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Gut decontamination in pediatric allogeneic hematopoietic

Sponsored by Dana-Farber Cancer Institute

Phase Quota
Phase 2

This research study is for participants who are undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and are at risk for developing acute graft-versus-host disease (GVHD). GVHD is a complication of HSCT in which immune cells from the donor cause inflammation and injury to tissues and organs of the HSCT recipient. Vancomycin-polymyxin B (commonly called "vancopoly") is an oral antibiotic that is given to people undergoing allogeneic HSCT as a preventive measure for acute GVHD. This research study is studying the effects of vancopoly on the microorganisms living in the intestine during and after stem cell transplantation.

Study Start Date: January 2016

Estimated Completion Date: May 2023

Specialties: Pediatrics: Peds Gastroenterology Infectious Disease: GI Infectious Disease,Peds Infectious Disease Gastroenterology: GI Infectious Disease,Peds Gastroenterology

Interventions

  • Drug: Vancomycin-polymyxin B

Inclusion criteria

  • Eligibility Criteria for Patients Undergoing Allogeneic HSCT
  • Recipient of 10/10 (HLA-A, -B, -C, -DRB1, -DQB1) matched bone marrow allogeneic hematopoietic stem cell transplantation (HSCT) OR 6/6 (HLA-A, -B, -DR) matched cord blood allogeneic HSCT
  • Participants may have underlying malignant or non-malignant hematologic disease, except for primary immunodeficiency, as the indication for their allogeneic HSCT
  • Participants must receive a myeloablative conditioning regimen. Anti-thymocyte globulin (ATG) in the conditioning regimen is permitted
  • Graft-versus-host disease (GVHD) prophylaxis with a calcineurin inhibitor and short-course methotrexate with or without steroids
  • Age ≥  4 years old and toilet-trained. Participants must be able to deposit stool samples directly into stool collection containers. Stool specimens from diapers are difficult to obtain and are prone to more sampling error, particularly for loose or liquid stools which are common in the peri-transplant period
  • Lansky/Karnofsky performance status ?60% (see Appendix A)
  • Ability to understand and/or the willingness of their parent or legally authorized representative to sign a written informed consent document
  • Eligibility Criteria for Healthy Bone Marrow Donors
  • Healthy individuals, ages ≥  4 years and toilet-trained, who have been identified by BCH or DFCI providers as fully-matched, sibling bone marrow donors for transplantation will also be eligible to participate in this study

Exclusion criteria

  • Patients undergoing allogeneic HSCT for correction of a primary immunodeficiency disorder (e.g. SCID)
  • Recipients of mismatched allogeneic HSCT
  • Patients receiving a reduced-intensity (non-myeloablative) conditioning regimen
  • Patients with age 10 years undergoing HSCT with a matched sibling donor. These patients are at very low risk of acute GVHD and do not receive gut decontamination per our institutional standard practice
  • Participants receiving GVHD prophylaxis with drugs other than calcineurin inhibitors, methotrexate or steroids
  • History of allergic reactions attributed to oral vancomycin or oral polymyxin B
  • Participants undergoing active therapy for immune-mediated or infectious colitis upon admission for allogeneic HSCT
  • Participants receiving antibiotic therapy for treatment of a bacterial infection or bacterial prophylaxis upon admission for allogeneic HSCT. Use of any agent (e.g. sulfamethoxazole/trimethoprim) for prophylaxis of Pneumocystis jirovecii pneumonia is permitted. Concurrent use of anti-fungal and anti-viral therapies is also permitted
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection or psychiatric illness/social situations that would limit compliance with study requirements      

Study Locations And Contact Information

  • Boston Childrens Hospital, Boston Massachusetts
    Contact: Jennifer Whangbo MD PhD 617-632-2664
  • DanaFarber Cancer Institute, Boston Massachusetts
    Contact: Jennifer Whangbo MD PhD 617-632-2664 Jennifer_Whangbo@dfci.harvard.edu

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