Allogeneic Hematopoietic Stem Cell Transplant for GATA2 Mutations

  • STATUS
    Recruiting
  • End date
    Dec 31, 2023
  • participants needed
    144
  • sponsor
    National Cancer Institute (NCI)
Updated on 12 September 2021
malignant disease
cancer
remission
stem cell transplantation
total body irradiation
fludarabine
tacrolimus
mycophenolate mofetil
cyclophosphamide
busulfan
filgrastim
ejection fraction
direct bilirubin
leukemia
bone marrow procedure
hematologic disorder
antithymocyte globulin
cytopenia
conjugated bilirubin
therapeutic agents
allogeneic hematopoietic stem cell transplant

Summary

Background
  • GATA2 deficiency is a disease caused by mutations in the GATA2 gene. It can cause different types of leukemia and other diseases. Researchers want to see if a stem cell transplant can be used to treat this condition. A stem cell transplant will give stem cells from a matching donor (related or unrelated) to a recipient. It will allow the donor stem cells to produce healthy bone marrow and blood cells that will attack the recipient s cancer cells.
    Objectives
  • To see if stem cell transplants are successful at treating GATA2 mutations and related conditions.
    Eligibility
  • Recipients who are between 8 and 70 years of age and have GATA2 deficiency.
    Design
  • All participants will be screened with a physical exam and medical history. Blood samples will be collected. Recipients will have imaging studies and other tests.
  • Recipients will have chemotherapy or radiation to prepare for the transplant. On the day of the transplant, they will receive the donated stem cells.
  • Recipients will stay in the hospital until their condition is stable after transplant.
  • Frequent blood tests and scans will be required for the first 6 months after the transplant, followed by less frequent visits over time.

Description

Background

Genetic and sporadic mutations on one allele of the GATA2 gene lead to a syndrome termed MonoMAC. MonoMAC is characterized by: 1) infections with Mycobacterium avium complex (MAC) and other opportunistic infections, 2) deficiency of monocytes, B-lymphocytes, and Natural Killer (NK) cells in the peripheral blood, and 3) progression to myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), and acute myelogenous leukemia (AML), and 4) mutations on one allele of GATA2 in most participants. We propose to evaluate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (HSCT) using different conditioning regimens from different donor sources in reconstituting normal hematopoiesis and reversing the disease phenotype in participants with mutations in GATA2, or the clinical syndrome of MonoMAC.

Objectives: Primary:

-To determine whether allogeneic hematopoietic stem cell transplant (HSCT) approach reconstitutes normal hematopoiesis and reverses the disease phenotype by one year posttransplant in participants with mutations in GATA2 or the clinical syndrome of MonoMAC.

Eligibility
  • Recipients ages 8-70 years old with mutations in GATA2 or the clinical syndrome of MonoMAC. Clinical history of at least one serious or disfiguring infection and GATA2 bone marrow immuneodeficiency disorder with loss of one or more immune populations in the bone marrow including monocytes, Natural Killer (NK) cells, and B-lymphocytes, with or without additional cytopenias involving the red blood cell, neutrophil, or platelet compartment.
  • Have a 10/10 or a 9/10 or an 8/10 HLA-matched related or unrelated donor (HLA -A, -B, -C, DRB1, DQB1 by high resolution typing) or a haploidentical related donor; unrelated donors are identified through the National Marrow Donor Program.

Design: Two Arms

  • Participants with mutations in GATA2, or the clinical syndrome of MonoMAC, with a 10/10 (or 9/10 matched if the mismatch is at DQ) HLA-matched related or unrelated donor will receive a pre-transplant conditioning regimen consisting of fludarabine 40 mg/m2 IV once daily for 4 days on day s -6, -5, -4, and -3, busulfan based on pharmacokinetic levels from test dose or real time pharmacokinetics (PKs) (3.2 mg/kg IV will be the default dose) once daily on days -6, -5, -4, and -3, and HSCT on day 0.
  • Participants with mutations in GATA2, or the clinical syndrome of MonoMAC, with a 9/10 or an 8/10 HLA-matched related or unrelated donor (if the mismatch is not at DQ), or with a haploidentical related donor, will receive a pre-transplant conditioning regimen consisting of cyclophosphamide 14.5 mg/kg IV once daily for 2 days on days -6 and -5, busulfan based on pharmacokinetic levels from test dose or real time PKs ( 3.2 mg/kg IV will be the default dose) once daily on days -4, -3, (if poor or very poor risk clonal cytogenetic abnormalities are present, then three days of busulfan IV once daily on days -4, -3, and -2 will be given), fludarabine 30 mg/m2 IV once daily for 5 days on days -6 to -2, 200 cGy TBI on day -1, and HSCT on day 0.
  • Post-transplant immunosuppression for GVHD prophylaxis for recipients of all groups will consist of cyclophosphamide 50 mg/kg IV once daily for 2 days on day's +3 and +4, along with mycophenolate mofetil from day +5 to approximately day +35 and tacrolimus from day +5 to approximately day +180. If there is no evidence of graft-versus- host disease, tacrolimus will be stopped or tapered at approximately day +180.

Details
Condition Immunodeficiency, miller-dieker syndrome, MYELODYSPLASTIC SYNDROME, Myelodysplastic Syndromes (MDS), GATA2, Immune Deficiency, Primary Immunodeficiency Disorders, MDS, myelodysplastic syndromes, immunodeficient, immunodeficiencies, decreased immune function, myelodysplastic syndrome (mds)
Treatment Tacrolimus, Mycophenolate Mofetil (MMF), allogeneic HSCT, Total Body Irradiation (TBI), Fludarabine(Fludara, Berlex Laboratories), Cyclophosphamide(CTX, Cytoxan), Busulfan (Busulfex), Allogeneic HSC, Busulfan Test dose, Equine Anti-Thymocyte Globulin, Mycophenolatemofetil (MMF), Fludarabine (Fludara, Berlex Laboratories), Cyclophosphamide (CTX, Cytoxan)
Clinical Study IdentifierNCT01861106
SponsorNational Cancer Institute (NCI)
Last Modified on12 September 2021

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