safety study of umbilical cord blood to treat pediatric traumatic brain injury

Conditions: Traumatic Brain Injury

Summary: the purpose of this study is to determine if it is safe to use stored autologous human umbilical cord blood (hucb) to treat pediatric patients that sustain a severe or moderate traumatic brain injury (tbi), and have not fully recovered as measured by the glasgow outcome score-expanded (gos-ec)/child at 6 to 18 months post-injury.

traumatic brain injury is the primary cause of pediatric trauma related morbidity and mortality. currently there is no reparative therapeutic option available, and all interventions are designed to prevent injury progression or secondary brain injury. pre-clinical data suggest that progenitor cellular infusions may reduce the severity of injury by a number of proposed mechanisms. the current study proposes a phase 1 safety trial using stored autologous ucb to treat patients that sustain a severe or moderate tbi, and have not fully recovered as measured by the glasgow outcome score-expanded/child at 6 to 18 months post-injury. we have chosen to use one bank that uses standardized processing and storage protocol to reduce cell product variability. families who have banked hucb at cord blood registry, inc. (cbr), will be prospectively notified of the possibility of using their child's stored ucb if they sustain a moderate or severe tbi and have a persistent deficit at 6-18 months. prior to enrolling in the study, patients will have their medical records, imaging studies reviewed, and a telephone interview will determine potential eligibility and exclusion criteria. if eligible, the patients will travel to houston to undergo a medical history and physical exam, neuropsychiatric evaluation, dt-mri imaging of the brain, and baseline laboratory evaluation. the ucb will be shipped to the center for cell and gene therapy for reanimation and characterization/determination of release criteria of the cell product (contamination-free). the ucb will be infused intravenously and the patient will be monitored as an in-patient in the pediatric intensive care unit (picu) located within children's memorial hermann hospital for 24 hours, after which the patient will be discharged but will return the next day for a final examination. follow-up visits will occur back at ut-houston at 180 days, 1 year and 2 years post-infusion - these visits will include medical history and physical exam, neurological and neuropsych evaluations, and dt-mri imaging of the brain.

Eligibility criteria:
inclusion criteria: * hospital admission glasgow coma score between 3 and 12 at the time of injury * injury occurring 6 to 18 months prior to study cord blood infusion (+/- 30 days) * ability of child and caregiver to travel to houston, and stay for at least 4 days, and to return for all follow-up visits * ability of child to understand (and speak) english * child's own cord blood banked at cord blood registry exclusion criteria: * inability to obtain all pertinent medical records, including pertinent physician notes, laboratory findings, and radiographic images, related to the original injury, hospitalization and rehabilitation * recent radiographic evidence of extensive stroke as evidenced by \>100ml lesion * pre-injury history of seizure disorder and/or neurological impairment * obliteration of perimesencephalic cistern on initial head ct/mri * initial hospital intracranial pressure (icp) \> 40 * unhealed fractures or wounds including osteomyelitis * pneumonia, or chronic lung disease requiring oxygen * spinal cord injury as diagnosed by ct or mr imaging or by clinical findings * cord blood sample contamination * participation in a concurrent intervention study

Keywords: traumatic brain injury tbi pediatric chronic