This is a pilot clinical trial of hematopoietic stem cell transplantation for patients with a diagnosis of Severe Combined Immune Deficiency (SCID) who do not have an HLA-matched sibling donor. The stem cells will be derived from a 1) matched unrelated donor (MUD), 2) unrelated cord blood donor, or 3) a haplo-identical (parental) donor (in descending order of preference).Patients will receive a novel conditioning regimen with Busulfan, Fludarabine and Anti-thymocyte globulin (ATG) followed by an unrelated donor hematopoietic stem cell transplant (HSCT) with T-cell depletion using the CliniMACS device.
The study is being conducted to assess the following: * overall survival * event-free survival (events are defined as: death,non-engraftment/2nd transplant, immune reconstitution failure) * acute toxicity of the conditioning regimen * engraftment frequency immune reconstitution frequency and tempo acute and chronic graft-versus-host disease (GVHD), frequency and severity. The outcome from this protocol will be compared to the retrospective cohort consisting of all patients who have undergone haplo-identical HSCT for SCID at CHLA from 1984-2006 based on the assessment of the above-listed endpoints. The CliniMACS device will be used for CD34+ selection in place of the Isolex 300i. The CliniMACS CD34 Reagent System is an investigational medical device that has not yet been approved by the FDA. This device is used in vitro to select and enrich specific cell populations. When using the CliniMACS CD34 Reagent, the system selects CD34+ cells from heterogenous hematological cell populations for transplantation in cases where this is clinically indicated.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
9
Remaining unmanipulated bone marrow will be processed to isolate CD34+ cells (T cell depleted).
Cord blood will be thawed (and processed if ABO incompatibility) per institutional SOP.
haplo-identical (parental) bone marrow will be processed for CD34+ cell isolation.
Children's Hospital Los Angeles
Los Angeles, California, United States
Number of Participants With Engraftment
Engraftment is defined as recovery of blood counts (neutrophil and platelet engraftment) with cells of donor origin, documented by either bone marrow or peripheral blood chimerism assays after hematopoietic stem cell transplant.
Time frame: 100 day
Number of Participants With Donor-derived CD3+ T Lymphocytes >/= 100/mm3
Absolute number of donor-derived CD3+ T lymphocytes \>/= 100/mm3 in participating subjects.
Time frame: 1 year
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peripheral blood stem cell will be processed for CD34+ cell isolation.