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Allogeneic Hematopoietic Stem Cell Transplantation With JSP191-Based Conditioning in Participants With GATA2 Deficiency

Primary Purpose

GATA2, Immunodeficiency

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Mycophenolate Mofetil
Tacrolimus
Post-Transplant Cyclophosphamide
Total Body Irradiation
Hematopoietic Cell Transplant
JSP191
Cyclophosphamide
Fludarabine
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for GATA2 focused on measuring Immunodeficiency, Hematopoietic Cell Transplant, Haploidentical

Eligibility Criteria

6 Years - 70 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: Age >= 6 and <= 70 years old Germline mutation in the GATA2 gene, predicted to be deleterious or previously reported in GATA2 deficiency as determined by targeted GATA2 sequencing performed at the NIH Clinical manifestation(s) consistent with a diagnosis of GATA2 deficiency, including any of the following (Note: only one clinical manifestation is required): History of severe, disfiguring, and/or recurrent infections Low monocyte (< 190 cells/microL), B cell (< 61 cells/microL) and/or NK cell (< 126 cells/microL) counts Myelodysplastic syndrome by World Health Organization (WHO) criteria Early stage GATA2 deficiency defined as a hypocellular for age bone marrow with less than 5% blasts and normal cytogenetics or favorable cytogenetics (defined as good or very good cytogenetics risk groups plus trisomy 8) Availability of an 8/8 HLA-matched related or unrelated donor, a 7/8 HLA-matched unrelated donor or a haploidentical related donor Lansky (for participants < 16 years of age) or Karnofsky (for participants >=16 years of age) performance status of >= 40% Left ventricular ejection fraction > 40%, preferably by 2-D echocardiogram (echo) obtained within 90 days prior to treatment initiation Participants must have adequate organ function as defined below: Total bilirubin <=2.5 x upper limit of normal (ULN) Alanine transaminase (ALT) and aspartate aminotransferase (AST) <= 5 x ULN Creatinine: Adult participants: <=2.0 mg/dl and creatinine clearance >= 30 ml/min. Pediatric participants (<18 years old): creatinine <1.5 mg/dL and a creatinine clearance using the Schwartz Formula > 30 mL/min/1.73m^2 Pulmonary function tests (PFT)s: FEV1 and adjusted DLCO >30%. Children who are unable to cooperate for PFTs due to age are still eligible if no evidence of dyspnea at rest and no need for supplemental oxygen Women of childbearing potential (WOCBP) and men must agree to use highly effective contraception (hormonal, intrauterine device (IUD), abstinence, tubal ligation, partner has had the previous vasectomy) at the study entry, for the duration of study treatment, and for at least one-year post-allogeneic HCT or 4 months after completion of chemotherapy preparative administration if HCT is not performed Breastfeeding participants must be willing to discontinue breastfeeding Willingness to remain in the NIH hospital or, if discharged, stay close to the NIH (60 minutes drive), for a minimum of 100 days after transplant or longer if there are complications. The participants must commit to having an adult caregiver with them during the first 100 days after transplant in case of discharging from the hospital before 100 days verified by social worker Participants with hepatitis B virus (HBV) or hepatitis C virus (HCV) antibody-positive testing are allowed if HBV DNA <100 IU/m or HCV RNA level is undetectable. Additionally, transplantation must be approved by a hepatology consult for these participants Participants or parents/guardians must be able to understand and willing to sign a written informed consent document EXCLUSION CRITERIA: Participants with a Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) score >8 Participants who have received any investigational agents within 4 weeks before treatment initiation with the exception of virus-specific T cells for the treatment of viral infection/reactivation prior to allogeneic HCT Participants with a history of hematologic malignancy (e.g., AML, CMML). Note: participants with MDS are included History of allergic reactions attributed to compounds of similar chemical or biologic composition to agents (fludarabine, cyclophosphamide, tacrolimus, mycophenolate mofetil, granulocyte-colony stimulating factor (G-CSF)) used in the study Presence of active malignancy. Note: participants with malignancy driven by viruses (e.g., human papillomavirus (HPV) or HPV or Epstein-Barr virus (EBV)) are allowed as the immune reconstitution after transplant may control the malignancy and participants with MDS are allowed Human immunodeficiency virus (HIV)-infected participants Pregnancy (confirmed with Beta-HCG serum or urine pregnancy test performed in WOCBP at screening) Uncontrolled intercurrent illness or social situations (as determined by social work consult) that would limit compliance with study requirements

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm A

Arm B

Arm Description

JSP191, Fludarabine, Total Body Irradiation

JSP191, Fludarabine, Cyclophosphamide, Total Body Irradiation

Outcomes

Primary Outcome Measures

To determine whether allogeneic hematopoietic cell transplantation with JSP191-based conditioning results in sustained donor engraftment by 100 days post-transplant in participants with GATA2 deficiency
Fraction of evaluable participants reported along with one-sided 90% confidence intervals and a two-sided 95% confidence interval

Secondary Outcome Measures

To determine whether allogeneic hematopoietic cell transplantation with JSP191-based conditioning results in restoration of normal hematopoiesis by one-year post-transplant in participants with GATA2 deficiency
Fraction of evaluated participants reported along with a 95% two-sided confidence interval.
The safety of allogeneic HCT in participants with GATA2 deficiency conditioned with JSP191
By arm, the participants with transplant-related toxicity will be reported by type and grade of event.
3-year overall survival
Determined using the Kaplan-Meier method, along with the median value and the 95% confidence interval
3-year event-free survival
Determined using the Kaplan-Meier method, along with the median value and the 95% confidence interval
3-year incidence of secondary graft failure
Fraction of participants will be reported separately by cohort along with 95% two-sided confidence interval
3-year incidence of grade III-IV acute and moderate to severe chronic graft versus host disease
Fractions of participants will be reported separately by cohort using simple estimates along with 95% two-sided confidence intervals. In addition, cumulative incidence curves along with 95% two-sided confidence interval.

Full Information

First Posted
June 15, 2023
Last Updated
October 24, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT05907746
Brief Title
Allogeneic Hematopoietic Stem Cell Transplantation With JSP191-Based Conditioning in Participants With GATA2 Deficiency
Official Title
A Phase II Study of Allogeneic Hematopoietic Stem Cell Transplantation With JSP191-Based Conditioning in Participants With GATA2 Deficiency
Study Type
Interventional

2. Study Status

Record Verification Date
September 6, 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 30, 2023 (Anticipated)
Primary Completion Date
July 31, 2031 (Anticipated)
Study Completion Date
July 31, 2031 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: People with GATA2 deficiency have a mutation on the GATA2 gene. This gene affects immune function. People with this disease are prone to serious infections; in time, they may develop blood cancers. A hematopoietic stem cell (HSC) transplant can cure GATA2 deficiency, but using stem cells donated by other people can cause serious side effects. Objective: To test a new drug (JSP191) to see if it can make HSC transplants safer. Eligibility: People aged 6 to 70 years who have GATA2 deficiency. Design: Participants will be screened. They will have a physical exam, with blood and urine tests. They will have tests of their heart and lung function. They may have a bone marrow biopsy: Their hip will be numbed; a large needle will be inserted to draw out tissue from inside the pelvis. Participants will have a central venous catheter placed in a vein of the neck or chest. This will be used to draw blood and administer drugs. JSP191 will be given through the catheter about 11 days before the transplant. This is part of conditioning: preparing the body to receive the new stem cells. Conditioning also includes other medications and total body irradiation. Donor stem cells will be administered through the catheter. Participants will receive other approved drugs to help prevent side effects. Participants will stay in the hospital from the beginning of the conditioning until several weeks after the transplant. They will remain in the local area for 100 days after discharge; they will come to the clinic at least once a week during this time. Follow-up visits will continue for 3 years.
Detailed Description
Background: GATA2 deficiency, an immunodeficiency and bone marrow failure disorder due to inherited or sporadic mutations in or loss of one allele of the GATA2 gene, is characterized by: 1) nontuberculous mycobacteria (NTM) and other opportunistic infections, 2) deficiency of monocytes, B lymphocytes, and Natural Killer (NK) cells in the peripheral blood, and 3) progression to myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), and acute myelogenous leukemia (AML). Allogeneic hematopoietic cell transplantation (HCT) appears to be curative, and interim results from protocol #13-C-0132, NCT01861106, demonstrated a 2-year event-free survival rate of 83% for 59 participants with GATA2 deficiency who underwent HCT with a busulfan-based conditioning regimen. However, traditional HCT approaches using alkylating agents such as busulfan continue to place recipients at risk for potentially life-threatening, transplant-related toxicities as well as late effects such as infertility and secondary malignancy. JSP191 is a humanized, glycosylated IgG1 monoclonal antibody that targets CD117 (human c-Kit) present on endogenous hematopoietic stem cells (HSC). JSP191 has been shown in pre-clinical and early clinical studies to safely deplete human and non-human primate HSC with minimal toxicity. Primary Objective: -To determine whether allogeneic hematopoietic cell transplantation with JSP191-based conditioning results in sustained donor engraftment by 100 days post-transplant in participants with GATA2 deficiency Eligibility: Recipients aged 6-70 years old with pathogenic germline mutations in GATA2 and clinical manifestations consistent with a diagnosis of GATA2 deficiency Have an 8/8 Human leukocyte antigen (HLA)-matched related or unrelated donor or a 7/8 HLA-matched unrelated donor or haploidentical related donor Have early stage GATA2 deficiency defined as a hypocellular for age bone marrow with less than 5% blasts and normal or favorable cytogenetics (defined as good or very good cytogenetics risk groups plus trisomy 8) Design: All participants with GATA2 deficiency will receive a pre-transplant conditioning regimen consisting of JSP191 administered as a single intravenous (IV) infusion on day -11 (range day-13 to -10) with pharmacokinetics, followed by fludarabine or fludarabine/cyclophosphamide IV infusions (3 or 5 days depending on the donor) and 200 cGy total body irradiation (TBI) on day -1. HCT will be infused on day 0. Participants with an 8/8 HLA-matched related or unrelated donor assigned to Arm A will receive a fludarabine for three days on days -4, -3, and -2. Participants with a 7/8 HLA-matched unrelated donor or a haploidentical related donor assigned to Arm B will receive a fludarabine for five days on days -6, -5, -4, -3, and -2, cyclophosphamide for 2 days on days -6 and -5 Post-transplant immunosuppression for Graft Versus Host Disease (GVHD) prophylaxis for recipients of Arms A and B will consist of cyclophosphamide for 2 days on days +3 and +4, along with mycophenolate mofetil from day +5 to approximately day +35 and tacrolimus from day +5 to approximately day +180. If there is no evidence of GVHD, tacrolimus will be stopped or tapered at approximately day +180

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
GATA2, Immunodeficiency
Keywords
Immunodeficiency, Hematopoietic Cell Transplant, Haploidentical

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Experimental
Arm Description
JSP191, Fludarabine, Total Body Irradiation
Arm Title
Arm B
Arm Type
Experimental
Arm Description
JSP191, Fludarabine, Cyclophosphamide, Total Body Irradiation
Intervention Type
Drug
Intervention Name(s)
Mycophenolate Mofetil
Intervention Description
15 mg/kg IV three times per day starting on day +5 until approximately day +30 (+/- 2 days)
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Intervention Description
0.02 mg/kg IV daily starting on day +5
Intervention Type
Drug
Intervention Name(s)
Post-Transplant Cyclophosphamide
Intervention Description
50 mg/kg IV daily on days +3 and +4
Intervention Type
Radiation
Intervention Name(s)
Total Body Irradiation
Intervention Description
200cGy on day -1
Intervention Type
Procedure
Intervention Name(s)
Hematopoietic Cell Transplant
Intervention Description
stem cell transplant on day 0
Intervention Type
Drug
Intervention Name(s)
JSP191
Intervention Description
Single 0.6 mg/kg IV infusion administered between days -13 and day -10
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
14.5 mg/kg IV daily on days -6 and -5; for 7/8 Unrelated or Haploidentical Donor, prior to transplant.
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Intervention Description
30 mg/m2 IV over 30 minutes daily. For 8/8 Matched Related or Unrelated Donor, fludarabine dose will be on days -4, -3, and -2. For 7/8 Unrelated or Haploidentical Donor, fludarabine dose will be on days -6, -5, -4, -3, and -2.
Primary Outcome Measure Information:
Title
To determine whether allogeneic hematopoietic cell transplantation with JSP191-based conditioning results in sustained donor engraftment by 100 days post-transplant in participants with GATA2 deficiency
Description
Fraction of evaluable participants reported along with one-sided 90% confidence intervals and a two-sided 95% confidence interval
Time Frame
100 days post-transplant
Secondary Outcome Measure Information:
Title
To determine whether allogeneic hematopoietic cell transplantation with JSP191-based conditioning results in restoration of normal hematopoiesis by one-year post-transplant in participants with GATA2 deficiency
Description
Fraction of evaluated participants reported along with a 95% two-sided confidence interval.
Time Frame
1 year post-transplant
Title
The safety of allogeneic HCT in participants with GATA2 deficiency conditioned with JSP191
Description
By arm, the participants with transplant-related toxicity will be reported by type and grade of event.
Time Frame
3 years post-transplant
Title
3-year overall survival
Description
Determined using the Kaplan-Meier method, along with the median value and the 95% confidence interval
Time Frame
3 years post-transplant
Title
3-year event-free survival
Description
Determined using the Kaplan-Meier method, along with the median value and the 95% confidence interval
Time Frame
3 years post-transplant
Title
3-year incidence of secondary graft failure
Description
Fraction of participants will be reported separately by cohort along with 95% two-sided confidence interval
Time Frame
3 years post-transplant
Title
3-year incidence of grade III-IV acute and moderate to severe chronic graft versus host disease
Description
Fractions of participants will be reported separately by cohort using simple estimates along with 95% two-sided confidence intervals. In addition, cumulative incidence curves along with 95% two-sided confidence interval.
Time Frame
+1, +2, and +3 years post-transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Age >= 6 and <= 70 years old Germline mutation in the GATA2 gene, predicted to be deleterious or previously reported in GATA2 deficiency as determined by targeted GATA2 sequencing performed at the NIH Clinical manifestation(s) consistent with a diagnosis of GATA2 deficiency, including any of the following (Note: only one clinical manifestation is required): History of severe, disfiguring, and/or recurrent infections Low monocyte (< 190 cells/microL), B cell (< 61 cells/microL) and/or NK cell (< 126 cells/microL) counts Myelodysplastic syndrome by World Health Organization (WHO) criteria Early stage GATA2 deficiency defined as a hypocellular for age bone marrow with less than 5% blasts and normal cytogenetics or favorable cytogenetics (defined as good or very good cytogenetics risk groups plus trisomy 8) Availability of an 8/8 HLA-matched related or unrelated donor, a 7/8 HLA-matched unrelated donor or a haploidentical related donor Lansky (for participants < 16 years of age) or Karnofsky (for participants >=16 years of age) performance status of >= 40% Left ventricular ejection fraction > 40%, preferably by 2-D echocardiogram (echo) obtained within 90 days prior to treatment initiation Participants must have adequate organ function as defined below: Total bilirubin <=2.5 x upper limit of normal (ULN) Alanine transaminase (ALT) and aspartate aminotransferase (AST) <= 5 x ULN Creatinine: Adult participants: <=2.0 mg/dl and creatinine clearance >= 30 ml/min. Pediatric participants (<18 years old): creatinine <1.5 mg/dL and a creatinine clearance using the Schwartz Formula > 30 mL/min/1.73m^2 Pulmonary function tests (PFT)s: FEV1 and adjusted DLCO >30%. Children who are unable to cooperate for PFTs due to age are still eligible if no evidence of dyspnea at rest and no need for supplemental oxygen Women of childbearing potential (WOCBP) and men must agree to use highly effective contraception (hormonal, intrauterine device (IUD), abstinence, tubal ligation, partner has had the previous vasectomy) at the study entry, for the duration of study treatment, and for at least one-year post-allogeneic HCT or 4 months after completion of chemotherapy preparative administration if HCT is not performed Breastfeeding participants must be willing to discontinue breastfeeding Willingness to remain in the NIH hospital or, if discharged, stay close to the NIH (60 minutes drive), for a minimum of 100 days after transplant or longer if there are complications. The participants must commit to having an adult caregiver with them during the first 100 days after transplant in case of discharging from the hospital before 100 days verified by social worker Participants with hepatitis B virus (HBV) or hepatitis C virus (HCV) antibody-positive testing are allowed if HBV DNA <100 IU/m or HCV RNA level is undetectable. Additionally, transplantation must be approved by a hepatology consult for these participants Participants or parents/guardians must be able to understand and willing to sign a written informed consent document EXCLUSION CRITERIA: Participants with a Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) score >8 Participants who have received any investigational agents within 4 weeks before treatment initiation with the exception of virus-specific T cells for the treatment of viral infection/reactivation prior to allogeneic HCT Participants with a history of hematologic malignancy (e.g., AML, CMML). Note: participants with MDS are included History of allergic reactions attributed to compounds of similar chemical or biologic composition to agents (fludarabine, cyclophosphamide, tacrolimus, mycophenolate mofetil, granulocyte-colony stimulating factor (G-CSF)) used in the study Presence of active malignancy. Note: participants with malignancy driven by viruses (e.g., human papillomavirus (HPV) or HPV or Epstein-Barr virus (EBV)) are allowed as the immune reconstitution after transplant may control the malignancy and participants with MDS are allowed Human immunodeficiency virus (HIV)-infected participants Pregnancy (confirmed with Beta-HCG serum or urine pregnancy test performed in WOCBP at screening) Uncontrolled intercurrent illness or social situations (as determined by social work consult) that would limit compliance with study requirements
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa Duncan, R.N.
Phone
(240) 858-7019
Email
duncanl@mail.nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Danielle E Pregent-Arnold, M.D.
Phone
(240) 281-3922
Email
danielle.arnold@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Danielle E Pregent-Arnold, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
National Cancer Institute Referral Office
Phone
888-624-1937

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All IPD recorded in the medical record will be shared with intramural investigators upon request.
IPD Sharing Time Frame
Clinical data available during the study and indefinitely.
IPD Sharing Access Criteria
Clinical data will be made available via subscription to BTRIS and with the permission of the study PI.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_001531-C.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Allogeneic Hematopoietic Stem Cell Transplantation With JSP191-Based Conditioning in Participants With GATA2 Deficiency

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