The Use of Etanercept (Enbrel®) in the Treatment of Acute Graft-Versus-Host Disease

NCT ID: NCT00141713

Last Updated: 2013-03-13

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2003-10-31
• Study Completion Date: 2006-12-31

Brief Summary

Etanercept (Enbrel) will be added to standard therapy for acute Graft-versus-Host Disease to see if the effectiveness of standard therapy can be improved.

Partial Funding Source- FDA OOPD

Detailed Description

The standard treatment for acute graft-versus-host disease is a combination of steroids and tacrolimus or cyclosporine. Previous work has shown that less than 50% of patients respond fully to GVHD. Without a good response, patients often have a prolonged treatment for this disease, often involving hospitalization and sometimes even death.

Etanercept is a drug that blocks a chemical called Tumor Necrosis Factor (TNF) from causing damage to tissue. Etanercept (Enbrel) will be added to help improve the response to standard treatment for graft-versus-host disease (GVHD).

This is an experimental research project. It is not known whether the etanercept will actually improve the body's response to graft-versus-host disease. This treatment is meant to determine if etanercept will improve your response to treatment of GVHD.

Conditions

Graft-Versus-Host Disease

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

1

etanercept treatment for GVHD

Group Type: EXPERIMENTAL

Etanercept

Intervention Type: DRUG

Patients enrolled on the study will receive etanercept at 0.4 mg/kg per dose up to a maximum of 25 mg per dose subcutaneously twice a week. Etanercept must be initiated within 72 hours of starting solumedrol.

Interventions

Etanercept

Patients enrolled on the study will receive etanercept at 0.4 mg/kg per dose up to a maximum of 25 mg per dose subcutaneously twice a week. Etanercept must be initiated within 72 hours of starting solumedrol.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patient may be transplanted with stem cells from any source using either a myeloablative or nonmyeloablative preparative regimen
• Patient may be any age
• Patient must have biopsy proven new onset of aGVHD; Clinical Grading must be II-IV and may occur after stem cell transplant or donor leukocyte infusion (DLI). Patients may begin Etanercept treatment prior to biopsy confirmation of GVHD. Acute GVHD will be determined by clinical presentation and not timing from stem cell infusion
• Patient must be on solumedrol at a dose of 2mg/kg/day of actual body weight for no more than 72 hours prior to the initiation of etanercept
• Patient must have evidence of neutrophil engraftment with an ANC of > 500 for three consecutive days
• Pulse ox > 90% on room air

Exclusion Criteria

• Pregnancy or nursing mother
• Intolerance or allergic reaction to etanercept
• Previous use of steroids for treatment of acute GVHD
• Active infection, chronic or localized, not responding to antibiotics, with continued signs of infection (patients with a positive C. Difficile test will not be excluded from the study)
• Condition that might predispose to developing serious infections (i.e. active and uncontrolled diabetes mellitus, sickle cell anemia)
• Other investigational agents for the treatment or prophylaxis of graft-vs-host disease within the past 2 weeks
• Serum creatinine > 2.0mg/dl
• Patients being treated for acute pulmonary dysfunction (IPS) study using etanercept
• Patients with hypotension believed to be secondary to sepsis syndrome or heart failure requiring > 1 inotropic agent, or dopamine >5mcg/kg/minute for blood pressure support
• Evidence of congestive heart failure on clinical exam
• Evidence of hepatic dysfunction with an ALT or AST > 2.5 x ULN, not due to GVHD

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Michigan Rogel Cancer Center

OTHER

Sponsor Role: lead

Responsible Party

John Levine, MD

Professor of Pediatrics

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

John E. Levine, MS MD

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Locations

The University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan, United States

Countries

United States

References

Levine JE, Paczesny S, Mineishi S, Braun T, Choi SW, Hutchinson RJ, Jones D, Khaled Y, Kitko CL, Bickley D, Krijanovski O, Reddy P, Yanik G, Ferrara JL. Etanercept plus methylprednisolone as initial therapy for acute graft-versus-host disease. Blood. 2008 Feb 15;111(4):2470-5. doi: 10.1182/blood-2007-09-112987. Epub 2007 Nov 27.

Reference Type: DERIVED

PMID: 18042798 (View on PubMed)

Other Identifiers

2003-0591

Identifier Type: OTHER

Identifier Source: secondary_id

FD-R-002397-03-2

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

UMCC 3-37

Identifier Type: -

Identifier Source: org_study_id