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Study 8 of 27 for search of: | "Adrenoleukodystrophy" |
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Sponsors and Collaborators: |
University of Minnesota Masonic Cancer Center, University of Minnesota |
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Information provided by: | University of Minnesota |
ClinicalTrials.gov Identifier: | NCT00383448 |
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 |
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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 |
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 |
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) |
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
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.
Ages Eligible for Study: | up to 55 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
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:
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:
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:
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:
Exclusion criteria:
Major organ dysfunction. Evidence of major organ impairment, including:
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
Contact: Paul Orchard, M.D. | 612-626-2961 | orcha001@umn.edu |
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 |
Principal Investigator: | Paul Orchard, MD | University of Minnesota Medical Center |
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 |
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 |
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 |
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 |