Dexamethasone, Intravenous Injection of Human Immunoglobulin, and Increased Infusion of Mononuclear Cells to Reduce Donor Specific Antibodies in Haploidentical Hematopoietic Stem Cell Transplantation

Sponsor
Hematology department of the 920th hospital
Study ID
NCT07698080
Phase
PHASE2
Status
Not Yet Recruiting

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Conditions

Eligibility Criteria

Sex
ALL
Age
18 Years - 65 Years
Healthy Volunteers
Not accepted

Interventions

  • Intravenous Immunoglobulin — BIOLOGICAL
    1 g/kg intravenously on day -1 prior to transplant.
  • Dexamethasone — DRUG
    25 mg/m² intravenously for 4 days prior to transplant (days -4 to -1).
  • Mononuclear Cells — BIOLOGICAL
    Additional donor MNCs infused on day 0. Dose stratified by baseline DSA MFI level: ≤5000: +2±2×10⁸/kg; 5000-10000: +4±2×10⁸/kg; \>10000: +6±2×10⁸/kg.

Study Details

This study tests whether a combination of three treatments - dexamethasone (a steroid), intravenous immunoglobulin (IVIG, a protein that helps the immune system), and an extra dose of donor mononuclear cells - can safely lower harmful antibodies called donor-specific antibodies (DSA) in patients who need a stem cell transplant from a half-matched (haploidentical) family donor. In these transplants, DSA are antibodies made by the patient's own body that attack the donor's stem cells. If DSA levels are high, the transplant is more likely to fail - the donor cells may not "take" (engraft). Currently, there is no single, simple, and reliable way to reduce DSA, and many existing methods have drawbacks. Based on the investigators' earlier experience in 11 patients, this three-part approach seemed to work well. All patients successfully engrafted, and DSA levels dropped quickly. Now the study team want to confirm these results in a larger, prospective, multicenter study. The investigators plan to enroll 60 patients aged 18-65 with blood cancers or other blood disorders who need a haploidentical transplant, have DSA levels above 500 MFI (a measure of antibody strength), and have no other suitable donor available. Participants will receive: * Dexamethasone (25 mg/m²) for 4 days before transplant, * IVIG (1 g/kg) one day before transplant, * Extra mononuclear cells on transplant day - the extra amount depends on how high their DSA level is (low, medium, or high). The main goal is to see how many patients have primary graft failure (when the donor cells never engraft). The study team will also measure how long it takes for blood counts to recover, rates of graft-versus-host disease, survival, and side effects. All participants will be followed for 1 year. This study will help the investigators find out whether this combination is a safe, simple, and effective way to improve transplant success for patients with DSA who have no other donor options.

Key Dates

First listed
Jul 13, 2026
Start date
Jul 3, 2026
Status verified
Jul 2026
Primary completion
Jul 3, 2028
Completion
Jul 3, 2028

Study Design

Enrollment
60 participants (estimated)
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT

Arms

  • Experimental: Triple Therapy to Reduce DSA in Haploidentical HSCT: A Prospective Multicenter Study
    Participants receive dexamethasone (25 mg/m² × 4 days) and intravenous immunoglobulin (1 g/kg) prior to haploidentical hematopoietic stem cell transplantation, plus an additional dose of donor mononuclear cells on transplant day. The additional dose is stratified by baseline DSA MFI level: ≤5000: +2±2×10⁸/kg; 5000-10000: +4±2×10⁸/kg; \>10000: +6±2×10⁸/kg.

Primary Outcome Measure

Primary Graft Failure (PGF) [ Time Frame: Day +28 post-transplant ]

Central Contacts

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