Remote Ischemic Conditioning in HSCT

Study Overview
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Brief Summary
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This is a feasibility study at a single site, Cincinnati Children's Hospital Medical Center. The hypothesis will be tested using a prospective study design. The purpose of the study is to determine tolerability and safety of remote ischemic conditioning in pediatric and adolescent patients undergoing HSCT, with the goal of a larger trial of efficacy to follow. The secondary purpose is to determine if remote ischemic conditioning will reduce subclinical cardiotoxicity as measured by markers of myocardial injury and stress in patients undergoing HSCT. The study will include multiple blood collections and echocardiograms.

Official Title
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Remote Ischemic Conditioning for Protection From Treatment-related Cardiotoxicity in Pediatric and Adolescent Patients Undergoing Hematopoietic Stem Cell Transplantation: a Feasibility Study

Conditions
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Hematopoietic Stem Cell Transplantations

Intervention / Treatment
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* Device: autoRIC®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pediatric, adolescent, or young adult patients, 10 years of age or above. Able to tolerate upper arm blood pressure inflation. Participating in the BMT Biorepository (2012-1156). Exclusion Criteria: Systolic blood pressure >160 mmHg. Previous diagnosis of cardiomyopathy (dilated, hypertrophic, restrictive, myocarditis) or congenital heart disease other than bicuspid aortic valve. Chronic kidney disease as defined as a pre-transplant GFR <80 Central line in both upper extremities. Known peripheral vascular disease or vasculitis. Platelet count less than 30,000. Known clotting disorder or hypercoagulability Non-English speaking patients.

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Device Feasibility
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Therapeutic Group<br>Therapeutic group receives remote ischemic conditioning. | Device: autoRIC®<br>* The autoRIC device will be modified by the company from the standard cuff inflation of 200 mmHg to 180 mmHg for the purposes of this study. Three cuff sizes are available from the company: small, medium, and large, correlating to standard adult cuff sizes. The remote ischemic preconditioning cycles will be performed daily by trained research personnel during the preparative regimen through day 0 (see Figure 1), defined as transplantation of stem cells (last preconditioning cycle on day -1). A control group will undergo a similar procedure, however, the cuff will not be inflated.<br>|
| No Intervention: Control Group<br>Control group does not receive remote ischemic conditioning. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events | Patients undergoing HSCT will tolerate remote ischemic conditioning and there will be no adverse effect on therapeutic efficacy or co-morbidities. | 18-24 months from start of enrollment |