Marrow Derived Autologous Stromal Cells for the Restoration of Salivary Hypofunction (MARSH): Study Protocol for a Phase I Dose Escalation Trial of Patients with Xerostomia after Radiation Therapy for Head and Neck Cancer

Background: Xerostomia, or dry mouth, is a common side effect of head and neck radiation. Current treatment options for radiation-induced xerostomia are generally supportive in nature. Adult stem cells are the ultimate source for replenishment of salivary gland tissue. Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are a viable cell-based therapy for xerostomia. We have undertaken studies enabling U.S. Food and Drug Administration Investigational New Drug status, demonstrating the normal phenotype, intact functionality, and pro-growth secretome of interferon-gamma (IFN gamma)-stimulated BM-MSCs taken from patients with head and neck cancer who have undergone radiation +/- chemotherapy. Here we present the protocol of MARSH, a first-in-human clinical trial of bone marrow-derived, IFN gamma-activated BM-MSCs for the treatment of radiation-induced xerostomia. Methods: This single-center phase 1 dose-escalation with expansion cohort, non-placebo-controlled study will assess the safety and tolerability of BM-MSCs for the treatment of radiation-induced xerostomia in patients who had head and neck cancer. The phase 1 dose-escalation study will be a 3 + 3 design with staggered enrollment. A total of 21 to 30 subjects (9 to 18 in phase 1 study, 12 in expansion cohort) will be enrolled. The primary endpoint is determining the recommended phase 2 dose (RP2D) of IFN gamma-stimulated BM-MSCs to enable further studies on the efficacy of BM-MSCs. Patients' bone marrow will be aspirated, and BM-MSCs will be expanded, stimulated with IFN gamma, and injected into the submandibular gland. The RP2D will be determined by dose-limiting toxicities occurring within 1 month of BM-MSC injection. Secondary outcomes of saliva amounts and composition, ultrasound of salivary glands, and quality of life surveys will be taken at 3-, 6-, 12-, and 24-month visits. Discussion: Autotransplantation of IFN gamma-stimulated BM-MSCs in salivary glands after radiation therapy or chemoradiation therapy may provide an innovative remedy to treat xerostomia and restore quality of life. This is the first therapy for radiation-induced xerostomia that may be curative. (c) 2021 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.