Allogeneic Bone Marrow Transplant for Inherited Metabolic Disorders

University of Minnesota (UMN)

Status and phase: Completed; Phase 2

Conditions: Hunter Syndrome; Sly Syndrome; Aspartylglucosaminuria; Maroteaux-Lamy Syndrome; Metachromatic Leukodystrophy (MLD); Alpha Mannosidosis; Sphingolipidoses; Mucopolysaccharidosis; Peroxisomal Disorders; Adrenoleukodystrophy (ALD); Fucosidosis; Hurler Syndrome; Krabbe Disease

Treatments: Drug: Cyclophosphamide; Drug: Busulfan; Procedure: Allogeneic stem cell transplantation; Drug: Campath-1H; Drug: Mycophenolate Mofetil; Drug: Cyclosporine A

Study type: Interventional

Funder types: Other

Identifiers

NCT01043640

2009LS088

MT2009-19 (Other Identifier)

Details and patient eligibility

About

Rationale: Chemotherapy administration before a donor stem cell transplant is necessary to stop the patient's immune system from rejecting the donor's stem cells. When healthy stem cells from a donor are infused into the patient, the donor white blood cells can provide the missing enzyme that causes the metabolic disease. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving a monoclonal antibody, alemtuzumab, before transplant and cyclosporine and mycophenolate mofetil before and after transplant may stop this from happening. This may be an effective treatment for inherited metabolic disorders.

Purpose: The design of this study is to achieve donor cell engraftment in patients with standard-risk inherited metabolic diseases with limited peri-transplant morbidity and mortality. This will be achieved through the administration of the chemotherapy regimen described. The intention is to follow transplanted patient for years after transplant monitoring them for complications of their disease and assisting families with a multifaceted interdisciplinary approach.

Full description

Primary Objective:

• To estimate the proportion of patients with donor derived engraftment at day 100 post transplant as defined by 80% or greater donor cells in the CD3 (T cell) fraction

Secondary Objectives:

• To determine the incidence and severity of graft-versus-host disease (GVHD) by day 100
• To determine the incidence of peri-transplant mortality (death by day 100)
• To monitor donor cell chimerism at various time points following allogeneic transplantation with this transplant regimen as determined at day 28, 42, 100, 6 months and yearly for 5 years.

Enrollment: 46 patients

Sex: All

Ages: Under 21 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Must have diagnosis of one of the following: mucopolysaccharidosis disorder, glycoprotein metabolic disorder, sphingolipidoses or inherited leukodystrophy, peroxisomal disorder or other inherited diseases of metabolism
• Must have an acceptable graft source as defined by University of Minnesota criteria
• Adequate organ function

Exclusion criteria

• Pregnant - menstruating females must have a negative serum pregnancy test within 14 days of treatment start
• Evidence of human immunodeficiency virus (HIV) infection or known HIV positive serology

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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46 participants in 1 patient group

Transplant Patients

Experimental group

Description:

Includes patients who received allogeneic stem cell transplantation following treatment plan of Campath-1H, cyclophosphamide, cyclosporine A, mycophenolate mofetil, and busulfan.

Treatment:

Drug: Cyclosporine A

Drug: Busulfan

Drug: Campath-1H

Procedure: Allogeneic stem cell transplantation

Drug: Cyclophosphamide

Drug: Mycophenolate Mofetil