T-Cell Depleted Alternative Donor Bone Marrow Transplant for Sickle Cell Disease (SCD) and Other Anemias
T-Cell Depleted, Alternative Donor Transplant in Pediatric and Adult Patients With Severe Sickle Cell Disease (SCD) and Other Transfusion-Dependent Anemias
Who can join
As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.
- Age
- 5 Years to 40 Years
- Sex
- All sexes
- Healthy volunteers
- Not accepted
- Compensation
- Not stated
Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.
What to expect
No one can promise a trial will help you personally — that is what the research is trying to find out.
What participation involves
Not stated in the study description — ask the study team about visits and procedures.
- Compensation
- Not stated
- Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
- Participants are monitored closely by the research team throughout the study.
- Some participants may receive access to an investigational treatment, which is still being studied.
- Your participation helps researchers learn whether this approach could help future patients.
About this study
In plain language
This study tests stem cell transplants from partly matched donors for people ages 5 to 40 with severe sickle cell disease or certain other anemias that need regular blood transfusions. Some T cells, a type of immune cell, are removed from the transplant to try to lower the risk that donor cells attack the patient's body.
The purpose of this study is to evaluate what effect, if any, mismatched unrelated volunteer donor and/or haploidentical related donor stem cell transplant may have on severe sickle cell disease and other transfusion dependent anemias. By using mismatched unrelated volunteer donor and/or haploidentical related donor stem cells, this study will increase the number of patients who can undergo a stem cell transplant for their specified disease. Additionally, using a T-cell depleted approach should reduce the incidence of graft-versus-host disease which would otherwise be increased in a mismatched transplant setting.
Compensation is read from the study's own description and may be missing — always confirm with the study team.
Eligibility
Who can join
- Be ages 5 to 40. You, your parent, or your legal guardian must give written permission to join.
- Have sickle cell disease of the SS or Sβ0-thalassemia type with serious problems that meet study rules, such as repeated pain or chest problems, strokes, frequent transfusions, abnormal blood flow tests, or organ damage. Or have beta-thalassemia or Diamond-Blackfan anemia needing regular transfusions, with too much iron in the body.
- For sickle cell disease, have tried hydroxyurea, a medicine for the disease, without success.
- Have a partly matched donor who meets study rules: at least 4 of 8 matching tissue markers for a relative, or 6 of 8 for an unrelated donor. A search must show no suitable fully matched unrelated donor or suitable cord blood option.
- Have kidney, liver, heart, and lung test results that meet study rules. Heart and lung doctors must approve the transplant. Extra liver tests may be needed if iron levels are high.
- Test negative for HIV. Females age 10 or older, or who have started periods, must have a negative pregnancy test unless they have had surgery to prevent pregnancy.
- Females who can become pregnant and sexually active males must agree to use approved birth control for up to 24 months after transplant, or as long as they take medicines that could harm a pregnancy or baby.
- Receive counseling about the risk of losing the ability to have children and options for storing sperm or collecting eggs.
Who can't join
- Have a better donor option, such as a matched brother, sister, or unrelated donor.
- Had a stem cell transplant within 6 months before the planned transplant preparation treatment.
- Had a brain or spinal cord event, such as a stroke, within 6 months before transplant preparation. Joining will be delayed until eligible.
- Are pregnant or breastfeeding.
- Have a bacterial, viral, or fungal infection that is not controlled.
- Have another health problem or test finding that the study doctor believes could raise risks, make study rules hard to follow, or affect the study results.
Simplified for readability. The official criteria below are what the study team uses.
Official eligibility criteria
Inclusion Criteria 1. Patient, parent, or legal guardian must have given written informed consent and/or assent according to FDA guidelines. 2. Ages 5 years to 40 years, at time of consent. 3. Diagnosis of Sickle Cell Disease (Hemoglobin SS, Sβ0-thalassemia) complicated by any of the following: * Recurrent acute painful episodes (also known as vaso-occlusive crises; VOC) despite supportive care, minimum of 2 new pain events per year requiring hospitalization for parenteral pain management in the previous 2 years. * Recurrent acute chest syndrome (ACS) despite supportive care, minimum of 2 episodes in preceding 2-year period. * Stroke or neurologic event lasting \> 24 hours with an accompanying infarct on MRI in any patient for all ages; Brain MRI with silent infarct without clinical event in patients ≤ 16 years. * Chronic transfusion therapy defined as \> 8 packed red blood cell transfusions per year in the year prior to enrollment and/or evidence of red blood cell alloimmunization. * Elevated transcranial Doppler velocities - \> 200 cm/s, via the non-imaging technique or \> 185 cm/s by the imaging technique measured on 2 separate occasions ≥ 1-month apart * Elevated TRV \> 2.6m/s in patients ≥ 16 years old. * Sickle-related renal insufficiency and/or sickle hepatopathy and/or any irreversible end-organ damage in patients ≥ 16 years old. OR Diagnosis of beta-thalassemia or Diamond-Blackfan anemia complicated by transfusion dependence with evidence of iron overload. 4. A minimum donor match of 4/8 via high resolution HLA typing at HLA-A, -B, -C, -DRB1 loci in the related setting or minimum donor match of 6/8 via high resolution HLA typing at HLA-A, -B, -C, -DRB1 loci (with the DRB1 locus as a full match requirement). An unrelated donor and cord blood search must have been completed without an eligible 8/8 matched unrelated donor or 6/8 cord blood unit available. Patients who may have acceptable cord blood donor options (4/6 or better) but are limited by cell dose of a single cord will also be eligible for the proposed study. 5. Adequate function of other organ systems as measured by: * Creatinine clearance or GFR ≥ 45 ml/min/1.73m. * Hepatic transaminases (ALT/AST) ≤ 3 x upper limit of normal. * Liver MR imaging for iron content should be performed in all patients with Ferritin \> 500 ng/mL. If hepatic iron content \> 10mg Fe/g liver should have hepatology consultation and liver biopsy to confirm absence of cirrhosis, fibrosis or hepatitis. * Adequate cardiac function as measure by echocardiogram (shortening fraction \> 26% or ejection fraction \> 40% or \>80% of age-specific normal). * Pulmonary evaluation testing demonstrating FEV1/FVC ≥ 60% of predicted for age and/or resting pulse oximeter ≥ 92% on room air. * Cardiology clearance to proceed with conditioning regimen and HSCT. * Pulmonology clearance to proceed with conditioning regimen and HSCT. 6. Subjects must be human immunodeficiency virus (HIV) negative by PCR. 7. Negative pregnancy test for females ≥10 years old or who have reached menarche, unless surgically sterilized. 8. All females of childbearing potential and sexually active males must agree to use an FDA approved method of birth control for up to 24 months after BMT or for as long as they are taking any medication that may harm a pregnancy, an unborn child or may cause a birth defect. 9. Subject and/or parent guardian will also be counseled regarding the potential risks of infertility following BMT and advised to discuss sperm banking or oocyte harvesting (Refer to section, 10. Hydroxyurea must have been trialed and failed in patients with sickle cell disease. Patient Exclusion Criteria 1. Patients with alternate, superior donor options (matched sibling donor or matched unrelated donor). 2. Patients who have undergone stem cell transplantation in the 6 months prior to anticipated conditioning. 3. Patients with history of a central nervous system (CNS) event within six months prior to start of conditioning (patient will be delayed until eligible). 4. Patients who are pregnant or lactating 5. Patients with uncontrolled bacterial, viral or fungal infection 6. Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study.
Study sites (1)
PA
- Children's Hospital of Pittsburgh of UPMC · Pittsburgh, PA 15224Paul Pszabolcs, MD · Principal investigatorMore trials in Pittsburgh