BONE MARROW FAILURE CLINICAL RESEARCH CENTER

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 描述(由申请人提供)：特发性骨髓衰竭状态和红细胞减少症(IBMFS&C)是一种罕见的疾病，其特征是造血祖细胞或干细胞衰竭，导致一个或全部血细胞谱系的产生不足。免疫病理生理学是所有这些疾病中许多病例的统一因素。先前的合作试验已经改善了再生障碍性贫血(AA)的有效药物治疗，但仍需要正在进行的多中心研究来进一步推进AA，特别是其他几乎没有有效治疗选择的骨骼IBMFS的结果。在这里，我们建议在克利夫兰临床基金会(CCF)癌症中心成立IBMFS&C罕见病临床研究中心(RDCRC)，由几个专业中心、患者权益团体和数据组成的联盟组成，并与数据技术协调中心(DTCC)合作。IBMFS&C RDCRC将重点治疗再生障碍性贫血、阵发性睡眠性血红蛋白尿、包括大颗粒淋巴细胞白血病和纯红细胞再生障碍性贫血在内的单系细胞减少症，以及各种骨髓增生异常综合征。本申请提供了一种改进IBMFS&C的医疗治疗的多目标方法，包括：1)为每个IBMFS实施定义护理标准的治疗算法，2)系统地评估可提高诊断准确性或对病理生理机制的理解的新的实验室分析，3)将患者纳入纵向跟踪研究，以将新的和已建立的诊断变量与结果相关联，4)比较每个相关疾病的医疗和移植方法，5)为目前没有良好治疗选择或没有标准治疗方法的疾病亚组开发实验性治疗方案，6)培训博士后研究员以开发IBMFS&C的临床试验和翻译研究项目，7)在IBMFS&C的诊断和管理方面对社区医生进行教育；8)与再生障碍性贫血和MDS国际基金会(AAMDSIF)合作，改善患者和医生的外联、教育和转诊资源。由于PI的专业知识，以及CCF CC的经验和规模，CCF具有独特的定位，可以作为IBMFS&C的RDCRC。一些领先的专家组成了一个医疗中心联盟，这将是RDCRC不可或缺的一部分。为了进一步支持其活动，这项工作的额外基础设施将包括在该联盟的每个中心成立一个罕见疾病办公室、专门的实验室测试地点、临床试验的监督、DTCC的数据管理以及AAMDSIF的患者转介和教育。IBMFS&C RDCRC和该联盟已经制定了一项计划，以教育研究员和社区医生了解IBMFS&C。这些努力的成功将部分通过跟踪转诊到参与标准治疗的中心或登记参加纵向和治疗方案来评估

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. DESCRIPTION (provided by applicant): Idiopathic bone marrow failure states and cytopenias (IBMFS&C) are rare disorders characterized by hematopoietic progenitor or stem cell failure resulting in deficient production of one, or all, blood cell lineages. Immune pathophysiology is a unifying factor in many cases of all these diseases. Prior collaborative trials have led to the improvement of effective medical therapy for aplastic anemia (AA), but ongoing multi-center studies are required to advance further the outcome for AA and especially the other bone IBMFS for which few useful treatment options exist. Here, we propose formation of the IBMFS&C Rare Disease Clinical Research Center (RDCRC) at The Cleveland Clinic Foundation (CCF) Cancer Center, encompassing a consortium of several specialized centers, patient advocacy group, and data and a collaboration with a data technology coordinating center (DTCC). The IBMFS&C RDCRC will focus on AA, paroxysmal nocturnal hemoglobinuria, single-lineage cytopenias including large granular lymphocyte leukemia and pure red cell aplasia, and various myelodysplastic syndromes. This application presents a multi-targeted approach to improving the medical therapy for IBMFS&C that includes: 1) implementing treatment algorithms for each IBMFS that define standards of care, 2) systematically evaluating novel laboratory assays that may improve the diagnostic accuracy or understanding of pathophysiologic mechanisms, 3) enrolling patients into a longitudinal follow-up study to correlate new and established diagnostic variables with outcome, 4) comparing medical and transplant approaches for each relevant disorder, 5) developing experimental treatment protocols for disease subsets currently without good treatment options or without a standard treatment approach, 6) training of post-doctoral fellows to develop clinical trials and translational research projects for the IBMFS&C, 7) educating community physicians in the diagnosis and management of the IBMFS&C, and 8) improving outreach, education and referral resources for patients and physicians, in collaboration with the Aplastic Anemia & MDS International Foundation (AAMDSIF). Due to the expertise of the PI, together with the experience and size of CCF CC, CCF uniquely is positioned to serve as an RDCRC in IBMFS&C. A number of leading experts formed a consortium of medical centers that will be an integral part of the RDCRC. To support further its activities, additional infrastructure for this effort will include a formation of a rare disease office in each of the centers of the consortium, specialized laboratory testing sites, oversight of clinical trials, data management by the DTCC, and patient referral and education by the AAMDSIF. The IBMFS&C RDCRC and the consortium have developed a plan for educating fellows and community physicians about IBMFS&C. The success of these efforts will be evaluated in part by tracking referrals to the participating centers for standard treatment, or enrollment in the longitudinal and treatment protocols