In Utero Hematopoietic Stem Cell Transplantation for Alpha-thalassemia Major (ATM)

    Not Recruiting
  • End date
    Feb 17, 2025
  • participants needed
  • sponsor
    University of California, San Francisco
Updated on 9 May 2022
stem cell transplantation
cell transplantation
blood transfusion
red blood cell transfusion
transfusion of red blood cells


The investigators aims to evaluate the safety of in utero hematopoietic stem cell transplantation in fetuses with alpha-thalassemia major performed at the time of in utero transfusion of red blood cells.


Alpha thalassemia major (ATM) is almost universally fatal in utero and represents an orphan disease with an unmet need for effective therapies. The only current treatment to allow the fetus to be born is to perform in utero transfusions (IUT) of red blood cells to treat the anemia and avoid the complications of hydrops and fetal demise. Often, affected pregnancies undergo elective termination after diagnosis. Cases with prenatal diagnosis of ATM who receive IUT and survive to birth will ultimately require lifelong monthly blood transfusions or bone marrow transplant, if a suitable donor is identified.

This is a phase 1 clinical trial to demonstrate the safety, feasibility and efficacy of performing in utero stem cell transplantation on fetuses affected with ATM. The investigators aim to recruit ten participants with a prenatal diagnosis of ATM. Participants will undergo bone marrow harvest and an in utero transfusion combined with maternal stem cells. Transplanting maternal cells into the fetus takes advantage of existing maternal-fetal tolerance during pregnancy. Hematopoietic stem cell (HSC) transplantation into the fetus takes advantage of the developing fetal immune system to induce tolerance to the transplanted cells without using conditioning or immunosuppression. Performing stem cell transplantation at the same time as IUT minimizes any additional procedural risk to the fetus.

The investigators hope to demonstrate that it is safe and feasible to perform in utero stem cell transplantation. Additionally, the investigators want to demonstrate postnatal chimerism of maternal cells so that, if a bone marrow transplant remains necessary after delivery, conditioning and immune suppression will not be required.

Condition Thalassemia, Thalassemia, beta Thalassemia, Alpha thalassemia, Blood disorder, Hematological Disorders, Hemoglobinopathy, Hydrops Fetalis, Alpha Thalassemia Major, Fetal Anemia, Hematological Disorders, thalassemia major, hemoglobinopathies, beta-thalassemia, alpha-thalassemia
Treatment in utero hematopoietic stem cell transplantation
Clinical Study IdentifierNCT02986698
SponsorUniversity of California, San Francisco
Last Modified on9 May 2022

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