Overview

Lung Transplant Plasmapheresis/Belatacept/Carfilzomib for Antibody Mediated Rejection and Desensitization

Status:
Withdrawn
Trial end date:
2020-10-30
Target enrollment:
0
Participant gender:
All
Summary
Antibody mediated rejection (AMR) post transplant contributes to poor long term outcomes after lung transplantation. Additionally, high antibodies detected pre transplant in candidates limit donor availability for lung transplant. This proposal would include belatacept in a multi-therapy regimen. Open label study with two patient cohorts for safety and efficacy of belatacept in a multi-modal protocol. The two patient cohorts are an AMR post-transplant cohort and pre-transplant desensitization cohort. A total of 10 patients will be enrolled.The primary objection is drug tolerability and secondary objectives are antibody measurements and allograft function.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Duke University
Collaborator:
Bristol-Myers Squibb
Treatments:
Abatacept
Antibodies
Immunoglobulins
Criteria
Inclusion Criteria:

Inclusion criteria for the AMR post-transplant cohort

- Positive DSAs and allograft dysfunction defined by changes in pulmonary physiology,
gas exchange, radiological features or deteriorating functional performance that is
highly suspicious for AMR

- Recipient is Epstein-Barr virus positive (EBV+) by serology

- Ability to provide signed and dated IRB approved written consent in accordance with
regulatory and institutional guidelines prior to any protocol-related procedure

Inclusion criteria for the pre-transplant desensitization cohort

- Elevated HLA antibodies (defined as MFI >1000) such that the calculated panel reactive
antibodies are >60%

- At least 2 HLA antibodies with Mean Fluorescent Intensity (MFI) <10,000 and at least 2
HLA antibodies with MFI <5,000 on undiluted serum that do not demonstrate an increase
in MFI with dilution at 1:16 (no evidence of a prozone effect).

- EBV+ by serology

- Clinically stable defined by not on invasive mechanical ventilation, extracorporeal
membrane oxygenation support or other invasive life support requiring ICU level of
care

- Ability to provide signed and dated IRB approved written consent in accordance with
regulatory and institutional guidelines prior to any protocol-related procedure

Exclusion criteria for both AMR post-transplant cohort and pre-transplant cohort

- Active systemic infection

- Allergy to carfilzomib or belatacept

- Known malignancy in the previous 2 years except for non-melanomatous skin cancer

- Pregnancy

- Inability to commit to complete treatment protocol at Duke as all procedures must be
completed at Duke

- Prisoners or those who are compulsory detained