Two key methods of GVHD prevention in allogeneic HSCT have a number of limitations: ex vivo T depletion is associated with an excess of infectious complications, and pharmacological immunosuppression with insufficient efficacy of GVHD prevention. Modern graft engineering technologies make it possible to create a graft with a balanced cell composition, reducing the risk of adverse events, in particular, severe forms of acute and chronic GVHD, while preserving the immunological function of the graft. In the proposed concept, enrichment of the T graft with regulatory cells will reduce the risk of GVHD and preserve a sufficient number of T lymphocytes in the graft for the formation of protective anti-infective immunity in the early stages after HSCT. The combination of partial T depletion and pharmacological immunosuppression minimized in volume and duration will combine the advantages of T depletion (early engraftment, low risk of GVHD, low risk of organ complications) and pharmacological prophylaxis (restoration of anti-infective immunity).
1. Infusion of ex-vivo T-depleted peripheral blood hematopoietic stem cells (CD3 depletion product) 2. Infusion of donor lymphocytes enriched with T regulatory lymphocytes (CD25 selective product) 3. Drug therapy (pharmacological prophylaxis of GVHD) * Cyclosporine A * Sirolimus o Ruxolitinib o Abatacept
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
64
The combination of partial T depletion and pharmacological immunosuppression minimized in volume and duration will combine the advantages of T depletion (early engraftment, low risk of GVHD, low risk of organ complications) and pharmacological prophylaxis (restoration of anti-infective immunity).
Pharmacological prophylaxis of GVHD is one of the key subjects of evaluation in the current study. Since the optimal pharmacological approach is not known, the allocation of the patients to study groups will be by randomization procedure, although not for the purpose of direct comparison, but for unbiased descriptive analysis. There will be four main groups and an additional group to be open for allocation based on the main group closing for fitting the stopping rules. The details of pharmacological GVHD prevention are Sirolimus 1 mg -3 till +30 4-8 ng/ml
Pharmacological prophylaxis of GVHD is one of the key subjects of evaluation in the current study. Since the optimal pharmacological approach is not known, the allocation of the patients to study groups will be by randomization procedure, although not for the purpose of direct comparison, but for unbiased descriptive analysis. There will be four main groups and an additional group to be open for allocation based on the main group closing for fitting the stopping rules. The details of pharmacological GVHD prevention regimens are Ruxolitinib 5 mg -2 till +30
Pharmacological prophylaxis of GVHD is one of the key subjects of evaluation in the current study. Since the optimal pharmacological approach is not known, the allocation of the patients to study groups will be by randomization procedure, although not for the purpose of direct comparison, but for unbiased descriptive analysis. There will be four main groups and an additional group to be open for allocation based on the main group closing for fitting the stopping rules. Abatacept 10 mg/kg -1, +7, +14, +28
National medical research center of pediatric haematology, oncology and immulogy named after Dmytriy Rogachyov, Moscow, 117198
Moscow, Russia
RECRUITINGFeasibility- Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
proportion of patients who received an infusion of the planned dose of regulatory T lymphocytes (at least 80%)
Time frame: day 30
Safety- Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Cumulative risk of GVHD Grade III-IV (target \< 5%)
Time frame: 120 days after HSCT
Cumulative probability of engraftment
Time frame: up to 100 day
Time to engraftment of neutrophils and platelets
Time frame: 100 day after HSCT
Cumulative risk of acute GVHD Grade II-IV
Time frame: up to 100 days after HSCT
Cumulative risk of viral
(CMV, ADV, EBV, HHV-6) DNA detection in blood, peak viral DNA load and the duration of detectable viral DNA (each virus separately)
Time frame: at 120 day after HSCT
cumulative risk of developing severe chronic GVHD
Severity of chronic GVHD
Time frame: at 2 years
Cumulative risk of leukemia relapse
Time frame: at 2 years
Cumulative risk of non-relapse mortality
Time frame: at 100 days and 2 years
Overall survival
Time frame: at 3 years
Event-free survival
Time frame: at 3 years
GVHD- and relapse-free survival
Time frame: at 3 years
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