Safety Study of Cord Blood Units for Stem Cell Transplants

A Multicenter Safety Study of Unlicensed, Investigational Cryopreserved Cord Blood Units (CBUs) Manufactured by the National Cord Blood Program (NCBP) and Provided for Unrelated Hematopoietic Stem Cell Transplantation of Pediatric and Adult Patients

National Cancer Institute (NCI), National Institute of Allergy and Infectious Diseases (NIAID), National Cord Blood Program, New York Blood Center

Background: - Cord blood is blood that is taken from the umbilical cord and placenta of healthy newborns after childbirth. The cord blood collected from a baby is called a cord blood unit. Cord blood units are stored frozen in public cord blood banks. About 10,000 cord blood transplants have been performed in children and adults for blood cancers and other diseases in the world. These transplants have helped save lives and improve treatments. However, not all available units of cord blood have been collected, stored, and licensed according to specific government requirements. These unlicensed units can still be used in transplant, but they can only be given as part of specific research studies. This study will evaluate the safety of giving these unlicensed units by recording any problems that may occur during and after giving the cord blood. Objectives: - To test the safety and effectiveness of unlicensed cord blood units in people who need stem cell transplants. Eligibility: - Individuals who are scheduled to have a stem cell transplant. Design: Participants will be screened with a medical history and physical exam. Participants will receive the cord blood unit as part of their stem cell transplant procedure. The transplant will be performed according to the current standard of care for the procedure. After the transplant, participants will be monitored for up to 1 year. Any problems or side effects from the transplant will be treated as necessary. All outcomes will be reported to the National Cord Blood Program and to the Center for International Blood and Marrow Transplant.

Background The requirement for licensure of human cell and blood products became part of the FDA final rules for Human Cells, Tissues, and Tissue-Based Products (HCT/Ps) (March 29, 2004 and May 25, 2005) in an effort to prevent transmission of communicable disease, minimize contamination and preserved integrity and function during processing, outline safety and effectiveness requirements for cells from unrelated donors or when HCT/Ps are more than minimally manipulated, assure labeling is clear accurate and not misleading and monitor and communicate with industry via establishment registration. As of October 20, 2011, those units of cord blood that do not meet the manufacturing requirements for licensure can only be distributed for transplantation if the transplant will occur under an IND research protocol. In addition to the licensure guidance, the FDA published a guidance in August 2011 titled Investigational New Drug Applications (INDs) for Minimally Manipulated, Unrelated Allogeneic Placental/Umbilical Cord Blood Intended for Hematopoietic Reconstitution for Specified Indications. This is a multi-center study of unlicensed, investigational cryopreserved cord blood units (CBUs) manufactured by the National Cord Blood Program (NCBP) which provides access and distribution on an Investigational New Drug (IND) application #6637 to sites with locally IRB-approved protocols for unrelated hematopoietic stem cell transplantation of pediatric and adult patients. Objectives -The primary objective of this study is to examine the safety of administration of the unlicensed investigational NCBP HPC-CORD Blood products, evaluating prospectively the incidence of serious adverse reactions as well as the incidence of all infusion related reactions after administration of unlicensed, investigational NCBP CBU. Secondary Objectives: In patients receiving a non-licensed NCBP CBU (HPC-CORD BLOOD): Assess incidence of transmission of infections Assess incidence of graft rejection Assess incidence of neutrophil engraftment >500 /ul Determine 1 year survival after cord blood transplantation Assess cumulative incidence of acute graft vs. host disease (GVHD) grades II to IV and grades III to IV Assess cumulative incidence of chronic GVHD Determine platelet engraftment of >20,000/ul and >50,000/ul Determine CBU-derived engraftment Eligibility Criteria Inclusion Criteria Patients of any age or either gender with indications for receipt of investigational HPC-CORD BLOOD who are participating in an NIH-IRB approved clinical trial for unrelated hematopoietic stem cell transplantation. Signed informed consent (and assent when applicable). Exclusion Criteria Patients who are receiving licensed CB products (only) Patients who are receiving unlicensed CB products from other CB banks (i.e. NMDP) Design This study is a multi-NIH institute endeavor designed to allow NHLBI, NCI and NIAID investigators access investigational HPC-CORD BLOOD for patients participating in NIH-IRB approved clinical trials for unrelated hematopoietic stem cell transplantation. Treatment, including pre-treatment conditioning and GVHD prophylaxis will occur per the institute s NIH-IRB approved clinical trial or the transplant center s specifications.

Unrelated Hematopoietic Stem Cell Transplantation, Cryopreserved Cord Blood Units, National Cord Blood Program

INCLUSION CRITERIA: Patients of any age or either gender with indications for receipt of investigational HPC-CORD BLOOD who are participating in an NIH-IRB approved clinical trial for unrelated hematopoietic stem cell transplantation. Signed informed consent (and assent when applicable). EXCLUSION CRITERIA: Patients who are receiving licensed CB products (only) Patients who are receiving unlicensed CB products from other CB banks (i.e. NMDP)