This is a study to evaluate the safety and toxicity of a treatment regimen consisting of 2 cycles of pre-transplant immunosuppressive therapy followed by myeloablative preparative regimen and allogeneic hematopoietic stem cell transplantation from a haploidentical donor in patients with sickle cell disease. The overall goal of this study is to expand the donor pool for hematopoietic stem cell transplantation in sickle cell disease using haploidentical donors, and to develop a non-toxic, myeloablative regimen, with the goal of achieving a consistent donor chimerism utilizing pre-transplant immunosuppressive therapy.
All patients will receive an haploidentical hematopoietic stem cell transplant with the following conditioning and GvHD prevention: Pre-transplant immunosuppressive therapy: 2 cycles of Fludarabine and Dexamethasone x 5 days each cycle Conditioning regimen: rATG daily x 3 days, Fludarabine daily x 6 days and Busulfan daily x 4 days GVHD prophylaxis: Cyclophosphamide day +3 and +4, Tacrolimus and Mycophenolate mofetil
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
Haploidentical stem cell transplantation with pre-transplant immunosuppressive therapy
City of Hope Medical Center
Duarte, California, United States
RECRUITINGRate of unacceptable adverse events that are defined as any of the following events that occur from start of pre-transplant immunosuppressive therapy to the first 100 days post HCT:
* Rate of death of any causes * Rate of study discontinuation or early withdrawal * Rate of graft failure • Primary graft failure is defined as failure to achieve a neutrophil count of 0.5 x 109/L before day +42 or mixed chimerism with failure to achieve \<30% Hgb S on electrophoresis after day +180. Secondary graft failure is defined as recovery followed by a sustained loss of initial graft. * Rate of grade 4 non-hematological toxicities per NCI CTCAE v4.03 that last more than 21 days
Time frame: 190 days
Time to donor neutrophil engraftment
Day of Neutrophil Engraftment: The first of three consecutive days on which the ANC is ≥0.5x109/L
Time frame: 24 months
Time to donor platelets engraftment
Day of Platelet engraftment: The first documented day on which the platelet count is \>20x109/L unsupported by platelet transfusions for 7 days
Time frame: 24 months
Rate of graft failure
Primary graft failure is defined as failure to achieve a neutrophil count of 0.5 x 109/L before day +42 or mixed chimerism with failure to achieve \<30% Hgb S on electrophoresis after day +180. Secondary graft failure is defined as recovery followed by a sustained loss of initial graft.
Time frame: 24 months
Incidence of acute GvHD (grade II - IV) during the first 100 days after transplantation
Time frame: 100 days after transplantation
Incidence of chronic GvHD
Time frame: 24 months
Overall survival rate
• Overall survival: the time from start of PTIS to death, or last follow-up, whichever comes first.
Time frame: 24 months
Event-free survival rate
• Event-free survival: the time from start of PTIS to death, the unacceptable events, or last follow-up, whichever comes first.
Time frame: 24 months
Disease free survival rate
• Disease free survival: the time from HCT to death, secondary graft failure, or last follow-up, whichever comes first.
Time frame: 24 months
Immune reconstitution at day 100, 180 and 365
• Immune reconstitution: measurement of CD3, CD4, CD8, CD11b, CD14, CD56, CD20/19, FoxP3+ Treg, and memory subsets.
Time frame: 24 months
Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v4.0 from start of pre-transplant immunosuppressive therapy to 24 months post transplant
Time frame: 24 months post-transplant
Percent of donor chimerism at 12 and 24 months after HCT
Time frame: 12 and 24 months after HCT
Change From Baseline in Pain Scores using Numerical Rating Scale or Faces Pain Rating Scale at 100 days, 6 months and 12 months post-transplant
Time frame: 100 days, 6 months and 12 months post-transplant
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