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Purpose

The objective of this study is to evaluate the efficacy and safety of RBC transfusion for support of acute anemia in cardiovascular surgery patients based on the clinical outcome of renal impairment following transfusion of red blood cells (RBCs) treated with the INTERCEPT Blood System (IBS) for Red Blood Cells compared to patients transfused with conventional RBCs.

Condition

Eligibility

Eligible Ages
Over 11 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Age ≥ 11 years of age
  2. Weight ≥ 40 kg
  3. Scheduled complex cardiac surgery with planned use of median sternotomy. The procedure may be performed either on-pump or off-pump. For the purposes of this protocol "Repeat procedure" means that the subject had a previous cardiac surgery with median sternotomy. Procedures that qualify as complex cardiac surgery include the following:
  4. Single Vessel Coronary Artery Bypass Graft, repeat procedure
  5. Multiple Coronary Artery Bypass Grafts, first or repeat procedure
  6. Single Valve Repair or Replacement, repeat procedure
  7. Multiple Valve Repair or Replacement, first or repeat procedure
  8. Surgery involving both Coronary Artery Bypass Graft(s) and Valve Repair(s), first or repeat procedure
  9. One or more of the following procedures, with or without Coronary Bypass Graft(s):
  10. left ventricular aneurysm repair,
  11. ventricular and/or atrial septal defect repairs,
  12. Batista procedure (surgical ventricular remodeling),
  13. surgical ventricular restoration,
  14. congenital defect repair, and
  15. aortic root procedures
  16. TRUST probability score (Alghamdi, Davis et al. 2006) ≥ 3, or currently on a regimen of aspirin, clopidogrel (or analogs) and/or GPIIb/IIIa inhibitors.
  17. Female subjects of child-bearing potential must meet the 2 criteria below:
  18. Have negative serum or urine pregnancy tests prior to study treatment to rule out pregnancy
  19. Use at least one method of birth control that results in a low failure rate (i.e., less than 1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomized partner
  20. Confirmed negative anti-human globulin (AHG) crossmatch with IBS RBCs to detect antibodies to IBS-treated RBCs prior to receiving first study transfusion
  21. Signed and dated informed consent form

Exclusion Criteria

  1. Pregnant or breast feeding.
  2. Refusal of blood products or other inability to comply with the protocol in the opinion of the Investigator or the treating physician.
  3. Treatment with any medication that is known to adversely affect RBC viability, such as, dapsone, levodopa, methyldopa, nitrofurantoin, and its derivatives, phenazopyridine and quinidine.
  4. Planned surgery is minimally invasive.
  5. Planned cardiac transplantation.
  6. Active autoimmune hemolytic anemia.
  7. Left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO) support pre-operatively or planned need post-operatively.
  8. Cardiogenic shock requiring pre-operative placement of an intra-aortic balloon pump (IABP) (IABP done for unstable angina or prophylactically for low ejection fraction is not excluded).
  9. Planned deep hypothermic circulatory arrest (DHCA).
  10. Planned use of autologous or directed donations.
  11. RBC transfusion during current hospitalization prior to enrollment and randomization (within 14 days).
  12. Participation in any one of the following types of clinical studies either concurrently or within the previous 28 days: investigational blood products, pharmacologic agents or imaging materials, including dyes, investigational surgical techniques, or devices. Studies of nutrition, psychology, or socioeconomic issues are not grounds for exclusion.
  13. Current diagnosis of either chronic kidney disease or acute kidney injury with sCr ≥ 1.8 mg/dL at screening or requiring RRT.
  14. Current diagnosis of either chronic or acute hepatic insufficiency or a total serum bilirubin greater than or equal to 2.0 mg/dL (≥34.2 µmol/L) at screening.
  15. Pre-existing antibody to RBC antigens that may make the provision of compatible study RBC components difficult.
  16. History of transfusion reactions requiring washed RBCs, volume reduced RBC, or RBCs with additive solution removed.
  17. Patients with documented IgA deficiency or a history of severe allergic reactions to blood products.
  18. Patients who require gamma-irradiated RBC blood components

Study Design

Phase
Phase 3
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
Parallel group
Primary Purpose
Treatment
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
INTERCEPT (test)
The INTERCEPT treatment process uses amustaline and glutathione together with a processing solution in a single-use disposable set and results in pathogen and leukocyte inactivated RBCs suspended in SAG-M additive solution (INTERCEPT RBCs). The INTERCEPT treatment will be performed on leukocyte reduced RBC components prepared from whole blood collections and suspended in AS-5 additive solution within 24 hours of collection. The test component is allogeneic INTERCEPT RBCs suspended in SAG-M and stored at 1°C to 6 for up to 35 days post-donation and administered intravenously. Dose and schedule of RBC transfusions will be determined by the treating physician.
  • Device: INTERCEPT
    Pathogen reduced RBCs
Active Comparator
Conventional (Control)
The control transfusion component is a conventional leukocyte-reduced RBC component in an FDA approved additive solution (AS-1, AS-3 or AS-5) stored at 1°C to 6°C for up to 35 days post-donation and administered intravenously. The Control RBC components will be handled and labeled in a manner so as to maintain blinding. Dose and schedule of RBC transfusions will be determined by the treating physician.
  • Device: Control
    Conventional RBCs

Recruiting Locations

UK Center for Clinical and Translational Science and nearby locations

University of Kentucky
Lexington, Kentucky 40356
Contact:
Michael Sekela, Dr
859-323-6494
mese223@uky.edu

More Details

NCT ID
NCT03459287
Status
Recruiting
Sponsor
Cerus Corporation

Study Contact

Alison Coombs
925-288-6203
acoombs@cerus.com

Detailed Description

This is a prospective, multicenter, randomized, double-blinded, active controlled, parallel-design, non-inferiority study.

Screening/Recruitment In order to minimize the number of patients who enroll in the study but do not require RBC transfusion, only patients with a relatively high likelihood to receive a RBC transfusion as determined by the Investigator (e.g., patients receiving aspirin, clopidogrel (or analogs) and/or GPIIb/IIIa inhibitors), or patients with a TRUST Score of >3 will be eligible for enrollment. Patients ≥ 11 years of age undergoing complex cardiac surgery will be identified through pre-operative scheduling procedures in advance of their operations.

All potentially eligible patients will be approached for study consent prior to their surgical procedure. Subjects who consent to the study will be assigned a study ID number and undergo screening. Screening data collection and procedures will include:

Demographics (age, sex), vital signs, height, weight, EKG, type of scheduled surgery, need for irradiated blood products, medical and surgical history, transfusion history, physical examination, concomitant medications, complete blood count, blood type, blood chemistry, coagulation panel, troponin, DAT test, immune reactivity to IBS RBCs, and pregnancy test (when applicable). All TRUST components will be collected on the CRF.

Randomization and Blinding Potentially eligible subjects will be screened and will be considered for randomization. If a subject is screened and receives a red cell transfusion prior to randomization, that subject will no longer be considered for randomization, and their participation in the study will end. An Interactive Web Response System will be used for electronic randomization of eligible patients. Randomization (in 1:1 ratio for Test:Control) stratified by site, pre-existing renal impairment (baseline sCr ≥1.2mg/dL), and cardiac surgery type will be employed. Randomized subjects who do not receive any study RBC transfusions during surgery or within the first 48 hours after completion of surgery, hospital discharge, or death, whichever occurs first, will be replaced.

Screening will include documentation of the patients' pre-surgical exposure to radiographic contrast media, number of prior pregnancies (females), complete blood count, blood chemistries, blood type, DAT, IAT, RBC antibody screen, and the presence of antibodies to INTERCEPT RBC. Data may be derived from the medical record where performed within 7 days of screening.

At screening, the subject's eligibility status will be entered into the electronic data capture system (EDC). On the day before or day of scheduled surgery, eligible subjects will be enrolled and randomized with a 1:1 ratio for Test: Control within each randomization stratum. Only appropriate blood bank staff will be able to access the treatment arm assignment. RBC unit labels will be identical for Test and Control products. Operating room staff, surgical staff, ICU staff, and others caring for participating patients, as well as the sponsor (and delegates) will be blinded to treatment assignment. Unblinded monitors will monitor the production of the RBC components.

Treatment Randomized subjects will be transfused with Test or Control RBCs during surgery (Day 0) through Day 7 post surgery, hospital discharge, or death, whichever is first, as clinically indicated and determined by the treating physician. Treatment assessments will be divided into an acute surgical care period starting the day of surgery until Day 7, hospital discharge, or death, whichever is first, during which study RBC (Test or Control) are administered, a post-surgical follow-up period of a minimum of 28 days after the last study transfusion to collect additional safety data, clinical assessment at day 30 and day 75 (±15) after the last study transfusion for mortality and RRT status, and collection of samples for serological screening for antibodies specific to IBS at end of study (75 (±15) days).

In all patients anesthesia and surgical procedures will be performed according to the local standards of the institution. Study RBC components will be ordered and administered to study subjects by their treating physicians, also according to the local standards of care. Following the study treatment period, subjects may receive conventional RBC components if additional transfusions are needed, as indicated by their treating physician.

Study Assessments: Monitoring and Follow-up Acute Surgical Care Period (Pre-operative to Post-operative Day 7) Hemodynamic and laboratory measures will be assessed pre-operatively (Day -1) and daily from post-operative Day 1 through post-operative Day 7, hospital discharge or death, whichever occurs first. If a subject is discharged prior to Day 7 but returns to the study site for standard care on Day 7, attempts will be made to perform phlebotomy on that day for a complete blood count and sCr determination. Randomized subjects who do not receive an RBC transfusion either during surgery or within the first 48 hours after surgery, hospital discharge, or death, whichever occurs first, will not be followed any longer and will be replaced.

Hemodynamic parameters that will be monitored include heart rate, blood pressure, mean arterial pressure, central venous pressure (CVP), peripheral oxygen saturation via pulse oximetry probe, arterial PO2, FiO2 and arterial oxygen saturation (as available in the medical records).

Laboratory parameters that will be monitored include BUN, creatinine, ALT, fibrinogen, bilirubin, troponin-I, lactic acid, hemoglobin and platelet counts. A blood sample for sCR will be taken at 48 (±4 hours) after completion of surgery, and sCr will be determined on a daily basis during the acute surgical care period up to 7 days post-surgery. Other parameters will be collected on a daily basis as available in the medical record. Laboratory parameters will be measured by a CLIA accredited local laboratory.

The use of radiographic contrast media will be documented starting 7 days prior to surgery, as will details related to the specific surgical procedure (type of procedure, start and end times, RBC components transfused, all other blood components transfused, estimated blood loss from the surgical procedure, concomitant medications, intraoperative cell recovery and reinfusion, hemodilution procedures, and nadir temperature. Additionally, daily estimated blood loss from chest tube(s) and from other sources, and day of chest tube removal will be recorded.

Transfusion reactions, AEs and SAEs will be documented on a daily basis from the time of randomization through post-operative and as available through day 28 after the last study transfusion.

Blood samples for detection of antibody to IBS RBC will be collected at Day 28 (± 3 days window) and Day 75 (±15 day window) following the last study transfusion.

Post-operative Day 8 to 28 Days After Last Study Transfusion Subjects will be monitored for transfusion reactions, AEs and SAEs as available following the 7-day treatment period, through 28 days after the last study transfusion or death, whichever occurs first, according to the local standard of care. In an outpatient setting, weekly telephone surveillance calls to the subject will be performed in order to collect safety events until the next follow-up visit.

28 (± 3) Days After Last Study Transfusion or Premature Discontinuation Subjects who have been discharged should be scheduled for the follow up visit 28 (±3) days after the last study transfusion to obtain additional safety information, including patient-reported AEs, SAEs, laboratory studies including sCr ,DAT/ IAT and RBC allo-antibodies; a sample for HLA antibodies and antibodies specific to IBS RBC will be obtained, either in hospital or at clinic visit. All randomized subjects who receive any study RBC transfusion must have their vital status documented at this visit, or earlier if the subject dies prior to the visit. Mortality and the need for RRT through Day 30 post-surgery will also be documented.

If a subject has been discharged, other safety information (e.g., AEs and SAEs) may be obtained through medical records, the subject's physician, or a telephone interview with either the subject or a family member.

End of Study (75±15 Days After last Study Transfusion) On 75±15 days after the last study transfusion (End of Study), serum samples for antibodies specific for IBS RBC will be obtained, either in hospital, at a clinic visitor or offsite. Mortality and the need for RRT will be assessed.

Data and Safety Monitoring Board (DSMB) The study data and safety will be monitored by an independent Data and Safety Monitoring Board (DSMB). The primary mission of the DSMB is to ensure patient safety and protocol compliance for data collection. The DSMB will be assembled by the Sponsor and composed of transfusion medicine, intensive care and/or cardiac surgery experts, and a statistician. DSMB members will be independent of the Sponsor.

Interim Analysis and Early Stopping Rule Aside from the interim sample size re-estimation, no interim analysis is planned for this study to compare treatment differences with respect to efficacy or safety at any time prior to the completion of the study. Specific stopping rules, defined for safety considerations, are defined in Section 4.6 of the protocol.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.