Biomarkers in Acute Graft-Versus-Host Disease and Extracorporeal Photopheresis Added to Investigator Chosen Therapies of Steroid Refractory Acute GVHD

• Status: Terminated
• Trial end date: 2019-10-31
• Target enrollment: 0
• Participant gender: All

Summary

Background:

• Some allogeneic stem cell transplant recipients get acute graft-versus-host disease (GVHD). They always get steroids as the first treatment, but this may not work. Those people where steroids are not enough may benefit from a treatment called extracorporeal photopheresis (ECP). ECP exposes white blood cells to ultraviolet light outside the body. Researchers want to study how certain markers in the blood predict the severity and outcome of acute GVHD and how ECP treatments work for people with acute GVHD. They will also study how these markers in the blood may help predict who should get ECP and its effects on the immune system.

Objectives:

• To learn more about treatments for acute GVHD after allogeneic stem cell transplantation.

Eligibility:

• Adults with acute GVHD enrolled in an National Cancer Institute (NCI) allogeneic transplantation protocol.

Design:

• Transplant physicians will confirm participant eligibility.

• Participants will receive treatment with steroids for their acute GVHD as prescribed by their transplant physician. This will continue while they are enrolled on this study.

• If steroids work in treating their acute GVHD, then every 28 days for 6 months, participants will have:

• a physical exam.

• blood tests.

• If steroids do not work, participants will get additional treatments as prescribed by their transplant physician who may choose to use ECP as a part of this additional treatment. For ECP, blood is removed through an intravenous (IV) catheter. A machine separates the white blood cells from the other blood parts. Those cells are treated with methoxsalen and exposed to ultraviolet light. Then they are returned to the participant through their IV.

• Participants who get ECP will over at least 6 months have:

• veins researched. They may have a catheter placed in a larger vein in the chest or groin.

• multiple blood tests.

• multiple pregnancy tests (if needed).

• multiple ECP procedures.

• At the end of ECP treatment and 6 months after ECP, participants will have additional physical exams and blood tests.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Cancer Institute (NCI)
• Treatments: Methoxsalen

Criteria

• INCLUSION CRITERIA:

• Age greater than or equal to18 years.

• Ability of subject to understand and the willingness to sign a written informed consent document.

• Subject must be also enrolled on an National Cancer Institute (NCI) allogeneic transplant protocol.

• Patients must agree to practice effective contraception (both male and female subjects, if the risk of conception exists)The effects of Extracorporeal Photopheresis (ECP) on the developing human fetus are unknown. For this reason and as well as other Methoxsalen used in this trial is in a class of agents that is known to be teratogenic, men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation, and for 4 months after the completion of study treatment. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately.

EXCLUSION CRITERIA:

• Any physical or mental condition that, in the opinion of the principal Investigator (PI), would cause the risk/benefit ratio of participation to be unacceptable.

• Inclusion of ECP in the treatment of any patient is contraindicated by any of the following:

• Unstable hemodynamics requiring vasopressors or other support measures not amenable to or medically appropriate for continuation during the procedure.

• Uncontrolled infection.

• Inability to maintain acceptable venous access.

• Uncontrolled or uncorrectable coagulopathy.

• Pregnant women are excluded from ECP because methoxsalen, an agent utilized for the study procedure, may cause fetal harm. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with methoxsalen, breastfeeding should be discontinued if the mother is treated with methoxsalen. Pregnancy will be evaluated prior to initiation of ECP.

• History of allergic or idiosyncratic/hypersensitivity reactions to 8- methoxypsoralen/psoralen compounds.

• History of a light-sensitive cutaneous disease

• Subjects with aphakia