NCT03173937 Unrelated Umbilical Cord Blood Transplantation for Severe Aplastic Anemia and Hypo-plastic MDS Using CordIn(TM), Umbilical Cord Blood-Derived Ex Vivo Expanded Stem and Progenitor Cells to Expedite Engraftment and Improve Transplant Outcome
| NCT ID | NCT03173937 |
| Status | Recruiting |
| Phase | Phase 1, Phase 2 |
| Sponsor | National Heart, Lung, and Blood Institute (NHLBI) |
| Condition | Severe Aplastic Anemia |
| Study Type | INTERVENTIONAL |
| Enrollment | 37 participants |
| Start Date | 2017-06-13 |
| Primary Completion | 2027-04-28 |
Eligibility & Interventions
Eligibility Fast-Check
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What to Expect as a Participant
You will actively receive the study intervention — which may be a drug, biologic, device, or procedure.
Phase 1 is the earliest stage of human testing — safety and dosage are the primary focus. Visits are frequent and medical supervision is intensive. You will be among the first people to receive this treatment.
This trial targets 37 participants in total. It began in 2017-06-13 with a primary completion date of 2027-04-28.
⚠ This information is for research awareness only. Always consult your physician before joining any clinical trial. Participation is voluntary and you may withdraw at any time.
Brief Summary
Background: Severe aplastic anemia (SAA) and myelodysplastic syndrome (MDS) are bone marrow diseases. People with these diseases usually need a bone marrow transplant. Researchers are testing ways to make stem cell transplant safer and more effective. Objective: To test if treating people with SAA or MDS with a co-infusion of blood stem cells from a family member and cord blood stem cells from an unrelated donor is safe and effective. Eligibility: Recipients ages 4-60 with SAA or MDS Donors ages 4-75 Design: Recipients will be screened with: * Blood, lung, and heart tests * Bone marrow biopsy * CT scan Recipients will have an IV line placed into a vein in the neck. Starting 11 days before the transplant they will have several chemotherapy infusions and 1 30-minute radiation dose. Recipients will get the donor cells through the IV line. They will stay in the hospital 3-4 weeks. After discharge, they will have visits: * First 3-4 months: 1-2 times weekly * Then every 6 months for 5 years Donors will be screened with: * Physical exam * Medical history * Blood tests Donors veins will be checked for suitability for stem cell collection. They may need an IV line to be placed in a thigh vein. Donors will get Filgrastim or biosimilar (G-CSF) injections daily for 5-7 days. On the last day, they will have apheresis: Blood drawn from one arm or leg runs through a machine and into the other arm or leg. This may be repeated 2 days or 2-4 weeks later.
Eligibility Criteria
* INCLUSION CRITERIA - RECIPIENT: * Diagnosed with severe aplastic anemia with bone marrow cellularity \<30% (excluding lymphocytes) associated with RBC or platelet transfusion dependence and/or neutropenia (absolute neutrophil count \<=1000 cells/ uL or for patients receiving granulocyte transfusions, absolute neutrophil count \<=1000 cells/ uL before beginning granulocyte transfusions). OR History of severe aplastic anemia transformed to MDS that meet the following criteria: a) International Prognostic Scoring System (IPSS) risk category of INT-1 or greater, b) \< 5% myeloblasts and \< 30% of cellularity in the bone marrow on screening morphologic analysis. -Intolerance of or failure to respond to immunosuppressive therapy. This also includes patients who have failed immunosuppressive therapy with ATG and cyclosporine or therapy with cyclosporine combined with eltrombopag in those who are intolerant of or do not have access to treatment with ATG. Identification of either a) at least one alternative donor (i.e. HLA- haploidentical related donor (i.e. \>=5/10 HLA match: HLA-A, B, C, DR, and DQ loci) or \>=9/10 HLA matched unrelated donor) who is available to serve as a stem cell donor for a salvage allogeneic transplant in the event that the CordIn(TM) unit has been rejected or b) umbilical cord blood unit/s that can be used for a salvage cord blood transplant in the event that the CordIn(TM) unit has been rejected. -Availability of at least one \>=4/8 HLA matched (HLA-A, B, C, and DR loci) cord blood unit from the National Marrow Donor Program (NMDP). The cord blood unit must contain a minimum TNC of at least 1.8 x 10\^9 and at least 1.5x10\^7/kg TNC and at least 8 x 10\^6 CD34+ cells (all doses prior to thawing). Exception: Cord units containing at least 8 x 10\^6 CD34+ cells but less than 1.8 x 10\^9 TNC may be eligible for use on this trial if 1. the pre-expansion CD34/kg recipient cell number is at least 1.5 x 10\^5 /kg AND 2. approval for use of this cord unit for expansion is granted by Gamida Cell. 3. the final cell counts on the cultured and non-cultured fractions meet the IND specified minimal release criteria. * The CBU will have undergone volume reduction (both plasma and red blood cell depletion) prior to cryopreservation. All CBUs should be procured from public banks that meet local applicable regulations. * Ages 4-60 years inclusive. * Ability to comprehend the investigational nature of the study and provide informed consent. The procedure will be explained to subjects aged 4-17 years with formal consent being obtained from parents or legal guardian. EXCLUSION CRITERIA - RECIPIENT (ANY OF THE FOLLOWING): * Availability of an HLA identical (12/12) matched related or unrelated donor who is available within optimal timeline and suitable considering graft source and established donor selection factors (e.g. age, sex, viral exposure, ABO compatibility, pregnancy status, etc) per PI discretion. * ECOG performance status of 2 or more. * Major anticipated illness or organ failure incompatible with survival from transplant. * Current pregnancy, or unwillingness to take oral contraceptives or use a barrier method of birth control or practice abstinence to refrain from pregnancy, if of childbearing potential for one year. * HIV positive. * Diagnosis of Fanconi s anemia (by chromosome breakage study). * Diffusion capacity of carbon monoxide (DLCO) \<40% using DLCO corrected for Hgb or lung volumes (patients under the age of 10 may be excluded from this criterion if they have difficulty performing the test correctly and thus are unable to have their DLCO assessed). * Left ventricular ejection fraction \< 40% (evaluated by ECHO). * Transaminases \> 5x upper limit of normal. * Serum bilirubin \>4 mg/dl. * Creatinine clearance \< 50 cc/min/BSAm2 by 24-hour urine collection adjusted by body surface area. * Serum creatinine \> 2.5 mg/dl * Presence of an active infection not adequately responding to appropriate therapy. * History of a malignant disease liable to relapse or progress within 5 years. * Allergy to bovine, Gentamicin, or to any product which may interfere with the treatment. * Presence of donor-specific antibodies (DSA) to the umbilical cord blood unit and for cohort 1, to the haplo-identical donor.
Contact & Investigator
Richard W Childs, M.D.
PRINCIPAL INVESTIGATOR
National Heart, Lung, and Blood Institute (NHLBI)
Frequently Asked Questions
Who can join the NCT03173937 clinical trial?
This trial is open to participants of all sexes, aged 4 Years or older, up to 75 Years, studying Severe Aplastic Anemia. Full inclusion and exclusion criteria are listed in the Eligibility Criteria section. Always confirm your eligibility with the research team before applying.
What phase is the NCT03173937 trial and what does that mean for participants?
Phase 1 trials are the first stage of human testing. The primary goal is to assess safety and determine appropriate dosage levels. Participants are closely monitored. These trials typically involve a small number of volunteers.
Is NCT03173937 currently recruiting?
Yes, NCT03173937 is actively recruiting participants. Contact the research team at melissa.spencer@nih.gov for enrollment information.
Where is the NCT03173937 trial being conducted?
This trial is being conducted at Bethesda, United States.
Who is sponsoring the NCT03173937 clinical trial?
NCT03173937 is sponsored by National Heart, Lung, and Blood Institute (NHLBI). The principal investigator is Richard W Childs, M.D. at National Heart, Lung, and Blood Institute (NHLBI). The trial plans to enroll 37 participants.