ClinicalTrials.gg
CompletedNCT02833805Updated Jul 12, 2022Results posted

NMA Haplo or MUD BMT for Newly Diagnosed Severe Aplastic Anemia

A Phase 2 interventional study of Thymoglobulin and Fludarabine in Severe Aplastic Anemia, Aplastic Anemia and Bone Marrow Failure, sponsored by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. Completed at 1 site in United States. Per ClinicalTrials.gov, last updated 2022-07-12.

Sponsored by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
21
Allocation
Not applicable
Sex
All
01

Study summary

Our primary objective is to determine if it is feasible for previously untreated severe aplastic anemia (SAA) patients to be transplanted using non-myeloablative conditioning and post transplantation cyclophosphamide.

Read the detailed description

This is a clinical trial of upfront bone marrow transplantation for patients with SAA who do not have a fully human leukocyte antigen (HLA) matched donor. The trial uses a conditioning regimen which has been successful in the refractory and relapsed setting to maximize engraftment and post transplant therapy to minimize graft versus host disease (GVHD). This would be used here in patients who have not yet undergone immunosuppressive therapy for their SAA or are thought to be unlikely to respond to immunosuppressive therapy for SAA.

02

Conditions studied

  • Severe Aplastic Anemia
  • Aplastic Anemia
  • Bone Marrow Failure
  • Immunosuppression

Keywords

  • immunosuppression
  • nonmyeloablative
  • non-myeloablative
  • allogeneic
  • tacrolimus
  • bone marrow
  • bone marrow transplant
  • cyclophosphamide
  • thymoglobulin
  • ATG
  • fludarabine
03

In context

Anemia, Aplastic

371 studies on the registry are indexed under Anemia, Aplastic; 98 are open to participants now.

This study's enrollment of 21 is below the median of 37 across 281 interventional studies indexed under Anemia, Aplastic.

Browse Anemia, Aplastic studies →

Lead sponsor

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins is the lead sponsor of 582 studies on the registry; 71 are open to participants now.

Of its 114 completed or terminated interventional studies of FDA-regulated products, 68 (60%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Confirmed diagnosis of inherited or acquired severe aplastic anemia (SAA)
  • One of the following available donors:

    1. HLA-haploidentical relative
    2. If recipient is >= 40 years old, may use HLA-matched related donor
    3. For recipients with inherited bone marrow failure syndromes (IBMFS) with clear evidence of same disorder in potential related donors, may use 10/10 matched unrelated donor
  • Recipient and/or legal guardian must sign protocol
  • Donor must be willing to donate bone marrow
  • (LVEF) >= 40%. For recipients \< 13 years old, shortening fraction >= 26% may be used instead.
  • \< 3 x (ULN) for age, unless patient has Gilbert's disease
  • (AST) and alanine aminotransferase (ALT) \< 5 x ULN for age
  • For patients >= 13 years old: estimated > 50 mL/min using Cockcroft-Gault formula and actual body weight
  • For patients >= 1 but \< 13 years old: (GFR) estimated by updated Schwartz formula >= 90 mL/min/1.73 m\^2. If estimated GFR is \< 90 mL/min/1.73 m\^2, 24-hour measured creatinine clearance must be > 50 mL/min/1.73 m\^2.
  • For patients >= 8 years old, diffusing capacity of the lung for carbon monoxide (DLCO) (corrected for ) > 40%; forced expiratory volume at one second () > 50%; forced vital capacity (FVC) > 50%
  • For patients \< 8 years old or unable to undergo pulmonary function testing: no evidence of dyspnea at rest; no need for supplemental oxygen; oxygen saturation > 92% on room air
  • /Lansky status (depending on age) >= 70%
  • Females and males of must agree to practice 2 effective methods of at the same time. If unwilling, they must agree to complete abstinence.

Exclusion criteria

Exclusion Criteria:

  • Previous administration of therapy for SAA.
  • Fanconi anemia. At minimum, this diagnosis must be excluded by diepoxybutane (DEB) or equivalent testing on peripheral blood or marrow in patients \< 30 years old.
  • Clonal cytogenetic abnormalities consistent with pre-myelodysplastic syndrome (pre-MDS) or MDS on bone marrow examination
  • Presence of anti-donor antibodies
  • Prior stem cell transplant
  • Prior solid organ transplant
  • Uncontrolled bacterial, viral, or fungal infection
  • seropositivity
  • Active or C infection determined by serology and/or nucleic acid testing (NAT)
  • Pregnancy or active breastfeeding
  • Prior except: resected basal carcinoma or treated cervical carcinoma in situ; cancer treated with curative intent > 5 years previously. Other prior cancers will not be allowed unless approved by the PI.
Terms in these criteria, in plain language(17)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

FEV1

From a breathing test (spirometry): how much air you can blow out in the first second. Often given as a percentage of what is expected for your age, height and sex.

Karnofsky performance status (KPS)

A 0–100 scale of how well someone can carry out everyday activities. 100 is no complaints and no signs of illness; 70 is able to look after yourself but not to work or keep up normal activity; 50 is needing considerable help and frequent medical care.

Studies often ask for 60 or 70 and above. Your doctor gives the score.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Allogeneic and autologous transplant

Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
21 participants (actual)

Study arms

  • Experimental
    Bone marrow transplant

    Non-myeloablative bone marrow transplant with a Thymoglobulin (ATG), fludarabine (Flu), cyclophosphamide (Cy), total body irradiation (TBI) preparative regimen and post-transplant Cy, mycophenolate mofetil (MMF), and tacrolimus as GVHD prophylaxis.

    Drug: Thymoglobulin · Drug: Fludarabine · Drug: Cyclophosphamide · Radiation: Total body irradiation · Drug: Tacrolimus · Drug: Mycophenolate mofetil

Interventions

  • Day -9: 0.5 mg/kg Days -8 and -7: 2 mg/kg daily

    Also known as: Anti-thymocyte globulin, ATG

  • Days -6 through -2: 30 mg/m\^2 IV daily

    Also known as: Fludara

  • Days -6 and -5: 14.5 mg/kg IV daily Days 3 and 4: 50 mg/kg IV daily

    Also known as: Cytoxan, Cy, CTX

  • RadiationTotal body irradiation

    Day -1: 200 centigray (cGy) in a single fraction

    Also known as: TBI

  • Start on Day 5 through Day 365

    Also known as: FK-506, FK506, Prograf

  • Days 5 through 35: 15 mg/kg PO three times daily (max 3 g/day)

    Also known as: MMF, CellCept

06

What researchers measure

Primary outcomes

  1. Overall Survival and Engraftment at One Year

    Number of enrolled participants who receive BMT, achieve engraftment, and are alive at one year post bone marrow transplant (BMT).

    Time frame: 1 year

Secondary outcomes

  1. Overall Survival at One Year

    Number of participants alive at one year after BMT.

    Time frame: 1 year

  2. Probability of Neutrophil Recovery as Assessed by the Number of Participants Who Have Recovered Neutrophil Counts

    Probability of neutrophil recovery will be assessed by the number of participants who have recovered neutrophil counts at 1 year (\>500 ANC).

    Time frame: 1 year

  3. Probability of Platelet Recovery as Assessed by Number of Participants Who Have Recovered Platelet Counts

    Probability of platelet recovery will be assessed by the number of participants who have recovered platelet counts at 1 year.

    Time frame: 1 year

  4. Number of Participants Who Experience Primary Graft Failure

    Number of participants who experience primary graft failure by one year after BMT.

    Time frame: 1 year

  5. Number of Participants Who Experience Secondary Graft Failure

    Number of participants who experience secondary graft failure by one year after BMT.

    Time frame: 1 year

  6. Number of Participants Who Experience Grades II-IV Acute GVHD

    Number of participants who experience grade II, III, or IV acute GVHD by Day 100.

    Time frame: Day 100

  7. Number of Participants Who Experience Grades III-IV Acute GVHD

    Number of participants who experience grade III or IV acute GVHD by Day 100.

    Time frame: Day 100

  8. Number of Participants Who Experience Chronic GVHD

    Number of participants who experience chronic GVHD by two years after BMT.

    Time frame: 2 years

  9. Number of Participants With Full Donor Chimerism

    Number of participants with full donor chimerism at Day 60.

    Time frame: Day 60

  10. GVHD-free Relapse-free Survival (GRFS)

    Number of participants alive, without relapse, and without GVHD at 1 year.

    Time frame: 1 year

  11. Transplant-related Mortality

    Number of participants deceased for reasons related to BMT at 1 year.

    Time frame: 1 year

07

Results

Posted Jul 12, 2022

Participant flow

Participant flow — Overall Study
MilestoneBone Marrow Transplant
Started21
Completed21
Not completed0

Outcome measures

PrimaryOverall Survival and Engraftment at One Year

Number of enrolled participants who receive BMT, achieve engraftment, and are alive at one year post bone marrow transplant (BMT).

Time frame:
1 year
Reported as:
Count of participants · Participants
Overall Survival and Engraftment at One Year
ParticipantsBone Marrow Transplant
Overall Survival and Engraftment at One Year19
SecondaryOverall Survival at One Year

Number of participants alive at one year after BMT.

Time frame:
1 year
Reported as:
Count of participants · Participants
Overall Survival at One Year
ParticipantsBone Marrow Transplant
Overall Survival at One Year19
SecondaryProbability of Neutrophil Recovery as Assessed by the Number of Participants Who Have Recovered Neutrophil Counts

Probability of neutrophil recovery will be assessed by the number of participants who have recovered neutrophil counts at 1 year (\>500 ANC).

Time frame:
1 year
Reported as:
Count of participants · Participants
Probability of Neutrophil Recovery as Assessed by the Number of Participants Who Have Recovered Neutrophil Counts
ParticipantsBone Marrow Transplant
Probability of Neutrophil Recovery as Assessed by the Number of Participants Who Have Recovered Neutrophil Counts21
SecondaryProbability of Platelet Recovery as Assessed by Number of Participants Who Have Recovered Platelet Counts

Probability of platelet recovery will be assessed by the number of participants who have recovered platelet counts at 1 year.

Time frame:
1 year
Reported as:
Count of participants · Participants
Probability of Platelet Recovery as Assessed by Number of Participants Who Have Recovered Platelet Counts
ParticipantsBone Marrow Transplant
Probability of Platelet Recovery as Assessed by Number of Participants Who Have Recovered Platelet Counts20
SecondaryNumber of Participants Who Experience Primary Graft Failure

Number of participants who experience primary graft failure by one year after BMT.

Time frame:
1 year
Reported as:
Count of participants · Participants
Number of Participants Who Experience Primary Graft Failure
ParticipantsBone Marrow Transplant
Number of Participants Who Experience Primary Graft Failure21
SecondaryNumber of Participants Who Experience Secondary Graft Failure

Number of participants who experience secondary graft failure by one year after BMT.

Time frame:
1 year
Reported as:
Count of participants · Participants
Number of Participants Who Experience Secondary Graft Failure
ParticipantsBone Marrow Transplant
Number of Participants Who Experience Secondary Graft Failure19
SecondaryNumber of Participants Who Experience Grades II-IV Acute GVHD

Number of participants who experience grade II, III, or IV acute GVHD by Day 100.

Time frame:
Day 100
Reported as:
Count of participants · Participants
Number of Participants Who Experience Grades II-IV Acute GVHD
ParticipantsBone Marrow Transplant
Number of Participants Who Experience Grades II-IV Acute GVHD4
SecondaryNumber of Participants Who Experience Grades III-IV Acute GVHD

Number of participants who experience grade III or IV acute GVHD by Day 100.

Time frame:
Day 100
Reported as:
Count of participants · Participants
Number of Participants Who Experience Grades III-IV Acute GVHD
ParticipantsBone Marrow Transplant
Number of Participants Who Experience Grades III-IV Acute GVHD2
SecondaryNumber of Participants Who Experience Chronic GVHD

Number of participants who experience chronic GVHD by two years after BMT.

Time frame:
2 years
Reported as:
Count of participants · Participants
Number of Participants Who Experience Chronic GVHD
ParticipantsBone Marrow Transplant
Number of Participants Who Experience Chronic GVHD1
SecondaryNumber of Participants With Full Donor Chimerism

Number of participants with full donor chimerism at Day 60.

Time frame:
Day 60
Reported as:
Count of participants · Participants
Number of Participants With Full Donor Chimerism
ParticipantsBone Marrow Transplant
Number of Participants With Full Donor Chimerism21
SecondaryGVHD-free Relapse-free Survival (GRFS)

Number of participants alive, without relapse, and without GVHD at 1 year.

Time frame:
1 year
Reported as:
Count of participants · Participants
GVHD-free Relapse-free Survival (GRFS)
ParticipantsBone Marrow Transplant
GVHD-free Relapse-free Survival (GRFS)19
SecondaryTransplant-related Mortality

Number of participants deceased for reasons related to BMT at 1 year.

Time frame:
1 year
Reported as:
Count of participants · Participants
Transplant-related Mortality
ParticipantsBone Marrow Transplant
Transplant-related Mortality2

Adverse events

Collected over Adverse events were monitored and collected from time of consent up to one year.. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Bone Marrow Transplant2/21 (9.5%)2/21 (9.5%)0/21 (0%)
Most frequent serious events
Most frequent serious events
EventBone Marrow Transplant
Gram negative rods BacteremiaInfections and infestations2/21

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Bone Marrow Transplant
<=18 years7
Between 18 and 65 years14
>=65 years0
Age, Continuous
Age, Continuous(years)Bone Marrow Transplant
Mean25 (3 to 69)
Sex: Female, Male
Sex: Female, Male(Participants)Bone Marrow Transplant
Female8
Male13
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Bone Marrow Transplant
American Indian or Alaska Native0
Asian1
Native Hawaiian or Other Pacific Islander0
Black or African American4
White14
More than one race0
Unknown or Not Reported2
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Bone Marrow Transplant
African American4
Caucasian14
Other3
Region of Enrollment
Region of Enrollment(Participants)Bone Marrow Transplant
United States21
08

Study locations

1 site
  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
    Baltimore, Maryland 21287, United States
09

References and documents

Publications

  • DeZern AE, Zahurak ML, Symons HJ, Cooke KR, Rosner GL, Gladstone DE, Huff CA, Swinnen LJ, Imus P, Borrello I, Wagner-Johnston N, Ambinder RF, Luznik L, Bolanos-Meade J, Fuchs EJ, Jones RJ, Brodsky RA. Haploidentical BMT for severe aplastic anemia with intensive GVHD prophylaxis including posttransplant cyclophosphamide. Blood Adv. 2020 Apr 28;4(8):1770-1779. doi: 10.1182/bloodadvances.2020001729. PubMed 32343796 ↗

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: No

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 12, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02833805
Responsible party
Sponsor
First posted
Jul 14, 2016
Start date
Sep 2016
Primary completion
Jul 2021
Completion
Jul 2021
Results posted
Jul 12, 2022
Last update
Jul 12, 2022

Study contacts

Amy E DeZern, MD
principal investigator · Johns Hopkins University

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Jun 2022. You cannot join it, but the record below documents what was studied.

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Studies of the drugs tested here: Thymoglobulin · Fludarabine · Cyclophosphamide · Tacrolimus · Mycophenolic Acid

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