Patients Treated for Chronic Granulomatous Disease (CGD) Since 1995


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Trial ID: NCT02082353


Chronic granulomatous disease (CGD) is an inherited immune system abnormality in which bone marrow transplantation (BMT) has been shown to be curative. However the risks of transplantation are high and not all patients with CGD may need to undergo this high risk procedure. This study will determine the long term medical condition and daily functioning of participants with CGD after a transplant and if possible, compare these results to participants who do not undergo a transplant.

Official Title

Analysis of Patients Treated for Chronic Granulomatous Disease Since January 1, 1995


Inclusion Criteria:

   - Participant Inclusion Criteria (Part 1 - Longitudinal Analysis)

      - CGD Patients Undergoing Transplant 1995 to Present with Birth Year In or After

         1. CGD Patients will be Defined by both Defective Neutrophil NADPH Oxidase
         Function and by Clinical History Consistent with CGD

         Patients must have both of:

         A functional assay demonstrating abnormal NADPH oxidase function (see A
         below); AND Clinical history consistent with CGD (see B below).


         Patients must have both "A" and "B":

         A. Function: Assays of NADPH Oxidase Function

         I. Dihydrorhodamine (DHR) Assay:

            - Blood sample was obtained at a time when patient was clinically stable
            and not critically ill, with control samples performed simultaneously
            indicating a qualified assay; and

            - Assay unequivocally demonstrates CGD with an stimulation index (SI) SI
            < 35 or equivalent. Assay report, including mean fluorescence intensity
            (MFI) from unstimulated and stimulated samples and gating strategy,
            must be de-identified and provided. OR

         II. Nitroblue Tetrazolium Oxidation Test (NBT):

         o Diagnostic of CGD (reported as reduced granulocyte oxidative response).
         Report must be de-identified and provided. AND

         B. Clinical History: One or More of the Following:

            - Severe and/or recurrent infection (liver, perirectal or lung abscess;
            pneumonia; adenitis; or osteomyelitis) due to, for example,
            Staphylococcus aureus, Burkholderia sp, Serratia marcescens,
            non-albicans Candida sp, Aspergillus sp or other mold; or Nocardia sp
            or other deep tissue infection characteristic of CGD

            - Sterile granulomatous disease in respiratory, gastrointestinal or
            urogenital tracts; or Crohn's disease-like colitis

            - A family history consistent with either X-linked or autosomal recessive

         In cases where either functional assay (A) or history (B) is equivocal, one
         or more of the following may be used to confirm a diagnosis of CGD:

         C. Absent or significantly reduced in expression or abnormal size of any of
         the 5 phox components (gp91 phox, p47 phox, p22 phox, p67phox, and p40phox)
         of NADPH oxidase, by either:

            - Western blot

            - Northern blot OR D. Mutation in a gene encoding one of the 5 phox
            components (gp91 phox, p47 phox, p22 phox, p67 phox, and p40 phox) of
            NADPH oxidase that is predictive of a decreased or absent oxidative
            burst. (Nonsense, frameshift, or previously described missense mutation
            associated with CGD).

         Molecular Diagnosis is Desirable In addition, molecular diagnosis (gene
         sequencing and expression analysis) of CGD is desirable and should be
         performed when possible.

         2. Further Characterization of Oxidase Level, Longitudinal Study, Prospective
         Cohort Patients who are to undergo transplantation during the study period
         must be further characterized as oxidase-null or oxidase positive by level
         of oxidase production by either:

            - DHR assay stimulation Index: where SI ≤ 2.5 will be classified as
            oxidase-null CGD. Those with SI > 2.5 will be classified as oxidase
            positive CGD. A single validated test that is accepted by the PID-CGD
            Review Panel is adequate, but testing on two occasions for validation
            is desirable. OR

            - Ferricytochrome C reduction assay of granulocytes with O2 < 2.3 nmoles
            /106 cells/h classified as oxidase-null CGD. A single validated test
            that is accepted by the PID-CGD Review Panel is adequate, but testing
            on two occasions for validation is desirable.


         o Genetic sequencing reporting a mutation that is unequivocally associated
         to absent oxidase production. (e.g. null mutations) will be classified as
         oxidase-null CGD (See discussion in Appendix I for how family history,
         genotype and CGD mutation information will be applied to assigning patients
         lacking any quantitative oxidase activity measurements to residual
         oxidase-null or residual oxidase-positive groups).

         3. Longitudinal Study, Retrospective Cohort Patients who have already been
         transplanted will be included regardless of whether further characterization
         by oxidase level (or genotype/mutation data) is possible or not.

      - Non-Transplanted CGD Patients with Birth Year In or After 1988 A non-transplant
      (conventional therapy) group of CGD subjects will be enrolled in the longitudinal
      study. The non-transplant subjects will be selected from the potentially eligible
      (retrospective) patient cohort with diagnosis of CGD treated with conventional
      non-transplant therapy. Participating sites will enter their entire retrospective
      cohort of CGD patients having birth year in or after 1988 into the registration
      cohort for this protocol. Baseline for both non-transplant subjects and HCT
      subjects for the purpose of comparing survival will be the year of birth.
      However, for non-transplant subjects, many of the detailed analyses such as
      infection and autoimmune complication rates will be assessed in the year
      preceding the date of last contact.

   - Participant Inclusion Criteria (Part 2 - Cross-Sectional Analysis) To participate in
   the Cross-Sectional Analysis, patients must have previously been enrolled into the
   Longitudinal Analysis of Protocol 6903. All transplanted subjects in the
   Cross-Sectional Analysis are surviving and shall have at least 3 years of follow-up
   post-transplant to be included. Non-transplanted CGD subjects will become eligible for
   consideration for the Cross-Sectional Analysis if they were eligible and enrolled in
   the retrospective cohort of the Longitudinal Analysis, and if/when they are > 3 years
   post-diagnosis of CGD. Provision of written informed consent will be required for
   inclusion in the Cross-Sectional Analysis.

Exclusion Criteria:

   - Participant Exclusion Criteria (Longitudinal and Cross- Sectional Analyses)

      - Presence of other primary immunodeficiency syndromes that do not meet the
      clinical and laboratory criteria for CGD.

      - Rac2 Deficiency

      - Myeloperoxidase Deficiency (MPO Deficiency)

      - Glutathione deficiency

      - Leukocyte adhesion deficiency syndrome

   - Non-transplant subjects:

      - The above exclusions pertain.

      - In addition, non-transplant subjects will be excluded if the only assessment of
      oxidase function available is the nitroblue tetrazolium (NBT) test (a
      non-quantitative test).


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Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Matthew Porteus, MD