Haploidentical Bone Marrow Transplantation in Sickle Cell Patients (BMTCTN1507)

Medical College of Wisconsin95 enrolled

Overview

This is a Phase II, single arm, multi-center trial, designed to estimate the efficacy and toxicity of haploidentical bone marrow transplantation (BMT) in patients with sickle cell disease (SCD). Based on their age and entry criteria patients are stratified into two groups: (1) children with severe SCD; and (2) adults with severe SCD.

This study is designed as a Phase II multi-center trial to determine the feasibility of achieving a high rate of event-free survival (EFS) at 2 years post transplant using pre-conditioning hydroxyurea (HU) with a conditioning regimen that consists of a combination of Thymoglobulin/Cyclophosphamide/Fludarabine/Thiotepa with post-grafting high-dose cyclophosphamide in patients with severe SCD who have HLA-haploidentical donors. EFS is defined as survival without a qualifying event. This is a single arm study in which participants will be enrolled into one of two strata. The first stratum will be restricted to children who have stroke and 40 children will be enrolled in this stratum. The second stratum will consist of adult patients with severe sickle cell disease and 40 participants will be enrolled in this stratum.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Sickle Cell Disease

Interventions

Haploidentical Bone Marrow TransplantationPROCEDURE

Eligible patients with a first degree Human Leukocyte Antigen (HLA)- haploidentical donor will undergo Haploidentical bone marrow transplantation at Day 0 with non T-cell depleted bone marrow. For Graft-vs-Host Disease (GVHD) prophylaxis, patients will be given sirolimus and mycophenolate mofetil beginning on Day +5.

HydroxyureaDRUG

HU will be given daily at 30mg/kg from Day -70 through Day -10.

Rabbit-ATGDRUG

Rabbit-ATG (rATG) will be given at 0.5mg/kg on Day -9, and at 2.0mg/kg on Day -8 and Day -7.

Eligibility

Sex: ALLMin age: 5 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: Adequate physical function as measured by all of the following: 1. A Karnofsky/Lansky performance score of ≥ 60. 2. Cardiac function: Left ventricular ejection fraction (LVEF) \> 40%; or LV shortening fraction \> 26% by cardiac echocardiogram or by Multi Gated Acquisition Scan (MUGA) scan. 3. Pulmonary function: Pulse oximetry with a baseline O2 saturation of ≥ 85% and Diffusing capacity of the lung for carbon monoxide (DLCO) \> 40% (corrected for hemoglobin). 4. Renal function: Serum creatinine ≤ 1.5 x upper limit of normal for age and estimated or measured creatinine clearance ≥ 70 mL/min/1.73 m² 5. Hepatic function: 1. Serum conjugated (direct) bilirubin \< 2x upper limit of normal for age as per local laboratory. Participants with hyperbilirubinemia as the result of hyperhemolysis, or a severe drop in hemoglobin post blood transfusion, are not excluded. 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 5x upper limit of normal as per local laboratory. 6. Liver MRI using a validated methodology per institutional preference (T2\* or R2\* or by ferriscan \[R2 MRI\]) for estimation of hepatic iron content is required for participants who are currently receiving ≥8 packed red blood cell transfusions per year for ≥1 year or have received ≥20 packed red blood cell transfusions (lifetime cumulative). Participants who have hepatic iron content ≥ 10 mg Fe/g liver dry weight by liver MRI must have a Gastroenterology/hepatology consultation with liver biopsy and histological examination including documentation of the absence of cirrhosis, bridging fibrosis, and active hepatitis. 7. Participants must be HLA typed at high resolution using DNA based typing at HLA-A, -B, -C, DRB1, and have available: An HLA haploidentical first degree relative donor (parents, siblings or half siblings, or children) with 2, 3, or 4 (out of 8) HLA-mismatches who is willing and able to donate bone marrow. A unidirectional mismatch in either the graft versus host or host versus graft direction is considered a mismatch. The donor and recipient must be HLA identical for at least one antigen (using high resolution DNA based typing) at the following genetic loci: HLA-A, HLA-B, HLA-C, and HLA-DRB1. Fulfillment of this criterion shall be considered sufficient evidence that the donor and recipient share one HLA haplotype, and typing of additional family members is not required. Confirmatory donor HLA typing must be completed \< 100 days prior to Segment A enrollment 8. Umbilical cord blood or peripheral blood stem cell donors will not be accepted. Inclusion Criteria for Stratum 1: Children Ages 5.00 - 14.99 years of age at enrollment 1. Age 5.00 - 14.99 years at Segment A enrollment 2. Participants with sickle cell anemiam disease (Hb SS or Sß° Thalassemia) who have one or more of the following: 1. A neurological event resulting in focal neurologic deficits that lasted ≥ 24 hours (classical clinical definition of stroke, not requiring imaging studies of the brain) OR a focal neurological event resulting in abnormalities on T2-weighted or FLAIR images using a MRI scan, indicative of an acute infarct, with no other reasonable medical explanation (definition of a stroke supported with MRI imaging scans of the brain), OR both. 2. Abnormal transcranial Doppler (TCD) measurement with a timed average maximum mean velocity of at least 200 cm/sec in the terminal portion of the internal carotid or proximal portion of middle cerebral artery or if the imaging TCD method is used \> 185 cm/sec plus evidence of intracranial vasculopathy. 3. Silent Cerebral Infarct defined as an infarct-like lesion based on an MRI signal abnormality at least 3 mm in one dimension and visible in two planes on FLAIR or T2-weighted images (or similar image with 3D imaging) and documented neurological examination performed by a neurologist demonstrating the participant has a normal neurologic examination or an abnormality on examination that could not be explained by the location of the brain lesion(s). 4. Acute severe vaso-occlusive pain episodes requiring hospitalization and recalcitrant to maximum medical therapy. Episodes of pain to be adjudicated by selected committee. 5. One acute chest syndrome episode resulting in intensive care admission requiring non-mechanical ventilatory support: simple nasal cannula, face mask that requires oxygen content (venti mask, non-rebreather), simple nasal cannula, face mask O2(e.g. ventimask, rebreather), CPAP, SiPAP, BiPAP, high flow nasal cannula (HFNC) or invasive mechanical ventilatory support (delivered by ETT or trach). 6. Right heart catheterization confirmed pulmonary artery pressure \>25 mmHG or mean pulmonary vascular resistance 206(57-421) dyn·s·cm-5 7. Essential hypertension on antihypertensive medications \>95% upper limit of normal age (as defined according to the American Academy of Pediatrics) 8. Recurrent priapism (episodes lasting at least 4 hours at least twice in the last 12 months or 3 times in the last 24 months) recalcitrant to medical treatment or unable to use hydroxyurea due to SCD phenotype with the approval of the adjudication committee Inclusion Criteria for Stratum 2: Adults Ages 15.00 - 45.99 at enrollment Participants with sickle cell anemia (Hb SS or Sß° Thalassemia) who are 15.00 - 45.99 years of age at enrollment AND who have one or more of the following: 1. Age 15.00 - 45.99 years at Segment A enrollment 2. Participants with sickle cell anemia (Hb SS or Sß° Thalassemia) who have one or more of the following: 1. A neurological event resulting in focal neurologic deficits that lasted ≥ 24 hours (classical clinical definition of stroke, not requiring imaging studies of the brain) OR a focal neurological event resulting in abnormalities on T2-weighted or FLAIR images using a MRI scan, indicative of an acute infarct, with no other reasonable medical explanation (definition of a stroke supported with MRI imaging scans of the brain), OR both. 2. History of two or more episodes of acute chest syndrome (ACS) in the 2-year period preceding enrollment despite the institution of supportive care measures (i.e. asthma therapy and/or hydroxyurea); 3. History of three or more severe vaso-occlusive pain crises per year in the 2-year period preceding enrollment despite the institution of supportive care measures (i.e. a pain management plan and/or treatment with hydroxyurea); painful episodes related to priapism, osteonecrosis or any sickle-related complication are acceptable; 4. Administration of regular RBC transfusion therapy, defined as receiving ≥8 packed red blood cell transfusions per year for ≥1 year in the 12 months before enrollment to prevent vaso-occlusive clinical complications (i.e. pain, stroke, and acute chest syndrome); 5. An echocardiographic finding of tricuspid valve regurgitant jet velocity (TRJV) ≥ 2.7 m/sec. Exclusion Criteria: 1. Participants who have an HLA-matched sibling who is able and willing to donate bone marrow. Patients with a HLA-matched unrelated donor are not excluded. 2. Uncontrolled bacterial, viral or fungal infection in the 6 weeks before enrollment (currently taking medication with evidence of progression of clinical symptoms or radiologic findings). 3. Evidence of HIV infection or known HIV positive serology. 4. Participants who have received a previous hematopoetic cell transplant (HCT). 5. Participants who have had an Encephaloduroarteriosynangiosis (EDAS) procedure in the 6 months prior to enrollment 6. Participants who have received a prior solid organ transplant 7. Participants who have participated in another clinical trial in which the patient received an investigational or off-label use of a drug or device within 3 months of enrollment. 8. Females who are pregnant or breastfeeding. 9. Participants with clinically significant, uncontrolled autoimmune disease, requiring active medical management (immunosuppressive therapy or chemotherapy), which, in the judgment of the local Principal Investigator, indicates that the patient could not tolerate transplantation. 10. Females of child bearing potential (to include all female participants \> 10 years of age, unless postmenopausal for a minimum of 1 year before the time of consent or surgically sterilized), who do not agree to practice two (2) effective methods of contraception at the same time, or do not agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject, from the time of signing of informed consent through 12 months post-transplant. 11. Males (even if surgical sterilized) who do not agree to practice effective barrier contraception, or who do not agree to practice true abstinence from the time of signing informed consent through 12 months post-transplant. 12. Presence of anti-donor specific HLA antibodies. HLA antibody presence and specificity will be determined by solid phase immunoassays. An anti-donor specific HLA antibody will be considered positive when the mean fluorescence intensity (MFI) is higher than the cut-off defined by each institution. Recommended cut-off values are MFI \>1000 for donor specific antibody to HLA-A, -B, and DRB1 and MFI \>2000 for HLA-C, DQB1 and DPB1. This must be measured before the final donor selection, and \< 100 days before enrollment in Segment A (preferably \< 30 days before Segment A enrollment). If MFI \>1000 for donor specific antibody to HLA-A, -B, DRB1 and/or MFI \>2000 for HLA-C, DQB1 and DPB1, documentation must be submitted to the DCC coordinator for review and approval by a Protocol Chair and/or Protocol Officer prior to enrollment

Locations (32)

Outcomes

Primary Outcomes

Percentage of Participants With Two-Year Post-Transplant Event Free Survival (EFS)

EFS is defined as survival without a qualifying event from transplant. Primary graft failure (PGF), secondary graft failure (SGF), second infusion of hematopoietic cells, or death from any cause will count as events for this endpoint. This endpoint was adjudicated by an Endpoint Review Committee. PGF is lack of engraftment on or before Day 42 post-transplant. Engraftment is defined as having greater than or equal to 5% donor cells post-transplant, from any molecular chimerism assessment (e.g., unsorted, myeloid, or T-cell) on a peripheral blood or bone marrow aspirate sample. SGF is defined as \< 5% donor whole blood or myeloid chimerism in peripheral blood or bone marrow beyond day +42 post-transplant in patients with prior documentation of hematopoietic recovery with \>5% donor cells by day +42 post-transplant. Infusion of a second stem cell product will be considered graft rejection, and counted toward primary or, depending on timing of the second infusion, secondary graft rejection

Time frame: 2 years post-transplant

Secondary Outcomes

Percentage of Participants With Two-Year Post-Transplant Overall Survival (OS)

Death from any cause will be the event and patients will be censored at the date of last contact or two years post-transplant, whichever comes first.

Time frame: 2 years post-transplant

Number of Participants With Graft Failure

Primary Graft Failure (PGF) is lack of engraftment on or before Day 42 post-transplant. Engraftment is defined as having greater than or equal to 5% donor cells post-transplant, from any molecular chimerism assessment (e.g., unsorted, myeloid, or T-cell) on a peripheral blood or bone marrow aspirate sample. Secondary Graft Failure (SGF) is defined as \< 5% donor whole blood or myeloid chimerism in peripheral blood or bone marrow beyond day +42 post-transplant in patients with prior documentation of hematopoietic recovery with \>5% donor cells by day +42 post-transplant. Infusion of a second stem cell product will be considered graft rejection, and counted toward primary or, depending on timing of the second infusion, secondary graft rejection.

Data from ClinicalTrials.gov

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Thiotepa will be given at 10mg/kg on Day -7

FludarabineDRUG

Fludarabine will be given at 30mg/m2 from Day -6 to Day -2

CyclophosphamideDRUG

Cyclophosphamide will be given at 14.5mg/kg on Day -6 and Day -5, and at 50 mg/kg on Days +3 and +4.

Total Body IrradiationRADIATION

Total Body Irradiation will be given at 200cGy on Day -1

MesnaDRUG

Mesna will be given at 40mg/kg on Days +3 and +4

University of Alabama at Birmingham

Birmingham, Alabama, United States

UCSF Benioff Children's Hospital Oakland

Oakland, California, United States

University of Colorado - Denver/Children's Hospital of Colorado

Aurora, Colorado, United States

Children's National Medical Center

Washington D.C., District of Columbia, United States

University of Florida College of Medicine

Gainesville, Florida, United States

Nicklaus Children's Hospital/University of Miami Children's Hospital

Miami, Florida, United States

H. Lee Moffitt Cancer Center

Tampa, Florida, United States

Northside Hospital

Atlanta, Georgia, United States

Riley Children's Hospital at IU Health

Indianapolis, Indiana, United States

Indiana University Medical Center

Indianapolis, Indiana, United States

...and 22 more locations

Time frame: 2 Years post-transplant

Percentage of Participants With Disease Recurrence Post-Transplant

Disease Recurrence is defined as primary graft failure, secondary graft failure, or sickle hemoglobin (HbS) \> 70% within 2 years post-transplant. Cumulative Incidence of Disease Recurrence was estimated with a 95% confidence interval using the Aalen-Johansen estimator with death prior to disease recurrence treated as a competing risk. This endpoint was adjudicated by an Endpoint Review Committee.

Time frame: 1 year and 2 years post-transplant

Percentage of Participants With Neutrophil Recovery Post-Transplant

Neutrophil recovery is defined as the first of 3 measurements on different days when the patient has an absolute neutrophil count of ≥500/μL after conditioning. The incidence of neutrophil recovery from transplant will be estimated using the cumulative incidence function with a 95% confidence interval using the Aalen-Johansen estimator with death or second transplant without neutrophil recovery as a competing risk.

Time frame: 42 Days post-transplant

Percentage of Participants With Platelet Recovery Post-Transplant

Platelet recovery is defined as the first day of a minimum of 3 measurements on different days that the patient has achieved a platelet count \> 50,000/μL AND did not receive a platelet transfusion in the previous 7 days. The incidence of platelet recovery from transplant will be estimated using the cumulative incidence function with a 95% confidence interval using the Aalen-Johansen estimator with death or second transplant without platelet recovery as a competing risk.

Time frame: 60 Days, 100 Days post-transplant

Mean Percentage of Donor Chimerism Post-Transplant

A point estimate and confidence interval will be provided for the mean percent donor chimerism at the time points specified including Day 28, Day 100, Day 180, 1 year, and 2 years post-transplant. For each participant's visit with multiple chimerism sources recorded, donor percentage is determined by taking the first non-missing chimerism percentage in the following order of sources: marrow, blood, myeloid, and t-cell.

Time frame: Days 28, 100, and 180 and at 1 and 2 years post-transplant

Percentage of Participants by Donor Chimerism Category Post-Transplant

At Day 28, Day 100, Day 180, 1 year and 2 years post-transplant, the proportions with low chimerism (\<5%), mixed chimerism (5-95%), or full chimerism (\>95%) will be tabulated and described. For each participant's visit with multiple chimerism sources recorded, donor percentage is determined by taking the first non-missing chimerism percentage in the following order of sources: marrow, blood, myeloid, and t-cell.

Time frame: Days 28, 100, and 180 and at 1 and 2 years post-transplant

Number of Participants by Maximum Acute GVHD Grade Post-Transplant

Acute GVHD was graded according to Consensus Criteria with higher grade indicating worse outcomes. Grade I aGVHD is defined as stage 1-2 skin rash and no liver or GI involvement. Grade II is stage 3 skin rash, or stage 1 liver involvement, or stage 1 GI involvement. Grade III is stage 0-3 skin rash, with stage 2-3 liver involvement, or stage 2-3 GI involvement. Grade IV is stage 4 skin rash, liver, or GI involvement. Maximum grade is defined as the maximum grade of acute GVHD (0-IV) that a participant experiences by Day 100 post-transplant.

Time frame: 100 Days post-transplant

Percentage of Participants With Acute GVHD Post-Transplant

Acute GVHD was graded according to Consensus Criteria with higher grade indicating worse outcomes. Grade I aGVHD is defined as stage 1-2 skin rash and no liver or GI involvement. Grade II is stage 3 skin rash, or stage 1 liver involvement, or stage 1 GI involvement. Grade III is stage 0-3 skin rash, with stage 2-3 liver involvement, or stage 2-3 GI involvement. Grade IV is stage 4 skin rash, liver, or GI involvement. The cumulative incidence of acute GVHD grade II-IV and III-IV at Day 100 was estimated using the Aalen-Johansen estimator with 95% confidence intervals, treating death prior to aGVHD as a competing event. Time to aGVHD is defined as time from transplant until onset of grades II-IV and III-IV aGVHD, respectively.

Time frame: 100 Days post-transplant

Number of Participants by Maximum Chronic GVHD Severity Post-Transplant

Chronic GVHD is based on NIH Consensus Criteria (2014 NIH Consensus Criteria) and includes mild, moderate and severe chronic GVHD. Skin/hair, ocular, oral, pulmonary, gastrointestinal, hepatic, genitourinary, musculoskeletal, and hematologic systems were scored on a 0-3 scale to reflect degree of cGVHD involvement. Maximum grade is defined as the maximum grade of chronic GVHD (mild, moderate, or severe) that a participant experiences by 2 years post-transplant.

Time frame: 2 Years post-transplant

Percentage of Participants With Chronic GVHD Post-Transplant

Percentage of participants with chronic GVHD (cGVHD) at will be estimated with 95% confidence intervals for each treatment group using the cumulative incidence estimate with the complementary log-log transformation, treating death prior to cGVHD as a competing event. Chronic GVHD is based on NIH Consensus Criteria (2014 NIH Consensus Criteria) and includes mild, moderate and severe chronic GVHD. Skin/hair, ocular, oral, pulmonary, gastrointestinal, hepatic, genitourinary, musculoskeletal, and hematologic systems were scored on a 0-3 scale to reflect degree of cGVHD involvement. This endpoint considers any cGVHD onset.

Time frame: 6 months, 1 year, 2 years post-transplant

Number of Participants With Complications and Events Post-Transplant

The number of participants experiencing the following complications and events will be tabulated at baseline, 1 year and 2 years post-transplant: Idiopathic pneumonia syndrome (IPS), Veno-occlusive disease (VOD), Various Central Nervous System (CNS) toxicities, Stroke, participants on immunosuppression for GVHD, and significant infections reported (any bacterial/fungal sepsis, Cytomegalovirus (CMV) reactivation with/without clinical disease, adenovirus, Epstein-Barr Virus (EBV)).

Time frame: Baseline, 1 year, and 2 years post-transplant

Number of Participants With Sickle Cell Disease Events of Special Interest Post-Transplant

Participants will be followed for the entire 2 year duration of their time on study for the recurrence of Sickle Cell Disease (SCD) related complications. These SCD related complications are referred to as SCD events of special interest (SCD-EOSI) and will be summarized with frequency. These SCD-EOSI include: pulmonary hypertension, new onset of significant cerebrovascular event, renal function compromise, new onset of avascular necrosis of hip or shoulder, new onset of leg ulceration, new onset of acute chest syndrome, and new onset of painful vaso-occlusive crisis requiring hospitalization or parenteral opioid drug in the outpatient setting.

Time frame: Baseline, 6 months, 1 year, 18 months, and 2 Years post-transplant

Summary of Hematological Outcomes in Percentages

Hematological Outcomes will be summarized with mean and standard deviation at various timepoints. Depending on the measurement, "baseline" could be pre-hydroxyurea conditioning (day -70 pre-transplant) and/or pre-thymoglobulin (day -7 pre-transplant). Measures include: hemoglobin (Hgb) %, reticulocyte count %, and hemoglobin S level %.

Time frame: Baseline, Day 28, Day 100, 6 months, 1, and 2 years post-transplant

Summary of Glomerular Filtration Rate (GFR)

Renal Function Outcomes will be summarized with mean and standard deviation at various timepoints. "Baseline" refers to pre-thymoglobulin (day -7 pre-transplant). Measures include: GFR (mL/min/1.73m2) and Estimated GFR. Estimated GFR is computed using the CKD-EPI Creatinine Equation 2021 for Adults and the Bedside Schwartz 2009 equation for Pediatrics.

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Lung Function in Liters

Lung Function Outcomes will be summarized with mean and standard deviation at various timepoints. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant). Measures include: FEV1 (L), FVC (L), and TLC (L). All values in this table were reported by study site.

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Cardiac Function

Cardiac Function is measured through tricuspid regurgitant jet velocity (TRJV). It will be summarized with mean and standard deviation at Baseline, 1, and 2 years post-transplant. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant).

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Six Minute Walk Distance

Six Minute Walk Distance is measured in meters to assess how far a participant can walk in 6 minutes. It will be summarized with mean and standard deviation at Baseline, 1, and 2 years post-transplant. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant). Change from baseline will also be provided at the 1 and 2 years post-transplant visit.

Time frame: Baseline, 1, and 2 years post-transplant

Mean Patient Reported Quality of Life (QoL) Score

Health-Related Quality of Life (QoL) assessed using the NIH's PROMIS short forms administered to English- and Spanish-speaking patients in the adult stratum. Questions about fatigue (short form 8a), pain interference (short form 8a), and pain intensity (short form 3a) are asked regarding the degree of difficulty in performing activities of daily living such as housework, social activities, and day to day activities. It is scored from 0 to 10 and converted to a standardized T-score with mean 50 and standard deviation 10. A higher T-score represents worse fatigue, pain interfering with more daily activities, and worse pain intensity.

Time frame: Baseline, 1, and 2 years post-transplant

Mean Patient Reported Pain Intensity Score From Pain Diary

Subjects who speak English and are 15 years or older will be asked to use a web-based diary to report pain intensity on a scale from 0 (no pain) to 10 (worst pain). Subject pain intensity score is reported as an aggregate of several AM and PM scores at Baseline, one year, and two years post-transplant timepoints.

Time frame: Baseline, 1, and 2 years post-transplant

Number of Participants by Cause of Death

Cause of Death is tabulated by age strata. Deaths among participants who were not transplanted are included.

Time frame: From Enrollment to 2 Years post-transplant

Number of Participants by Maximum Grade of Infection

Number of participants who reported the Maximum Infection Severity of Grade 2 and Grade 3. Only grade 2 and grade 3 infections occurring post transplantation were reported on the study. Grade 2 and grade 3 infections are defined by the BMT CTN Technical MOP. Higher infection grade indicates worse infection severity. The infection grading criteria are published online (https://bmtctn.net/administrative-manual-procedures-moppolicy-guidelines). Severity of grade 1, 2 and 3 are described for bacterial, fungal, viral, parasitic, and nonmicrobiological infections. For example, grade 2 fungal infections are defined as candida esophagitis, or proven or probably fungal sinusistis confirmed radiologically without orbital, brain or bone involvement. Grade 3 fungal infections are defined as Fungemia including candidemia, Proven or probably invasive fungal infections, Disseminated infections with histoplasmosis, blastomycosis, coccidiomycosis, or Cryptococcus, or Pneumocystis jiroveci pneumonia.

Time frame: From Transplant to 2 Years post-transplant

Frequencies of Infections Categorized by Infection Type

The number of systemic infections is reported. Infections are categorized by infection type. A participant can report multiple types of infections, so the categories are not mutually exclusive for participants. All grade 2 and grade 3 infections, as defined by the BMT CTN Technical MOP, occurring post transplantation were reported on the study.

Time frame: From Transplant to 2 Years post-transplant

Frequency of Hospital Readmissions by Cause

Participants could be readmitted to a hospital for many reasons during follow-up. The causes of each readmission are tabulated by age strata. The protocol-specified scheduled transplant hospitalization is not included in this table.

Time frame: From Transplant to 2 Years post-transplant

Summary of Lactate Dehydrogenase (LDH)

Hematological Outcomes will be summarized with mean and standard deviation at various post-transplant timepoints. Measures in this table include: LDH (U/L)

Time frame: Day 28, Day 100, 6 months, 1, and 2 years post-transplant

Summary of Bilirubin

Hematological Outcomes will be summarized with mean and standard deviation at various timepoints. Baseline timepoint is pre-thymoglobulin (day -7 pre-transplant). Measures in this table include: Bilirubin (mg/dL)

Time frame: Baseline, Day 28, Day 100, 6 months, 1, and 2 years post-transplant

Summary of Serum Ferritin

Hematological Outcomes will be summarized with mean and standard deviation at various timepoints. Baseline refers to pre-thymoglobulin (day -7 pre-transplant). Measures in this table include: Serum Ferritin Level (ng/dL)

Time frame: Baseline pre-thymoglobulin visit (day -7 pre-transplant)

Summary of Creatinine Clearance

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Urine Albumin Creatine Ratio

Renal Function Outcomes will be summarized with mean and standard deviation at various timepoints. Measures include: Urine Albumin Creatine Ratio (mg/g).

Time frame: 1 and 2 years post-transplant

Summary of Lung Function Percent Predicted

Lung Function Outcomes will be summarized with mean and standard deviation at various timepoints. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant). Measures include: FEV1 (percent predicted), FVC (percent predicted), FEV1/FVC (percent predicted), and TLC (percent predicted). All values in this table, including percent predicted, were reported by study site.

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Lung Function Ratio of Liters

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Lung Function Percentages of Lab Measure

Lung Function Outcomes will be summarized with mean and standard deviation at various timepoints. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant). Measures include: DLCO (%) and Oxygen Saturation (%). All values in this table were reported by study site.

Time frame: Baseline, 1, and 2 years post-transplant

Summary of Lung Function Ratio of Percent Predicted

Lung Function Outcomes will be summarized with mean and standard deviation at various timepoints. "Baseline" refers to pre-hydroxyurea (day -70 pre-transplant). Measures include: FEV1/FVC (ratio of percent predicted). All values in this table were reported by study site.

Time frame: Baseline, 1, and 2 years post-transplant