Patients Treated for Chronic Granulomatous Disease (CGD) Since 1995

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID) (NIH)

Overall Status

Enrolling by invitation

CT.gov ID

NCT02082353

Collaborator

Rare Diseases Clinical Research Network (Other), Primary Immune Deficiency Treatment Consortium (PIDTC) (Other)

1,480

Enrollment

Locations

Duration (Months)

33.6

Patients Per Site

0.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Chronic granulomatous disease (CGD) is an inherited immune system abnormality in which bone marrow transplantation (BMT) has been shown to be curative. However the risks of transplantation are high and not all patients with CGD may need to undergo this high risk procedure. This study will determine the long term medical condition and daily functioning of participants with CGD after a transplant and if possible, compare these results to participants who do not undergo a transplant.

Condition or Disease	Intervention/Treatment	Phase
Granulomatous Disease, Chronic

Detailed Description

Chronic granulomatous disease (CGD) is an immune deficiency where the neutrophils (a type of white blood cell that kills bacteria and fungi) do no work properly. Some individuals with CGD have neutrophils that do not work at all, whereas others have neutrophils that work partially, but not normally. In the past (over 20 years ago), most individuals with CGD were managed with antibiotics and antifungal medications alone. As the science of blood and marrow transplant (BMT) improved, some with CGD started to receive a BMT. It remained controversial whether individuals with CGD should receive a BMT or medical management alone (antibiotics, antifungals, and other treatments that do not include BMT).

The aim of this natural history study is to better define the role of BMT compared to medical management of CGD. Specifically, what are the outcomes of BMT versus medical management alone, why do some individuals with CGD benefit from BMT, and what are the long-term outcomes of both approaches. Researchers are interested in how individuals with CGD who have no neutrophil function may differ from those with some neutrophil function, how the types of infections and inflammatory complications of CGD impact on survival and how BMT may improve these complications. There are also questions as to how the types of bacteria (called the microbiome) found in the gastrointestinal tract (colon, large intestine) of individuals with CGD influences certain inflammatory complications (such as colitis), and how BMT changes the microbiome in individuals with CGD. All of this will help doctors in the future to better treat patients with CGD.

This study includes a retrospective (looking back into the past), cross-sectional (one time collection of information and/or research testing) and a prospective (looking from today and into the future) component. These are known as longitudinal studies (e.g., looking at information of participants over time).

Persons with CGD who were born 1988 to the present day are eligible, regardless of whether they received a BMT (as long as the BMT was after 1995) or medical therapy only. Individuals who are newly diagnosed with CGD can also be enrolled and followed longitudinally (over time), to determine their outcome from the choice of therapy that is made. An important component of this study is the 'cross sectional' study, where participants with more than 3 years of follow-up after transplant or diagnosis are asked to provide additional research blood work, and information is gathered regarding long-term transplant outcomes such as infections, graft-versus-host disease, autoimmune diseases, and quality of life. In addition, the participants will be asked to provide stool samples to allow investigators to look at how certain bacteria found in the gut (called the microbiome) affect complications of CGD, such as gastrointestinal disease. This will allow primary immune deficiency investigators/doctors to better understand the outcomes of different therapeutic approaches and to best design new treatments and clinical trials in the future for children with CGD.

Study Design

Study Type:

Observational

Anticipated Enrollment :

1480 participants

Observational Model:

Cohort

Time Perspective:

Other

Official Title:

Analysis of Patients Treated for Chronic Granulomatous Disease Since January 1, 1995

Study Start Date :

Jun 1, 2014

Anticipated Primary Completion Date :

Nov 1, 2021

Anticipated Study Completion Date :

Nov 1, 2021

Arms and Interventions

Arm	Intervention/Treatment
Retrospective CGD Cohort Longitudinal analysis
Prospective CGD Cohort Longitudinal analysis
HCT CGD Cohort Cross-sectional analysis
Conventional Non-Transplant CGD Cohort Longitudinal analysis

Outcome Measures

Primary Outcome Measures

Death [HCT to date of death, up to an expected average of 3 years]
The event analyzed is death from any cause. The time from HCT to death or last follow up will be analyzed. Cause of death will also be collected. Surviving patients will be censored at the time of last observation.

Secondary Outcome Measures

Engraftment [an expected average of 3 years]
Engraftment will be measures in whole blood using either fluorescent in situ hybridization (FISH) for sex chromosomes or short tandem repeat polymerase chain reaction (PCR) or (STRs) in whole blood.
Quality of Life Measures [an expected average of 3 years]
Age appropriate testing will be performed at the cross-sectional visit in patients surviving at least two years posttransplant: Pediatrics quality of life (QL) Family Impact Module, Parent Report Peds QL Infant Scales Module (ages 1-24 months), Parent Report Peds QL Generic Core Scales for Toddlers (ages 2-4 yr), Parent Report Peds QL Generic Core Scales (ages 5-25 yr), Child/Parent Reports Peds QL Transplant Module Standard Form (SF)-36 (adult) Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT BMT) (adult)
Infections [an expected average of 3 years]
CGD or transplant-related and transplant-related infection
Autoimmune or inflammatory complications [an expected average of 3 years]
- For HCT subjects, inflammation (inflammatory complications) includes chronic graft-versus-host disease (GVHD)

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Participant Inclusion Criteria (Part 1 - Longitudinal Analysis)
CGD Patients Undergoing Transplant 1995 to Present with Birth Year In or After 1988

CGD Patients will be Defined by both Defective Neutrophil NADPH Oxidase Function and by Clinical History Consistent with CGD

Patients must have both of:

A functional assay demonstrating abnormal NADPH oxidase function (see A below); AND Clinical history consistent with CGD (see B below).

Patients must have both "A" and "B":

Function: Assays of NADPH Oxidase Function

I. Dihydrorhodamine (DHR) Assay:

Blood sample was obtained at a time when patient was clinically stable and not critically ill, with control samples performed simultaneously indicating a qualified assay; and
Assay unequivocally demonstrates CGD with an stimulation index (SI) SI < 35 or equivalent. Assay report, including mean fluorescence intensity (MFI) from unstimulated and stimulated samples and gating strategy, must be de-identified and provided. OR

II. Nitroblue Tetrazolium Oxidation Test (NBT):

o Diagnostic of CGD (reported as reduced granulocyte oxidative response). Report must be de-identified and provided. AND

B. Clinical History: One or More of the Following:

Severe and/or recurrent infection (liver, perirectal or lung abscess; pneumonia; adenitis; or osteomyelitis) due to, for example, Staphylococcus aureus, Burkholderia sp, Serratia marcescens, non-albicans Candida sp, Aspergillus sp or other mold; or Nocardia sp or other deep tissue infection characteristic of CGD
Sterile granulomatous disease in respiratory, gastrointestinal or urogenital tracts; or Crohn's disease-like colitis
A family history consistent with either X-linked or autosomal recessive CGD

In cases where either functional assay (A) or history (B) is equivocal, one or more of the following may be used to confirm a diagnosis of CGD:

Absent or significantly reduced in expression or abnormal size of any of the 5 phox components (gp91 phox, p47 phox, p22 phox, p67phox, and p40phox) of NADPH oxidase, by either:

Western blot
Northern blot OR D. Mutation in a gene encoding one of the 5 phox components (gp91 phox, p47 phox, p22 phox, p67 phox, and p40 phox) of NADPH oxidase that is predictive of a decreased or absent oxidative burst. (Nonsense, frameshift, or previously described missense mutation associated with CGD).

Molecular Diagnosis is Desirable In addition, molecular diagnosis (gene sequencing and expression analysis) of CGD is desirable and should be performed when possible.

Further Characterization of Oxidase Level, Longitudinal Study, Prospective Cohort Patients who are to undergo transplantation during the study period must be further characterized as oxidase-null or oxidase positive by level of oxidase production by either:

DHR assay stimulation Index: where SI ≤ 2.5 will be classified as oxidase-null CGD. Those with SI > 2.5 will be classified as oxidase positive CGD. A single validated test that is accepted by the PID-CGD Review Panel is adequate, but testing on two occasions for validation is desirable. OR
Ferricytochrome C reduction assay of granulocytes with O2 < 2.3 nmoles /106 cells/h classified as oxidase-null CGD. A single validated test that is accepted by the PID-CGD Review Panel is adequate, but testing on two occasions for validation is desirable.

o Genetic sequencing reporting a mutation that is unequivocally associated to absent oxidase production. (e.g. null mutations) will be classified as oxidase-null CGD (See discussion in Appendix I for how family history, genotype and CGD mutation information will be applied to assigning patients lacking any quantitative oxidase activity measurements to residual oxidase-null or residual oxidase-positive groups).

Longitudinal Study, Retrospective Cohort Patients who have already been transplanted will be included regardless of whether further characterization by oxidase level (or genotype/mutation data) is possible or not.

Non-Transplanted CGD Patients with Birth Year In or After 1988 A non-transplant (conventional therapy) group of CGD subjects will be enrolled in the longitudinal study. The non-transplant subjects will be selected from the potentially eligible (retrospective) patient cohort with diagnosis of CGD treated with conventional non-transplant therapy. Participating sites will enter their entire retrospective cohort of CGD patients having birth year in or after 1988 into the registration cohort for this protocol. Baseline for both non-transplant subjects and HCT subjects for the purpose of comparing survival will be the year of birth. However, for non-transplant subjects, many of the detailed analyses such as infection and autoimmune complication rates will be assessed in the year preceding the date of last contact.
Participant Inclusion Criteria (Part 2 - Cross-Sectional Analysis) To participate in the Cross-Sectional Analysis, patients must have previously been enrolled into the Longitudinal Analysis of Protocol 6903. All transplanted subjects in the Cross-Sectional Analysis are surviving and shall have at least 3 years of follow-up post-transplant to be included. Non-transplanted CGD subjects will become eligible for consideration for the Cross-Sectional Analysis if they were eligible and enrolled in the retrospective cohort of the Longitudinal Analysis, and if/when they are > 3 years post-diagnosis of CGD. Provision of written informed consent will be required for inclusion in the Cross-Sectional Analysis.

Exclusion Criteria:

Participant Exclusion Criteria (Longitudinal and Cross- Sectional Analyses)
Presence of other primary immunodeficiency syndromes that do not meet the clinical and laboratory criteria for CGD.
Rac2 Deficiency
Myeloperoxidase Deficiency (MPO Deficiency)
Glutathione deficiency
Leukocyte adhesion deficiency syndrome
Non-transplant subjects:
The above exclusions pertain.
In addition, non-transplant subjects will be excluded if the only assessment of oxidase function available is the nitroblue tetrazolium (NBT) test (a non-quantitative test).

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham	Birmingham	Alabama	United States	35233
2	Phoenix Children's Hospital	Phoenix	Arizona	United States	85016
3	Children's Hospital Los Angeles	Los Angeles	California	United States	90027
4	UCLA	Los Angeles	California	United States	90095-1752
5	Lucile Salter Packard Children's Hospital at Stanford	Palo Alto	California	United States	94304
6	University of California (UCSF) Benioff Children's Hospital	San Francisco	California	United States	94143-1278
7	Children's Hospital Colorado	Aurora	Colorado	United States	80045
8	Alfred I. duPont Hospital for Children/Nemours	Wilmington	Delaware	United States	19803
9	Children's National Medical Center, Washington DC	Washington	District of Columbia	United States	20010-2970
10	Johns Hopkins All Children's Hospital - St. Petersburg, FL	Saint Petersburg	Florida	United States	33701
11	Children's Healthcare of Atlanta, Emory University	Atlanta	Georgia	United States	30322
12	Ann & Robert H. Lurie Children's Hospital of Chicago	Chicago	Illinois	United States	60611
13	Children's Hospital of New Orleans at LSUHSC	New Orleans	Louisiana	United States	70118
14	NIH Clinical Center Genetic Immunotherapy Section	Bethesda	Maryland	United States	20892
15	Children's Hospital Boston	Boston	Massachusetts	United States	02115
16	University of Michigan Health System	Ann Arbor	Michigan	United States	48109
17	University of Minnesota Medical Center	Minneapolis	Minnesota	United States	55455
18	Mayo Clinic Hospital	Rochester	Minnesota	United States	55902
19	Cardinal Glennon Children's Hospital/ St. Louis University	Saint Louis	Missouri	United States	63104
20	Washington University/ St.Louis Children's Hospital	Saint Louis	Missouri	United States	63110
21	Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
22	Memorial Sloan-kettering Cancer Center	New York	New York	United States	10065
23	University of Rochester Medical Center/ Golisano Children's Hospital	Rochester	New York	United States	14642
24	New York Medical College, Maria Fareri Children's Hospital	Valhalla	New York	United States	10595
25	Duke University	Durham	North Carolina	United States	27710
26	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio	United States	45229
27	Rainbow Babies/ University Hospitals Case Medical Center	Cleveland	Ohio	United States	44106
28	Nationwide Children's Hospital	Columbus	Ohio	United States	43205
29	Oregon Health and Science University	Portland	Oregon	United States	97239-3098
30	The Children's Hospital of Philadelphia	Philadelphia	Pennsylvania	United States	19104
31	Children's Hospital of Pittsburgh of UPMC	Pittsburgh	Pennsylvania	United States	15224
32	St. Jude Children's Research Hospital	Memphis	Tennessee	United States	38105
33	University of Texas Southwestern Medical Center at Dallas	Dallas	Texas	United States	75235
34	Texas Children's Hospital, Baylor College of Medicine	Houston	Texas	United States	77030
35	Methodist Children's Hospital of South Texas/Texas Transplant Institute	San Antonio	Texas	United States	78229
36	Primary Children's Medical Center/ University of Utah	Salt Lake City	Utah	United States	84113
37	Seattle Children's Research Institute	Seattle	Washington	United States	98101
38	University of Wisconsin/ American Family Children's Hospital	Madison	Wisconsin	United States	53705-2275
39	Children's Hospital of Wisconsin-Milwaukee	Milwaukee	Wisconsin	United States	53226
40	Alberta Children's Hospital	Calgary	Alberta	Canada	T3B 6A8
41	British Columbia Children's Hospital	Vancouver	British Columbia	Canada	V6H 3V4
42	Cancer Care Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
43	The Hospital for Sick Children	Toronto	Ontario	Canada	M5G 1XB
44	CHU St. Justine	Montreal	Quebec	Canada	H3T 1C5

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)
Rare Diseases Clinical Research Network
Primary Immune Deficiency Treatment Consortium (PIDTC)

Investigators

Principal Investigator: Jennifer M. Puck, MD, University of California, San Francisco
Principal Investigator: Donald B. Kohn, MD, University of California, Los Angeles