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Monitoring of Measles-specific Immune Status in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients (MaRROwVacc)

Primary Purpose

Transplantation, Hematopoietic Stem Cell

Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Biological samples (blood and oral fluid)
Sponsored by
Hospices Civils de Lyon
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Transplantation, Hematopoietic Stem Cell

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Study population: Aged ≥ 18 years and ≤ 75 years, Have received an allo-HSCT ≥ 24 months ago, In complete remission of initial hematologic disease and with successful engraftment (recipient chimerism <0.3% on whole blood), Without extensive chronic GVHD, Having given their written consent, Affiliated to a social security plan, Able to attend all scheduled visits and to comply with all study procedures. Healthy volunteers: Aged ≥ 18 years and ≤ 75 years, Having a history of measles (=convalescent) or have been vaccinated in the past with two doses of MMR (=vaccinated), Having given their written consent, Affiliated to a social security plan. Exclusion Criteria: Study population: History of autoimmune disease or acquired immunodeficiency (other than the hematological disease), Patients undergoing pharmacological immunosuppression or biotherapy or extracorporeal photopheresis at the time of inclusion, or whose immunosuppressive treatment (corticosteroids and anti-rejection agents) has been stopped less than 3 months ago, or whose biotherapy (anti-cytokines, anti-JAK, anti-CD20 etc.) has been stopped less than 3 months ago (12 months for anti-CD20 including rituximab), or whose extracorporeal photopheresis has been stopped less than 3 months ago, Patients having received ≥ 1 infusion of IVIG in the 8 months prior to inclusion, Patients whose last HSCT was an autograft, Patients with known chronic active infection with human immunodeficiency virus (HIV) and/or hepatitis B or C virus(es), Patients deprived of liberty by judicial or administrative decision, Patients under legal protection or unable to consent to the study, Patients participating in another interventional research study with an exclusion period still in progress at pre-inclusion, Pregnant, parturient or breast-feeding women. Healthy volunteers: History of autoimmune disease or acquired immunodeficiency, History of pharmacological immunosuppression or biotherapy discontinued less than 3 months ago (12 months for anti-CD20 including rituximab), History of IVIG infusion in the 8 months prior to inclusion, Persons deprived of liberty by judicial or administrative decision.

Sites / Locations

  • Hôpital de la Croix Rousse - service des maladies infectieuses et tropicalesRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Allo-HSCT recipients

Healthy volunteers (HV)

Arm Description

Adult recipients of allogenic hematopoietic stem cell transplantation, eligible for live-attenuated vaccines, i.e. who are more than 24 months after their HSCT, without GVHD and more than 3 months after cessation of any immunosuppressant treatment

Healthy adults with a history of measles (=convalescents) or vaccinated with two doses of MMR in the past (=vaccinated)

Outcomes

Primary Outcome Measures

Combined quantification of measles-specific markers of T-cell-mediated immunity (interferon-gamma [IFNγ]-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ) and B-cell-mediated immunity (antibody-secreting cells [ASC])
To explore the measles-specific T- and B-cell-mediated systemic immune memory pre-existing to MMR (re)vaccination in allo-HSCT recipients eligible for MMR revaccination according to current French recommendations (i.e., regardless of measles serostatus), T- and B-ELISpot techniques on PBMC, qPCR and cytokine measurement on whole blood, will be performed after ex vivo antigen stimulation

Secondary Outcome Measures

Kinetics of anti-measles total IgG and IgA titers (serum)
To characterize the total measles-specific systemic humoral immune response before and after MMR (re)vaccination, anti-measles antibodies will be measured in serum by ELISA
Kinetics of anti-measles neutralizing antibody titers (serum)
To characterize the neutralizing measles-specific systemic humoral immune response before and after MMR (re)vaccination, neutralizing serum antibodies titers will be determined through seroneutralization techniques
Combined quantification of measles-specific markers of T-cell-mediated immunity (IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ) and B-cell-mediated immunity (ASC) after two doses of MMR
To explore the measles-specific T- and B-cell-mediated systemic immune response after completing MMR (re)vaccination, T- and B-ELISpot techniques on PBMC, qPCR and cytokine measurement on whole blood, will be performed after ex vivo antigen stimulation
Kinetics of anti-measles IgA titers (oral fluid)
To characterize the measles-specific mucosal humoral immune response before and after MMR (re)vaccination, anti-measles IgA will be measured in oral fluid by ELISA
Difference in immunity markers (total IgG and IgA, neutralizing antibody titers [serum]; IgA titers [oral fluid]; IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ; ASC) between HV and allo-HSCT recipients
To compare the measles-specific systemic and mucosal immune response between convalescent/vaccinated HV and allo-HSCT recipients, markers of B-cell and T-cell-mediated immunity will be evaluated in convalescent/vaccinated HV at a single timepoint and compared to immunity markers evaluated in allo-HSCT recipients before and after MMR (re)vaccination
Analysis of measles-specific immunity markers (total IgG and IgA, neutralizing antibody titers [serum]; IgA titers [oral fluid]; IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ; ASC) according to patient characteristics
To determine the impact of demographic, hematological, transplant-related characteristics, post-transplant complications and measles serostatus on measles-specific B-cell and T-cell immunity markers, before and after MMR (re)vaccination, bivariate and multivariate analysis will be carried out
Local and systemic adverse events after the first and the second MMR dose
To describe the tolerance of the two MMR schedule in allo-HSCT recipients, solicited adverse events will be recorded up to day+14 and unsolicited adverse events will be recorded up to day+28 after each MMR dose through self-monitoring

Full Information

First Posted
June 28, 2023
Last Updated
August 21, 2023
Sponsor
Hospices Civils de Lyon
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1. Study Identification

Unique Protocol Identification Number
NCT05947864
Brief Title
Monitoring of Measles-specific Immune Status in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients
Acronym
MaRROwVacc
Official Title
Monitoring of Measles-specific Immune Status in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients: a Prospective Cohort Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 17, 2023 (Actual)
Primary Completion Date
July 2025 (Anticipated)
Study Completion Date
July 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospices Civils de Lyon

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Measles, a highly contagious disease, is potentially serious in adult allogenic hematopoietic stem cell transplant (allo-HSCT) recipients. Because of the loss of immunity to vaccine preventable diseases after allo-HSCT, French Health Authorities (Haut Conseil de Santé Publique, HCSP) recommend (re)vaccination of all allo-HSCT recipients against measles-mumps-rubella (MMR) from 24 months post-transplant onwards, in the absence of graft-versus-host disease (GVHD) and at least 3 months after cessation of all immunosuppressive treatments, irrespective of measles serostatus. Nevertheless, some French experts argue that systematic assessment of measles antibody titre is justified after allo-HSCT, prior to revaccination, in order to avoid "unnecessary" revaccination of allo-HSCT recipients who are still seropositive. At the international level, recommendations also vary: the ECIL group and IDSA advocate revaccination of measles seronegative patients only, while some American Hematology experts recommend not to base the decision of revaccination on the serological status, given the inevitable loss of antibodies and specific long-term immune memory in the absence of revaccination. Several obstacles to the application of the recommendations can therefore be identified: (i) the risk of vaccine-transmitted disease due to the live-attenuated nature of MMR, (ii) the lack of robust data on the immunogenicity and tolerability of the MMR vaccine in this particular population, and (iii) conflicting recommendations to guide the decision of revaccination. This study aims at answering the question of whether some allo-HSCT recipients may retain a measles-specific cellular immune memory at distance from their allo-HSCT.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Transplantation, Hematopoietic Stem Cell

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Allo-HSCT recipients
Arm Type
Experimental
Arm Description
Adult recipients of allogenic hematopoietic stem cell transplantation, eligible for live-attenuated vaccines, i.e. who are more than 24 months after their HSCT, without GVHD and more than 3 months after cessation of any immunosuppressant treatment
Arm Title
Healthy volunteers (HV)
Arm Type
Placebo Comparator
Arm Description
Healthy adults with a history of measles (=convalescents) or vaccinated with two doses of MMR in the past (=vaccinated)
Intervention Type
Biological
Intervention Name(s)
Biological samples (blood and oral fluid)
Intervention Description
For the study population (allo-HSCT recipients): 4 visits with biological sampling (blood and oral fluid) at each visit: Visit V1 (inclusion visit = D1): immediately before the first dose of MMR (dose-1), Visit V2 (D1 + 35 (+/-7) days): immediately before the second dose of MMR (dose-2) Visit V3 (D1 + 70 (+/-14) days) Visit V4 (D1 + 365 (+/-90) days) For healthy volunteers: a single visit (V1) with biological sampling (blood and oral fluid)
Primary Outcome Measure Information:
Title
Combined quantification of measles-specific markers of T-cell-mediated immunity (interferon-gamma [IFNγ]-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ) and B-cell-mediated immunity (antibody-secreting cells [ASC])
Description
To explore the measles-specific T- and B-cell-mediated systemic immune memory pre-existing to MMR (re)vaccination in allo-HSCT recipients eligible for MMR revaccination according to current French recommendations (i.e., regardless of measles serostatus), T- and B-ELISpot techniques on PBMC, qPCR and cytokine measurement on whole blood, will be performed after ex vivo antigen stimulation
Time Frame
At Day 1, before routine vaccination with MMR in allo-HSCT recipients
Secondary Outcome Measure Information:
Title
Kinetics of anti-measles total IgG and IgA titers (serum)
Description
To characterize the total measles-specific systemic humoral immune response before and after MMR (re)vaccination, anti-measles antibodies will be measured in serum by ELISA
Time Frame
At Day 1, Day 35, Day 70 and Day 365 in allo-HSCT recipients
Title
Kinetics of anti-measles neutralizing antibody titers (serum)
Description
To characterize the neutralizing measles-specific systemic humoral immune response before and after MMR (re)vaccination, neutralizing serum antibodies titers will be determined through seroneutralization techniques
Time Frame
At Day 1, Day 70 and Day 365 in allo-HSCT recipients
Title
Combined quantification of measles-specific markers of T-cell-mediated immunity (IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ) and B-cell-mediated immunity (ASC) after two doses of MMR
Description
To explore the measles-specific T- and B-cell-mediated systemic immune response after completing MMR (re)vaccination, T- and B-ELISpot techniques on PBMC, qPCR and cytokine measurement on whole blood, will be performed after ex vivo antigen stimulation
Time Frame
At Day 365, after completion of MMR (re)vaccination schedule in allo-HSCT recipients
Title
Kinetics of anti-measles IgA titers (oral fluid)
Description
To characterize the measles-specific mucosal humoral immune response before and after MMR (re)vaccination, anti-measles IgA will be measured in oral fluid by ELISA
Time Frame
At Day 1 and Day 70 in allo-HSCT recipients
Title
Difference in immunity markers (total IgG and IgA, neutralizing antibody titers [serum]; IgA titers [oral fluid]; IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ; ASC) between HV and allo-HSCT recipients
Description
To compare the measles-specific systemic and mucosal immune response between convalescent/vaccinated HV and allo-HSCT recipients, markers of B-cell and T-cell-mediated immunity will be evaluated in convalescent/vaccinated HV at a single timepoint and compared to immunity markers evaluated in allo-HSCT recipients before and after MMR (re)vaccination
Time Frame
At Day 1 and Day 70
Title
Analysis of measles-specific immunity markers (total IgG and IgA, neutralizing antibody titers [serum]; IgA titers [oral fluid]; IFNγ-secreting cells; copies of ifnγ mRNA transcripts; amount of IFNγ; ASC) according to patient characteristics
Description
To determine the impact of demographic, hematological, transplant-related characteristics, post-transplant complications and measles serostatus on measles-specific B-cell and T-cell immunity markers, before and after MMR (re)vaccination, bivariate and multivariate analysis will be carried out
Time Frame
At Day 1, Day 35, Day 70 and Day 365 in allo-HSCT recipients
Title
Local and systemic adverse events after the first and the second MMR dose
Description
To describe the tolerance of the two MMR schedule in allo-HSCT recipients, solicited adverse events will be recorded up to day+14 and unsolicited adverse events will be recorded up to day+28 after each MMR dose through self-monitoring
Time Frame
At Day 35 and Day 70, in allo-HSCT recipients

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Study population: Aged ≥ 18 years and ≤ 75 years, Have received an allo-HSCT ≥ 24 months ago, In complete remission of initial hematologic disease and with successful engraftment (recipient chimerism <0.3% on whole blood), Without extensive chronic GVHD, Having given their written consent, Affiliated to a social security plan, Able to attend all scheduled visits and to comply with all study procedures. Healthy volunteers: Aged ≥ 18 years and ≤ 75 years, Having a history of measles (=convalescent) or have been vaccinated in the past with two doses of MMR (=vaccinated), Having given their written consent, Affiliated to a social security plan. Exclusion Criteria: Study population: History of autoimmune disease or acquired immunodeficiency (other than the hematological disease), Patients undergoing pharmacological immunosuppression or biotherapy or extracorporeal photopheresis at the time of inclusion, or whose immunosuppressive treatment (corticosteroids and anti-rejection agents) has been stopped less than 3 months ago, or whose biotherapy (anti-cytokines, anti-JAK, anti-CD20 etc.) has been stopped less than 3 months ago (12 months for anti-CD20 including rituximab), or whose extracorporeal photopheresis has been stopped less than 3 months ago, Patients having received ≥ 1 infusion of IVIG in the 8 months prior to inclusion, Patients whose last HSCT was an autograft, Patients with known chronic active infection with human immunodeficiency virus (HIV) and/or hepatitis B or C virus(es), Patients deprived of liberty by judicial or administrative decision, Patients under legal protection or unable to consent to the study, Patients participating in another interventional research study with an exclusion period still in progress at pre-inclusion, Pregnant, parturient or breast-feeding women. Healthy volunteers: History of autoimmune disease or acquired immunodeficiency, History of pharmacological immunosuppression or biotherapy discontinued less than 3 months ago (12 months for anti-CD20 including rituximab), History of IVIG infusion in the 8 months prior to inclusion, Persons deprived of liberty by judicial or administrative decision.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Anne CONRAD
Phone
+33 4 72 07 11 07
Email
anne.conrad@chu-lyon.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Florence ADER
Phone
+33 4 72 07 11 07
Email
florence.ader@chu-lyon.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anne CONRAD
Organizational Affiliation
Hospices Civils de Lyon
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hôpital de la Croix Rousse - service des maladies infectieuses et tropicales
City
Lyon
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Anne CONRAD, Dr
Phone
+33 4 72 07 11 07
Email
anne.conrad@chu-lyon.fr

12. IPD Sharing Statement

Learn more about this trial

Monitoring of Measles-specific Immune Status in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients

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