Trial Outcomes & Findings for Desensitization in Kidney Transplantation (NCT NCT00908583)

NCT ID: NCT00908583

Last Updated: 2016-04-01

Results Overview

Number of living donor transplant candidates who convert to a negative flow T- and B-cell crossmatch via desensitization and are subsequently transplanted

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

44 participants

Primary outcome timeframe

1 year post baseline

Results posted on

2016-04-01

Participant Flow

Subjects could be enrolled in multiple study phases. Enrollment in phases 1-2 was an adaptive approach and was fixed a priori in Phases 3-5. The adaptive approach was based on treatment effect (immunodominant antibody (iAb) reduction).

44 subjects received 52 treatments in this study. 7 subjects were enrolled in multiple phases. Four patients received treatment in two study phases (two patients were enrolled in Phases 1 and 2, one patient was enrolled in study Phases 1 and 3, and one patient was enrolled in Phases 2 and 3). One patient was enrolled in Phases 1, 2 and 4.

Participant milestones

Participant milestones
Measure
All Study Participants
Combined study participants all phases.
Phase 1
STARTED
20
Phase 1
COMPLETED
15
Phase 1
NOT COMPLETED
5
Phase 2
STARTED
12
Phase 2
COMPLETED
10
Phase 2
NOT COMPLETED
2
Phase 3
STARTED
10
Phase 3
COMPLETED
8
Phase 3
NOT COMPLETED
2
Phase 4
STARTED
5
Phase 4
COMPLETED
3
Phase 4
NOT COMPLETED
2
Phase 5
STARTED
5
Phase 5
COMPLETED
2
Phase 5
NOT COMPLETED
3

Reasons for withdrawal

Reasons for withdrawal
Measure
All Study Participants
Combined study participants all phases.
Phase 1
Withdrawal by Subject
1
Phase 1
Adverse Event
4
Phase 2
Physician Decision
1
Phase 2
Adverse Event
1
Phase 3
Adverse Event
2
Phase 4
Adverse Event
1
Phase 4
Physician Decision
1
Phase 5
Adverse Event
3

Baseline Characteristics

Desensitization in Kidney Transplantation

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
All Study Participants
n=44 Participants
Combined study participants, all phases.
Age, Continuous
45.2 years
STANDARD_DEVIATION 10.2 • n=93 Participants
Sex: Female, Male
Female
28 Participants
n=93 Participants
Sex: Female, Male
Male
16 Participants
n=93 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=93 Participants
Race (NIH/OMB)
Asian
0 Participants
n=93 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=93 Participants
Race (NIH/OMB)
Black or African American
16 Participants
n=93 Participants
Race (NIH/OMB)
White
28 Participants
n=93 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=93 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=93 Participants
Region of Enrollment
United States
44 participants
n=93 Participants

PRIMARY outcome

Timeframe: 1 year post baseline

Number of living donor transplant candidates who convert to a negative flow T- and B-cell crossmatch via desensitization and are subsequently transplanted

Outcome measures

Outcome measures
Measure
Phase 1, Cycle 1
n=44 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 1 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Number of Living Donor Transplant Candidates That Are Transplanted
19 participants

SECONDARY outcome

Timeframe: Study Day 62

Incidence of grade 3 and above non-hematologic toxicities. Incidence of grade 4 hematologic toxicities. Incidence of all grades of peripheral neuropathy. Incidence of Cytomegalovirus (CMV), Polyomavirus Allograft Nephropathy (PVN), and Posttransplant Lymphoproliferative Disorder (PTLD).

Outcome measures

Outcome measures
Measure
Phase 1, Cycle 1
n=19 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 1 Cycle 2
n=16 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Cycle 1
n=11 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2 Cycle 2
n=10 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 1
n=10 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 2
n=8 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
n=4 Participants
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
n=5 Participants
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Overall Safety of Bortezomib
Incidence of CTCAE Grade 3 Anemia (<8.0-6.5 g/dL)
1 participants
2 participants
1 participants
0 participants
0 participants
0 participants
0 participants
1 participants
Overall Safety of Bortezomib
Incidence of CTCAE Grade 4 Anemia (<6.5g/dL)
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of CTCAE Grade 3 Thrombocytopenia
1 participants
2 participants
0 participants
0 participants
1 participants
1 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of CTCAE Grade 4 Thrombocytopenia
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of CTCAE Grade 3 Neutropenia
0 participants
1 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of CTCAE Grade 4 Neutropenia
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of new onset level 1 PN
1 participants
0 participants
3 participants
2 participants
0 participants
1 participants
0 participants
1 participants
Overall Safety of Bortezomib
Incidence of new onset level 2 PN
5 participants
3 participants
2 participants
3 participants
2 participants
1 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of new onset level 3 PN
1 participants
3 participants
0 participants
0 participants
1 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of new onset level 4 PN
0 participants
1 participants
1 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Incidence of new onset level 5 PN
1 participants
0 participants
0 participants
0 participants
0 participants
1 participants
0 participants
0 participants
Overall Safety of Bortezomib
CMV D+/R- Status
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
CMV Viremia or Invasive Disease
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Polyomavirus Allograft Nephropathy (PVN)
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
Overall Safety of Bortezomib
Malignancy
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants
0 participants

SECONDARY outcome

Timeframe: 46 days

Number of patients on the waiting list whose cytotoxic PRA is decreased by 50%.

Outcome measures

Outcome measures
Measure
Phase 1, Cycle 1
n=44 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 1 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Number of Patients Whose Cytotoxic Panel Reactive Antibody (PRA) is Decreased by 50%
6 participants

SECONDARY outcome

Timeframe: 6 months post transplant

Population: One graft loss occurred due to graft thrombosis within 24 hours (due to unrecognized hypercoagulability disorder without AMR). Two patients were transplanted at other centers and data was not available. This dropped the number of analyzed patients to 16 from 19.

Acute rejection rate at 6 months of all desensitized and transplanted patients

Outcome measures

Outcome measures
Measure
Phase 1, Cycle 1
n=16 Participants
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 1 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2 Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 1
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3, Cycle 2
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Acute Rejection Rate
3 participants

Adverse Events

Phase 1, Two Stages

Serious events: 6 serious events
Other events: 2 other events
Deaths: 0 deaths

Phase 2, Two Stages

Serious events: 1 serious events
Other events: 4 other events
Deaths: 0 deaths

Phase 3

Serious events: 4 serious events
Other events: 4 other events
Deaths: 0 deaths

Phase 4, Single Stage

Serious events: 2 serious events
Other events: 0 other events
Deaths: 0 deaths

Phase 5, Single Stage

Serious events: 2 serious events
Other events: 1 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Phase 1, Two Stages
n=20 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Two Stages
n=12 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3
n=10 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
n=5 participants at risk
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
n=5 participants at risk
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Musculoskeletal and connective tissue disorders
Generalized Weakness
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Hepatobiliary disorders
Pancreatitis
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Hepatobiliary disorders
Elevated Liver Function Test
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Cardiac disorders
Chest Pain
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Nervous system disorders
Seizure
10.0%
2/20 • Number of events 2 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Gastrointestinal disorders
Nausea/Vomiting
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
40.0%
2/5 • Number of events 2 • 1 year
0.00%
0/5 • 1 year
General disorders
Hypoxemia
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Nervous system disorders
Peripheral Neuropathy
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Cardiac disorders
Atrial Fibrillation
0.00%
0/20 • 1 year
8.3%
1/12 • Number of events 1 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Respiratory, thoracic and mediastinal disorders
Dyspnea
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
10.0%
1/10 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Eye disorders
Blurred Vision
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
20.0%
2/10 • Number of events 2 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Gastrointestinal disorders
Abdominal Pain
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
10.0%
1/10 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
General disorders
Headache
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
20.0%
1/5 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
Endocrine disorders
Diarrhea
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
20.0%
1/5 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
Metabolism and nutrition disorders
Hypocalcemia
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
20.0%
1/5 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
Skin and subcutaneous tissue disorders
Perivascular Dermatitis
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
20.0%
1/5 • Number of events 1 • 1 year
General disorders
Facial Weakness
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
20.0%
1/5 • Number of events 1 • 1 year

Other adverse events

Other adverse events
Measure
Phase 1, Two Stages
n=20 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 2, Two Stages
n=12 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 3
n=10 participants at risk
Deletional, two stage approach with terminal plasmapheresis Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 4, Single Stage
n=5 participants at risk
Deletional, one stage approach with six doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Phase 5, Single Stage
n=5 participants at risk
Deletional, one stage approach with eight doses of plasmapheresis prior to each bortezomib dose Deletional therapy/plasmapheresis: B lymphocyte/plasma cell deletional therapy will be administered
Infections and infestations
Pneumonia
0.00%
0/20 • 1 year
16.7%
2/12 • Number of events 2 • 1 year
20.0%
2/10 • Number of events 2 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Infections and infestations
Upper Respiratory Infection
0.00%
0/20 • 1 year
16.7%
2/12 • Number of events 2 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
20.0%
1/5 • Number of events 1 • 1 year
Nervous system disorders
Peripheral Sensory Neuropathy (PN)
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Blood and lymphatic system disorders
Thrombocytopenia
5.0%
1/20 • Number of events 1 • 1 year
0.00%
0/12 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Infections and infestations
Foot Infection
0.00%
0/20 • 1 year
8.3%
1/12 • Number of events 1 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Respiratory, thoracic and mediastinal disorders
Pulmonary Edema
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
10.0%
1/10 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Infections and infestations
Upper Respiratory Viral Infection
0.00%
0/20 • 1 year
8.3%
1/12 • Number of events 1 • 1 year
0.00%
0/10 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year
Cardiac disorders
Cardiopulomonary Instability
0.00%
0/20 • 1 year
0.00%
0/12 • 1 year
10.0%
1/10 • Number of events 1 • 1 year
0.00%
0/5 • 1 year
0.00%
0/5 • 1 year

Additional Information

E. Steve Woodle

University of Cincinnati

Phone: 513-558-6001

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place