Sirolimus (Rapamune ) for Relapse Prevention in People With Severe Aplastic Anemia Responsive to Immunosuppressive Therapy

Launched by NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) · Dec 1, 2016

Keywords

ClinConnect Summary

This clinical trial is studying whether a medication called sirolimus can help prevent severe aplastic anemia (SAA) from coming back after patients stop taking another medication called cyclosporine. SAA is a condition where the body doesn’t produce enough blood cells, which can be very serious. While cyclosporine can improve blood counts, stopping it may lead to a relapse in about one-third of patients. By comparing patients who take sirolimus after stopping cyclosporine to those who just stop cyclosporine, researchers hope to find out if sirolimus makes a difference in keeping the disease from returning.

To participate in this trial, individuals must be at least 2 years old and have been responding well to treatment that included cyclosporine for the past six months. Participants will be closely monitored over a period of five years, including weekly blood tests and periodic check-ups, to see how they respond to the treatments. If you or a family member are considering joining, it’s important to know that this study is looking for people who have had a good response to previous treatments and are not currently taking certain medications that could interfere with the study.

Gender

ALL

Eligibility criteria

• * INCLUSION CRITERIA:
• • 1. Age greater than or equal to 2 years old
• • 2. Weight greater than 12 kg
• • 3. Previous diagnosis of SAA by bone marrow biopsy and cytogenetics, treated with lymphodepleting therapy ATG, cyclophosphamide or alemtuzumab that included cyclosporine. The lymphodepleting therapy must have been administered at least 12 months prior.
• • 4. Continuous treatment with cyclosporine for the previous 6 months (excluding minor dose delays not exceeding more than 30 days).
• 5. Evidence of a hematologic response to an lymphodepletion-based regimen as evidence of at least two of the following:
• • Absolute neutrophil count greater than or equal to 500/uL
• • Platelet count greater than or equal to 20,000/uL (without transfusion support)
• • Absolute reticulocyte count greater than or equal to 60,000/uL (or hemoglobin 10 gm/dL without transfusion support)
• EXCLUSION CRITERIA:
• • 1. Evidence of relapse of aplastic anemia due to cyclosporine withdrawal during the previous 6 months
• • 2. Prior use of sirolimus or other mTOR inhibitor within 12 weeks of study entry
• • 3. Myelodysplastic syndrome or acute myeloid leukemia, according to WHO diagnostic criteria (if baseline BM consistent with MDS after enrollment, patients will be considered ineligible and immediately exit the study, and the subject can be replaced with another subject)
• • 4. Patients that are on CYP3A4 inhibitors and cannot replace these medications with other equivalent medications for the period of study: protease inhibitors (ritonavir, indinavir, nelfinavir, saquinavir), some macrolide antibiotics (clarithromycin, telithromycin, erythromycin), azole anti-fungals (fluconazole, itraconazole, ketoconazole), metroclopramide, felodipine, nifedipine, carbamazepine, phenobarbital, grapefruit juice and St. John s Wort.
• • 5. Anaphylactic or hypersensitivity reaction to sirolimus
• • 6. Patients with infections not adequately responding to appropriate therapy as evidenced by persistence of a clear source of infection that, in the view of the investigator, would preclude safe treatment with sirolimus.
• • 7. Current pregnancy, or unwillingness to take oral contraceptives or use the barrier methods of birth control or practice abstinence to refrain from pregnancy if of childbearing potential during the course of the study 8. Lactating women, due to the potentially harmful effects on the nursing child.
• • 9. Patients who have received live vaccines within the past 30 days
• • 10. Patients with cancer who are actively receiving chemotherapeutic treatment or who take drugs with hematological effects such as thrombopoietin receptor agonists (such as eltrombopag), granulocyte-colony stimulating factor or erythroid stimulating agents.
• • 11. Moribund status such that death within 7 to 10 days is likely. Comorbidities of such severity that in the view of the Investigator it would likely preclude the patient's ability to tolerate sirolimus.
• • 12. Inability to understand the investigational nature of the study or to give informed consent or without a legally authorized representative or surrogate that can provide informed consent.