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Aplastic AnemiaPhase 2NCT00578903

Allogeneic Stem Cell Transplant for Patients With Severe Aplastic Anemia

A Phase 2 study testing Cytoxan, Campath and Total Body Irradiation (TBI) in people with Aplastic Anemia, run by Baylor College of Medicine at 2 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Patients have been diagnosed with severe Aplastic Anemia that have not responded to treatment with immunosuppressive therapy (drugs that suppress the immune system, for example Steroids). The immune system is the system in the body that helps protect the body and fights bacterial, viral and fungal infections. Read more about this study

Who is it for?
Ages 1 minute to 60 years
Conditions the study is for
Aplastic Anemia
What is being tested?
Cytoxan, Campath and Total Body Irradiation (TBI)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
22 participants
Where
2 sitesUnited States
Study dates
Feb 2002to Jul 2012
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 minute to 60 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Diagnosis of Severe Aplastic Anemia (SAA) based on bone marrow aspirate and biopsy results.
  • Failure to respond to immunosuppressive therapy.
  • Lack of an Human Leukocyte Antigen (HLA) identical family member.
  • A 6/6 or 5/6 HLA matched unrelated donor or a 5/6 matched related donor available after high resolution HLA typing.
  • Age from birth to 60 years.

Who cannot join

  • Severe disease other than aplastic anemia that would limit the probability of survival during the graft procedure. Patients who present with active infection must be treated to maximally resolve this problem before beginning the conditioning regimen.
  • Human immunodeficiency virus (HIV) seropositive patients
  • Patients who have clonal cytogenetic abnormalities or a myelodysplastic syndrome.
  • Patient greater than 60 years of age.
  • Women who are pregnant or nursing.
  • Patients with active hepatitis
Show all 9Show fewer
  • Patients with severe cardiac dysfunction defined as shortening fraction < 25%.
  • Patients with severe renal dysfunction defined as creatinine clearance < 40 ml/mim/1.73m2.
  • Patient with severe pulmonary dysfunction with forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) 40% of predicted or 3 standard deviations (SD) below normal.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Texas Children's Hospital

    Houston, Texas, 77030

  • The Methodist Hospital

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: Allogeneic Stem Cell Transplantation for Patients With Severe Aplastic Anemia, Using Matched Unrelated Donors and Mismatched Related Donors (SAA MUD)

Patients have been diagnosed with severe Aplastic Anemia that have not responded to treatment with immunosuppressive therapy (drugs that suppress the immune system, for example Steroids). The immune system is the system in the body that helps protect the body and fights bacterial, viral and fungal infections.

Research studies have shown that patients with Aplastic Anemia have improved survival (may live longer) after receiving a HLA (Human Leukocyte Antigen) identical sibling (brother and sister) stem cell transplants. Patients who do not have matched siblings can undergo immunosuppressive therapy, which has also shown to improve outcome. Unfortunately patients who do not respond to immunosuppressive therapy usually die. The best chance of survival for these patients is an HLA matched unrelated or mismatched related stem cell transplant as described below.

Read more

Stem cells are created in the bone marrow. They mature into different types of blood cells that people need including red blood cells which carry oxygen around the body, white blood cells which help fight infections, and platelets which help the blood to clot and prevent bleeding. For a matched unrelated stem cell transplant, stem cells are collected from a person (donor) who is not related to the patient but who has the same type of stem cells. For a mismatched related stem cell transplant, stem cells are collected from a donor who is related to the patient and whose stem cells are almost the same as those of the patient but not exactly. The patient then receives high dose chemotherapy. This chemotherapy kills the stem cells in the patient's bone marrow. Stem cells that have been collected from the donor are then given to the patient to replace the stem cells that have been killed.

The major problems associated with these types of stem cell transplants are graft rejection (where the patient's immune system rejects the donor stem cells) and severe graft versus host disease (GVHD), where the donors stem cell reacts against the patient's tissues in the body.

Read the detailed description

Before patients receive any treatments, they will have the following:

  • Complete history and physical exam
  • Dental consultation
  • Bone marrow aspirate
  • Blood tests
  • Urinanalysis
  • Tests to look at your lungs (Chest X-ray and PFT's and DLCO)
  • Tests to look at your heart (EKG, MUGA, or echocardiogram)
  • Pregnancy test for females of childbearing age.

Once the decision has been made by the patients to have a mismatched related or matched unrelated stem cell transplant, the patient will receive treatment called a "conditioning regimen" to prepare their body for the transplant. The purpose of this conditioning regimen is to kill the stem cells in the bone marrow, so that the patients immune system is suppressed (lowered or stopped from working), so their body will not reject the donors stem cells (transplant).

The medicines which will be given as part of the conditioning regimen include Cyclophosphamide (Cytoxan) and Campath 1H. Both of these medications are approved by the Food and Drug Administration. Cyclophosphamide will be given for four days in a row. Cyclophosphamide is broken down into different chemicals and removed from the body in the urine. These different chemicals can cause bleeding in the bladder. Mesna is a drug that will be given with Cytoxan to prevent the build up of these chemicals that cause bleeding from the bladder. Campath 1H will also be given for four days. After the medicines, the patient will receive total body irradiation (TBI). Total body irradiation is strong doses of radiation (like x-rays) given to almost the whole body. One dose of TBI will be given to patients receiving a matched stem cell infusion while two doses of TBI will be given to patients receiving a mismatch stem cell infusion. After the conditioning regimen, the patient will then receive the stem cells (transplant). These stem cells will be given as an infusion (drip) into a vein.

Patients will receive the drugs Tacrolimus (FK506) and Methotrexate to help prevent the complication of graft versus host disease. Methotrexate will be given on days 1, 3, 6 and 11 after they receive the stem cells. During this time, the patient will be on the stem cell transplant unit in protective isolation to help protect from developing infections.

The following evaluations will be done as part of the stem cell transplant.

EVALUATION DURING THE FIRST 100 DAYS:

  • Physical examination daily until discharged, then weekly.
  • Peripheral Blood for chimerism studies (looks at the presence of cells from the donor and from the patient existing together after the transplant)
  • Complete blood count (CBC) and platelets daily until discharge, then at least weekly
  • Blood chemistry (Electrolytes, BUN, creatinine, glucose, calcium, uric acid, total protein, albumin, ALT, AST, LDH, total bilirubin, LDH, magnesium) checked daily until discharge, then at least weekly
  • FK506 blood levels twice a week until discharge, then at least weekly
  • Blood tests for CMV (a type of virus) weekly

DAY 100-365:

  • Physical examination at least monthly through Day 365
  • Peripheral blood for chimerism studies
  • Follow-up for patients with chronic GVHD as needed
  • Chest X-ray
  • CBC and Blood chemistry tests as above checked monthly

YEARLY EVALUATION:

  • Biopsies as needed (taking tissue samples for testing)
  • Chest x-ray
  • CBC and Blood chemistry evaluations as listed above
  • Peripheral blood for chimerism studies

IMMUNOLOGIC TESTING:

We will also be looking at the patients immune function. To do this, we will take 30 ml (2 tablespoonfuls) of blood every two weeks for two months, then monthly for 6 months, and then every 3 months for 2 years. When possible, the blood that is taken will be taken through an existing IV line. However, at times drawing the blood will require another stick with a needle. These blood tests will be done for research purposes as part of this study. All other blood tests listed above are done as part of good clinical care for patients receiving a stem cell transplant.

Conditions
Aplastic Anemia
Being tested
Cytoxan, Campath, Total Body Irradiation (TBI), FK-506, Methotrexate
Keywords
Severe Aplastic Anemia, Severe
Medical subject headings
Anemia, Aplastic, Lymphoma, Follicular

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CytoxanDrug

    Also called Cyclophosphamide

    Cytoxan will be given at 50 mg/kg per dose for 4 successive days.

  • CampathDrug

    Also called alemtuzumab

    Campath will be given at a dose of 3 mg for patients whose weight is between 5 and 15 kg; at a dose of 5 mg for patients whose weight is between 16 and 30 kg; and at a dose of 10 mg for patients whose weight is greater than 30 kg. The last dose of Campath should be 24 hours or more before stem cell infusion.

  • Total Body Irradiation (TBI)Radiation

    Also called Irradiation

    TBI will be given at a dose of 200 cGy for 6/6 HLA match and at a dose of 400 cGy in two fractions of 200 cGy each for 5/6 HLA matched donor.

  • FK-506Drug

    Also called Tacrolimus

    FK-506 will be given at a dose of 0.03 mg/kg/day via continuous infusion over 24 hours from 4pm on day -2 until engraftment or when patient is able to take by mouth (PO), then 0.03 mg/kg PO every 12 hours.

  • MethotrexateDrug

    Methotrexate will be administered on day +1, day +3, day +6 and day +11 at a dose of 5 mg/m2. The day +11 dose may be omitted at the discretion of the bone marrow transplant (BMT) in-patient attending physician.

  • Stem cell infusionProcedure or surgery

    Where possible patients will receive bone marrow. Marrow will be collected as per National Marrow Donor Program (NMDP) guidelines to provide a volume of 15-20 ml/kg of marrow and/or 2-4 X 10^8 nucleated cells/kg. In case marrow cannot be collected, peripheral blood stem cell (PBSC) will be substituted. A minimum of 5-6 X 10^6 CD 34+ cells/kg should be collected, with a target of 10 X 10^6/kg.

Study groups in NCT00578903
Study groupRoleWhat they receive
PatientsExperimentalPatients with a diagnosis of severe aplastic anemia who require an allogeneic stem cell transplant but lack an Human Leukocyte Antigen (HLA) identical family member. Cytoxan, Campath, TBI-Total Body Irradiation, FK-506, Methotrexate, Stem Cell Infusion
Receives: Drug: Cytoxan; Drug: Campath; Radiation: Total Body Irradiation (TBI); Drug: FK-506; Drug: Methotrexate; Procedure: Stem cell infusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Subjects Alive at 100 Days Post Transplant

    Measured: 100 days

Secondary outcomes (5)
  1. Number of Patients With Engraftment Rate at 100 Days Post Transplant

    Absolute neutrophil count greater than 0.5 X 10^9/ml for at least 3 days

    Measured: 100 days post transplant

  2. Number of Patients With Acute GVHD at 100 Days Post Transplant

    Measured: 100 days

  3. Number of Patients With Chronic GVHD at 2 Years Post Transplant

    Measured: 2 years

  4. Number of Subjects Alive at 1 Year Post Transplant

    Measured: 1 year

  5. Number of Subjects Alive at 2 Years Post Transplant

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Dec 2007 (estimated)
  2. Study startFeb 2002
  3. Primary completionJul 2012
  4. Study completionJul 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
22 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00578903
Sponsor's protocol ID
10915-SAA MUD
Other IDs
SAA MUD
Status last verified
Mar 2016
First submitted
19 Dec 2007
Last updated
22 Apr 2016
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Cytoxan, Campath and Total Body Irradiation (TBI) in people with Aplastic Anemia, run by Baylor College of Medicine at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 22 Apr 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 11 Oct 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Subjects Alive at 100 Days Post Transplant (time frame: 100 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Apr 2016.

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