Intrabone Infusion of Umbilical Cord Blood Stem Cells

Henrique Bittencourt, MD, PhD15 enrolled

Overview

The purpose of this study is to determine if the method of intrabone infusion of hematologic stem cells can increase and accelerate hematopoietic reconstitution after umbilical cord blood transplantation in pediatric patients.

Umbilical cord blood transplantation (UCBT) has been increasingly used to treat malignant and non-malignant haematological, immunodeficiency and some metabolic diseases. UCBT offers the advantages of easy procurement, no risk to donors, a reduced risk of transmitting infections, immediate availability of cryopreserved units, and acceptable partial HLA mismatches. However, patients treated with UCBT show delayed hematopoietic and immunological recoveries, have higher rates of infection, and relapse from the original malignant disease, which can all lead to life threatening problems. UCBT can also result in a higher rate of graft failure compared to other hematopoietic stem cell transplantation (HSCT) sources. The problem of a slower hematopoietic recovery post-UCBT has been addressed using a number of different approaches in adult patients.In adults, use of intrabone injection of cord blood results in a faster hematopoietic recovery in a phase II study. However, there is no clinical trial in pediatric patients. This study is addressed to determine if a change in the cord blood stem cell infusion method can increase and accelerate hematopoietic reconstitution after UCBT in pediatric patients.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Hematopoietic Stem Cell Transplantation

Interventions

Intrabone infusion of umbilical cord blood stem cellsPROCEDURE

Eligibility

Sex: ALLMin age: 1 YearMax age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: * One to 21 years of age; * More than 10 kg in weight; * Diagnosis of hematopoietic disorders (malignant or not) with an indication for hematopoietic stem cell transplantation; * Absence of an HLA-identical related donor; * Availability of a single cord blood (CB) with at least 3 x 10\^7 nucleated cells (NCs)/kg (if HLA identical or 1 HLA-mismatch) or at least 4 x 10\^7 NCs/kg (if a 2 HLA-mismatch) at freezing. Use of two CB units ("double cord transplant") will be allowed provided that: 1) a single CB unit fulfilling the above criteria is not available; 2) a maximum of 2 HLA mismatch is present for each CB unit; and 3) a minimum of 4 x 10\^7 NCs/kg (as the sum for both CB units) is present at freezing. * A myeloablative-conditioning regimen; * A Lansky (for patients less than 16 years of age) or Karnofsky (for patients more than 16 years of age) score equal to or higher than 70%. * Adequate organ function as follows: * Cardiac (ejection fraction \> 50%); * Renal (serum creatinine within the normal range for age, and creatinine clearance or a GFR \> 70 ml/min/1.73m2); * Hepatic (AST or ALT \< 5 x upper limit of normal for age); * Pulmonary (FEV1, FVC, and DLCO ≥ 50% by pulmonary function tests or, in children unable to cooperate, no sign of dyspnea at rest, no exercise intolerance, no supplementary oxygen therapy, and a normal pulmonary radiography or pulmonary scan); * No sign of uncontrolled systemic bacterial, fungal or viral infection; * Written informed consent by the patient or his/her legal guardian Exclusion Criteria: * Non-myeloablative conditioning; * Pregnancy or breastfeeding; * HIV positive serology; * Bone disease (e.g. osteopetrosis, osteogenesis imperfecta) * Previous autologous or allogeneic hematopoietic stem cell transplantation performed up to one year before enrolment, except in the case of non-engraftment or early rejection of a previous allogeneic stem cell transplantation. * Active skin infection at the site of intrabone injection. * History of intolerance/allergy to sedation medications or local anesthetics. * Contraindication to sedation

Locations (1)

Centre Hospitalier Universitaire Sainte-Justine

Montreal, Quebec, Canada

Outcomes

Primary Outcomes

Platelet recovery rate

First of seven days of untransfused platelet count higher than 20 x 10\^9/L

Time frame: at 100 days post- transplantation

Secondary Outcomes

Neutrophil recovery rate

First of three days of absolute neutrophil count equal or higher than 0.5 x 10\^9/L

Time frame: at 60 days post- transplantation

Immunological reconstitution

Total number of T cells (and subpopulations), B and NK (natural killer) cells in peripheral blood at different time-points

Time frame: at 30, 60, 100, 180, and 360 days post- transplantation

Donor chimerism rate

Percentage of donor(s) cells in peripheral blood at different time-points

Time frame: at 30, 60,100, and 180 days post-transplantation

Acute GVHD (grade 2-4) rate

Incidence of grade II-IV acute GVHD (Graft versus Host Disease)

Time frame: at 180 days

Infection rate (bacterial, viral, fungal and parasitic)

Clinical and microbiological documented infections will be reported according to anatomic site, date of onset and microorganism

Time frame: at 180 days post-transplantation

Event-free and overall survival

Event-free survival is defined as the time interval between transplantation and relapse, graft rejection, death or last follow-up, whichever occurs first; Overall survival is defined as the time between transplantation and death or last follow-up

Time frame: at 2 years

Data from ClinicalTrials.gov

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