Cord Blood Infusion for Ischemic Stroke

NCT ID: NCT02397018

Last Updated: 2019-10-17

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 10 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-05-31
• Study Completion Date: 2017-02-23

Brief Summary

This is a phase one study investigating the safety of a single, intravenous infusion of banked allogeneic umbilical cord blood in subjects following an acute ischemic stroke. The cord blood infusion must be given within 3-10 days of the stroke. Follow up phone calls will occur at 1, 6, and 12 months post-infusion, and will include telephone surveys on post-stroke rehabilitation and functioning. A follow up clinic visit at 90 days will include a neurological exam, MRI, and blood tests.

Detailed Description

The purpose of this study is to assess the safety of a single, intravenous infusion of banked allogeneic umbilical cord blood in subjects within 3-10 days following an acute ischemic stroke. The subjects will not be pre-treated with immunosuppressive agents. The primary objective is safety assessment and the secondary objectives are to determine which outcome measures can be used as primary and secondary endpoints for future randomized Phase 2 clinical trials, and to describe clinical responses, if any. All subjects will receive standard of care acute and rehabilitation treatments while enrolled in this study.

This is a multicenter Phase 1 safety study in patients 18-80 years of age who have sustained a recent ischemic stroke. A total of 10 subjects will be enrolled. Subjects will be given a series of baseline neurological assessments, blood tests, and MRI. Umbilical cord blood units will be selected from a public cord blood bank based on ABO/Rh blood type and cell dose, targeting a range of 0.5 to 5 x 10^7 total nucleated cells/kg. Umbilical cord blood will be administered intravenously as a single infusion between 3 and 10 days post-stroke. Subjects will be monitored for 6 hours post-infusion, and follow up will occur 24 hours later. Subsequent follow up phone calls will occur at 1, 6, and 12 months, and will include telephone surveys on post-stroke rehabilitation and functioning. A follow up clinic visit at 90 days will include a neurological exam, MRI, and blood tests.

Risks of cord blood infusion include infusion-related reactions such as anaphylaxis, urticaria, dyspnea, hypoxia, cough, wheezing, bronchospasm, nausea, vomiting, hives, fever, hypertension, hypotension, bradycardia, tachycardia, rigors, chills, infection, and hemoglobinuria. Less likely, long-term risks include transmission of infection or Graft vs Host Disease.

Conditions

Stroke

Study Design

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

Study Groups

Allogeneic Umbilical Cord Blood Infusion

All subjects in this study will receive an intravenous infusion of ABO/Rh matched umbilical cord blood.

Group Type: EXPERIMENTAL

allogeneic umbilical cord blood

Intervention Type: BIOLOGICAL

Umbilical cord blood units will be selected from a public cord blood bank based on ABO/Rh blood type and cell dose, targeting a range of 0.5 to 5 x 10\^7 total nucleated cells per kilogram. The cord blood unit will be intravenously infused into the subject over 5-30 minutes at a rate not exceeding 5 mL/kg/hr. Subjects will not receive immunosuppressive medications or any other cytoreduction prior to infusion.

Interventions

allogeneic umbilical cord blood

Umbilical cord blood units will be selected from a public cord blood bank based on ABO/Rh blood type and cell dose, targeting a range of 0.5 to 5 x 10\^7 total nucleated cells per kilogram. The cord blood unit will be intravenously infused into the subject over 5-30 minutes at a rate not exceeding 5 mL/kg/hr. Subjects will not receive immunosuppressive medications or any other cytoreduction prior to infusion.

Intervention Type: BIOLOGICAL

Other Intervention Names

cord blood; umbilical cord blood

Eligibility Criteria

Inclusion Criteria

An individual is eligible for inclusion if all of the following apply:

1. Is 18-80 years old

2. Has had a recent (within the past 9 days), acute, cortical, hemispheric, ischemic stroke in the middle cerebral artery (MCA) distribution without a midline shift as detected by magnetic resonance imaging (MRI) as a diffusion-weighted image (DWI) abnormality

3. Has a National Institutes of Health Stroke Scale (NIHSS) score of 8-15 (R) and 8-18 (L) at the time of enrollment with no more than a 4 point increase (worsening of score) from the baseline score compared to 24 hours prior to infusion

4. Subjects must have a platelet count >100,000/uL, hemoglobin >8gm/dl, and white blood cell count (wbc) >2,500/uL.

5. Subjects who received tissue plasminogen activator (tPA) or underwent mechanical reperfusion may be included in the study.

6. Is able to provide consent to study or consent is obtained from the subject's legally authorized representative

7. Subjects of childbearing potential must practice effective contraception during the study, and be willing to continue contraception for at least 6 months after intervention so that, in the opinion of the investigator, they will not become pregnant during the course of the study

8. Is a good candidate for the trial, in the opinion of the investigator

9. Agrees to participate in follow up visits

10. Has an ABO/Rh matched umbilical cord blood unit with a minimum of 0.5 x 10^7 total nucleated cells (TNCC)/kg based on the pre-cryopreservation TNCC.

Exclusion Criteria

An individual is ineligible to participate if any of the following apply.

Medical Conditions:

1. Has a medical history of neurological or orthopedic pathology with a deficit as a consequence that results in a modified Rankin Scale >1 before stroke or has a pre-existing cognitive deficit

2. Has clinically significant and/or symptomatic hemorrhage associated with stroke

3. Has new intracranial hemorrhage, edema, or mass effect that may place patient at increased risk for secondary deterioration when assessed prior to infusion

4. Has hypotension as defined as the need for IV pressor support of systolic blood pressure <90

5. Has isolated brain stem stroke

6. Has pure lacunar stroke

7. Requires mechanical ventilation

8. Requires a craniotomy

9. Has a serious psychiatric or neurological disease which could alter evaluation on functional or cognitive scales

10. Has an active systemic infection or is HIV positive

11. Has had an active malignancy within 3 years prior to the start of screening excluding skin cancers other than melanoma

12. Has known coagulopathy such as Factor V Leyden, AntiPhospholipid Syndrome (APC), Protein C, Protein S deficiency, sickle cell, anticardiolipin antibody, or phospholipid syndrome

13. Has any concurrent illness or condition that in the opinion of the investigator might interfere with treatment or evaluation of safety

14. Has current or recent history of alcohol or drug abuse, or stroke associated with drug abuse

15. Pregnant as documented by urine or blood test

Concomitant or Prior Therapies:

1. Subjects currently receiving immunosuppressant drugs

2. History of prior transfusion reaction

3. Currently on dialysis

4. Recipient of bone marrow or organ transplant

5. Renal insufficiency with serum creatinine >2.0 mg/dL

6. Hepatic insufficiency (bilirubin >2.5mg/dL or transaminases >5x the upper limit of normal). Patients with Gilberts syndrome are eligible for study enrollment if other liver function tests are normal, regardless of bilirubin level.

7. Any previous or current treatment with angiogenic growth factors, cytokines, gene or stem cell therapy

8. Subjects participating in another interventional clinical trial of an investigational therapy within 30 days of screening

Other:

1. Pregnant or lactating women

2. Unable to be evaluated for follow up visits

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Joanne Kurtzberg, MD

OTHER

Sponsor Role: lead

Responsible Party

Joanne Kurtzberg, MD

Principal Investigator

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Joanne Kurtzberg, M.D.

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

Duke University Medical Center

Durham, North Carolina, United States

Houston Methodist

Houston, Texas, United States

Countries

United States

References

Laskowitz DT, Bennett ER, Durham RJ, Volpi JJ, Wiese JR, Frankel M, Shpall E, Wilson JM, Troy J, Kurtzberg J. Allogeneic Umbilical Cord Blood Infusion for Adults with Ischemic Stroke: Clinical Outcomes from a Phase I Safety Study. Stem Cells Transl Med. 2018 Jul;7(7):521-529. doi: 10.1002/sctm.18-0008. Epub 2018 May 12.

Reference Type: RESULT

PMID: 29752869 (View on PubMed)

Other Identifiers

Pro00059284

Identifier Type: -

Identifier Source: org_study_id