RECRUITING

A Phase II Study of Allogeneic Hematopoietic Stem Cell Transplant for Subjects With VEXAS (Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic) Syndrome

Conditions

Immunodeficiency Hematopoietic Stem Cell Transplantation Immune Dysregulation Haploidentical hematoinflammatory diseases Myelodysplastic Syndromes Autoimmune Disorders

Quick Navigation

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

Background: Allogeneic hematopoietic stem cell transplant involves taking blood stem cells from a donor and giving them to a recipient. The transplants are used to treat certain diseases and cancers. Researchers want to see if the transplant can treat VEXAS Syndrome. Objective: To see if stem cell transplants can be successfully performed in people with VEXAS and even improve the disease. Eligibility: People ages 18-75 who have VEXAS Syndrome that has caused significant health problems and standard treatment either has not worked or is not available. Design: Participants will be screened with: Physical exam Medical review Blood and urine tests Heart and lung function tests Bone marrow biopsy Participants will have a chest x-ray. They will have an imaging scan of the head, chest, abdomen, pelvis, and sinus. They will have a bone density scan. They will have a dental exam and eye exam. They will meet with specialists. They will repeat some screening tests. Participants will be admitted to the NIH hospital. They have a central venous catheter put into a vein in the chest or neck. They will receive drugs to prepare their bone marrow for the transplant. They may have total body irradiation. They will receive the donor stem cells through the catheter. They will get other drugs to prevent complications and infections. After discharge, they must stay in the DC area for 3 months for weekly study visits. Participants will have study visits 30, 60, 100, 180, 210, 240, 300, and 360 days later. After that, they will have yearly visits for 2 years and then be contacted yearly by phone....

Official Title

A Phase II Study of Allogeneic Hematopoietic Stem Cell Transplant for Subjects With VEXAS (Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic) Syndrome

Quick Facts

Study Start:2023-02-23

Study Completion:2026-07-01

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT05027945

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years to 75 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
* Age \>= 18-year-old and \<= 75-year-old * Availability of an 8/8 or 7/8 HLA-matched related or unrelated donor, or a haploidentical related donor * Karnofsky performance status of \>= 40% * Adequate end-organ function, defined as follow: 1. Left ventricular ejection fraction \> 35%, preferably by 2-D echocardiogram (ECHO) obtained within 60 days prior to treatment initiation. 2. Creatinine \<= 2.0 mg/dl and creatinine clearance \>= 30 ml/min; 3. Serum conjugated bilirubin \< 3.0 mg/dl; serum ALT and AST \<= 5 times upper limit of normal. * Pulmonary function tests: FEV1 and DLCO \>30% * Ability of subject to understand and the willingness to sign a written informed consent document. * As therapeutic agents used in this trial may be harmful to a fetus, individuals of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) at the study entry and for at least one-year post-allo HCT. Should an individual become pregnant or suspect they are pregnant while she or her partner is participating in the study, she should inform her treating physician immediately. * Willingness to remain in the NIH hospital or, if discharged, live within 2 hours drive from the NIH, for a minimum of 100 days after transplant or longer, if there are complications. If outpatient in the first 100 days after transplant, participant must commit to having an adult caregiver with them at all times. * Somatic mutation in UBA1 performed by a CLIA or CAP certified laboratory. NOTE: Participants without a mutation or unknown mutation status may be eligible if they have a clinical history that is characteristic of an individual with VEXAS syndrome including two or more of a-e below. * Inflammatory clinical phenotype for VEXAS syndrome with at least one VEXAS disease manifestation below: 1. constitutional symptoms including fevers, fatigue, and weight loss 2. cutaneous symptoms of VEXAS including biopsy proven neutrophilic dermatosis, cutaneous vasculitis, periorbital inflammation 3. pulmonary symptoms of VEXAS with pulmonary infiltrates, pleural effusion 4. musculoskeletal or cartilaginous involvement including inflammatory arthritis, ear chondritis, and nasal chondritis 5. inflammatory disease in other major organ systems including cardiac, gastrointestinal, ocular, etc. * Presence of cytopenia defined as at least one of the following:	* HCT Comorbidity Index \>= 5. Note: Comorbidities that are specifically addressed in the inclusion criteria will not be included in the calculation of HCT-CI score. * Participants with multiple myeloma. Note: participants with low risk smoldering multiple myeloma or monoclonal gammopathy of unknown significance will not be excluded) * Participants who are receiving any other investigational agents within the last 30 days before treatment initiation. * HIV-positive patients are ineligible because these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. * History of allergic reactions attributed to compounds of similar chemical or biologic composition to agents (steroids, cyclophosphamide, busulfan, tacrolimus, MMF, filgrastim or filgrastim biosimilar) used in the study. * Pregnant individuals are excluded from this study because the study agents have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with the study agents, breastfeeding should be discontinued if the mother is treated with the study agents. * Uncontrolled intercurrent illness or social situations (as determined by a licensed master social worker) that would limit compliance with study requirements. * Presence of active uncontrolled infections that in the opinion of the PI would make it unsafe to proceed with transplantation. * Active psychiatric disorder which is deemed by the PI to have significant risk of compromising compliance with the transplant protocol.

Inclusion Criteria

Exclusion Criteria

* Age \>= 18-year-old and \<= 75-year-old
* Availability of an 8/8 or 7/8 HLA-matched related or unrelated donor, or a haploidentical related donor
* Karnofsky performance status of \>= 40%
* Adequate end-organ function, defined as follow:
1. Left ventricular ejection fraction \> 35%, preferably by 2-D echocardiogram (ECHO) obtained within 60 days prior to treatment initiation.
2. Creatinine \<= 2.0 mg/dl and creatinine clearance \>= 30 ml/min;
3. Serum conjugated bilirubin \< 3.0 mg/dl; serum ALT and AST \<= 5 times upper limit of normal.
* Pulmonary function tests: FEV1 and DLCO \>30%
* Ability of subject to understand and the willingness to sign a written informed consent document.
* As therapeutic agents used in this trial may be harmful to a fetus, individuals of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) at the study entry and for at least one-year post-allo HCT. Should an individual become pregnant or suspect they are pregnant while she or her partner is participating in the study, she should inform her treating physician immediately.
* Willingness to remain in the NIH hospital or, if discharged, live within 2 hours drive from the NIH, for a minimum of 100 days after transplant or longer, if there are complications. If outpatient in the first 100 days after transplant, participant must commit to having an adult caregiver with them at all times.
* Somatic mutation in UBA1 performed by a CLIA or CAP certified laboratory. NOTE: Participants without a mutation or unknown mutation status may be eligible if they have a clinical history that is characteristic of an individual with VEXAS syndrome including two or more of a-e below.
* Inflammatory clinical phenotype for VEXAS syndrome with at least one VEXAS disease manifestation below:
1. constitutional symptoms including fevers, fatigue, and weight loss
2. cutaneous symptoms of VEXAS including biopsy proven neutrophilic dermatosis, cutaneous vasculitis, periorbital inflammation
3. pulmonary symptoms of VEXAS with pulmonary infiltrates, pleural effusion
4. musculoskeletal or cartilaginous involvement including inflammatory arthritis, ear chondritis, and nasal chondritis
5. inflammatory disease in other major organ systems including cardiac, gastrointestinal, ocular, etc.
* Presence of cytopenia defined as at least one of the following:

* HCT Comorbidity Index \>= 5. Note: Comorbidities that are specifically addressed in the inclusion criteria will not be included in the calculation of HCT-CI score.
* Participants with multiple myeloma. Note: participants with low risk smoldering multiple myeloma or monoclonal gammopathy of unknown significance will not be excluded)
* Participants who are receiving any other investigational agents within the last 30 days before treatment initiation.
* HIV-positive patients are ineligible because these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to agents (steroids, cyclophosphamide, busulfan, tacrolimus, MMF, filgrastim or filgrastim biosimilar) used in the study.
* Pregnant individuals are excluded from this study because the study agents have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with the study agents, breastfeeding should be discontinued if the mother is treated with the study agents.
* Uncontrolled intercurrent illness or social situations (as determined by a licensed master social worker) that would limit compliance with study requirements.
* Presence of active uncontrolled infections that in the opinion of the PI would make it unsafe to proceed with transplantation.
* Active psychiatric disorder which is deemed by the PI to have significant risk of compromising compliance with the transplant protocol.

Contacts and Locations

Study Contact

Bhavisha A Patel, M.D.

CONTACT

(301) 402-3477

bhavisha.patel@nih.gov

Dennis D Hickstein, M.D.

CONTACT

(240) 760-6169

hicksted@mail.nih.gov

Principal Investigator

Dennis D Hickstein, M.D.

PRINCIPAL_INVESTIGATOR

National Cancer Institute (NCI)

Study Locations (Sites)

National Institutes of Health Clinical Center

Bethesda, Maryland, 20892

United States

Collaborators and Investigators

Sponsor: National Cancer Institute (NCI)

Dennis D Hickstein, M.D., PRINCIPAL_INVESTIGATOR, National Cancer Institute (NCI)

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2023-02-23

Study Completion Date2026-07-01

Study Record Updates

Study Start Date2023-02-23

Study Completion Date2026-07-01

Terms related to this study

Keywords Provided by Researchers

Immune Dysregulation
Haploidentical
hematoinflammatory diseases
Myelodysplastic Syndromes
Autoimmune Disorders

Additional Relevant MeSH Terms

Immunodeficiency
Hematopoietic Stem Cell Transplantation