The purpose of this study is to determine whether bilateral orthotopic lung transplantation (BOLT) followed by cadaveric partially-matched hematopoietic stem cell transplantation (HSCT) is safe and effective for patients aged 5-45 years with primary immunodeficiency (PID) and end-stage lung disease.
This is an original IND for an investigator initiated phase I/II study. The primary purpose of the study is to evaluate the safety and efficacy of performing bilateral orthotopic lung transplantation (BOLT) followed by cadaveric, partially HLA-matched CD3+/CD19+-depleted hematopoietic stem cell transplantation (HSCT) from the same donor for patients with primary immunodeficiency diseases (PID) and end-stage lung disease. For many patients with primary immunodeficiencies, HSCT is a curative, life-saving therapy, resulting in restoration of function in the immune system. Patients with primary immunodeficiencies often develop pulmonary complications as a result of chronic or recurrent infections, making them ineligible for HSCT due to the high risk of mortality and pulmonary complications. Lung transplant prior to HSCT would allow for restoration of pulmonary function prior to HSCT, allowing PID patients to proceed to HSCT, which would be curative for the patient's underlying immunodeficiency. As a secondary aim after successful engraftment with donor bone marrow, there is realistic hope for tolerating planned withdrawal of immunosuppression achieving eventual freedom from all immunosuppressive drugs and attaining a tolerant state.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Negative selection for CD3/CD19 will be performed on a CliniMACS® depletion device within 36 hours of collection and given at time no less than 8 weeks post lung transplant.
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
Safety: Death
How many, if any, patients die.
Time frame: Up to 2 years post stem cell transplant
Safety: Engraftment syndrome
How many, if any, patients develop engraftment syndrome.
Time frame: Up to 2 years post stem cell transplant
Safety: Engraftment failure
How many patients, if any, develop engraftment failure.
Time frame: Up to 2 years post stem cell transplant
Safety: Rituximab
The number of grade 4 and 5 events potentially related to rituximab.
Time frame: Up to 2 years post stem cell transplant
Efficacy: BOS score
Bronchiolitis Obliterans Syndrome (BOS) score for all patients who receive both lungs and stem cell transplants.
Time frame: 1 year post stem cell transplant
Efficacy: T-cell chimerism
The number of patients who have ≥ 25% donor T-cell chimerism.
Time frame: 1 year post stem cell transplant
Efficacy: Myeloid chimerism
The number of patients with myeloid disorders (e.g. CGD) who attain ≥ 10% myeloid chimerism.
Time frame: 1 year post stem cell transplant
Efficacy: B-cell chimerism
The number of patients with B-cell disorders who attain ≥ 10% B-cell chimerism.
Time frame: 1 year post stem cell transplant
Feasibility of meeting BMT eligibility critieria
The number of patients who are able to proceed to BMT within 6 months following lung transplant.
Time frame: Up to 2 years post stem cell transplant
Tolerance
Development of tolerance to both the host and pulmonary graft.
Time frame: Up to 2 years post stem cell transplant
Long-term complications
Long-term complications of combined solid organ and BMT.
Time frame: Up to 2 years post stem cell transplant
Graft failure
The number of patients who develop graft failure.
Time frame: Up to 2 years post stem cell transplant
Acute cellular rejection
The number of patients who develop acute cellular rejection.
Time frame: Up to 2 years post stem cell transplant
Acute graft-versus-host disease (GVHD)
The number of patient who develop acute graft-versus-host disease (GVHD).
Time frame: Up to 2 years post stem cell transplant
Chronic graft-versus-host disease (GVHD)
The number of patient who develop chronic graft-versus-host disease (GVHD).
Time frame: Up to 2 years post stem cell transplant
Ability to withdraw immunosuppression
The number of patients who are able to start immunosuppression withdrawal.
Time frame: 1 year post stem cell transplant
Time to withdraw immunosuppression
Time from BMT to withdrawal of immunosuppression.
Time frame: Up to 2 years post stem cell transplant
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Pathogen-specific immunity
Time from BMT to independence from treatment dose antimicrobial drugs.
Time frame: Up to 2 years post stem cell transplant
Lymphocyte count - for T-cell lymphopenias
The number of patients who are able to achieve an age adjusted, low limit normal range lymphocyte count.
Time frame: 1 year post stem cell transplant
Chronic lung allograft dysfunction
The number of patients who develop chronic lung allograft dysfunction post-lung transplant for all subjects, lung only and lung+stem cell transplant.
Time frame: 1 year post lung transplant
Allograft failure
The number of patients who develop allograft failure post-lung transplant for all subjects, lung only and lung+stem cell transplant.
Time frame: 1 year post lung transplant
Rituximab related adverse events
The number of grade 4 or 5 adverse events possibly related to the use of rituximab.
Time frame: From the time of the first dose of rituximab up to the start of BMT conditioning.