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Hematopoietic Stem Cell Transplantation in Autoimmune-Related Retinopathy(ARRON)

Primary Purpose

Retinal Disease

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Hematopoietic stem cell transplantation.
Sponsored by
Richard Burt, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinal Disease

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age between 18-60. Diagnosis of ARRON syndrome. Diagnostic criteria described below. Unexplained visual loss over weeks to months. The visual loss includes both visual acuity and field loss define as follows: Visual acuity: 20/40 or less OR Visual field: perimetric mean deviation -5b Positive antibody to retina or optic nerve. OR A response to immunosuppressive drugs or immune modulators (response is defined by improvement of vision or decrease the rate of decline of visual loss). Absence of malignancy {negative physical examination, gastrointestinal endoscopies, mammography and gynecologic examination (for female), and serum PSA measurement (for male) within a year}. Negative MRI of brain. The patient has failed at least 3 months of corticosteroids (prednisone 0.5mg/kg to start), IVIG and at least one other immunosuppressive drug such as methotrexate, Imuran, cyclosporine, etc. Failure is defined by decline of visual acuity (by standard Snellen acuity clinical testing) or visual field (by Humphrey Automated Machine with the 30-2 program or using Kinetic Visual Fields on the Goldman Perimeter) Exclusion Criteria: Absence of light perception lasting more than 6 months Any illness that in the opinion of the investigators would jeopardize the ability of the patient to tolerate aggressive chemotherapy. Prior history of malignancy except localized basal cell, squamous skin cancer or carcinoma in situ of the cervix. Other malignancies for which the patient is judged to be cured, such as head and neck cancer, or breast cancer will be considered on an individual basis. Positive pregnancy test. Inability or unwillingness to pursue effective means of birth control. Effective birth control is defined as 1) refraining from all acts of vaginal intercourse (ABSTINENCE); 2) consistent use of birth control pills; 3) injectable birth control methods (Depo-provera, Norplant); 4) tubal sterilization or male partner who has undergone vasectomy; 5) placement of an IUD (intrauterine device); or 6) use, with every act of intercourse, of diaphragm with contraceptive jelly and/or condoms with contraceptive foam. Failure to willingly accept or comprehend irreversible sterility as a side effect of therapy. FEV1/FVC < 60% of predicted after bronchodilator therapy (if necessary). DLCO < 50% of predicted. Active ischemic heart disease and/or those who have had a myocardial infarction within 6 months. Resting LVEF < 40 %. Bilirubin > 2.0 mg/dl Serum creatinine > 2.0 mg/dl. Known hypersensitivity to mouse, rabbit, or E. Coli derived proteins, or to iron compounds/medications. Presence of metallic objects implanted in the body that would preclude the ability of the patient to safely have MRI exams. Diagnosis of primary progressive MS. Platelet count < 100,00/ul Psychiatric illness, mental deficiency or cognitive dysfunction making compliance with treatment or informed consent impossible. Active infection except asymptomatic bacteruria.

Sites / Locations

  • Northwestern University, Feinberg School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

stem cell transplantation

Arm Description

Outcomes

Primary Outcome Measures

Standard Snellen acuity clinical testing and improvement visual fields is done by using Humphrey Automated Machine with 30-2 program or using Kinetic Visual Fields on the Goldman Perimeter)

Secondary Outcome Measures

Full Information

First Posted
January 15, 2006
Last Updated
April 4, 2013
Sponsor
Richard Burt, MD
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1. Study Identification

Unique Protocol Identification Number
NCT00278486
Brief Title
Hematopoietic Stem Cell Transplantation in Autoimmune-Related Retinopathy(ARRON)
Official Title
Immune Ablation and Hematopoietic Stem Cell Transplantation in Patients With Autoimmune-Related Retinopathy and Optic Neuropathy (ARRON) Syndrome (Not Associated With Cancer)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Terminated
Why Stopped
First subject over five years after the transplant. The second subject is not in compliance with follow ups. We do not plan to enroll more subjects.
Study Start Date
August 2004 (undefined)
Primary Completion Date
April 2012 (Actual)
Study Completion Date
April 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Richard Burt, MD

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
ARRON is a disease believed to be due to immune cells, cells which normally protect the body, but are now attacking the tissue in the retina and/or optic nerve. In addition, the disease may affect the nerves in the ear or other parts of the body . The affected nerves fail to respond, or respond only weakly, to stimuli causing numbing, tingling, pain, and progressive muscle weakness. If the nerves to the ear are affected, reduced hearing or deafness may result. The likelihood of progression of your disease is high. This study is designed to examine whether treating patients with high dose cyclophosphamide and rabbit ATG (drugs which reduce the function of the immune system) followed by return of previously collected blood stem cells will stop the progression of ARRON syndrome. Stem cells are undeveloped cells that have the capacity to grow into mature blood cells, which normally circulate in the blood stream. The purpose of the cyclophosphamide and rabbit ATG is to destroy the cells in the immune system which are thought to be causing this disease. The purpose of the stem cell infusion is to restore the body's blood production, which will be severely impaired by the high dose chemotherapy and to produce a normal immune system that will no longer attack the body.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinal Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
stem cell transplantation
Arm Type
Experimental
Intervention Type
Biological
Intervention Name(s)
Hematopoietic stem cell transplantation.
Intervention Description
Autologous hematopoietic stem cell transplantation will be performed.
Primary Outcome Measure Information:
Title
Standard Snellen acuity clinical testing and improvement visual fields is done by using Humphrey Automated Machine with 30-2 program or using Kinetic Visual Fields on the Goldman Perimeter)
Time Frame
5 years after transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age between 18-60. Diagnosis of ARRON syndrome. Diagnostic criteria described below. Unexplained visual loss over weeks to months. The visual loss includes both visual acuity and field loss define as follows: Visual acuity: 20/40 or less OR Visual field: perimetric mean deviation -5b Positive antibody to retina or optic nerve. OR A response to immunosuppressive drugs or immune modulators (response is defined by improvement of vision or decrease the rate of decline of visual loss). Absence of malignancy {negative physical examination, gastrointestinal endoscopies, mammography and gynecologic examination (for female), and serum PSA measurement (for male) within a year}. Negative MRI of brain. The patient has failed at least 3 months of corticosteroids (prednisone 0.5mg/kg to start), IVIG and at least one other immunosuppressive drug such as methotrexate, Imuran, cyclosporine, etc. Failure is defined by decline of visual acuity (by standard Snellen acuity clinical testing) or visual field (by Humphrey Automated Machine with the 30-2 program or using Kinetic Visual Fields on the Goldman Perimeter) Exclusion Criteria: Absence of light perception lasting more than 6 months Any illness that in the opinion of the investigators would jeopardize the ability of the patient to tolerate aggressive chemotherapy. Prior history of malignancy except localized basal cell, squamous skin cancer or carcinoma in situ of the cervix. Other malignancies for which the patient is judged to be cured, such as head and neck cancer, or breast cancer will be considered on an individual basis. Positive pregnancy test. Inability or unwillingness to pursue effective means of birth control. Effective birth control is defined as 1) refraining from all acts of vaginal intercourse (ABSTINENCE); 2) consistent use of birth control pills; 3) injectable birth control methods (Depo-provera, Norplant); 4) tubal sterilization or male partner who has undergone vasectomy; 5) placement of an IUD (intrauterine device); or 6) use, with every act of intercourse, of diaphragm with contraceptive jelly and/or condoms with contraceptive foam. Failure to willingly accept or comprehend irreversible sterility as a side effect of therapy. FEV1/FVC < 60% of predicted after bronchodilator therapy (if necessary). DLCO < 50% of predicted. Active ischemic heart disease and/or those who have had a myocardial infarction within 6 months. Resting LVEF < 40 %. Bilirubin > 2.0 mg/dl Serum creatinine > 2.0 mg/dl. Known hypersensitivity to mouse, rabbit, or E. Coli derived proteins, or to iron compounds/medications. Presence of metallic objects implanted in the body that would preclude the ability of the patient to safely have MRI exams. Diagnosis of primary progressive MS. Platelet count < 100,00/ul Psychiatric illness, mental deficiency or cognitive dysfunction making compliance with treatment or informed consent impossible. Active infection except asymptomatic bacteruria.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard Burt, MD
Organizational Affiliation
Northwestern University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Northwestern University, Feinberg School of Medicine
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States

12. IPD Sharing Statement

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Hematopoietic Stem Cell Transplantation in Autoimmune-Related Retinopathy(ARRON)

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