Clinical trial NCT00642655 (phase 1/phase 2, status: completed)
Conditions: kidney transplant
ICD codes: T86.11, T86.12, T86.13, Z94.0, T86.10, T86.19, Z48.22
Drugs: ivig and rituximab
SMILES: ClCCN(CCCl)P1(=O)NCCCO1
Eligibility criteria:

        Inclusion Criteria:

          -  Patients eligible for the study will be those who have anti-HLA antibody (Panel
             Reactive Antibody [PRA]) of >30% and are eligible for transplantation at Cedars-Sinai
             Medical Center. We currently anticipate entering 20 patients over the course of the
             study. We currently have ~100 patients on our wait list that would meet the above
             criteria. Patients will be selected based on the ability of IVIG to inhibit the
             cytotoxic anti-HLA antibody activity in vitro. They will then receive IVIG 2gm/kg X1
             on day 1 while on hemodialysis. Seven days later, the patients will receive Rituxan®
             1gm in the CSMC Cancer Infusion Center as per protocol for Rituxan® infusion. The
             second Rituxan® infusion will be on day#22. The patients will have monitoring of
             anti-HLA antibody and outlined tests as shown above.

          -  Able and willing to give written informed consent and comply with the requirements of
             the study protocol

          -  Adequate liver function, as indicated by normal liver function tests (NL: AST, ALT,
             Bilirubin and negative tests for hepatitis C and hepatitis B.

          -  Negative serum pregnancy test (for women of child bearing age)

          -  Men and women of reproductive potential must agree to use an acceptable method of
             birth control during treatment and for twelve months (1 year) after completion of
             treatment.

        Exclusion Criteria:

          -  Treatment with any investigational agent within 4 weeks of screening or 5 half-lives
             of the investigational drug (whichever is longer)

               -  Receipt of a live vaccine within 4 weeks prior to randomization

               -  Previous Treatment with Rituximab (MabThera® / Rituxan®)

               -  Prior antibody therapy

               -  History of severe allergic or anaphylactic reactions to humanized or murine
                  monoclonal antibodies

               -  History of HIV (positive HIV, HIV conducted during screening)

               -  History of Hepatitis B and/or Hepatitis C

               -  History of recurrent significant infection or history of recurrent bacterial
                  infections

               -  Known active bacterial, viral fungal mycobacterial, or other infection (including
                  tuberculosis or atypical mycobacterial disease, but excluding fungal infections
                  of nail beds) or any major episode of infection requiring hospitalization or
                  treatment with i.v. antibiotics within 4 weeks of screening or oral antibiotics
                  within 2 weeks prior to screening

               -  Lack of peripheral venous access

               -  History of drug, alcohol, or chemical abuse within 6 months prior to screening

               -  Pregnancy (a negative serum pregnancy test should be performed for all women of
                  childbearing potential within 7 days of treatment) or lactation

               -  Concomitant malignancies or previous malignancies within the last five years,
                  with the exception of adequately treated basal or squamous cell carcinoma of the
                  skin or carcinoma in situ of the cervix.

               -  History of psychiatric disorder

               -  Significant cardiac or pulmonary disease (including obstructive pulmonary
                  disease)

               -  Any other disease, metabolic dysfunction, physical examination finding, or
                  clinical laboratory finding giving reasonable suspicion of a disease or condition
                  that contraindicates the use of an investigational drug or that may affect the
                  interpretation of the results or render the patient at high risk from treatment
                  complications

               -  Inability to comply with study and follow-up procedures

        Laboratory Exclusion Criteria (at Screening)

          -  Hemoglobin: < 8.5 gm/dL

          -  Platelets: < 100,000/mm

          -  AST or ALT >2.5 x Upper Limit of Normal unless related to primary disease.

          -  Positive Hepatitis B or C serology

          -  Positive HIV