This study is currently recruiting participants.
Number
19-I-0140
Sponsoring Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Recruitment Detail
Type: Participants currently recruited/enrolled Gender: Male & Female Min Age: 18 Years Max Age: 70 Years
Referral Letter Required
Yes
Population Exclusion(s)
Fetuses;Pregnant Women;Children
Keywords
CD8 Counts; B-Cell Activating Factor (BAFF); Heterogeneous Disorder; Autoimmune Disease
Recruitment Keyword(s)
None
Condition(s)
Idiopathic CD4 Lymphopenia
Investigational Drug(s)
Investigational Device(s)
Intervention(s)
Biological/Vaccine: Belimumab
Supporting Site
National Institute of Allergy and Infectious Diseases
People with Idiopathic CD4 lymphopenia (ICL) have lower numbers of a type of white blood cell called CD4 cells. White blood cells fight against infections. Low levels of CD4 cells may make a person more likely to get sick. There are no approved treatments for ICL. Researchers think a drug called belimumab may be able to help in specific situations.
Objective:
To see if belimumab is safe for people with ICL.
Eligibility:
People ages 18-70 who have ICL and are participating in NIH protocol 09-I-0102 (EPIC)
Design:
Participants will be screened with:
Medical and medication history
Physical exam
Questionnaire about mental health and depression
Blood and urine tests
Participants will have a baseline visit. This will include some repeats of the screening tests. They may also have leukapheresis: Blood will be taken from a needle in one arm and passed through a machine that separates out the white blood cells. The rest of the blood will be returned through a needle in the other arm.
Participants will receive 8 doses of belimumab through IV: A needle will insert a thin plastic tube into an arm vein. Belimumab will be given through the IV line. The first 3 doses will be given every 2 weeks. The other 5 will be given once every 4 weeks. Participants will have a physical exam and blood and urine tests at each dosing visit. They will be monitored for up to 4 hours after the infusion.
Participants will have 3 follow-up visits, at around 8, 16, and 24 weeks after the last dose of belimumab. They will have a physical exam and blood and urine tests. Once they finish this protocol and they will continue to be followed under 09-I-0102 (EPIC study).
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INCLUSION CRITERIA: Individuals must meet all of the following criteria to be eligible for study participation: -Aged 18-70 years. -Enrolled in study 09-I-0102. -Has a documented diagnosis of ICL, defined as the following: --CD4 count < 300 cells/microliter in at least 2 separate measurements 6 weeks apart at any point in the past, AND --CD4 count < 300 cells/microliter within previous 90 days. -Evidence for autoantibody positivity (eg, ANA or in the research flow method looking for antilymphocyte antibodies). -Female participants of childbearing potential must agree to use adequate contraception when engaging in sexual activities that can result in pregnancy, beginning at day 0 (or day 30 for hormonal contraception) until 4 months after the last dose of belimumab. Acceptable methods of contraception include the following: --Hormonal contraception. --Male or female condom. --Diaphragm or cervical cap with a spermicide. --Intrauterine device. -Able to provide informed consent. -Willing to allow samples to be stored for future research. EXCLUSION CRITERIA: Individuals meeting any of the following criteria will be excluded from study participation: -Prior receipt of belimumab for any reason. -Allergy to any component of belimumab formulation. -HIV infection or other recognized congenital or acquired immunodeficiency. -Current moderate or severe acute illness (eg, febrile illness, seizure, myocardial infarction, cerebrovascular accident, pulmonary embolism) or progressive serious infection related to ICL that, in the opinion of the principal investigator, would make the participant unsuitable for the study. Pre-existing infections that have been stable both clinically and with laboratory (eg, cryptococcal antigen titer or histoplasma antigen level) and radiographic evaluations on maintenance therapy over at least a year will be eligible. -Untreated hepatitis B or C (acute or chronic). -Active tuberculosis infection. -Serum creatinine > 1.5 times the upper limit of normal (ULN). -Hemoglobin < 8 g/dL. -Alanine transaminase or aspartate transaminase > 2 times ULN. -Serum IgG < 400 mg/L. -Current use of systemic glucocorticosteroids, with the exception of corticosteroid nasal spray or inhaler and topical steroids. -Any cancer diagnosis or autoimmune condition requiring systemic chemotherapy or immunomodulant-affecting antibody responses (eg, rituximab, ibrutinib), IV or SC Ig supplementation, radiation therapy, or any such treatment within the previous 6 months. Apremilast, Plaquenil, or nonsteroidal anti-inflammatory drugs will not be exclusionary. -Severe depression. Psychiatry may be consulted prior to final eligibility decision. -Infections (recently acquired or exacerbation of a chronic infection) that required new medications for management within the past 60 days. -Receipt of any vaccination within the past 30 days. -Pregnant. -Breastfeeding. -Any behavioral or substance use issue that would compromise appropriate follow up and participation in this study. Concomitant diagnosis of SLE will not be exclusionary. Although SLE can be associated with lymphopenia, patients with lupus and extreme lymphopenia in the absence of cytotoxic or immunosuppressive medications and history of unusual infections will be eligible if they are participants of study 09-I-0102.
Individuals must meet all of the following criteria to be eligible for study participation:
-Aged 18-70 years.
-Enrolled in study 09-I-0102.
-Has a documented diagnosis of ICL, defined as the following:
--CD4 count < 300 cells/microliter in at least 2 separate measurements 6 weeks apart at any point in the past, AND
--CD4 count < 300 cells/microliter within previous 90 days.
-Evidence for autoantibody positivity (eg, ANA or in the research flow method looking for antilymphocyte antibodies).
-Female participants of childbearing potential must agree to use adequate contraception when engaging in sexual activities that can result in pregnancy, beginning at day 0 (or day 30 for hormonal contraception) until 4 months after the last dose of belimumab.
Acceptable methods of contraception include the following:
--Hormonal contraception.
--Male or female condom.
--Diaphragm or cervical cap with a spermicide.
--Intrauterine device.
-Able to provide informed consent.
-Willing to allow samples to be stored for future research.
EXCLUSION CRITERIA:
Individuals meeting any of the following criteria will be excluded from study participation:
-Prior receipt of belimumab for any reason.
-Allergy to any component of belimumab formulation.
-HIV infection or other recognized congenital or acquired immunodeficiency.
-Current moderate or severe acute illness (eg, febrile illness, seizure, myocardial infarction, cerebrovascular accident, pulmonary embolism) or progressive serious infection related to ICL that, in the opinion of the principal investigator, would make the participant unsuitable for the study. Pre-existing infections that have been stable both clinically and with laboratory (eg, cryptococcal antigen titer or histoplasma antigen level) and radiographic evaluations on maintenance therapy over at least a year will be eligible.
-Untreated hepatitis B or C (acute or chronic).
-Active tuberculosis infection.
-Serum creatinine > 1.5 times the upper limit of normal (ULN).
-Hemoglobin < 8 g/dL.
-Alanine transaminase or aspartate transaminase > 2 times ULN.
-Serum IgG < 400 mg/L.
-Current use of systemic glucocorticosteroids, with the exception of corticosteroid nasal spray or inhaler and topical steroids.
-Any cancer diagnosis or autoimmune condition requiring systemic chemotherapy or immunomodulant-affecting antibody responses (eg, rituximab, ibrutinib), IV or SC Ig supplementation, radiation therapy, or any such treatment within the previous 6 months. Apremilast, Plaquenil, or nonsteroidal anti-inflammatory drugs will not be exclusionary.
-Severe depression. Psychiatry may be consulted prior to final eligibility decision.
-Infections (recently acquired or exacerbation of a chronic infection) that required new medications for management within the past 60 days.
-Receipt of any vaccination within the past 30 days.
-Pregnant.
-Breastfeeding.
-Any behavioral or substance use issue that would compromise appropriate follow up and participation in this study.
Concomitant diagnosis of SLE will not be exclusionary. Although SLE can be associated with lymphopenia, patients with lupus and extreme lymphopenia in the absence of cytotoxic or immunosuppressive medications and history of unusual infections will be eligible if they are participants of study 09-I-0102.
Principal Investigator
Referral Contact
For more information: