Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressive and fatal neurodegenerative disorder. Its global prevalence is approximately 0.73-1.89 per 100,000 individuals. In China, there are about 200,000 ALS patients, with approximately 25,000 new cases diagnosed annually. Microglia, the resident immune cells of the central nervous system (CNS), rapidly transition from a resting state to a pro-inflammatory phenotype (M1) in ALS. This activation leads to the release of a large number of inflammatory factors (such as TNF-α, IL-1β, IL-6, NO, ROS) and chemokines (such as MCP-1/CCL2), and triggers the NLRP3 inflammasome. Furthermore, systemic immune dysregulation plays a significant role in the pathogenesis of ALS. ALS patients exhibit reduced numbers of regulatory T cells (Tregs), alterations of activated CD8+ T cell infiltrates, and a shift in the helper T cell (Th1/Th2) balance towards the pro-inflammatory Th1 phenotype. In recent years, therapeutic strategies targeting novel pathways such as neuroinflammation, immune dysregulation, and energy metabolism have emerged, including the infusion of Tregs, mesenchymal stem cells (MSCs), and neural stem cells. However, these approaches have still failed to halt disease progression \[NCT05695521, NCT03280056, NCT06973629, NCT02290886\]. Recent research suggests that hematopoietic stem cell transplantation (HSCT) may disrupt the activation cycle between astrocytes and microglia, alleviate chronic inflammatory states in the CNS, partially mitigate mitochondrial dysfunction, and thereby slow neurodegeneration. Unrelated umbilical cord blood transplantation offers advantages such as low HLA-matching requirements, a lower risk of graft-versus-host disease (GVHD), a potent graft-versus-leukemia (GVL) effect, and immediate availability. Investigators plan to conduct an exploratory clinical trial to evaluate the safety and efficacy of umbilical cord blood transplantation for ALS patients. The preliminary plan is to enroll 8 adult subjects. Following successful neutrophil engraftment (defined as an absolute neutrophil count ≥0.5×10⁹/L for three consecutive days) and confirmation of complete donor chimerism. The trial will focus on assessing transplantation-related complications and patient tolerance. A 3-month post-transplantation follow-up will be conducted for a comprehensive evaluation of safety and efficacy for ALS patients.
Please see the detailed description in following content
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
Mobilization and Collection of Recipient's Autologous Peripheral Blood Hematopoietic Stem Cells during the Screening Phase for Cryopreservation and Future Use: G-CSF at 5 µg/kg, administered subcutaneously every 12 hours (q12h). Collection begins when the white blood cell count exceeds 5×10⁹/L and the platelet count exceeds 50×10⁹/L. The collected cells are cryopreserved in liquid nitrogen.
A reduced-intensity myeloablative conditioning regimen consisting of Fludarabine (Flu), Melphalan (Mel), Thiotepa (TT), and Total Marrow Irradiation (TMI) is employed.
A combination of Cyclosporine A (CsA) and short-course Mycophenolate Mofetil (MMF) is used.
UCB Infusion: On transplant day 0, the thawed umbilical cord blood unit is infused. Dexamethasone 5 mg is administered intravenously 30 minutes prior to the infusion.
Rescue Protocol for Graft Failure: The cryopreserved autologous peripheral HSCs are reinfused to restore hematopoietic function.
Institute of Hematology & Blood Diseases Hospital
Tianjin, China
Overall survival
Survival status of ALS patients after umbilical cord blood transplantation
Time frame: 1 year, 3 year, 5 year
LVGI Safety Score
Considering the limited assessment conditions within the transplant isolation unit, this study has modified and simplified the ALSFRS-R scale and incorporated the Inbody score, which provides a comprehensive assessment of muscle mass and body fat mass, to form the "LVGI" safety score. Among the components, VCmax refers to maximum lung capacity; Grip quantifies upper limb strength using a dynamometer, with the Grip Strength-to-Body Weight Index calculated as Grip Strength (kg) / Body Weight (kg) × 100. The results of each assessment are compared. A change within ± 20% in the LSGI score within the first month post-transplantation compared to the pre-transplantation score is considered safe.
Time frame: 3 month, 6 month, 1 year
ALS related assessment
Assessment of Disease Functional Progression: The ALSFRS-R scale was used to conduct standardized assessments at baseline (1, 3, 6, 12, 18, and 24 months post-transplantation). Biomarker of Neuroaxonal Injury: Peripheral blood and CSF samples were collected from patients to assess neurofilament light chain (NFL). By analyzing changes in NFL relative to baseline, the dynamic changes in neuroaxonal injury following umbilical cord blood transplantation intervention were objectively evaluated. Imaging Evaluation: MR and PET-CT.
Time frame: 3 month, 6 month, 1 year
Assessment of Drug-Induced Liver and Kidney Toxicity
Liver - RUCAM Score: \<1: Excluded 1-2: Unlikely 3-5: Possible 6-8: Probable 8: Highly probable Kidney - KDIGO Score: Acute Kidney Injury (AKI) is defined by meeting any one of the following three criteria: ① Increase in serum creatinine (Scr) by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 hours; ② Increase in Scr to \>1.5 times the baseline value, which is known or presumed to have occurred within the prior 7 days; ③ Urine output \<0.5 mL/(kg·h) for 6 hours.
Time frame: up to 24 weeks
Assessment of acute GVHD
Primarily based on the modified Glucksberg criteria and the acute GVHD International Consortium (MAGIC) grading criteria.
Time frame: up to 24 weeks
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