GM-CSF for Reversal of immunopAralysis in pediatriC sEpsis-induced MODS Study (GRACE)

Nationwide Children's Hospital logo

Nationwide Children's Hospital

Status and phase

Active, not recruiting
Phase 4

Conditions

Pediatric Sepsis-induced MODS

Treatments

Drug: GM-CSF

Study type

Interventional

Funder types

Other

Identifiers

NCT03769844
GRACE

Details and patient eligibility

About

This study is an open-label, multi-center, interventional trial in which children with sepsis-induced MODS undergo surveillance immune function testing beginning on Day 2 of MODS. Those children who demonstrate immunoparalysis (TNF-alpha response <200 pg/ml) will receive a 7-day course of GM-CSF at a dose of 125 or 250 mcg/m2/day by either the intravenous (IV) or subcutaneous (SQ) route. The goal of the study is to establish the dose and route of delivery that results in resolution of immunoparalysis (TNF-alpha response >=200 pg/ml) by the morning after the 3rd scheduled dose with persistent resolution of immunoparalysis on the morning after the 7th scheduled dose. Resolution of immunoparalysis in 8 out of the first 10 subjects in a study treatment arm represents a successful dose and route. The goal of this study will be achieved through the following Specific Aims: Specific Aim 1. Establish the immunologic efficacy of GM-CSF administered by the IV and SQ routes in children with immunoparalysis in the setting of sepsis-induced MODS. Specific Aim 2. Estimate the pharmacokinetic parameters by the IV and SQ GM-CSF administered in pediatric sepsis-induced MODS. Specific Aim 3. Demonstrate the feasibility of screening, enrollment, drug delivery, and sample collection for a multi-center immunostimulation trial in children with sepsis-induced MODS.

Enrollment

120 estimated patients

Sex

All

Ages

Under 17 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • >= 40 weeks gestational age to <18 years; AND
  • Onset of >=2 new organ dysfunctions (compared to pre-sepsis baseline) as measured by the Proulx criteria; AND
  • Documented or suspected infection as the MODS inciting event.

Exclusion criteria

  • Unable to collect a cumulative total of 20.5 mL of blood for this study due to research blood draw limits; OR
  • Limitation of care order at the time of screening; OR
  • Patients at high risk for brain death; OR
  • Active (or planned within 7 days) immunosuppressive treatment for oncologic, transplant, or rheumatologic disease; OR
  • Known primary immunodeficiency disorder; OR
  • Diagnosis of myeloid leukemia, myelodysplasia, or autoimmune thrombocytopenia;OR
  • Known allergy to GM-CSF; OR
  • Documented hyperferritinemia (serum ferritin >= 500 ng/ml) during current sepsis event; OR
  • Contraindication to SQ injection (ECMO); OR
  • Burns where >5% of the total body surface area is affected; OR
  • Renal replacement therapy at the time of screening; OR
  • On ECMO or anticipated to require ECMO; OR
  • Known pregnancy; OR
  • Inability to collect and ship sample for immune testing on MODS Day 2; OR
  • Previous enrollment in the GRACE study

Trial design

Primary purpose

Treatment

Allocation

Non-Randomized

Interventional model

Sequential Assignment

Masking

None (Open label)

120 participants in 4 patient groups

IV GM-CSF 125 mcg/m2/dose
Experimental group
Description:
Subjects in this arm who demonstrate immunoparalysis will receive GM-CSF by the intravenous (IV) route at a dose of 125 mcg/m2/day for 7 consecutive days.
Treatment:
Drug: GM-CSF
SQ GM-CSF 125 mcg/m2/dose
Experimental group
Description:
Subjects in this arm who demonstrate immunoparalysis will receive GM-CSF by the subcutaneous (SQ) route at a dose of 125 mcg/m2/day for 7 consecutive days.
Treatment:
Drug: GM-CSF
IV GM-CSF 250 mcg/m2/dose
Experimental group
Description:
If the IV 125 mcg/m2/dose arm is not successful in the first cohort of subjects, we will transition to 250 mcg/m2/day via the IV route for 7 consecutive days in a subsequent cohort.
Treatment:
Drug: GM-CSF
SQ GM-CSF 250 mcg/m2/dose
Experimental group
Description:
If the SQ 125 mcg/m2/dose arm is not successful in a cohort of subjects (or if the IV dose had to be escalated to 250 mcg/m2/dose), we will transition to 250 mcg/m2/day via the SQ route for 7 consecutive days in a subsequent cohort.
Treatment:
Drug: GM-CSF

Trial contacts and locations

8

Loading...

Data sourced from clinicaltrials.gov

Clinical trials

Find clinical trialsTrials by location
© Copyright 2024 Veeva Systems