Autologous Stem Cell Transplant for Crohn's Disease

ID#: NCT03219359

Age: 18 years - 66+

Gender: All

Healthy Subjects: No

Study Phase: Phase 2

Recruitment Status: Recruiting

Start Date: July 12, 2017

End Date: January 01, 2021

Contact Information:
Louis Cohen, MD
(212) 241-8100
Aaron Etra, MD
Summary: Crohn's Disease (CD) is an inflammatory bowel disease. It can lead to significant complications and discomfort in the stomach and intestines. Crohn's disease is a debilitating, incurable disease of immune cells; it affects almost 1 million people in the United States. CD is characterized by inflammation of the stomach and intestine as well as organs outside of the intestines such as the skin, eyes, and joints. Current therapies to treat CD aim to suppress the patient's immune cells but these therapies become ineffective for the majority of patients and lead to complications including the requirement for surgical bowel resection, impaired quality of life, and lifelong disability. Hematopoietic stem cell transplantation (HCT) is a procedure used to treat a number of medical conditions including Crohn's disease. To improve success of HCT in CD doctors considered combining transplant with other drugs to improve the chances of achieving remission and also maintaining the remission. The Investigators' plan in this study is to incorporate the drug Vedolizumab after transplant to test if this drug will improve remission and make patients healthier. Patients may qualify to take part in this research study because Crohn's disease is active, because surgery is not a treatment option and because there is evidence that the disease has failed to respond to treatments for Crohn's disease including the following: - corticosteroids - azathioprine, 6-mercaptopurine, methotrexate - Anti-TNFα (infliximab, adalimumab, certolizumab, golimumab) - Anti-integrin agents (natalizumab, Vedolizumab) If patients meet entry criteria will undergo a baseline endoscopy, colonoscopy and MR or CT enterography. If documentation of active mucosal disease patients will then be tapered off of current medications and undergo stem cell mobilization. Mobilization will involve low dose chemotherapy, growth factors and require 1-2 week hospitalization. Patients will then undergo stem cell transplant which will involve high dose chemotherapy and require a 2-4 week hospitalization. After restoration of the immune system patients will be placed on vedolizumab per standard dosing (0,2,6 then 8 every weeks) for a total of 8 doses. Patients will have monthly study visits and a repeat colonoscopy and MR/CT scan at 6 months.

Inclusion Criteria:

- Diagnosis of Crohn's disease by standard criteria

- Active disease based on clinical symptoms, defined as CDAI >250. In patients with an ostomy, the number of liquid stools score in the CDAI will be replaced by the number of times that the ostomy bag is emptied daily.

- Active disease based on endoscopic evaluation, defined as SES-CD score > 3 in at least one bowel segment

- Failure to respond to (or intolerant/adverse reaction to or declines) a member of each of the class of drugs listed below:

1. corticosteroids

2. azathioprine,

3. 6-mercaptopurine, methotrexate

4. Anti-TNFα (infliximab, adalimumab, certolizumab, golimumab)

5. Anti-integrin agents (natalizumab, vedolizumab)

6. Ustekinumab

- Failure to respond refers to ongoing objective inflammation with symptoms and, as is traditional, is defined by the gastroenterologist evaluating the patient.

- No surgical therapeutic option secondary to risk of short bowel syndrome or patient refusal

Exclusion Criteria:

- History of significant toxicity to any medications used in trial (cyclophosphamide, thymoglobulin, vedolizumab)

- Pregnant or breastfeeding

- Age <18

- Karnofsky Performance Score <60

- Patients who have an uncontrolled infection (presumed or documented) despite appropriate therapy for at least one month

- Patients with symptomatic coronary artery disease or uncontrolled congestive heart failure.

- HIV infected

- Ejection fraction <30% or requiring supplemental continuous oxygen.

- DLCO <35% or requiring supplementary oxygen.

- Patients for whom an insufficient number of stem cells (<2 X 10^6/kg) have been collected.