Feasibility of Haploidentical Hematopoietic Stem Cell Transplantation Using CAMPATH-1H

Sponsor

Tehran University of Medical Sciences (Other)

Overall Status

Completed

CT.gov ID

NCT00458250

Collaborator

(none)

Enrollment

Location

Duration (Months)

0.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Many patients suffering various malignant and non-malignant diseases need hematopoietic stem cell transplantation from a healthy person. In the majority of cases there is no matched related or unrelated donor.

Some researchers have been performed transplantation from semi-matched (haploidentical) related donors with relatively good results.

Chinese researchers have been performed this kind of transplantation using CAMPATH-1H and their reports indicates good results.

Chinese populations have more homogenous genetic background than Iranians. In this project, we are going to study the feasibility of this method of haploidentical transplantation in Iranian patients.

Condition or Disease	Intervention/Treatment	Phase
Leukemia, Myeloid, Acute Leukemia, Lymphoblastic, Acute	Procedure: Haploidentical hematopoietic stem cell transplantation Drug: Busulfan Drug: Cyclophosphamide Drug: CAMPATH-1H Drug: Cyclosporin A Drug: Methotrexate	Phase 1

Detailed Description

Haploidentical hematopoietic stem cell transplantation is a very important therapeutic intervention for treatment of some genetic disorders and hematological malignancies.

In the majority of cases, there is no matched related or unrelated donor. Haploidentical hematopoietic stem cell transplantation is a promising alternative for critical cases.

To avoid severe graft versus host disease (GVHD), two types of T cell depletion (TCD) had been used: total TCD and partial TCD.

Total TCD has disadvantages such as increased rate of rejection and relapse, and increased rate of infections due to delayed immune reconstitution.

Partial TCD has been done by in vivo and/or in vitro methods. In haploidentical transplantation, donor partial TCD (ex vivo TCD) without recipient TCD increases the rate of rejection and can not prevent severe GVHD successfully.

In vivo TCD by partial depletion of donor and recipient T cells has been done in haploidentical transplantation with good results (to some extent inferior to full matched transplantations) by using CAMPATH, ATG, etc.

Most of these studies have been performed in Chinese and Japanese populations that have more homogenous genetic background than other populations.

In order to study the feasibility of this kind of transplantation in Iranian patients, we defined a project to perform haploidentical hematopoietic stem cell transplantation by using in vivo CAMPATH-1H.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

10 participants

Allocation:

Non-Randomized

Intervention Model:

Factorial Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Haploidentical Hematopoietic Stem Cell Transplantation in the Treatment of Hematological Malignancies Using CAMPATH-1H

Study Start Date :

Sep 1, 2006

Actual Study Completion Date :

Feb 1, 2008

Outcome Measures

Primary Outcome Measures

Engraftment one month after transplantation [Up to 30 days from transplantation]

Secondary Outcome Measures

six months survival [Up to 180 days after transplantation]

Eligibility Criteria

Criteria

Ages Eligible for Study:

2 Years to 50 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

INCLUSION CRITERIA - RECIPIENT: (all of the following)

Ages 5-50 years
Acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL)
Second remission (CR2) in standard risk patients or CR1 in cases with high-risk features (poor cytogenetic changes or secondary to myelodysplastic syndrome)
Unavailability of HLA identical related donor or matched unrelated donor.
Unavailability of other therapeutic intervention that prolongs patient survival.
Lack of active infection.
No history of allergy to CAMPATH.
For adults: Ability to comprehend the investigational nature of the study and provide informed consent. For minors: Written informed consent from one parent or guardian..
Social and intellectual competency of the patient and his/her family to follow medical recommendations.

INCLUSION CRITERIA - DONOR:

The donor must be haploidentical with the recipient: In the order of priority, siblings who have an identical paternal HLA haplotype with the patient, offspring (for female patients that do not have appropriate sibling), and mother.
Possibly, it is better that the donor and recipient to be of same blood group and sex..
Possibly, it is better that female donors not to be multiparous.
Weight greater than or equal to 18 kg.
Age between 2 and 60 years old.
For adults: Ability to comprehend the investigational nature of the study and provide informed consent. For minors: Written informed consent from one parent or guardian and informed assent: The process will be explained to the minor on a level of complexity appropriate for their age and ability to comprehend.
Negative two-way WBC crossmatch with the recipient.

Exclusion Criteria:

EXCLUSION CRITERIA - RECIPIENT: (ANY OF THE FOLLOWING)

Major anticipated illness or organ failure incompatible with survival from transplantation.
Severe psychiatric illness. Mental deficiency sufficiently severe as to make compliance with the transplantation procedure unlikely and making informed consent impossible.
Positive pregnancy test for women of childbearing age.
HIV positive
Active infection
Left ventricular ejection fraction less than 40%
AST/SGOT greater than 20 x ULN (CTCAE grade IV v3.0)
Bilirubin greater than 10 x ULN (CTCAE grade IV v3.0)
Creatinine greater than 6 x ULN (CTCAE grade IV v 3.0)
Occurrence of allergy symptoms and signs during CAMPATH infusion. EXCLUSION CRITERIA - DONOR: (ANY OF THE FOLLOWING)
Pregnant or lactating
Unfit to receive filgrastim (G-CSF) and undergo apheresis (abnormal blood counts, history of stroke, uncontrolled hypertension)
Sickling hemoglobinopathies including HbSS, HbAS, HbSC
HBsAg or HIV positive
Active infection
CMV positive (for CMV negative recipients)
Severe psychiatric illness. Mental deficiency sufficiently severe as to make compliance with the BMT treatment unlikely and making informed consent impossible
Contraindication to general anesthesia.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Hematology-Oncology & BMT Research Center	Tehran		Iran, Islamic Republic of	14114

Sponsors and Collaborators

Tehran University of Medical Sciences

Investigators

Study Director: Mohammadreza Ostadali, MD, Ph.D., Hematology-Oncology & BMT Research Center
Principal Investigator: Ardeshir Ghavamzadeh, MD, Hematology-Oncology & BMT Research Center
Principal Investigator: Kamran Alimoghaddam, MD, Hematology-Oncology & BMT Research Center