The objective of this study is to evaluate the efficacy of using a reduced-intensity condition (RIC) regimen with umbilical cord blood transplant (UCBT), double cord UCBT, matched unrelated donor (MUD) bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) in patients with non-malignant disorders that are amenable to treatment with hematopoietic stem cell transplant (HSCT). After transplant, subjects will be followed for late effects and for ongoing graft success.
For some non-malignant diseases (NMD; i.e., thalassemia, sickle cell disease, most immune deficiencies) a hematopoietic stem cell transplant may be curative by healthy donor stem cell engraftment alone. HSCT in patients with NMD differs from that in malignant disorders for two important reasons: 1) these patients are typically naïve to chemotherapy and immunosuppression. This may potentially lead to difficulties with engraftment. And 2) RIC with subsequent bone marrow chimerism may be beneficial even in mixed chimerism and result in decreased transplant-related mortality (TRM). Nevertheless, any previous organ damage, as a result of the underlying disease, may remain present after the HSCT. For other diseases (metabolic disorders, some immunodeficiencies, etc.), a transplant is not curative. For these diseases, the main intent of the transplant is to slow down, or stop, the progress of the disease. In select few cases/diseases, the presence of healthy bone marrow derived cells may even prevent progression and prevent neurological decline. Research funds are not available to assist with enrollment on this trial. In this research study, instead of using the standard myeloablative conditioning, the study doctor is using RIC, in which significantly lower doses of chemotherapy will be used. The lower doses may not eradicate every stem cell in the patient's bone marrow, however, in the presented combination, the intention is to eliminate already formed immune cells and provide maximum growth advantage to healthy donor stem cells. This paves the way to successful engraftment of donor stem cells. Engrafting donor stem cells can outcompete, and donor lymphocytes could suppress, the patients' surviving stem cells. With RIC, the side effects on the brain, heart, lung, liver, and other organ functions are less severe and late toxic effects should also be reduced. The purpose of this study is to collect data from the patients undergoing reduced-intensity conditioning before HSCT, and compare it to the standard myeloablative conditioning. It is expected there will be therapeutic benefits, paired with better survival rate, less organ toxicity and improved quality of life, following the RIC compared to the myeloablative regimen.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Oral administration
Intravenous (IV) administration.
IV administration
IV administration
IV administration
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
RECRUITINGPost-transplant treatment-related mortality (TRM)
The number of deaths related to the research intervention at day 100, 6 months, and 1 year post-transplant.
Time frame: 1 year post-transplant
Neurodevelopmental milestones
Evaluation of the pace of attaining neurodevelopmental milestones after reduced-intensity conditioning as compared to myeloablative conditioning historical controls from the target population(s).
Time frame: 1 year post-transplant
Immune Reconstitution
Evaluation of the pace of immune reconstitution.
Time frame: 1 year post-transplant
Severe opportunistic infections
Evaluation of the incidence of severe opportunistic infections.
Time frame: 1 year post-transplant
GVHD occurrence
Description of the incidence of acute graft versus host disease (GVHD) (II-IV) and chronic extensive GVHD.
Time frame: 1 year post-transplant
Donor cell engraftment
Determination of the feasibility of attaining robust donor cell engraftment (\>50% donor chimerism at 6 months) following reduced-intensity conditioning (RIC) regimens prior to HSCT in the target population(s).
Time frame: 6 months post-transplant
Normal enzyme level
Determination of the feasibility of attaining and sustaining normal enzyme levels in the target population(s).
Time frame: 1 year post-transplant
Neutrophil recovery
Determination of the pace of neutrophil recovery.
Time frame: 1 year post-transplant
Platelet recovery
Determination of the pace of platelet recovery.
Time frame: 1 year post-transplant
Grade 3-4 organ toxicity
The number of grade 3-4 organ adverse events.
Time frame: 1 year post-transplant
Late graft failure
Evaluation of the incidence of late graft failure.
Time frame: 1 year post-transplant
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