Study of BEGEDINA® vs "Conventional Treatment" for Treating Steroid-Resistant Acute GvHD

This is an interventional treatment trial for Graft vs Host Disease focused on measuring Graft vs Host Disease, Immune System Diseases, Dipeptidyl Peptidase 4, CD4-Positive T-Lymphocytes, Hematopoietic Stem Cell Transplantation Read More

Inclusion Criteria:

1. Age ≥18 and ≤65 years of age.
2. Recipient of an allogeneic hematopoietic stem cell transplantation (HSCT). Note: Subjects with GvHD following donor lymphocyte infusion post-HSCT are also eligible
3. Steroid-resistant acute GvHD, Grade II-IV, defined as: progressive disease (deterioration of at least 1 stage in 1 organ) after 3 days of primary treatment with methylprednisolone 2 mg/kg, or equivalent. or lack of at least a partial response (PR) after 7 days of primary treatment with methylprednisolone 2 mg/kg or equivalent. or lack of a complete response (CR) after 14 days of primary treatment with methylprednisolone 2 mg/kg or equivalent. Note: Subjects who may have received an increase in their steroid dose treatment prior to randomization will be eligible for enrollment. An increase in steroid dose will not be considered as second-line therapy.
4. Evidence of previous myeloid engraftment (absolute neutrophil count ≥0.5 x 10^9/L).
5. Karnofsky Performance Status Scale ≥50%.
6. Adequate renal function as defined by serum creatinine ≤2 × upper limit of normal or calculated creatinine clearance (CrCl) of ≥30 mL/min using the Cockroft-Gault equation: Calculated CrCl= ([140-age in years] x [ideal body mass {IBM} in kg])/72 x (serum creatinine value in mg/dL), where IBM = IBM (kg) = ([height in cm- 154] × 0.9) + (50 if male, 45.5 if female).
7. Subject must be willing and able to comply with study requirements, remain at the clinic, and return to the clinic for the follow-up evaluation, as specified in this protocol during the study period.
8. Able and willing to provide signed informed consent.

Exclusion Criteria:

Subjects will not be entered in the study for any of the following reasons:

1. Prior second-line systemic treatment for GvHD.
2. Received agents other than steroids for primary treatment of acute GvHD.
3. Stage 1-2 skin acute GvHD alone (with no other organ involvement).
4. Acute steroid resistant GvHD beyond 28 days from first-line therapy (primary treatment).
5. Evidence of severe hepatic veno-occlusive disease or sinusoidal obstruction.
6. Evidence of encephalopathy.
7. Life expectancy <3 weeks.
8. Presence of chronic GvHD
9. Second or subsequent allogeneic transplant.
10. Previous solid organ transplant (with the exception of a corneal transplant >3 months prior to screening).
11. Relapsed disease after last transplant.
12. Human immunodeficiency virus positive.
13. Evidence of lung disease that is likely to require more than 2 liter per minute of O2 via face mask or an estimated FiO2 of 28% via other delivery methods in order to sustain an O2 saturation of 92% within the next 3 days.
14. Any underlying or current medical or psychiatric condition that, in the opinion of the investigator, would interfere with the evaluation of the subject including uncontrolled infection, heart failure, pulmonary hypertension. Any other serious medical condition, as judged by the investigator, which places the subject at an unacceptable risk if he or she were to participate in the study or confounds the ability to interpret data from the study.
15. Administration of any other investigational agents (not approved by the United States Food and Drug Agency [FDA] or European Medicines Agency [EMA] for any indication) within 30 days of randomization. Participated in any interventional clinical trial for an acute GvHD therapeutic agent or for an immunomodulatory drug, within the past 30 days or within 5 half-lives of the study treatment, whichever is the greater. Participated or is currently participating in any bone marrow derived autologous and allogeneic stem cell or gene therapy study.
16. Known hypersensitivity to murine proteins.
17. Women who are pregnant, breastfeeding or at risk to become pregnant during study participation; female subjects of childbearing potential who have not been started on an anti-ovulatory regimen prior to initiation of chemo-inductive regimen must test negative for pregnancy (serum) at the time of enrollment.
18. Male and female subjects who do not agree to take adequate measures to avoid pregnancy prior to study entry and for the duration of participation in the study (or for at least 3 months following the last dose of study drug, whichever is longer) (acceptable methods of birth control are described in protocol Section 6.2.1.6).