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Congenital Pediatric DisordersUCBNCT00950846

Umbilical Cord Blood Transplant for Congenital Pediatric Disorders

A study testing Busulfan, Cytoxan and Fludarabine in people with Congenital Pediatric Disorders, run by Baylor College of Medicine at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine the safety and effectiveness of Umbilical Cord Blood Transplant (UCBT) to treat the patient's disease, and to see if this treatment can decrease the incidence of GVHD. Read more about this study

Who is it for?
Ages Up to 17 years
Conditions the study is for
Congenital Pediatric Disorders
What is being tested?
Busulfan, Cytoxan and Fludarabine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteUnited States
Study dates
Sep 2009to 4 Feb 2021
Phase
Interventional
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 Up to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Patients less than 18 years of age.
  • Patients with a congenital or acquired immunologic, hematological, or metabolic pediatric disease (including SCID) in which stem cell transplantation has been beneficial.
  • Related or Unrelated Umbilical Cord Blood Unit with 0-1 antigen mismatch, 5-6 HLA- A and B (at low to intermediate resolution) and DRB1 (at high resolution).
  • Total cryopreserved HSC graft cell dose must be 5 x 10^7 or greater nucleated cells per kilogram recipient body weight.
  • Lansky/Karnofsky scores 60 or greater.
  • Patient has DLCO > 50% predicted or FEV1 > 50%, if applicable.
  • Written informed consent and/or signed assent line from patient, parent or guardian.

Who cannot join

  • Patients with uncontrolled infections as assessed by the principal investigator only. For bacterial infections, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to starting conditioning. For fungal infections patients must be receiving definitive systemic antifungal therapy and have no signs of progressing infection for 1 week prior to enrollment. Progressing infection is defined as hemodynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
  • Severe renal disease (creatinine > 3X normal for age).
  • Severe hepatic disease (direct bilirubin > 3 mg/dL or SGOT > 500).
  • Patients with symptomatic cardiac failure unrelieved by medical therapy or evidence of significant cardiac dysfunction by echocardiogram (shortening fraction < 20%).
  • HIV positive.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Texas Children's Hospital

    Houston, Texas, 77030

Other trials in United States

About this study

The purpose of this study is to determine the safety and effectiveness of Umbilical Cord Blood Transplant (UCBT) to treat the patient's disease, and to see if this treatment can decrease the incidence of GVHD.

This study is for patients that were born with a disease that affects their body's metabolism or immune system. The doctor plans to treat the patient for this illness with a stem cell transplant.

Read more

While improved medical care has allowed many people with these diseases to live longer, the only way to truly cure the diseases is by means of a stem cell transplant from a donor who does not have the disease. A stem cell transplant will replace sick cells with new healthy donor cells. Stem cells grow into different types of blood cells that people need, including red blood cells, white blood cells, and platelets. In a stem cell transplant, the patients own stem cells would be killed by chemotherapy drug and then replaced by stem cells from the donor. Stem cells can be collected from the bone marrow, peripheral blood or umbilical cords. In this study, umbilical cords will be the source of the stem cells.

Currently, large inventories of umbilical cord blood units are available in public banks for transplantation in those lacking bone marrow donors. UCB transplants offer several advantages over adult bone marrow or peripheral blood stem cell transplants, including:

  1. Rapid availability,
  2. Absence of donor risk,
  3. Low risk of transmissible infectious diseases,
  4. Low risk of acute GvHD (as compared to recipients of unrelated donor marrow and peripheral blood cells).

The two main causes of death after umbilical cord blood transplantation for disorders for these kinds of patients, are graft failure and infection.

In this study we are trying to address these two problems by using different drugs to prepare patients for the transplant.

To help improve engraftment (cells begin to grow), we will include the drug Fludarabine to the usually used Busulfan and Cytoxan that the study patients will receive before their transplant.

We will try to decrease the chance of developing graft-versus-host disease (GvHD) by using Cyclosporin A (CSA) and Mycophenolate Mofetil (MMF), instead of Anti-Thymocyte Globulin (ATG) which is normally used.

Read the detailed description

Patients will be examined to make sure that they meet the requirements of this study. There will be tests of the heart and of the lungs. X-rays will be taken of the lungs and other organs, depending on the disease. An MRI and consultations with different specialists will also be conducted.

Patients also must have a negative pregnancy test before entering this study if they are a woman of childbearing potential. The blood will be tested for viruses and to look at the functioning of the liver and kidneys. The examination also includes HIV testing. If the patient has HIV, they will not be able to be treated on this protocol.

After we have determined that the patient is eligible for treatment on this study and a suitable UCB stem donor has been found, they will have a central line placed.

After placement of the central line, the following chemotherapy will be given to after admission to the hospital:

  • 9 days before the infusion through 6 days before the infusion: Busulfan every 6 hours for 16 total doses.
  • 5 days before the infusion through 2 days before the infusion: Cytoxan given daily for 4 days over 2 hours. (It can be given over 1 to 4 hours if needed as decided by the physician). Mesna will be given per standards.
  • 4 days before the infusion through 1 day before the infusion: Fludarabine given daily for 4 days over 1 hour.

Stem cell transplant (infusion of the UCB stem cells) - defined as Day 0 of the treatment. All other "numbered" days relate to this infusion date. For example, Day 1 is the first day after the stem cell transplant.

Standard Therapy: Phenytoin will be given according to the standards of the TCH formulary.

Cyclosporin A (CSA) will be given starting 2 days prior to the stem cell infusion. It will be given daily over 2 hours every 12 hours, and then tapered if no GvHD is present.

Administration of Mycophenolate Mofetil (MMF) will start on the day the stem cell infusion is completed, and will continue daily for 45 days unless the patient develops GvHD.

Intravenous Immunoglobulins (IVIG) will be given as per CAGT SOP for infections prophylaxis.

Granulocyte Colony-Stimulating Factor (GCSF) will be given daily starting at Day +7 until ANC is greater than 2,500 for three consecutive days.

Study Evaluation: Patients will have various study evaluations, including blood samples, before and after the transplant.

Follow-Up: After year 1, the patients will be asked to return to the clinic once a year for consultations. These consultations with specialists will be similar to the ones the patients had before their transplant.

Being tested
Busulfan, Cytoxan, Fludarabine, Cord Blood Stem Cell Infusion
Keywords
Congenital Pediatric Disorders, Umbilical Cord Blood Transplant, Congenital Abnormalities, Cord Blood Stem Cell Transplantation, Busulfan, Cytoxan, Cyclophosphamide, Fludarabine
Medical subject headings
Congenital Abnormalities

What participants receive

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

  • BusulfanDrug

    Also called Busulfex

    Day -9, -8, -7 and -6

    Patients less than or equal to 12 kg: 1.1 mg/kg/dose IV every 6 hours for 16 doses total; patients >12 kg: 0.8 mg/kg/dose IV every 6 hours for 16 doses.

  • CytoxanDrug

    Also called Cyclophosphamide

    (50 mg/kg/dose) will be given IV on Days -5, - 4, -3, and -2 over 2 hours (can be given over 1 to 4 hours as determined by the treating physician). The total dose to be given over 4 days is 200 mg/kg.

  • FludarabineDrug

    Also called Fludera

    40 mg/m2/day IV over 1 hour for patients greater than 10 kg, or 1.3 mg/kg/day for patients less than or equal to 10 kg.

  • Cord Blood Stem Cell InfusionProcedure or surgery

    The cord blood stem cells will be infused on Day 0.

Study groups in NCT00950846
Study groupRoleWhat they receive
Umbilical Cord Blood Transplant Treatment PlanExperimentalBusulfan, Cytoxan, Fludarabine, Cord Blood Stem Cell Infusion
Receives: Drug: Busulfan; Drug: Cytoxan; Drug: Fludarabine; Procedure: Cord Blood Stem Cell Infusion

What is being measured

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

  1. Overall Survival at 100 Days After Umbilical Cord Blood Transplant in Pediatric Patients.

    To determine the overall survival rate at 100 days after umbilical cord blood transplant in pediatric patients with myeloid hematological malignancies.

    Measured: 100 days

  2. Overall Survival at 1 Year After Umbilical Cord Blood Transplant in Pediatric Patients.

    To determine the overall survival rate at 1 year after umbilical cord blood transplant in pediatric patients with myeloid hematological malignancies.

    Measured: 1 year

  3. Overall Survival at 3 Years After Umbilical Cord Blood Transplant in Pediatric Patients.

    To determine the overall survival rate at 3 years after umbilical cord blood transplant in pediatric patients with myeloid hematological malignancies.

    Measured: 3 years

Secondary outcomes (5)
  1. Number of Participants With Platelet Engraftment

    Achievement of untransfused platelet count > 20 x 10^9/L on three consecutive days

    Measured: Day 42

  2. Incidence of Severe Grade III-IV Acute GvHD at Day 100.

    Number of participants with acute GVHD graded by the method of Przepiorka et al, which evaluates skin involvement, lower and upper GI, and liver function (bilirubin), each being graded in stages from 0 to 4, where 0 means no acute GVHD, and 4 is the highest stage of acute GVHD.

    Measured: Day 100

  3. Number of Participants With Chronic GvHD

    Number of participants with chronic GVHD graded by the method of Przepiorka et al, which evaluates skin, joints, oral, ocular, hepatic, esophagus, GI, respiratory, platelet, and musculoskeletal involvement, in stages from 0 to 3.

    Measured: 1 year

  4. Number of Participants With Donor Engraftment After Transplant.

    To evaluate donor engraftment at 100 days, 6 and 12 months after transplant.

    Measured: 100 days, 6 months and 12 months

  5. Number of Participants With Neutrophil Engraftment

    Achievement of absolute neutrophil count > 0.5 x 10^9/L on three consecutive days

    Measured: Day 42

Timeline

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

  1. First posted3 Aug 2009 (estimated)
  2. Study startSep 2009
  3. Primary completion21 Jul 2020
  4. Study completion4 Feb 2021

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 N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00950846
Sponsor's protocol ID
25064-UCB
Acronym
UCB
Status last verified
Oct 2023
First submitted
30 Jul 2009
Last updated
30 Oct 2023
Data monitoring committee
Yes

Publications

  • Martinez C, Aguayo-Hiraldo P, Chaimowitz N, Forbes L, Rider N, Nicholas S, Seeborg F, Chinen J, Chinn I, Davis C, Roseblatt H, Noroski L, Omer B, John T, Yassine K, Naik S, Craddock J, Bhar S, Allen C, Ahmed N, Sasa G, Steffin D, Doherty E, George A, Salem B, Friend B, Hegde M, Brenner MK, Heslop HE, Leen A, Pena A, Wu M, Hanson IC, Krance RA. Cord blood transplantation for nonmalignant disorders: early functional immunity and high survival. Blood Adv. 2023 May 9;7(9):1823-1830. doi: 10.1182/bloodadvances.2022009038.

    PubMed 36453638

Questions about this trial

What is this clinical trial studying?

A study testing Busulfan, Cytoxan and Fludarabine in people with Congenital Pediatric Disorders, run by Baylor College of Medicine at 1 site 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 7 inclusion and 5 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: finished, as of the sponsor's last update on 30 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 30 Oct 2023). 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?

Overall Survival at 100 Days After Umbilical Cord Blood Transplant in Pediatric Patients. (time frame: 100 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00950846, which also lists 1 linked publication.

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 30 Oct 2023.

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