Multi-institutional Prospective Pilot Research of Imaging and blood biomarker EValuation of Engraftment after ALlogeneic Hematopoietic Stem Cell Transplantation in Children and Adults (REVEAL)
Eligibility: Inclusion Criteria
• General
• Ability to undergo 18F FLT imaging without sedation
• Patients > 4 years of age and less than 70 years of age at highest risk for graft failure: cord blood HSCT, haplo HSCT, or lack of engraftment by day 28.
• Diagnosed with a condition for which hematopoietic stem cell transplant (HSCT) is standard of care and HSCT is planned (Arm A) or occurred (Arm B)
• Able to perform FLT imaging without anesthesia
• In morphologic remission prior to HSCT
• Patient or guardian able to give informed consent
• No investigational therapies within past 28 days Karnofsky or Lansky performance status > 60%
• Arm A
• Cord blood recipients: Absence of donor specific antibodies to cord HLA
• Haplo-identical recipients: >= 5/10 and 7/8 allele mismatch donor
• Diagnosed with a condition for which myeloablative hematopoietic stem cell transplant (HSCT) is standard of care and HSCT is planned
• Total bilirubin 2.5 mg/dL (unless documented Gilbert's syndrome) and transaminases (ALT and AST) 5 x the upper limit of normal
• Creatinine clearance or GFR > 60 ml/min/1.73 m2. (performed pre-HSCT)
• FEV1 > 80% pre or post-bronchiolator whichever is higher and DLCO Adj > 70% (performed pre-HSCT if age appropriate) and Sa02 > 94% on room air
• Ejection fraction > 50% (performed pre-HSCT)
• Arm B
• ¿ Non-engraftment recipients of cord or > 5/10 and 7/8 allele mismatch donor transplant (related or unrelated): primary graft failure as defined by ANC not > 500 for 3 consecutive days and at least 24 days after HSCT.
• Inclusion Criteria - Donors
• 2 cords and >.4/6 match to recipient for each (as per current National Marrow Donor guidelines), with a dose >2 x 10e6 CD34 cells/kg for each cord OR > 5/10 and 7/8 allele mismatch related donor
• Institutional guidelines met for donor suitability
Exclusion Criteria
• History of psychiatric disorder which may compromise compliance with transplant protocol, or which does not allow for appropriate informed consent
• Clinically significant systemic illness with manifestations of significant organ dysfunction which, in the judgment of the PI, or Co-I, would render the patient unlikely to tolerate the protocol therapy or complete the study
• Presence of active malignancy from an organ system other than hematopoietic
• Pregnant or lactating females
• Patients who are unable or unwilling to use effective form (s) of contraception during the course of the study
• Prior history of fluorothymidine allergy or intolerance
• Decline enrolment on CIBMTR research protocol