Clinical Trial: Combined Bone Marrow and Renal Transplantation for Hematologic Disorders With End Stage Renal Disease

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Combined HLA-Matched Bone Marrow and Kidney Transplantation for Multiple Myeloma or Other Hematologic Disorders With End Stage Renal Disease

Brief Summary: This pilot trial offers the unique opportunity for both the treatment of multiple myeloma or systemic AL amyloidosis for which hematopoietic stem cell transplantation would be ordinarily indicated and the reversal of end-stage renal failure, while avoiding the risks associated with long-term standard anti-rejection therapy used in renal transplantation. The primary objectives of this study are to assess renal allograft tolerance (that is, the acceptance of the kidney without the need for anti-rejection therapy), assess anti-tumor response rates in multiple myeloma and AL amyloidosis, and assess complication rates for genetically (HLA) matched related donor combined bone marrow and kidney transplantation using a low dose total body irradiation based preparative regimen.

Detailed Summary: The induction of transplantation tolerance involves the specific elimination of the immune response to the transplant but not to other antigens. In the realm of kidney transplantation, tolerance means that the recipient is unable to detect the donor transplant kidney as foreign, and therefore the recipient is unable to reject the kidney. Donor bone marrow engraftment leads to kidney graft tolerance in animal models. Renal failure is a major complication of multiple myeloma and AL amyloidosis for which the only known cure is allogeneic bone marrow transplantation. Standard bone marrow transplantation is associated with prohibitive toxicities in patients with end stage renal disease, and is generally not considered an option for those patients. Patients with multiple myeloma and AL amyloidosis are excluded from conventional renal transplantation protocols because of their underlying malignancy. A less toxic bone marrow transplantation protocol, utilizing low dose total body irradiation and anti-thymocyte globulin, combined with renal transplantation, could provide an opportunity for cure of the myeloma or amyloidosis and correction of end stage renal disease. In addition, successful marrow engraftment may be expected to lead to a state of tolerance. Successful implementation of tolerance would be a major benefit to transplant recipients. The significance of developing tolerance is that the patient could be spared the disabling complications of indefinite immunosuppression, which include infections, cataracts, osteoporosis, diabetes, atherosclerosis, hypertension, and malignancy.
Sponsor: Massachusetts General Hospital

Current Primary Outcome: The primary endpoint is the renal allograft rejection rate at 6 months post-transplant. [ Time Frame: Participants will be followed on an intention-to-treat basis, and data from all enrolled participants will be collected, irrespective of outcome, for the scheduled minimum follow-up period of 3 years. ]

BUN and creatinine will be measured daily while hospitalized, then weekly up to 100 days, then at month 6, and years 1, 1.5, 2, 3.

Renal biopsies will be performed as clinically indicated for suspected rejection



Original Primary Outcome: Same as current

Current Secondary Outcome: Assess anti-tumor response rates in patients with hematologic malignancies [ Time Frame: Participants will be followed on an intention-to-treat basis, and data from all enrolled participants will be collected, irrespective of outcome, for the scheduled minimum follow-up period of 3 years. ]

  • Bone marrow biopsy and aspirate for patients with hematologic malignancy and prior bone marrow involvement (pre-transplant, Day 100, 6 months, year 1, year 2).
  • Quantification of serum and urine M protein and serum free light chain analyses for patients with myeloma (Days 35, 70, 100, month 6, year 1, year 1.5, year 2, year 3).
  • Quantitative immunoglobulin analysis (Days 7, 14, 21, 28, 42, 56, 70, 84, 100, month 6, year 1, year 1.5, year 2, year 3).
  • Additional disease staging procedures and studies for other hematologic malignancies as clinically indicated.


Original Secondary Outcome: Same as current

Information By: Massachusetts General Hospital

Dates:
Date Received: May 30, 2014
Date Started: February 2015
Date Completion: February 2021
Last Updated: September 30, 2016
Last Verified: September 2016