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HSCT for High Risk Inherited Inborn Errors
This study is currently recruiting participants.
Verified by University of Minnesota, September 2008
Sponsors and Collaborators: University of Minnesota
Masonic Cancer Center, University of Minnesota
Information provided by: University of Minnesota
ClinicalTrials.gov Identifier: NCT00383448
  Purpose

Hematopoietic stem cell transplantation has proven effective therapy for individuals with adrenoleukodystrophy (ALD), metachromatic leukodystrophy (MLD) or globoid cell leukodystrophy (GLD, or Krabbe disease). This protocol also considers other inherited metabolic diseases such as but no limited to, GM1 gangliosidosis, Tay Sachs disease, Sanfillippo syndrome or Sandhoff disease, I-cell disease (mucolipidosis II).

For patients with advanced or rapidly progressive disease, the morbidity and mortality with transplantation is unacceptably high. Unfortunately, there are no viable alternative therapeutic options for these patients; if transplantation is not performed the patients are sent home to die. Our group at Minnesota has developed a new protocol incorporating transplantation using a reduced intensity conditioning regimen designed to decrease toxicity associated with the transplant procedure. This regimen will make use of the drug clofarabine, which has lympholytic and immune suppressive properties without the neurologic toxicity observed in the related compound, fludarabine, commonly used for transplantation. In addition, several agents providing anti-oxidant and anti-inflammatory properties will be used to assist in the stabilization of the disease processes. This revised transplant protocol will test the following: 1) the ability to achieve engraftment with the reduced intensity protocol, 2) the mortality associated with transplant by day 100, 3) patient outcomes, based on differential neurologic, neuropsychologic, imaging and biologic evaluations prior to transplantation and at designated points after transplantation (day 100, 6 months, 1, 2 and 5 years). Additional biologic studies will include pharmacokinetics of clofarabine and mycophenylate mofetil (MMF). In addition, for patients undergoing lumbar puncture studies, CSF will be requested for determinations of biologic parameters.


Condition Intervention
Adrenoleukodystrophy
Metachromatic Leukodystrophy
Globoid Cell Leukodystrophy
Tay Sachs Disease
Sandhoffs Disease
I-Cell Disease
Sanfillipo
GM1 Gangliosidosis
Drug: Campath
Drug: Clofarabine
Procedure: Total body Irradiation
Drug: Melphalan

Genetics Home Reference related topics: beta-ketothiolase deficiency cholesteryl ester storage disease familial encephalopathy with neuroserpin inclusion bodies Farber lipogranulomatosis GM2-gangliosidosis, AB variant Krabbe disease L1 syndrome leukoencephalopathy with vanishing white matter long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency megalencephalic leukoencephalopathy with subcortical cysts metachromatic leukodystrophy mitochondrial trifunctional protein deficiency primary carnitine deficiency Sandhoff disease Tay-Sachs disease X-linked adrenoleukodystrophy
MedlinePlus related topics: Addison's Disease Leukodystrophies Tay-Sachs Disease
Drug Information available for: Melphalan Alemtuzumab Melphalan hydrochloride Sarcolysin Campath Clofarabine
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Efficacy Study
Official Title: Treatment of High Risk, Inherited Lysosomal And Peroxisomal Disorders by Reduced Intensity Hematopoietic Stem Cell Transplantation

Further study details as provided by University of Minnesota:

Primary Outcome Measures:
  • To evaluate the ability to achieve donor cell engraftment with related, unrelated and cord blood grafts using a Campath-1H, clofarabine, melphalan and total body irradiation regimen. [ Time Frame: 5 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • determine the toxicity associated with this regimen, including neurologic, gastrointestinal, renal, pulmonary, cardiac and hepatic complications. [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: September 2006
Estimated Study Completion Date: September 2011
Estimated Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Campath

    Prior to the first dose, a test dose will be given of 1 mg IV. If no difficulties are observed within 4 hours, the daily dose of 0.3 mg/kg intravenously over 2 hours can be administered. This may start on the day of admission.

    5 days of: 0.3 mg/kg intravenously over 2 hours

    Drug: Clofarabine
    5 days of: 40 mg/m2 intravenously over 2 hours
    Procedure: Total body Irradiation
    Administration of TBI: The dose of TBI will be 200 cGy given in a single fraction on day -1. The dose rate will be between 10-19 cGy/minute prescribed to the midplane of the patient at the level of the umbilicus.
    Drug: Melphalan
    140 mg/m2 intravenously over 30 minutes
Detailed Description:

Hematopoietic stem cell transplantation has proven effective therapy for individuals with adrenoleukodystrophy (ALD), metachromatic leukodystrophy (MLD) or globoid cell leukodystrophy (GLD, or Krabbe disease). However, for patients with advanced or rapidly progressive disease, the morbidity and mortality with transplantation is unacceptably high. Unfortunately, there are no viable alternative therapeutic options for these patients; if transplantation is not performed the patients are sent home to die. Our group at Minnesota has developed a new protocol incorporating transplantation using a reduced intensity conditioning regimen designed to decrease toxicity associated with the transplant procedure. This regimen will make use of the drug clofarabine, which has lympholytic and immune suppressive properties without the neurologic toxicity observed in the related compound, fludarabine, commonly used for transplantation. In addition, several agents providing anti-oxidant and anti-inflammatory properties will be used to assist in the stabilization of the disease processes. This revised transplant protocol will test the following: 1) the ability to achieve engraftment with the reduced intensity protocol, 2) the mortality associated with transplant by day 100, 3) patient outcomes, based on differential neurologic, neuropsychologic, imaging and biologic evaluations prior to transplantation and at designated points after transplantation (day 100, 6 months, 1, 2 and 5 years). Additional biologic studies will include pharmacokinetics of clofarabine and mycophenylate mofetil (MMF), develop experience in kinetics of N-acetylcysteine, and evaluate biologic markers of oxidative status during transplantation. In addition, for patients undergoing lumbar puncture studies, CSF will be requested for determinations of biologic parameters.

  Eligibility

Ages Eligible for Study:   up to 55 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Adrenoleukodystrophy: Patients from 0-55 years of age diagnosed with ALD as determined by very long chain fatty acid testing will be eligible for this protocol if they have evidence of cerebral or cerebellar disease based on MRI testing, AND they are determined high risk for any of the following reasons:

  1. Age >18 years
  2. MRI score >10
  3. Evidence of aggressive disease that in the judgment of the Inherited Metabolic and Storage Disease group is sufficiently concerning to consider transplantation with a reduced intensity regimen instead of a standard full preparative regimen.

Metachromatic Leukodystrophy: Patients from 0-55 years of age diagnosed with MLD as determined by determinations of arylsulfatase A testing will be eligible for this protocol IF they are determined high risk for any of the following reasons:

  1. Age >18 years
  2. Symptomatic disease, as based on neurologic examination, or evidence of deterioration based on subsequent neuropsychologic evaluations.
  3. Evidence of aggressive disease such as rapidly changing MRI determinations that in the judgment of the Inherited Metabolic and Storage Disease group is sufficiently concerning to consider transplantation with a reduced intensity regimen instead of a standard full preparative regimen.

Globoid Cell Leukodystrophy: Patients from 0-55 years of age diagnosed with GLD as determined by determinations of galactocerebrosidase testing will be eligible for this protocol IF they are determined high risk for any of the following reasons:

  1. Age >18 years
  2. Symptomatic disease, as based on neurologic examination, or evidence of deterioration based on subsequent neuropsychologic evaluations.
  3. Evidence of aggressive disease such as rapidly changing MRI determinations that in the judgment of the Inherited Metabolic and Storage Disease group is sufficiently concerning to consider transplantation with a reduced intensity regimen instead of a standard full preparative regimen.

Patients with GM1 gangliosidosis, Tay Sachs disease, Sanfilippo syndrome or Sandhoff disease or other inherited metabolic diseases including but not limited to I-cell disease (mucolipidosis II) who are determined to be sufficiently advanced or high risk based on the following reasons:

  1. Symptomatic disease, as based on neurologic examination, or evidence of deterioration based on subsequent neuropsychologic evaluations.
  2. Evidence of an expected poor outcome based on genetic testing or a prior family history of aggressive disease.
  3. Other metabolic disorders, including but not limited to I-cell disease, that are deemed to be high-risk for a poor outcome with a standard transplant regimen due to anticipated toxicity based on experience gained at the University of Minnesota or other centers.

Exclusion criteria:

Major organ dysfunction. Evidence of major organ impairment, including:

  1. Cardiac: ejection fraction <25%
  2. Renal: serum Cr >3 x normal or Cr clearance <20 mL/min.
  3. Hepatic: total bilirubin >5 x normal, or ALT > 5 x normal
  4. Pulmonary: requirement for respiratory support, as defined by continuous requirement for oxygen supplementation Pregnancy HIV: Evidence of HIV infection or known HIV positive serology Inability to Obtain Consent: Patients or parents are psychologically incapable of undergoing BMT with associated strict isolation or documented history of medical non-compliance.

Advanced Disease Exclusion: Following evaluation, if a consensus of the members of the Inherited Metabolic and Storage Disease Program is that a patient is too advanced to benefit in a measurable and meaningful way from transplant, this will be communicated to the family, and transplant will not be offered. Measures to assist in those determinations may include: neurologic/neurocognitive functions such as activities of daily living, motor function, vision, hearing, interaction with environment, toileting, swallowing, or other standardized measures

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00383448

Contacts
Contact: Paul Orchard, M.D. 612-626-2961 orcha001@umn.edu

Locations
United States, Minnesota
University of Minnesota Medical Center Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Paul Orchard, MD     612-626-2961     orcha001@umn.edu    
Sub-Investigator: Kendra Bjoraker, Ph.D.            
Sub-Investigator: Lawrence Charnas, MD            
Sub-Investigator: Katherine Dusenbery, MD            
Sub-Investigator: Margaret MacMillan, MD            
Sub-Investigator: Elsa Shapiro, MD            
Sub-Investigator: Marcie Tomblyn, MD            
Sub-Investigator: Jakub Tolar, MD, Ph.D.            
Sub-Investigator: John Wagner, MD            
Sub-Investigator: Brenda Weigel, MD            
Sponsors and Collaborators
University of Minnesota
Masonic Cancer Center, University of Minnesota
Investigators
Principal Investigator: Paul Orchard, MD University of Minnesota Medical Center
  More Information

Responsible Party: University of Minnesota ( Paul Orchard, M.D. )
Study ID Numbers: 0606M87246, MT2006-14
Study First Received: September 29, 2006
Last Updated: September 12, 2008
ClinicalTrials.gov Identifier: NCT00383448  
Health Authority: United States: Institutional Review Board

Keywords provided by University of Minnesota:
Adrenoleukodystrophy (ALD)
Stem cell transplantation
Inborn errors of metabolism
Metachromatic leukodystrophy (MLD)
Globoid cell leukodystrophy (GLD or Krabbe)
Tay Sachs
Sandhoff
Sanfillipo
GM1 gangliosidosis
I-cell
mucolipidosis

Study placed in the following topic categories:
Sphingolipidoses
Adrenal Gland Diseases
Demyelinating diseases
Tay-Sachs disease
Hypoadrenalism
Brain Diseases
Metabolism, Inborn Errors
Heredodegenerative Disorders, Nervous System
I cell disease
Alemtuzumab
Adrenoleukodystrophy
Addison Disease
Brain Diseases, Metabolic, Inborn
Metachromatic leukodystrophy
Tay-Sachs Disease
Sandhoff disease
Adrenal Insufficiency
Metabolic Diseases
Demyelinating Diseases
Lysosomal Storage Diseases
Endocrine System Diseases
Mental Retardation
Gangliosidosis, GM1
Beta-galactosidase-1 deficiency
Lipidoses
Metabolic disorder
Lipid Metabolism Disorders
Brain Diseases, Metabolic
Lipid Metabolism, Inborn Errors
Melphalan

Additional relevant MeSH terms:
Immune System Diseases
Antineoplastic Agents
Lysosomal Storage Diseases, Nervous System
Therapeutic Uses
Nervous System Diseases
Sulfatidosis
Mental Retardation, X-Linked
Hereditary Central Nervous System Demyelinating Diseases
Carbohydrate Metabolism, Inborn Errors
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 16, 2009