Chronic granulomatous disease (CGD) affects white blood cell function. Currently, the only curative treatment is bone marrow transplant to replace the abnormal stem cells with new ones (donor cells) capable of making a normal immune system. Transplant problems include graft versus host disease (GvHD) and graft rejection. With GvHD, donor cells attack the recipient s normal tissue. Researchers want to use preparation drugs and a high cell dose to increase graft success. They want to use 2 immunosuppressive drugs (cyclophosphamide and sirolimus) to lessen the risk of GvHD.
Study Description: Alemtuzumab, targeted busulfan, and TBI, with a 10/10 related or MUD donor graft or a 9/10 single HLA mismatch graft followed by post-transplant cyclophosphamide. Primary Objectives: To determine engraftment rates with the use of high cell doses, without increasing the risk of GvHD by using post-transplant cyclophosphamide and sirolimus in conjunction with a busulfan based conditioning regimen. We will compare the incidence of graft rejection/failure and GvHD to the incidence obtained from Protocol 07-I-0075. Secondary Objectives: To measure the engraftment rate and the engraftment kinetics using such a regimen. To assess the level and kinetics of immune reconstitution (via chimerism) when using post- transplant cyclophosphamide. To further elucidate the factors involved in the development of GvHD and graft rejection/failure. To evaluate the risk of viral infections in the setting of Alemtuzumab (Campath-1H) and post-transplant cyclophosphamide. Primary Endpoint: Reduced incidence of graft failure or rejection (as defined by \>20% engraftment by oxidase- positive neutrophils in at least 95% of participants by Day 100, 6 months, and 1 year post BMT) will be assessed as event-free survival (EFS). Graft failure will result in disease recurrence. This will be assessed in a composite form along with GvHD (see Biostatistical Considerations section 17). Secondary Endpoints: Same or reduced rate of grade 3-4 aGvHD of \<20% . Establish stable mixed chimerism. Improve rapidity of immune reconstitution. Overall survival. Tertiary Endpoints: Evaluation of inflammatory markers as risk factors for engraftment syndrome
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Transplant Conditioning Drug: Monoclonal antibody that targets recipient and donor T-cells to prevent graft verses host disease. Not an IND. This is a well studied drug, and is not under an IND.
Transplant Conditioning Drug: Chemotherapy to create space in the patient's bone marrow so that the donor peripheral blood stem cells can repopulate in the patient's bone marrow. This is a well studied drug, and is not under an IND.
Immunosuppressant to prevent donor peripheral blood stem cell rejection and graft versus host disease. This is a well studied drug, and is not under an IND.
Post transplant cyclophosphamide given to prevent graft verses host disease. This is a well studied drug, and is not under an IND.
Transplant Conditioning Total Body Radiation (300cGy in 2 fractionated doses), given only to patient receiving matched unrelated donor cells, to create space in the patient's bone marrow so that the donor peripheral blood stem cells can repopulate in the patient's bone marrow.
Donor Peripheral blood stem cells, either matched unrelated donor or matched related relative to replace the patient's immune cells with functional immune cells. The peripheral blood stem cells are not regulated by the FDA.
National Institutes of Health Clinical Center
Bethesda, Maryland, United States
To determine engraftment rates with the use of high cell doses, without increasing the risk of GvHD by using post-transplant cyclophosphamide and sirolimus in conjunction with a busulfan- based conditioning regimen. We will compare the incidence...
This study is still recruiting patients.
Time frame: 5 years
To measure the engraftment rate and the engraftment kinetics using such a regimen
This study is still recruiting patients
Time frame: 5 years
To assess the level and kinetics of immune reconstitution (via chimerism) when using post- transplant cyclophosphamide
This study is still recruiting patients
Time frame: 5 years
To further elucidate the factors involved in the development of GvHD and graft rejection/failure
This study is still recruiting patients
Time frame: 5 years
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