Preventing Stem Cell Transplant Complications With a Blood Separator Machine
Study Details
Study Description
Brief Summary
Background:
- Researchers are working to make stem cell transplant procedures safer and more effective. One complication of transplants is graft-versus-host disease (GVHD). This complication happens when certain white blood cells from the donor attack the recipient's own body. Researchers want to test a blood separator machine that may help remove more of the donor's white blood cells before transplant. They will study donors and recipients during stem cell transplant to see how well this process can prevent GVHD and other complications.
Objectives:
- To see if a new blood separator machine can improve outcomes of stem cell transplants.
Eligibility:
-
Individuals between 10 and 75 years of age who are having a stem cell transplant for leukemia or other blood-related cancers.
-
Donors for the stem cell transplant.
Design:
-
Recipients and donors will be screened with a physical exam and medical history.
-
Donors will have two blood collection procedures. The first will collect only white blood cells, and return the rest of the blood. After the first collection, participants will have filgrastim injections to help their stem cells enter their blood. Then, they will have a second blood collection for the stem cells.
-
Recipients will have radiation and chemotherapy to prepare for the stem cell transplant. They will then have the stem cell transplant with the donor cells that have been treated with the blood separator machine.
-
Recipients will be monitored closely after the procedure. They may receive some of their donor's white blood cells if needed to fight serious infections.
-
Recipients will have the regular standard of care after their transplant. Blood samples will be taken and any side effects will be monitored and treated.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 1/Phase 2 |
Detailed Description
Peripheral blood stem cell transplant research carried out by the NHLBI BMT Unit focus on transplant techniques designed to decrease graft versus host disease (GVHD), increase the graft-versus-leukemia (GVL) effect and reduce the risk of post-transplant graft rejection.
Through incremental transplant clinical trials we have shown that by controlling the stem cell (CD34+ cell) and T lymphocyte (CD3+ cell) dose, severe GVHD can be reduced whilst beneficial GVL effects can be preserved. We found that T cell depleted transplants using the Nexell/Baxter Isolex 300i system and subsequently, the Miltenyi CliniMACS[registered] CD34+ system to obtain high CD34+ doses depleted of lymphocytes were safe to administer and associated with less severe acute GVHD and promising response rates and overall survival. Our previous trials have helped us to create the transplant environment (significant lymphodepletion and minimal post transplant immunosuppression) that make for an ideal platform for adoptive cellular immunotherapy. Adoptive cell transfer is the passive transfer of immune cells, into a new recipient host with the goal of transferring the immunologic functionality and characteristics into the new host.
This protocol is designed to evaluate the safety and efficacy of the Miltenyi CliniMACS[registered] CD 34 selection system in HLA-matched sibling allogeneic peripheral blood stem cell transplant. The manipulation of the graft is the primary research intervention, subject to IDE# 15632, and all other aspects of clinical management on this protocol are standard care. The target CD34+ dose range will be >3 x 10(6)/kg and the target CD3+ dose range will be 5 x 10(4)/kg to 1 x 10(6)/kg. Once we demonstrate adequacy of this platform for engraftment and absence of significant GVHD in ten consecutive recipients, we will seek IRB permission to proceed with planned adoptive cellular therapies.
The protocol will accrue up to 96 transplant recipients aged 10-80 with a hematological malignancy and their HLA-matched sibling donors, in whom allogeneic stem cell transplantation from an HLA-matched sibling would be routinely indicated. Diagnostic categories will include acute and chronic leukemia, myelodysplastic syndromes, lymphomas, multiple myeloma and myeloproliferative syndromes.
Subjects will receive a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m(2) total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS[registered] system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity.
The overall objective is to assess the feasibility of using this system as a platform for cellular immunotherapy initiatives. The primary study endpoint will be overall survival at day +200. Stopping criteria for safety will monitor non-relapse mortality at day +200 and late disease free survival at 2 years. Secondary endpoints will be standard transplant outcome variables such as non-hematologic toxicity, incidence and severity of acute and chronic GVHD and relapse of disease.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: CD34+ cell positively selected graft stem cell recipient Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
Device: Graft Manipulation (CD34+ Selection)
|
Outcome Measures
Primary Outcome Measures
- Overall Survival [200 days]
Determine the rate of overall survival at 200 day
Secondary Outcome Measures
- Disease Free Survival at 2 Years [2 years]
Disease Free Survival at 2 years
- Disease Progression [3 years]
Incidence of relapse / disease progression
- Incidence of Acute GVHD [100 days]
Participants who develop acute GVHD
- Incidence of Chronic GVHD [3 years]
Participants who develop chronic GVHD
- Median Time to ANC>500/mm3 [3 years]
Time in days
- Median Time to Platelets>20K/mm3 [3 years]
Time in days
- Severity of Acute GVHD [100 days]
Grade I
- Severity of Acute GVHD [100 days]
Grade II
- Severity of Acute GVHD [100 days]
Grade III
- Severity of Acute GVHD [100 days]
Grade IV
- Severity of Chronic GVHD [3 years]
Extensive
- Severity of Chronic GVHD [3 years]
Limited
Eligibility Criteria
Criteria
- INCLUSION CRITERIA RECIPIENT
5.1.1 Ages 10-80 years inclusive
5.1.2 Any one of the following hematologic conditions, confirmed by pathology, meeting a standard indication for allogeneic stem cell transplant:
5.1.2.1 Chronic myelogenous leukemia (CML): Subjects under the age of 21 in chronic phase OR Subjects ages 10-80 in chronic phase who have failed or are intolerant to treatment with second generation tyrosine inhibitors OR Subjects ages 10-80 in accelerated phase or blast transformation. OR
5.1.2.2 Acute lymphoblastic leukemia (ALL): any of these categories: Adult ALL including standard risk; Pediatric ALL in first remission with high-risk features (presenting leukocyte count >100,000/cu mm, karyotypes t(9; 22), t4, t19, t11, biphenotypic leukemia). All second or subsequent remissions, primary induction failure, partially responding or untreated relapse. OR
5.1.2.3 Acute myelogenous leukemia (AML): AML in first remission - except AML with good risk karyotypes: AML M3 (t15; 17), AML M4Eo (inv 16), c-kit unmutated AML t (8; 21). All AML in second or subsequent remission, primary induction failure and resistant relapse. OR
5.1.2.4 Myelodysplastic syndromes(MDS): any of these categories - refractory anemia with transfusion dependence, refractory anemia with ANC<500/microL, refractory anemia with excess of blasts, transformation to acute leukemia, chronic myelomonocytic leukemia, atypical MDS/myeloproliferative syndromes. OR
5.1.2.5 Myeloproliferative disorders including atypical (Ph-negative) chronic myeloid and neutrophilic leukemias, progressing myelofibrosis, and polycythemia vera, essential thrombocythemia either in transformation to acute leukemia or with progressive transfusion requirements or pancytopenia. OR
5.1.2.6 Chronic lymphocytic leukemia refractory to fludarabine treatment and with bulky progressive disease or with thrombocytopenia (less than or equal to 100,000 / microl) or anemia (less than or equal to 10g/dl) not due to recent chemotherapy. OR
5.1.2.7 Non-Hodgkin s lymphoma including Mantle cell lymphoma relapsing or refractory to standard of care treatments. OR
5.1.2.8 Multiple myeloma, Waldenstroms macroglobulinemia, unresponsive or relapsed following standard of care treatments. OR
5.1.2.9 Hodgkin's Lymphoma relapsing following an autologous transplant. OR
5.1.2.10 Other rare hematologic malignancies for which hematopoietic stem cell transplantation has been performed and offers a durable remission or as the only option for potential for cure.
-
Chemotherapy-resistant multisystem Langerhans cell histiocytosis (MSLCH) especially involving organs like the bone marrow, liver, spleen, and lungs
-
Aggressive systemic mastocytosis, and mast cell leukemia (MCL) in first CR (CR1)
-
Hypereosinophilic syndrome who have failed imatinib therapy or FIP1L1-PDGFRa-negative patients who develop end-organ dysfunction
-
Adult T-cell leukemia/lymphoma at first diagnosis
-
Refractory or disseminated nasal-type extranodal NK/T-lymphoma or aggressive Natural killer cell leukemia/lymphoma
-
Mycosis fungoides and S(SqrRoot)(Copyright)zary syndrome after failure of two or three initial therapies
-
Primary or relapsed refractory Angioimmunoblastic T-cell lymphoma at first diagnosis
-
Hepatosplenic T-cell lymphoma (gamma/delta T-cell lymphoma) at first diagnosis
-
T-cell prolymphocytic leukemia at first diagnosis
-
Subcutaneous panniculitic T-cell lymphoma at first diagnosis
-
Hematodermic neoplasm (blastic natural killer cell lymphoma or Blastic plasmacytoid dendritic cell neoplasm) at first diagnosis
5.1.3 HLA identical (6/6) related donor.
5.1.4 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. Informed oral assent from minors: the process will be explained to the minor on a level of complexity appropriate for their age and ability to comprehend.
EXCLUSION CRITERIA RECIPIENT (any of the following)
5.2.1 Major anticipated illness or organ failure incompatible with survival from transplant
5.2.2 Severe psychiatric illness or mental deficiency sufficiently severe as to make compliance with the transplant treatment unlikely and making informed consent impossible.
5.2.3 Positive pregnancy test for women of childbearing age
5.2.4 DLCO adjusted for Hb and ventilation< 50% predicted
5.2.5 Left ventricular ejection fraction < 40% (evaluated by ECHO) or < 30% (evaluated by MUGA)
5.2.6 AST/SGOT > 10 times ULN
5.2.7 Total bilirubin > 5 times ULN
5.2.8 Estimated GFR < 15 mL/min
5.2.9 Recipients who have active infections with HIV or active hepatitis C (HCV)
INCLUSION CRITERIA DONOR
5.3.1 Related donor, HLA identical (6/6) with recipient
5.3.2 Weight greater than or equal to 18 kg
5.3.3 Age greater than or equal to 2 or less than or equal to 80 years old
5.3.4 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.
EXCLUSION CRITERIA DONOR (any of the following)
5.4.1 Pregnant or breast-feeding. Lactating donors are permitted provided breast milk is discarded during the days filgrastim (G-CSF) is given
5.4.2 Unfit to receive G-CSF and undergo apheresis (abnormal blood counts, history of stroke, uncontrolled hypertension)
5.4.3 Sickling hemoglobinopathy including HbSS, HbSC
5.4.4 Donors who are positive for HIV, active hepatitis B (HBV), hepatitis C (HCV) or human Tcell lymphotropic virus (HTLV-I/II)
5.4.5 Severe psychiatric illness or mental deficiency sufficiently severe as to make compliance with the donation process unlikely, and making informed consent impossible.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda | Maryland | United States | 20892 |
Sponsors and Collaborators
- National Heart, Lung, and Blood Institute (NHLBI)
- Children's National Research Institute
Investigators
- Principal Investigator: Sawa Ito, M.D., National Heart, Lung, and Blood Institute (NHLBI)
Study Documents (Full-Text)
More Information
Publications
- Appelbaum FR. Haematopoietic cell transplantation as immunotherapy. Nature. 2001 May 17;411(6835):385-9. Review.
- Armitage JO. Bone marrow transplantation. N Engl J Med. 1994 Mar 24;330(12):827-38. Review.
- Barrett AJ. Graft-versus-host disease: basic considerations. Recent Results Cancer Res. 1993;132:185-95. Review.
- 130144
- 13-H-0144
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail | 1 participant signed consent but did not start study |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Period Title: Overall Study | |
| STARTED | 40 |
| COMPLETED | 30 |
| NOT COMPLETED | 10 |
Baseline Characteristics
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Overall Participants | 40 |
| Age (Count of Participants) | |
| <=18 years |
2
5%
|
| Between 18 and 65 years |
32
80%
|
| >=65 years |
6
15%
|
| Sex: Female, Male (Count of Participants) | |
| Female |
21
52.5%
|
| Male |
19
47.5%
|
| Ethnicity (NIH/OMB) (Count of Participants) | |
| Hispanic or Latino |
21
52.5%
|
| Not Hispanic or Latino |
19
47.5%
|
| Unknown or Not Reported |
0
0%
|
| Race (NIH/OMB) (Count of Participants) | |
| American Indian or Alaska Native |
0
0%
|
| Asian |
5
12.5%
|
| Native Hawaiian or Other Pacific Islander |
0
0%
|
| Black or African American |
3
7.5%
|
| White |
13
32.5%
|
| More than one race |
4
10%
|
| Unknown or Not Reported |
15
37.5%
|
Outcome Measures
| Title | Disease Free Survival at 2 Years |
|---|---|
| Description | Disease Free Survival at 2 years |
| Time Frame | 2 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Number [percentage of participant] |
60.8
|
| Title | Disease Progression |
|---|---|
| Description | Incidence of relapse / disease progression |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
11
27.5%
|
| Title | Incidence of Acute GVHD |
|---|---|
| Description | Participants who develop acute GVHD |
| Time Frame | 100 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
26
65%
|
| Title | Incidence of Chronic GVHD |
|---|---|
| Description | Participants who develop chronic GVHD |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
14
35%
|
| Title | Median Time to ANC>500/mm3 |
|---|---|
| Description | Time in days |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Median (95% Confidence Interval) [Days] |
12
|
| Title | Median Time to Platelets>20K/mm3 |
|---|---|
| Description | Time in days |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Median (95% Confidence Interval) [Days] |
15
|
| Title | Overall Survival |
|---|---|
| Description | Determine the rate of overall survival at 200 day |
| Time Frame | 200 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
36
90%
|
| Title | Severity of Acute GVHD |
|---|---|
| Description | Grade I |
| Time Frame | 100 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
10
25%
|
| Title | Severity of Acute GVHD |
|---|---|
| Description | Grade II |
| Time Frame | 100 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
7
17.5%
|
| Title | Severity of Acute GVHD |
|---|---|
| Description | Grade III |
| Time Frame | 100 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
8
20%
|
| Title | Severity of Acute GVHD |
|---|---|
| Description | Grade IV |
| Time Frame | 100 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
1
2.5%
|
| Title | Severity of Chronic GVHD |
|---|---|
| Description | Extensive |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
10
25%
|
| Title | Severity of Chronic GVHD |
|---|---|
| Description | Limited |
| Time Frame | 3 years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Subjects for whom the Miltenyi CliniMACS CD34 selection system was used for graft manipulation in HLA-matched sibling allogeneic stem cell transplantation |
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient |
|---|---|
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. |
| Measure Participants | 40 |
| Count of Participants [Participants] |
4
10%
|
Adverse Events
| Time Frame | 3 years | |
|---|---|---|
| Adverse Event Reporting Description | ||
| Arm/Group Title | CD34+ Cell Positively Selected Graft Stem Cell Recipient | |
| Arm/Group Description | Recipients received a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg total), fludarabine (125 mg/m2 total) and total body irradiation (1200 cGy with lung shielding to 600 cGy), followed by an infusion of a stem cell product selected for CD34+ progenitors using the Miltenyi CliniMACS® system. Older subjects will receive a lower dose of irradiation (800 or 600 cGy based on age) to reduce the regimen intensity. | |
All Cause Mortality |
||
| CD34+ Cell Positively Selected Graft Stem Cell Recipient | ||
| Affected / at Risk (%) | # Events | |
| Total | 11/40 (27.5%) | |
Serious Adverse Events |
||
| CD34+ Cell Positively Selected Graft Stem Cell Recipient | ||
| Affected / at Risk (%) | # Events | |
| Total | 38/40 (95%) | |
| Blood and lymphatic system disorders | ||
| Anaemia | 1/40 (2.5%) | |
| Engraftment syndrome | 1/40 (2.5%) | |
| Febrile neutropenia | 1/40 (2.5%) | |
| Thrombocytopenia | 1/40 (2.5%) | |
| Cardiac disorders | ||
| Cardiac failure congestive | 1/40 (2.5%) | |
| Cardiomyopathy acute | 1/40 (2.5%) | |
| Diastolic dysfunction | 1/40 (2.5%) | |
| Fluid overload | 2/40 (5%) | |
| Tachycardia | 1/40 (2.5%) | |
| Gastrointestinal disorders | ||
| Abdominal discomfort | 1/40 (2.5%) | |
| Appendicitis | 1/40 (2.5%) | |
| Clostridium difficile colitis | 1/40 (2.5%) | |
| Constipation | 1/40 (2.5%) | |
| Cytomegalovirus gastrointestinal infection | 1/40 (2.5%) | |
| Diarrhoea | 3/40 (7.5%) | |
| Gastritis | 1/40 (2.5%) | |
| Gastroenteritis astroviral | 1/40 (2.5%) | |
| Gastrointestinal haemorrhage | 1/40 (2.5%) | |
| Nausea | 1/40 (2.5%) | |
| Viral diarrhoea | 1/40 (2.5%) | |
| Vomiting | 1/40 (2.5%) | |
| General disorders | ||
| Adult failure to thrive | 1/40 (2.5%) | |
| Catheter site pain | 1/40 (2.5%) | |
| Drug withdrawal convulsions | 1/40 (2.5%) | |
| Drug withdrawal syndrome | 1/40 (2.5%) | |
| Incarcerated hernia | 1/40 (2.5%) | |
| Pain | 1/40 (2.5%) | |
| Immune system disorders | ||
| Acute graft versus host disease in intestine | 7/40 (17.5%) | |
| Acute graft versus host disease in skin | 3/40 (7.5%) | |
| Chronic graft versus host disease | 1/40 (2.5%) | |
| Chronic graft versus host disease in intestine | 3/40 (7.5%) | |
| Food allergy | 1/40 (2.5%) | |
| Reaction to preservatives | 1/40 (2.5%) | |
| Transplant rejection | 1/40 (2.5%) | |
| Infections and infestations | ||
| Adenovirus infection | 2/40 (5%) | |
| Bacteraemia | 6/40 (15%) | |
| BK virus infection | 2/40 (5%) | |
| Candida infection | 1/40 (2.5%) | |
| Cellulitis | 1/40 (2.5%) | |
| Clostridium difficile infection | 5/40 (12.5%) | |
| Cystitis | 1/40 (2.5%) | |
| Cytomegalovirus infection | 7/40 (17.5%) | |
| Epstein-Barr viraemia | 1/40 (2.5%) | |
| Escherichia bacteraemia | 3/40 (7.5%) | |
| Escherichia sepsis | 2/40 (5%) | |
| Fungaemia | 1/40 (2.5%) | |
| Influenza | 1/40 (2.5%) | |
| Klebsiella infection | 1/40 (2.5%) | |
| Lung infection | 1/40 (2.5%) | |
| Pneumonia | 5/40 (12.5%) | |
| Pneumonia fungal | 1/40 (2.5%) | |
| Pyelonephritis | 1/40 (2.5%) | |
| Salmonella sepsis | 1/40 (2.5%) | |
| Sepsis | 4/40 (10%) | |
| Septic shock | 1/40 (2.5%) | |
| Stenotrophomonas infection | 1/40 (2.5%) | |
| suspected infection | 5/40 (12.5%) | |
| Upper respiratory tract infection | 1/40 (2.5%) | |
| Urinary tract infection | 3/40 (7.5%) | |
| Varicella zoster virus infection | 1/40 (2.5%) | |
| Vulvovaginal human papilloma virus infection | 1/40 (2.5%) | |
| Wound abscess | 1/40 (2.5%) | |
| Injury, poisoning and procedural complications | ||
| Delayed engraftment | 1/40 (2.5%) | |
| Engraft failure | 1/40 (2.5%) | |
| Humerus fracture | 1/40 (2.5%) | |
| Procedural headache | 1/40 (2.5%) | |
| Investigations | ||
| Anion gap | 1/40 (2.5%) | |
| Body temperature increased | 12/40 (30%) | |
| Hyperkalaemia | 1/40 (2.5%) | |
| Nervous system disorders | ||
| Headache | 1/40 (2.5%) | |
| Orthostatic hypotension | 1/40 (2.5%) | |
| Posterior reversible encephalopathy syndrome | 1/40 (2.5%) | |
| Psychiatric disorders | ||
| Altered state of consciousness | 1/40 (2.5%) | |
| Mental status changes | 1/40 (2.5%) | |
| Respiratory, thoracic and mediastinal disorders | ||
| Pulmonary embolism | 1/40 (2.5%) | |
| Surgical and medical procedures | ||
| Mucositis management | 1/40 (2.5%) | |
| Vascular disorders | ||
| Orthostatic hypotension | 1/40 (2.5%) | |
| Syncope | 1/40 (2.5%) | |
Other (Not Including Serious) Adverse Events |
||
| CD34+ Cell Positively Selected Graft Stem Cell Recipient | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/40 (0%) | |
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Aue, Georg |
|---|---|
| Organization | National Heart Lung and Blood Institute |
| Phone | +1 301 451 7141 |
| aueg@nhlbi.nih.gov |
- 130144
- 13-H-0144