Allogeneic Stem Cell Transplantation (ALLOSCT) in Recessive Dystrophic Epidermolysis Bullosa (RDEB)

Condition(s) targeted: Epidermolysis Bullosa

Intervention: Reduced Intensity Transplant conditioning (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: Columbia University

Official(s) and/or principal investigator(s):
Mitchell S Cairo, MD, Principal Investigator, Affiliation: Columbia University Medical Center

Overall contact:
Mitchell S Cairo, MD, Phone: 212-305-8316, Email: mc1310@columbia.edu

Reduced Intensity Conditioning (RIC) and Allogeneic Stem Cell Transplantation (AlloSCT) from family-related donors and unrelated cord blood (UCB) donors will be safe and well tolerated in selected patients with RDEB.

To determine the event-free survival (EFS) and overall survival (OS) following RIC consisting of busulfan/fludarabine/alemtuzumab (BFA) and AlloSCT in selected patients with RDEB.

Official title: A Pilot Study of Reduced Intensity Conditioning (RIC) and Allogeneic Stem Cell Transplantation (ALLOSCT) In Children With Recessive Dystrophic Epidermolysis Bullosa (RDEB)

Study design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study

Primary outcome: To determine the event-free survival (EFS) and overall survival (OS) following RIC consisting of busulfan/fludarabine/alemtuzumab (BFA) and AlloSCT in selected patients with RDEB.

Secondary outcome:

Quantitate the percent of whole blood (CD45), T-cell (CD3), and NK cell (CD56) chimerism following RIC and AlloSCT in selected patients with RDEB

Quantitate the percent of donor skin dermal chimerism following RIC and AlloSCT in selected patients with RDEB.

Compare the gene and protein expression of COL7A1 in the skin pre and post AlloSCT

Detailed description: Epidermolysis bullosa (EB), is a diverse group of genodermatoses, which is considered a rare and orphan disease and affects approximately 1 in 20,000 people in the United States for a cumulative total of close to 20,000[1-4]. There are three major subtypes of inherited EB, including EB simplex (EBS), junctional EB (JEB), and dystrophic EB[1-4]. RDEB is among the most severe and represents approximately 10% of all forms of EB[1-4]. A rough estimate would then project that there are several thousand patients with RDEB in the U. S. at the current time. Up to 30 different clinical phenotypes and mutations in at least 10 structural genes in different sub-types of EB have been reported[4-8]. In addition to heritable subtypes of EB, there is an acquired autoimmune form in which the patients develop auto-antibodies directed against similar proteins of the inherited dystrophic forms of EB, including EB acquisita (EBA).

We have previously reported our experience with RIC with BFA [48] in pediatric AlloSCT recipients (mean age 9. 5 yrs [1. 4-21], 11/4 M/F, 10 non-malignant, 5 malignant disease, [6 sibling, 5 UCB, 5 matched unrelated donor]); median time to ANC ≥ 500/mm3 and platelet count ≥20K/mm3 was 22 and 30 days, respectively. Probability of day +180 and 365 donor chimerism was 90% (Figure 7), and OS was 95% (Figure 8). This conditioning regimen therefore results in a high degree of donor chimerism and survival with minimal regimen related mortality.

Minimum age: N/A. Maximum age: 21 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Recessive Dystrophic Epidermolysis Bullosa (RDEB)

- Diagnosis of RDEB using molecular diagnosis and sequencing of mutations

- Skin biopsy to determine status of type VII collagen by IF, EM and q-PCR

- Age ≤21 years

- Patient must have adequate organ function as below:

1. Adequate renal function defined as:

- Serum creatinine less than or equal to 1. 5 x normal, or

- Creatinine clearance or radioisotope GFR =40 ml/min/m2 or > 60 ml/min/1. 73

m2 or an equivalent GFR as determined by the institutional normal range

2. Adequate liver function defined as:

- SGOT (AST) or SGPT (ALT) < 5. 0 x normal

3. Adequate cardiac function defined as:

- Shortening fraction of ≥28% by echocardiogram, or

- Ejection fraction of ≥48% by radionuclide angiogram or echocardiogram

4. Adequate pulmonary function defined as:

- Uncorrected DLCO≥35% by pulmonary function test

- For children who are uncooperative, no evidence of dyspnea at rest

Exclusion Criteria:

- Karnofsky/Lansky Performance Score <60%

- Pregnant or nursing

- Uncontrolled bacterial, viral or mold infection

- History or presence of skin squamous cell carcinoma

Mitchell S Cairo, MD, Phone: 212-305-8316, Email: mc1310@columbia.edu

Morgan Stanley Children's Hospital of NYP, New York, New York 10032, United States; Recruiting
Mitchell S Cairo, MD, Phone: 212-305-8316, Email: mc1310@columbia.edu
Claire Fanelli, RN, Phone: 212-305-2050, Email: cf2370@columbia.edu
Mitchell S Cairo, MD, Principal Investigator

Starting date: March 2009
Ending date: July 2014
Last updated: April 23, 2009