Autologous Stem cell Transplantation In refractory Crohn’s disease – Low Intensity Therapy Evaluation
The ASTIClite trial whether testing if autologous haematopoietic stem cell transplant is an effective treatment for Crohn’s disease in patients who have not responded to current licensed treatments.
Crohn’s disease is a long term condition that causes inflammation of the lining of the digestive system. It most commonly occurs in the small and large intestine. There is no cure for Crohn’s disease.
Current treatments include steroids, immunosuppressants, biologics (such as anti-TNF therapy or Vedolizumab) and specialised nutritional diets. These treatments are used to help reduce the degree of intestinal inflammation and hence the symptoms of Crohn’s disease; however some patients do not respond to these treatments or experience only temporary benefit, which is why the search for more effective treatments is continuing.
An experimental treatment has been developed for severe Crohn’s disease, called ‘high dose immunoablation followed by autologous hematopoietic stem cell transplantation’. Hematopoietic blood stem cells are young, undifferentiated blood cells that can develop into differentiated ones, including lymphocytes. Over-active lymphocytes are thought to contribute to the development of Crohn’s disease. This treatment involves removing over-active lymphocytes from the blood and bone marrow and replacing them using blood stem cells taken from the patient earlier in the process.
At present, over 100 patients suffering from Crohn’s disease have been treated with stem cell transplantation worldwide. The results from those studies suggest that the therapy may be effective, but it cannot be concluded yet whether this treatment is better than any current standard treatment. In addition, participants in previous studies reported significant side effects from the high intensity treatment, most commonly relating to infections during the treatment. In response to this, a low intensity treatment has been developed, but not yet tested against the current standard treatment.
The ASTIClite trial aims to assess whether stem cell transplantation, with a low intensity treatment regimen, can reduce the symptoms and activity of Crohn’s disease and enhance quality of life, compared to current standard care. The trial will also assess the safety of the procedure, explore the mechanisms involved in immune reconstitution and whether patients who do experience recurrent disease after the stem cell transplant will respond to treatments which had not worked previously. Finally, we will assess the long-term safety and efficacy in patients undergoing stem cell transplantation over a minimum of a further 4 years.
Potential participants will be discussed by a multidisciplinary team of gastroenterologists and haematologists to ensure stem cell transplantation would be appropriate. After informed consent, they will then undergo a series of screening investigations to confirm they meet the inclusion criteria for the trial. If eligible, they will be randomised to either receive the haematopoietic stem cell transplant (HSCT) or usual care. Two patients will receive stem cell transplant for each patient that receives usual care.
Usual care can be any current treatment available for Crohn’s disease, except for stem cell transplant. For patients who are randomised to the transplant, stem cells will be removed (harvested) from patients in a process called mobilisation and stored for later use. Patients will then undergo chemotherapy to eliminate their immune cells. Then, the stem cells that were harvested earlier are transplanted (re-infused) into the patients’ blood. The re-infused stem cells give rise to a new generation of immune cells, replacing cells of the original ‘sick’ immune system.
Both groups will be followed intensively for 48 weeks. By comparing the progress of patients who undergo stem cell transplantation with those who receive usual care, the study will allow the value of stem cell transplantation to be assessed. Patients will also be invited to consent to a longer term follow up study, which will collect data on the safety and efficacy of the HSCT procedure for at least a further four years after the main trial. This data will be collected through the EBMT registry.
If you have any questions, please contact us on our central team email address: firstname.lastname@example.org
|Barts Health NHS Trust||Prof James Lindsay||Prof John Gribben|
|Cambridge University Hospitals NHS Foundation Trust||Dr Miles Parkes||
Dr Ben Uttenthal
|Edinburgh Western General Hospital, NHS Lothian||Dr Shahida Din||Dr Peter Johnson|
|Guy’s & St Thomas’ NHS Foundation Trust
(Transplant Centre: King’s College Hospital NHS Foundation Trust)
|Dr Peter Irving||Dr Majid Kazmi|
|Royal Liverpool and Broadgreen University Hospital NHS Trust
(Transplant Centre: Clatterbridge Cancer Centre NHS Foundation Trust)
|Dr Sreedhar Subramanian||Dr Amit Patel|
|Nottingham University Hospitals NHS Trust||Dr Gordon Moran||
Dr Jenny Byrne
|Oxford University Hospitals NHS Foundation Trust||Prof Simon Travis||Dr Andy Peniket|
|Sheffield Teaching Hospitals NHS Foundation Trust||Prof Alan Lobo||Prof John Snowden|
- Prof James Lindsay
- Prof John Snowden
- Dr Daniel Hind
- Diana Papaioannou (on Maternity Leave)
- Lizzie Swaby (on Maternity Leave)
- Elena Sheldon
- Hannah Berrntsson
- Heather Dakin
- Mike Bradburn
- Ellen Lee
- Amanda Loban,
- Kirsty Pemberton
- Chris Turtle
- Emily Turton
This project is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership (project number 15/178/09). The views expressed in this publication are those of the author(s) and not necessarily those of the MRC, NHS, NIHR or the Department of Health.
Bart’s Health NHS Foundation Trust
- ISRCTN - ASTIClite RCT
- ISRCTN - ASTIClite EBMT follow up study
- NIHR EME
- Prospect (login access required)
- Scram (login access required)
- ASTiClite Protocol v7.1 (12 July 2019) (PDF, 1.5MB)
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