This is an open-label, single-institution study to assess the safety and the efficacy of the Sip-Tego regimen for the induction of donor-specific immunologic unresponsiveness to a renal allograft. The investigators propose to treat 6 adult subjects in end-stage renal disease (ESRD) who do not demonstrate evidence of prior sensitization.
The conditioning regimen to be used in this protocol consists of an ordered series of procedures and treatments including thymic irradiation, low-dose cyclophosphamide, antibody administration (Siplizumab, rituximab and tegoprubart), and bone marrow cell infusion. The surgical techniques for the renal transplant will be accomplished according to the surgeon's clinical judgment and experience using standard techniques in use at the institution. The donor nephrectomy will be accomplished according to the surgeon's clinical judgment and experience. The conditioning regimen requires six days leading up to the day of transplantation, which is designated as study Day 0. Negative numbers in descending order designate days pre-transplant, while positive numbers in ascending order designate days post-transplant. Refer to Figure 2 in Section 1.2. for the schema of the conditioning regimen.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
The conditioning regimen to be used in this protocol consists of an ordered series of procedures and treatments including thymic irradiation, low-dose cyclophosphamide, antibody administration (Siplizumab, rituximab and tegoprubart), and bone marrow cell infusion.
The donor will undergo nephrectomy and under general anesthesia. Donors will undergo bone marrow harvested under general anesthesia. Sufficient marrow will be obtained to provide at least 2 x 108 nucleated cells per kilogram weight of the recipient.
Recipients will receive a conditioning regimen that includes rituximab on study day -6 and -2, Siplizumab (0.6mg/kg) on day -6, -1, 0 and +1, cyclophosphamide (CP, 22.5mg/kg) on days -5 and -4. Tegoprubart (Fc-modified anti-CD154 mAB, Eledon Pharm) 20mg/kg will be administered on days 0, 2, 5, 12 and 19).
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGInduction of mixed chimerism without chimeric transition syndrome
This will be measured by a chimerism level of \>0% donor chimerism at anytime post transplant, and when the level is returning to 0% chimerism there is no evidence of chimeric transition syndrome. This is defined in the protocol by any of the following The clinical symptoms of CTS include acute kidney injury with rapid deterioration of kidney function (elevated creatinine, decreased blood flow to the renal allograft by US), minor to moderate fever, fluid retention or peripheral edema.
Time frame: 7 Years
Achievement of IS minimization (tacrolimus or Belatacept monotherapy)
This will be measured by a patient weaning and maintaining only one agent of immunosuppression (either Tacrolimus or Belatacept)
Time frame: 7 Years
Number of patients who complete full immunosuppression withdrawal
The number (and therefore percentage) of patients who discontinue all immunosuppression (ie. completely stop Tacrolimus or Belatacept)
Time frame: 7 Years
Participants who are alive at the end of the study
Time frame: 7 Years
Kidney Graft Survival
Time frame: 7 Years
Incidence of CTS
Time frame: 7 Years
Incidence of Acute Rejection
Time frame: 7 Years
Incidence of Donor Specific Antibody development
Time frame: 7 Years
Incidence of Chronic Rejection
Time frame: 7 Years
Incidence of GVHD (Acute or Chronic)
Time frame: 100 days
Incidence of clinically significant or resistant Opportunistic Infections
Time frame: 7 Years
Recovery of neutrophils to normal range
A neutrophil count that is within normal lab range (after early myelosuppression from conditioning regimen)
Time frame: 7 Years
Recovery of Platelets to normal range
A Platelet count that is within normal lab range (after early myelosuppression from conditioning regimen)
Time frame: 7 Years
Incidence of Serious Adverse Events
Time frame: 7 Years
Incidence of Radiation related toxicities
Time frame: 7 Years
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