Autologous Hematopoietic Stem Cell Transplantation: ASCT Regimen
1. Autologous hematopoietic stem cell collection
Mobilization with chemotherapy plus cytokines:
* Cyclophosphamide: 30 mg/kg/d, administered intravenously for 2 consecutive days.
* G-CSF: 5-10 μg/kg/d subcutaneous injection for 5 consecutive days. Collection target: CD34+ cells ≥ 2×10⁶/kg; repeat leukapheresis permitted to meet target dose.
2. Conditioning Regimen:
* Thiotepa: 5 mg/kg/d Day -7
* Fludarabine: 5 mg/kg/d Days -6 to -2 (5 total days)
* Rituximab: 375 mg/m² Day -1
3. Stem cell infusion: Day 0 Infusion dose: ≥ 2×10⁶ CD34+ cells/kg
Study summary
This study aims to evaluate the safety, feasibility, and preliminary efficacy of autologous hematopoietic stem cell transplantation (ASCT) in the treatment of neurological damage associated with hereditary homocysteine remethylation disorders. Meanwhile, peripheral blood, cerebrospinal fluid, and related clinical samples will be prospectively collected before and after transplantation to dynamically monitor changes in immune reconstitution and neuroinflammatory biomarkers. The study intends to explore the impact of immune system resetting on disease progression and central nervous system immune microenvironment, providing evidence for subsequent precise patient stratification and optimized therapeutic strategies.
Eligibility
Sex
ALL
Min age
18 Years
Max age
55 Years
Healthy volunteers
No
Inclusion Criteria:
1. Aged 18 to 55 years, regardless of gender.
2. Comprehensive clinical, biochemical, and genetic diagnosis of hereditary homocysteine remethylation disorders.
3. Evidence of neurological involvement, including but not limited to gait disturbance, balance impairment, cognitive dysfunction, cerebral white matter lesions.
4. Prior standardized metabolic therapy (folic acid, vitamin B12, betaine) with suboptimal clinical response.
5. Persistent severe metabolic abnormality, i.e., sustained elevated homocysteine (\>50 umol/L).
6. Multidisciplinary consensus confirming lack of effective alternative therapies and ongoing risk of disease progression.
7. Voluntary participation, signed informed consent, adequate treatment adherence, and willingness to complete follow-up assessments.
Exclusion Criteria:
1. Prior hematopoietic stem cell transplantation or other cell transplantation.
2. Severe dysfunction of critical organs (heart, lung, liver, kidney) deemed incompatible with study treatment by investigators.
3. Active, uncontrolled infection.
4. Active tuberculosis, hepatitis B, hepatitis C, HIV infection, or other infectious diseases judged inappropriate for enrollment by investigators.
5. Active malignancy or prior malignant history that may confound safety and efficacy evaluations.
6. Severe underlying comorbidities likely to interfere with study treatment or outcome assessment.
7. Severe psychiatric disorder or cognitive impairment with poor adherence precluding completion of treatment and follow-up.
8. Pregnant or lactating females, or participants unwilling to use effective contraception throughout the study period.
9. Severe hypersensitivity to any study-related medication or intervention.
10. Participation in other interventional clinical trials within the past 4 weeks or ongoing observation period of another clinical trial.
11. No documented disease progression within the preceding 12 months.
12. Minimal neurological symptoms with no meaningful impact on activities of daily living and low short-term progression risk per investigator assessment.
13. Established standard therapies proven to alter natural disease history with stable disease and satisfactory therapeutic response.
14. End-stage disease with extensive irreversible neurological impairment (severe motor/cognitive failure or multi-organ dysfunction) with minimal expected therapeutic benefit.
15. Any other conditions deemed unsuitable for study participation by investigators.
Primary outcome measure(s)
Primary Endpoint: Incidence of adverse events within 100 days post ASCT — 100 days post ASCT
Trial sites (2)
Facility
City
Region
Status
Institute of Hematology & Blood Diseases Hospital, China
Tianjin
Tianjin Municipality
General Hospital of Tianjin Medical University
Tianjin
Tianjin Municipality
More Institute of Hematology & Blood Diseases Hospital, China trials in China
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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