Alefacept for Prevention of Graft Versus Host Disease (GVHD)

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

26 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-06-30

Study Completion Date

2013-12-31

Brief Summary

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Alefacept (AMEVIVE®) is an immunosuppressive dimeric fusion protein. It was shown to interfere with lymphocyte activation by specifically binding to the lymphocyte antigen, CD2, and inhibiting LFA-3/CD2 interaction. Alefacept was evaluated in two randomized, double-blind, placebo-controlled studies in adults with chronic (\>1 year) plaque psoriasis and a minimum body surface area involvement of 10% who were candidates for or had previously received systemic therapy or phototherapy. The response to alefacept was significantly better in both studies. In both studies, onset of response to alefacept treatment (defined as at least 50% reduction of baseline Psoriasis Area and Severity Index (PASI)) began 60 days after the start of therapy.

Graft versus host disease (GVHD) is the most ominous side effect of allogeneic stem cell transplantation (SCT). It causes severe inflammatory process, which is usually located to the skin, gut and liver. Treatment of GVHD consists of various immuno-suppressive and immuno-modulating drugs, including steroids, cyclosporine, tacrolimus, methotrexate etc. These drugs unfortunately can also cause severe immunologic failure that makes the patient prone to infection and malignancy, and other medication-specific side effects. In spite of this effect on the immune system, not all of the patients achieve control of GVHD, which usually rapidly leads to death. Despite the use of innovative immunosuppressive modalities, the prognosis of steroid resistant GVHD is usually poor.

It was shown that CD2 depletion of allografts could prevent GVHD. Alefacept was never systemically tried in GVHD but A phase II study of BTI-322, a rat monoclonal IgG2b directed against the CD2 antigen in steroid-refractory acute GVHD showed a total response rate of 55%. We showed that alefacept might have a beneficial effect in controlling steroid resistant aGVHD and chronic GVHD. It was also shown to dramatically change the nature of transfusion associated GVHD.

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Detailed Description

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Conditions

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Graft Versus Host Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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1

Alefacept

Group Type EXPERIMENTAL

Alefacept (AMEVIVE®)

Intervention Type DRUG

Alefacept

2

Group Type PLACEBO_COMPARATOR

control group

Intervention Type DRUG

these patients will receive the same treatment as group A, without alefacept

Interventions

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Alefacept (AMEVIVE®)

Alefacept

Intervention Type DRUG

control group

these patients will receive the same treatment as group A, without alefacept

Intervention Type DRUG

Other Intervention Names

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Alefacept

Eligibility Criteria

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Inclusion Criteria

1. Patient age 14-75 years old with a disease necessitating allogeneic SCT.
2. In order to increase security, only full matched donors will be allowed and must be willing and capable of donating peripheral blood stem cells preferably, or bone marrow progenitor cells using conventional techniques, and lymphocytes if indicated.
3. Patients must sign written informed consents.
4. Patients must have an ECOG PS ≤ 2; creatinine \< 2.0 mg/dl; ejection fraction \> 40%; DLCO \> 50% of predicted; serum bilirubin \< 3 gm/dl; elevated GPT or GOT \> 3 x normal values.

2. Active life-threatening infection.
3. Overt untreated infection.
4. Hypersensitivity to alefacept.
5. HIV seropositivity, Hepatitis B or C antigen positivity with active hepatitis.
6. Pregnant or lactating women.
7. Donor contraindication (HIV seropositive confirmed by western blot).
8. Hepatitis B antigenemia.
9. Evidence of bone marrow disease.
10. Unable to donate bone marrow or peripheral blood due to concurrent medical condition.
11. Inability to comply with study requirements.

Minimum Eligible Age

14 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No