Clinical Trial: Evaluation of Umbilical Cord-Derived Wharton's Jelly Stem Cells for the Treatment of Acute Graft Versus Host Disease

Study Status: Not yet recruiting
Recruit Status: Not yet recruiting
Study Type: Interventional

Official Title: A Phase I Study To Evaluate the Safety of Umbilical Cord - Derived, Ex-Vivo Cultured and Expanded Wharton's Jelly Mesenchymal Stem Cells for the Treatment of De Novo High Risk Acute or Steroid Refract

Brief Summary: This study evaluates the safety and effectiveness of two different doses of umbilical cord derived, ex-vivo cultured and expanded Wharton's jelly mesenchymal stem cells (MSCTC-0010) in the treatment of acute Graft versus Host Disease (aGVHD). The first 5 participants enrolled in the study will receive a lower dose of MSCTC-0010. If none of the first 5 participants have treatment-related serious adverse events (TRSAEs) for 42 days, then the next 5 participants will receive a slightly higher dose of MSCTC-0010.

Detailed Summary:

The curative potential of Allogeneic hematopoietic stem cell transplantation (allo-HCT), when applied as a therapy in the management of hematologic malignancies, specifically, derives from an immunologically driven, graft-versus-tumor effect mediated principally by donor T-cells, and is associated with a lesser risk for relapse when compared to high dose chemo-radio therapy and autologous HCT. Donor derived T-cells are also responsible for mediating the occurrence of GVHD, a common transplant-related complication, affecting a significant percentage of patients undergoing allo-HCT leading to the destruction of host tissues. The standard initial treatment for both acute and chronic GVHD is steroid-based therapy. Unfortunately, many of these patients will become resistant to steroid therapy and will subsequently be treated with second-line immunosuppressive agents. De novo high-risk aGVHD and steroid-refractory aGVHD portends a very poor prognosis; second-line agents frequently prove ineffective, and as a result, survival is < 10% at 5 years. Therefore, alternative therapies are needed to treat aGVHD following allo-HCT, particularly in the setting of de novo high-risk acute or steroid-resistant disease.

Due to the large numbers of Mesenchymal stem cells (MSC) that can be obtained from the umbilical cord, the availability of this tissue, their higher growth rates and expansion capacity, and their immune properties, including: (1) low immunogenicity and lack of stimulation of allogeneic T-lymphocyte proliferation, (2) suppression of the proliferation of activated T-lymphocytes, (3) increased production of regulatory T-cells, and (4) a shift in the immune response towards tolerance, Wharton's jelly mesenchymal stem cells (WJMSC) may be a preferred option for MSC.

The rationale for cell dosing in this protocol is based on publ
Sponsor: Joseph McGuirk

Current Primary Outcome: proportion of participants who have a TRSAE after infusion of MSCTC 0010 [ Time Frame: 45 days ]

TRSAE is defined as a serious adverse event (SAE) that has a "probable" or "definite" relation to the MSCTC-0010 infusion. This study will use the descriptions and grading scales from Common Terminology Criteria for Adverse Events version 4.03 (CTCAE v4.03) for hematologic and non-hematologic toxicities.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Proportion of participants who achieve a complete response (CR) of aGVHD by study day 42 [ Time Frame: 42 days ]
    Complete response is defined as a complete resolution of GVHD.
  • Proportion of participants with improvement of GVHD in 1 or more organs involved with GVHD by day 42 [ Time Frame: 42 days ]
    GVHD will be graded by organ (skin, liver, and gastrointestinal [GI])
  • Occurrence of addition of escalated immunosuppressive therapy by day 90 [ Time Frame: 90 days ]
    Starting at the day 14 evaluation, if the acute GVHD continues to be unresponsive or worsens, additional agents or changes in immunosuppresive therapy will be at discretion of the Investigator per institutional standards.
  • Occurrence of Formation of ectopic tissue foci at day 90 [ Time Frame: 90 days ]
    Defined as ectopic tissue formation of greater than 1.0 centimeter (cm) evaluated by comparison CT scan from screening to day 90.


Original Secondary Outcome: Same as current

Information By: University of Kansas Medical Center

Dates:
Date Received: May 16, 2017
Date Started: August 2017
Date Completion: August 2019
Last Updated: May 16, 2017
Last Verified: May 2017