Patients Treated for SCID (1968-Present)

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Brief Title

Patients Treated for SCID (1968-Present)

Official Title

A Retrospective and Cross-Sectional Analysis of Patients Treated for SCID Since January 1,1968 (RDCRN PIDTC-6902)

Brief Summary

      Individuals with a past diagnosis of severe combined immune deficiency (including many cases
      of "leaky SCID", Omenn syndrome, and reticular dysgenesis) who have undergone blood and
      marrow transplant, gene therapy, or enzyme replacement in the past may be eligible for this
      study. The purpose of study is to look backwards at what has already been done in the. Over
      800 patients with SCID are expected to be enrolled, making this one of the largest studies
      ever to describe outcomes for patients with SCID treated at many different hospitals around
      North America.
    

Detailed Description

      One of the most important components of this study is the "cross sectional" aspect. Patients
      who have received their treatments (BMT, gene therapy, enzyme replacement) many years ago are
      asked to come back to the hospital where they were treated. During this visit, additional
      research bloodwork is drawn, and information is gathered regarding long-term transplant
      outcomes such as infections, graft-versus-host disease, autoimmune diseases, and quality of
      life. This will allow PIDTC researchers to better understand long-term outcomes from
      procedures that occurred many years ago (sometimes over 30 years ago). This will help
      researchers to best design new treatments and clinical trials in the future for children with
      SCID.
    


Study Type

Observational


Primary Outcome

Retrospective Study - Part 1

Secondary Outcome

 Retrospective Study Part 1

Condition

SCID


Study Arms / Comparison Groups

 Stratum A -Typical SCID
Description:  Typical Severe Combined Immunodeficiency (SCID), Adenosine Deaminase-Deficient ADA SCID, and X-linked SCID (XSCID) who received a transplant

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information



Estimated Enrollment

1007

Start Date

May 15, 2011

Completion Date

August 2023

Primary Completion Date

August 2023

Eligibility Criteria

        Inclusion Criteria:

        Strata A, B, and C (Part 1 - Retrospective Study)-

          -  Individuals with Severe Combined Immune Deficiency (SCID) diagnosis who:

             --were treated at a location participating in this consortium from 1968 until present,
             and

             --are not enrolled in RDCRN PIDTC-6901 (ClinicalTrials.gov ID: NCT01186913).

          -  Subjects who received HCT/GT/ERT prior to the present date are eligible for the
             retrospective study. The enrollment criteria for subjects who died prior to definitive
             therapy are the same as for Strata A, B and C.

        Stratum A, Typical SCID:

          -  Individuals who meet the following inclusion criteria and who received HCT are
             eligible for enrollment into Stratum A of the study:

               -  Absence or very low number of T cells (CD3 T cells < 300/microliter), and no or
                  very low T cell function (< 10% of lower limit of normal) as measured by response
                  to phytohemagglutinin (PHA) or cells of maternal origin present.

               -  If maternal cells are present but the patient does not meet criteria for very low
                  T cell function as defined, the assigned reviewers for the potential subject, and
                  if necessary, the full PID-SCID RP will review the laboratory report to determine
                  if criteria of maternal engraftment are met for Protocol 6902.

               -  Laboratory report of testing for maternal engraftment is required, for evaluation
                  by the PID-SCID RP.

        Stratum B, Leaky SCID, Omenn Syndrome, Reticular Dysgenesis:

        Individuals who meet the following criteria are eligible for enrollment into Stratum B of
        the study:

        Leaky SCID-

          -  Maternal lymphocytes tested for and not detected and,

          -  Either one or both of the following (a,b):

             a) < 50% of lower limit of normal T cell function (as measured by response to PHA OR <
             50% of lower limit of normal T cell function as measured by response to CD3/CD28
             antibody, b) Absent or < 30% lower limit of normal proliferative responses to candida
             and tetanus toxoid antigens postvaccination or exposure,

          -  AND at least one of the following (a through e):

               1. Reduced number of CD3 T cells,

               2. > 80% of CD3+ or CD4 T cells are CD45RO+,

          -  AND/OR >80% of CD3+ or CD4+ T cells are,CD62L negative,

          -  AND/OR >50% of CD3+ or CD4+ T cells express HLA-DR (at < 4 years of age),

          -  AND/OR are oligoclonal T cells. c) Hypomorphic mutation in IL2RG in a male, or
             homozygous hypomorphic mutation or compound heterozygosity with at least one
             hypomorphic mutation in an autosomal SCID-causing gene.

             d) Low TRECs and/or the percentage of CD4+/45RA+/CD31+ or CD4+/45RA+/CD62L+ cells is
             below the lower limit of normal.

             e) Functional testing in vitro supporting impaired, but not absent, activity of the
             mutant protein,

               -  AND does not meet criteria for Omenn Syndrome,

               -  AND does not have known selective loss of lymphocytes, Ataxia- Telangiectasia, or
                  congenital heart defect associated with lymphopenia, unless a SCID genotype is
                  also present.

        Omenn Syndrome (OS):

          -  Generalized skin rash,

          -  Maternal engraftment tested for and not detected,

          -  Absent or low (up to 30% of normal) T cell proliferation to antigens to which the
             patient has been exposed.

          -  If the proliferation to antigen was not performed, but at least 4 of the following 10
             supportive criteria, at least one of which must be among those marked with an asterisk
             (*) are present, the patient is eligible: hepatomegaly; splenomegaly; lymphadenopathy;
             elevated IgE; elevated absolute eosinophil count; *oligoclonal T cells measured by
             CDR3 length or flow cytometry >80% of CD4+ T cells are CD45RO+ ;*proliferation to PHA
             is reduced <50% of lower limit of normal or SI <30; *proliferative response in mixed
             leukocyte reaction is reduced to increment cpm < 20% or SI <20; hypomorphic mutation
             to SCID causing gene; low TRECs and/or percentage of CD 4+/ RA+/CD31+; or
             CD4+/RA+/CD62L+ cells below the lower limit of normal.

        Reticular Dysgenesis (RD):

          -  Absence or very low number of T cells (CD3 T cells <300/microliter),

          -  No or very low (<10% of lower limit of normal) T cell function (as measured by
             response to phytohemagglutinin (PHA),

          -  Severe congenital neutropenia (absolute neutrophil count <200/microliter),

          -  AND at least one of the following:

               -  Sensorineural deafness and/or absence of granulopoiesis at bone marrow
                  examination and/or a deleterious AK2 mutation,

               -  absence of granulopoiesis on bone marrow examination; a pathogenic mutation in
                  the adenylate kinase 2 (AK2) gene identified.

        Stratum C, SCID with Non-HCT Treatments:

        -Individuals who meet the following criteria and were treated with PEG-ADA or gene therapy
        with autologous modified cells are eligible for enrollment into Stratum C (SCID with
        non-HCT treatments) of the study-

        - Any SCID patient previously treated with a thymus transplant (includes intention to treat
        with HCT, as well as PEG-ADA ERT or gene therapy).

        Strata A, B, and C (Part 2 - Cross-Sectional Study):

        Patient inclusion criteria for the cross sectional study: Eligibility for Strata A, B and C
        are the same as for the retrospective study except that all the patients in the
        cross-sectional study are currently surviving and are at least 2 years post the most recent
        class of therapy.

        Exclusion Criteria:

        Parts 1 and 2 - Retrospective and Cross-Sectional Studies -

          -  Lack of appropriate testing to rule out HIV infection after 1997 (p24 antigen or more
             sensitive) or other cause of secondary immunodeficiency,

          -  Presence of DiGeorge syndrome,

          -  Most patients with other PIDs such as nucleoside phosphorylase deficiency, ZAP70
             deficiency, CD40 ligand deficiency, NEMO deficiency, XLP, cartilage hair hypoplasia or
             ataxia telangiectasia will not meet the inclusion criteria for Stratum A, B, or C
             above; however, a patient with one of the above may meet the inclusion criteria for
             Stratum B and if so will be included-

               -  MHC Class I and MHC Class II antigen deficiency are excluded,

               -  Metabolic conditions that imitate SCID or related disorders such as folate
                  transporter deficiency, severe zinc deficiency, transcobalamin deficiency.
      

Gender

All

Ages

N/A - N/A

Accepts Healthy Volunteers

No

Contacts

Elie Haddad, MD, PhD, , 

Location Countries

Canada

Location Countries

Canada

Administrative Informations


NCT ID

NCT01346150

Organization ID

DAIT RDCRN PIDTC-6902


Responsible Party

Sponsor

Study Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

Collaborators

 Primary Immune Deficiency Treatment Consortium (PIDTC)

Study Sponsor

Elie Haddad, MD, PhD, Study Chair, University of Montréal, CHU Sainte-Justine


Verification Date

November 2020