A Phase II Study of Allogeneic Hematopoietic Stem Cell Transplant for Subjects With VEXAS (Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic) Syndrome
Background: Allogeneic hematopoietic stem cell transplant involves taking blood stem cells from a donor and giving them to a recipient. The transplants are used to treat certain diseases and cancers. Researchers want to see if the transplant can treat VEXAS Syndrome.
Objective: To see if stem cell transplants can be successfully performed in people with VEXAS and even improve the disease.
Eligibility: People ages 18-75 who have VEXAS Syndrome that has caused significant health problems and standard treatment either has not worked or is not available.
Design: Participants will be screened with: Physical exam Medical review Blood and urine tests Heart and lung function tests Bone marrow biopsy Participants will have a chest x-ray. They will have an imaging scan of the head, chest, abdomen, pelvis, and sinus. They will have a bone density scan. They will have a dental exam and eye exam. They will meet with specialists. They will repeat some screening tests. Participants will be admitted to the NIH hospital. They have a central venous catheter put into a vein in the chest or neck. They will receive drugs to prepare their bone marrow for the transplant. They may have total body irradiation. They will receive the donor stem cells through the catheter. They will get other drugs to prevent complications and infections. After discharge, they must stay in the DC area for 3 months for weekly study visits. Participants will have study visits 30, 60, 100, 180, 210, 240, 300, and 360 days later. After that, they will have yearly visits for 2 years and then be contacted yearly by phone....
• Non-disease related
⁃ Age \>= 18-year-old and \<= 75-year-old
⁃ Availability of an 8/8 or 7/8 HLA-matched related or unrelated donor, or a haploidentical related donor
⁃ Karnofsky performance status of \>= 40%
⁃ Adequate end-organ function, defined as follow:
∙ Left ventricular ejection fraction \> 35%, preferably by 2-D echocardiogram (ECHO) obtained within 60 days prior to treatment initiation.
‣ Creatinine \<= 2.0 mg/dl and creatinine clearance \>= 30 ml/min;
‣ Serum conjugated bilirubin \< 3.0 mg/dl; serum ALT and AST \<= 5 times upper limit of normal.
⁃ Pulmonary function tests: FEV1 and DLCO \>30%
⁃ Ability of subject to understand and the willingness to sign a written informed consent document.
⁃ As therapeutic agents used in this trial may be harmful to a fetus, individuals of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) at the study entry and for at least one-year post-allo HCT. Should an individual become pregnant or suspect they are pregnant while she or her partner is participating in the study, she should inform her treating physician immediately.
⁃ Willingness to remain in the NIH hospital or, if discharged, live within 2 hours drive from the NIH, for a minimum of 100 days after transplant or longer, if there are complications. If outpatient in the first 100 days after transplant, participant must commit to having an adult caregiver with them at all times.
• Disease related
⁃ Somatic mutation in UBA1 performed by a CLIA or CAP certified laboratory. NOTE: Participants without a mutation or unknown mutation status may be eligible if they have a clinical history that is characteristic of an individual with VEXAS syndrome including two or more of a-e below.
⁃ Inflammatory clinical phenotype for VEXAS syndrome with at least one VEXAS disease manifestation below:
∙ constitutional symptoms including fevers, fatigue, and weight loss
‣ cutaneous symptoms of VEXAS including biopsy proven neutrophilic dermatosis, cutaneous vasculitis, periorbital inflammation
‣ pulmonary symptoms of VEXAS with pulmonary infiltrates, pleural effusion
‣ musculoskeletal or cartilaginous involvement including inflammatory arthritis, ear chondritis, and nasal chondritis
‣ inflammatory disease in other major organ systems including cardiac, gastrointestinal, ocular, etc.
⁃ Presence of cytopenia defined as at least one of the following:
⁃ i. Absolute neutrophil count \<=1000/ microliter
• ii. platelet count \<= 75,000/microliter or platelet transfusion dependence (at least 4 platelet transfusions in the 8 weeks prior to study entry
• iii. hemoglobin \<= 10.0g/dL or red cell transfusion-dependence (at least 4 units of PRBCs in the 8 weeks prior to treatment initiation) or meeting criteria for myeloid neoplasm (MN) by updated 2022 WHO criteria or 2022 International Consensus Classification (ICC) of myeloid neoplasms and acute leukemia
• OR:
• Participants who have failed standard medical management (requiring \>= 0.5mg/kg per day of prednisone for the above listed inflammatory condition or intolerance or refractory to use of corticosteroids and/or steroid sparing medications as well as biological response modifiers over the last 6 months), or when no standard medical treatment is available.