Pre-Transplant Immune Suppression With Hematopoietic Cell Transplantation From Haploidentical Donors for Adults and Children With Sickle Cell Disease or ß-Thalassemia (Haplo PTCy)
Summary
Hematopoietic Cell Transplantation/HCT involves receiving healthy blood-forming cells (stem cells) from a donor to replace the diseased or damaged cells in participants' bone marrow. The researchers think giving participants treatment with fludarabine and dexamethasone, drugs that lower the activity of the body's immune system (immune suppression), before standard conditioning therapy and HCT may help prevent serious side effects, including graft failure and GvHD. In this study, depending on how participants' body responds to the fludarabine and dexamethasone, the study doctor may decide participants should receive another drug, called cyclophosphamide, instead of fludarabine. In addition, depending on the results of participants' routine blood tests, participants may receive the drugs bortezomib and rituximab, which also help with immune suppression.
Arms & interventions
- DrugFludarabine
PK-guided fludarabine dosing will be used for each of the 2 cycles, using the InsightRx DoseMeRx platform.
- DrugCyclophosphamide
Cyclophosphamide will be administered Post-Transplant
- DrugTacrolimus
Tacrolimus will be administered beginning on day +5
- DrugMycophenolate Mofetil
Mycophenolate mofetil (MMF) will be administered three times daily starting on day +5.
- BiologicalRabbit ATG
The dose and schedule of ATG will be determined according to the nomogram in Appendix A
- DrugDexamethasone
Standard Regimen: Dexamethasone on days -68 to -64 and days -40 to -36.
- DrugBortezomib
Bortezomib on days -71, -68, -65, -61, -43, -40, -37, and -33
- DrugRituximab
Rituximab on days -71, -58, -43, and -30.
Outcome measures
Primary
Number of participants with treatment related mortality/TRM or primary graft failure
The primary outcome is to estimate treatment-related mortality (TRM) or primary graft failure at 1 year post-HCT.
Time frame: 1 year
Eligibility criteria
Study locations (6)
Memorial Sloan Kettering at Basking Ridge (Consent only)
Basking Ridge, New Jersey, 07920
Memorial Sloan Kettering Monmouth (Consent only)
Middletown, New Jersey, 07748
Memorial Sloan Kettering Bergen (Consent only)
Montvale, New Jersey, 07645
Memorial Sloan Kettering Suffolk - Commack (Consent only)
Commack, New York, 11725
Memorial Sloan Kettering Westchester (Consent only)
Harrison, New York, 10604
Memorial Sloan Kettering Nassau (All protocol activities)
Rockville Centre, New York, 11553