A Study of CD45RA+ Depleted Haploidentical Stem Cell Transplantation in Children With Relapsed or Refractory Solid Tumors and Lymphomas
Condition: Ewing Sarcoma; Gastrointestinal Tumor; Germ Cell Tumor; Hepatic Tumor; Lymphoma; Wilms Tumor; Rhabdoid Tumor; Clear Cell Carcinoma; Renal Cell Carcinoma; Melanoma; Neuroblastoma; Rhabdomyosarcoma; Non-rhabdomyosarcoma
MeSH terms: Lymphoma; Carcinoma; Neoplasms; Neuroblastoma; Rhabdomyosarcoma; Sarcoma, Ewing; Wilms Tumor; Rhabdoid Tumor; Digestive System Neoplasms; Gastrointestinal Neoplasms; Adenomyoepithelioma; Adenocarcinoma, Clear Cell
Study type: Interventional
Phase: Phase 1

Summary: 
      This is a phase I study designed to determine the feasibility of transplantation using a
      novel transplant approach that employs a two-stage haploidentical cell infusion following
      myeloablative conditioning. This strategy, which includes selective depletion of naïve T
      cells, may speed immune reconstitution thereby potentially reducing the limitations of
      traditional haploidentical hematopoietic stem cell transplantation (HSCT) and increasing its
      potential therapeutic application. Additionally, the investigators intend to explore overall
      survival, event-free survival, hematopoietic cell recovery and engraftment as well as
      infection rates and complications in these patients.
    

Detailed description: 
      Twelve participants and 12 donors will be enrolled on this study. Donors will undergo seven
      days of hematopoietic stem cell (HSC) mobilization followed by two apheresis collections.
      Each apheresis collection will be processed by the CliniMACS system.

      DONORS: A mobilization regimen of granulocyte colony stimulating factor (G-CSF) will be used
      to obtain a peripheral blood stem cell (PBSC) product from the donor. Apheresis will be
      performed for a minimum of two consecutive days, including one day for each cell product
      delivered.

      STUDY PARTICIPANTS: Participants will undergo a two-stage haploidentical cell infusion
      following myeloablative conditioning. The first cell infusion will be a CD3-depleted product
      and the second infusion will be a CD45RA-depleted product.

      Primary Objective:

        -  To determine the feasibility of haploidentical HSCT using two infusions engineered by
           negative selection on the Miltenyi CliniMACS system- the first by selective depletion of
           CD3+ cells, followed by a second depleted of CD45RA+ cells, in children with relapsed or
           refractory solid tumors or lymphomas.

      Secondary Objectives:

        -  To estimate hematopoietic cell recovery and engraftment rates for the patients.

        -  To estimate infection rates and complications.

        -  To estimate the one-year overall survival (OS) and event-free survival (EFS) for the
           study patients.
    

Intervention name(s): alemtuzumab; fludarabine; sirolimus; Busulfan; melphalan; stem cells; CliniMACS
Intervention type(s): Drug; Drug; Drug; Drug; Drug; Biological; Device
Intervention description(s): Patients receive alemtuzumab on days -14 through -12 (Day 0 = stem cell transplantation).; Patients receive fludarabine phosphate on days -11 through -7. (Day 0 = stem cell transplantation.); Patients receive sirolimus beginning on day -1 with taper beginning on day 90. (Day 0 = stem cell transplantation.)
Participants treated after activation of protocol revision 2.3 on 06/05/2014 have not and will not receive sirolimus as part of their therapy.; Patients receive busulfan on days -6 through -3. (Day 0 = stem cell transplantation.); Patients receive melphalan on days -2 and -1. (Day 0 = stem cell transplantation.); Patients undergo CD3 depleted haploidentical hematopoietic stem cell transplant (HSCT) on day 0. Patients also undergo CD45RA depleted HSCT infusion on day 1. (Day 0 = stem cell transplantation.); The mechanism of action of the CliniMACS Cell Selection System is based on magnetic-activated cell sorting (MACS). The CliniMACS device is a powerful tool for the isolation of many cell types from heterogeneous cell mixtures, (e.g. apheresis products). These can then be separated in a magnetic field using an immunomagnetic label specific for the cell type of interest, such as CD3+ human T cells.
Other intervention name(s): CAMPATH-1H; Campath(R); Fludara(R); Rapamycin; Rapamune(R); Busulfex(R); Myleran(R); L-phenylalanine mustard; phenylalanine mustard; L-PAM; L-sarcolysin; HSCT; Stem cell transplantation; Cell Selection System
Intervention MeSH terms: Sirolimus; Fludarabine; Melphalan; Busulfan; Mechlorethamine; Alemtuzumab
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment