Nonmyeloablative Stem Cell Transplant in Children with Sickle Cell Disease and a Major ABO-Incompatible Matched Sibling Donor
Trial Parameters
Brief Summary
The aim of this study to evaluate the safety and efficacy of a nonmyeloablative conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in pediatric patients with sickle cell disease (SCD) who have a matched related major ABO-incompatible donor. The nonmyeloablative regimen will use alemtuzumab, total body irradiation (TBI) and sirolimus for immune suppression. This study will expand the access of HSCT for patients with SCD who are currently not eligible because of donor restrictions.
Eligibility Criteria
Inclusion Criteria: * Patients must be ≥ 12 months and \< 19 years of age at the time of study enrollment. * Patients must have sickle cell disease as defined by hemoglobin electropheresis, as follows: * homozygous Hb S disease (HbSS), * sickle-Hb C disease (HbSC), * sickle beta-plus-thalassemia (HbS/β+), or * sickle beta-null-thalassemia (HbS/βo) * Patients must meet standard eligibility criteria to undergo HSCT, including but not limited to one or more of the following: * history of repeated (more than 1) bony (vaso-occlusive) crisis * history of stroke * elevated transcranial Doppler velocity not eligible for hydroxyurea, as per TWiTCH trial (ie. severe vasculopathy) * history of acute chest crisis or splenic sequestration crisis * history of priapism in males * history of osteonecrosis * pulmonary hypertension as documented by tricuspid regurgitation jet velocity (TRV) \> 2.5 m/s on echocardiogram * red cell allo-immunization (≥ 2 antibodies) during long term transfusion therapy *