Primary Immunodeficiency Diseases |
| D051359 | Lymphohistiocytosis, Hemophagocytic |
| ID | Term |
|---|---|
| D001855 | Bone Marrow Diseases |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| D015616 | Histiocytosis, Non-Langerhans-Cell |
| D015614 | Histiocytosis |
| D008206 | Lymphatic Diseases |
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