This is an open-label, single institution, phase II study in patients with epidermolysis bullosa (EB). The underlying hypothesis is that the infusion of bone marrow or umbilical cord blood from a healthy unaffected donor will correct the collagen, laminin, integrin, or plakin deficiency and reduce the skin fragility characteristic of severe forms of EB. A secondary hypothesis is that mesenchymal stem cells from a healthy donor will enhance the safety and efficacy of the allogeneic hematopoietic stem cell transplant as well as serve as a source of renewable cells for the treatment of focal areas of residual blistering.
The primary objective of this study is to estimate the event-free survival rate by 1 year post-transplant with an event defined as a death or failure to have a demonstrable increase in collagen, laminin, integrin, keratin or plakin deposition by 1 year post-transplant or other biochemical, structural or physical measure of improvement. The secondary objectives of this study are to i) determine the incidence of transplant-related mortality (TRM) at 180 days; ii) describe the pattern of biochemical improvement as measured by an increase in protein expression (collagen, laminin, integrin, keratin or plakin) and related structural and physical changes; iii) describe health quality of life at day 365 and 730 as compared to pretreatment results; iv) describe the pattern and durability of HSC and third party MSC engraftment in the skin; v) determine the probability of survival at 1 year. Patients with severe epidermolysis bullosa will be screened to meet the eligibility requirements, related or unrelated donor marrow or UCB will be infused, and subjects will be followed for a minimum of 5 years after stem cell transplant. A target accrual of 75 subjects over 5 years will be recruited to the study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
Cyclophosphamide 50 mg/kg/day IV over 2 hours x 1 day, total dose 50 mg/kg will be administered on Day -6.
40 mg/m\^2/day intravenously on Days -6, -5, -4, -3 and -2.
30 mg/kg on Days -4, -3 and -2.
Targeting AUC 1000 umol/min
infused via intravenous drip on Day 0
300 cGY on Day -1 administered in a single fraction at a dose rate of 10-19 cGy/minute prescribed to the midplane of the patient at the level of the umbilicus.
Bone marrow or UCB products will be infused as soon as the product arrives and within 30 minutes. The product is infused via IV drip.
University of Minnesota Masonic Cancer Center and Medical Center
Minneapolis, Minnesota, United States
Percentage of Participants With Event-free Survival
Event-free survival rate, with an event defined as death or failure to have a demonstrable increase in collagen, laminin, intergrin, keratin or plakin deposition. Assessed at follow up appointments through questionnaire and patient samples.
Time frame: 1 year and 2 Years Post-transplant
Percentage of Participants Transplant-related Mortality (TRM)
Incidence of transplant-related mortality (TRM)
Time frame: 180 Days Post Transplant
Average Biochemical Improvement
Pattern of biochemical improvement measured by cumulative increase in protein expression and related structural and physical changes
Time frame: 1 Year Post-Transplant
Measure Patients Quality of Life Using a Questionnaire
Health quality of life questionnaire as compared to pretreatment results. Scores can range from 0 to 100. The QOLS scores are summed so that a higher score indicates higher quality of life.
Time frame: Pretreatment and 1 year
Durability of HSC Donor Engraftment in the Skin
Incidence of HSC donor engraftment in the skin
Time frame: 100 Days
Probability of Survival
Surviving patients one year after engraftment
Time frame: 1 Year
Percentage of Participants Who Experienced Acute GVHD
Incidence of acute GCHD
Time frame: 100 Days
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