Biochemical Correction of Severe Epidermolysis Bullosa by Allogeneic Stem Cell Transplantation
Inclusion Criteria:
- Diagnosis of severe form of epidermolysis bullosa (EB) characterized by collagen,
laminin, integrin, keratin or plakin deficiency. Assessment criteria for severe EB:
- Severe blistering disease requiring dressings on >50% of the body surface area
- Documented collagen, laminin, integrin, keratin or plakin deficiency (by
immunofluorescence staining with protein specific antibodies or Western blotting
and by mutation analysis)
- Poor performance status as a result of EB (Lansky or Karnofsky <50%)
- Adequate Organ Function Criteria
- Renal: glomerular filtration rate > 60ml/min/1.73m2 patients aged ≤ 10 years
- Hepatic: bilirubin, aspartate aminotransferase/alanine aminotransferase
(AST/ALT), Alkaline phosphatase (ALP) < 5 x upper limit of normal
- Pulmonary: oxygen saturation >92%
- Cardiac: left ventricular ejection fraction ≥ 45%, normal electrocardiogram
(EKG) or approved by Cardiology for transplant.
- Performance status: ≥ 50% Lansky; ≥ 50% Karnofsky
- Available Healthy HSC Donor (order of preference)
- Related Donor (marrow or UCB)
- HLA-A, B, C, DRB1 genotypic identical (sibling) donor
- HLA-A, B, C, DRB1 phenotypic identical donor
- 7/8 HLA matched donor at HLA-A, B, C, DRB1
- Unrelated Donor
- Marrow
- HLA-A, B, C, DRB1 phenotypic identical donor
- 7/8 HLA matched donor at HLA-A, B, C, DRB1
- UCB
- HLA-A, B (antigen level) and DRB1 (allele level) matched donor
- 5/6 HLA matched donor at HLA-A, B, DRB1
- 4/6 HLA matched donor at HLA-A, B, DRB1
- Voluntary written consent
Exclusion Criteria:
- Active systemic infection at time of transplantation (including active infection with
Aspergillus or other mold within 30 days).
- History of human immunodeficiency virus (HIV) infection
- Prior transplantation with donor skin
- Evidence of squamous cell carcinoma
- Donor has EB
- Pregnancy or breast feeding. Females of child-bearing age must have a documented
negative pregnancy test and agree to use contraception as a condition for enrollment.