Haploidentical PBMC Transplant for Severe Congenital Anemias
Running, not enrolling · Phase 1/Phase 2
Conditions studied: Sickle Cell Anemia
In brief
Background: Bone marrow transplantation (BMT), which involves transplanting a donor's marrow stem cells, is capable of curing some congenital anemias. BMT usually involves high-intensity treatment with chemotherapy and radiation to kill abnormal cells, which affects all systems of the body. People with anemias often have damage to other organs such as the kidneys, which can be further damaged by the chemotherapy. Only approximately 20 percent of patients have a full-matched donor, making treatment for many people with anemias unavailable. However, 90 percent of patients may have a half-matched donor, but using a half-matched donor increases the toxicity of BMT. Objectives: To determine if a research BMT with half-matched donor cells, low-intensity radiation, immunosuppressant drugs, and no chemotherapy will be effective in patients with sickle cell disease and Beta-thalassemia. To determine the effectiveness of cyclophosphamide, an immunosuppressant drug, in preventing rejection of the donor cells. Eligibility: Recipients are individuals at least 18 years of age who have been diagnosed with sickle cell disease and Beta-thalassemia, and who have a family member who is a haploidentical (i.e., half match) tissue match. Donors are healthy individuals between the ages of 2 and 80 who are found to be suitable donors. Design: Donors will undergo apheresis, which involves withdrawing blood from one arm vein, passing it through a machine that removes bone marrow stem cells, and returning the remaining blood through the vein in the other arm. Donors will receive a drug that causes the stem cells to be released into the bloodstream prior to the apheresis procedure. Recipients will undergo routine physical and laboratory examinations, including bone marrow sampling at the beginning of the study. After transplantation, physical and laboratory examinations will occur on a weekly or twice weekly basis at the outpatient clinic. Recipients will be examined every 6 months starting 100 days posttransplant for 5 years. Recipients will receive low-dose radiation in two treatments 1 and 2 days before the transplant. They will also be given immunosuppressant therapy with alemtuzumab and sirolimus. Another immunosuppressant drug, cyclophosphamide, will be given in the future as needed to subsets of the recipients to prevent rejection of donor cells. Recipients will receive the donor stem cells through a previously inserted central line. The process takes up to 8 hours. Recipients will receive blood transfusions as necessary to prevent anemia and bleeding during the posttransplant period. They may also receive intravenous antibiotics to prevent infection.
Key facts
- Study ID
- NCT00977691
- Run by
- National Heart, Lung, and Blood Institute (NHLBI)
- People needed
- 23
- Starts
- 2009-12-14
- Expected to finish
- 2026-09-10
- Last updated by the study team
- 2026-04-23
Who can join
Age: 2 and older, up to 80. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Donor
- 3.1 Haploidentical relative donor
- 3.2 Weight greater than or equal to 20 kg (insofar that the weight difference between recipient and donor does not exceed a reasonable likelihood of being able to obtain an adequate cell dose from the donor within two aphereses)
- 3.3 Fit to receive filgrastim (G-CSF) and to give peripheral blood stem cells (blood counts and blood pressure within DTM standards)
- 3.4 No history of congestive heart failure or unstable angina, and no history of stroke)
- 3.4 Ability to comprehend and willing to sign an informed consent; assent obtained from minors
- EXCLUSION CRITERIA:
- Donor: (any of the following would exclude the donor from participating)
- 4.1 Pregnant or lactating
- 4.2 HIV positive
- 4.3 Hemoglobin S greater than or equal to 50 percent, or beta
- thalassemia intermedia
You may not qualify if…
- Recipient (any of the following would exclude the subject from participating)
- 2.1 6/6 HLA-matched with or without an ABO minor mismatched sibling donor
- 2.2 ECOG performance status of 3 or more
- 2.3 Evidence of uncontrolled bacterial, viral, or fungal infections (currently taking medication and progression of clinical symptoms) within one month prior to starting the conditioning regimen. Patients with fever or suspected minor infection should await resolution of symptoms before starting the conditioning regimen.
- 2.4 Major anticipated illness or organ failure incompatible with survival from PBSC transplant
- 2.5 Pregnant or lactating
- 2.6 Major ABO mismatch
- INCLUSION CRITERIA:
- Donor
- 3.1 Haploidentical relative donor
- 3.2 Weight greater than or equal to 20 kg (insofar that the weight difference between recipient and donor does not exceed a reasonable likelihood of being able to obtain an adequate cell dose from the donor within two aphereses)
- 3.3 Fit to receive filgrastim (G-CSF) and to give peripheral blood stem cells (blood counts and blood pressure within DTM standards)
- 3.4 No history of congestive heart failure or unstable angina, and no history of stroke)
- 3.4 Ability to comprehend and willing to sign an informed consent; assent obtained from minors
- EXCLUSION CRITERIA:
- Donor: (any of the following would exclude the donor from participating)
- 4.1 Pregnant or lactating
- 4.2 HIV positive
- 4.3 Hemoglobin S greater than or equal to 50 percent, or beta
- thalassemia intermedia
Where it is running
- National Institutes of Health Clinical Center, 9000 Rockville Pike — Bethesda, Maryland, United States
Full record on ClinicalTrials.gov
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