Key Dates

Related Announcements

NOT-HL-20-790 - Notice of Change in Topic Areas of Interest for NOT-HL-20-761, Notice of Special Interest (NOSI): Pulmonary Complications of Hematopoietic Stem Cell Transplantation in Childhood

PA-19-056 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

NOT-HL-22-020 - Notice of Extension of NOT-HL-20-761 "Notice of Special Interest (NOSI): Pulmonary Complications of Hematopoietic Stem Cell Transplantation in Childhood"

Issued by

Purpose

Approximately 2500 pediatric hematopoietic stem cell transplants (HCT) are currently performed annually in the U.S. With promising advances in the technique of HCT and expansion in its scope, this exciting therapeutic modality is used in more and more life-threatening malignant and non-malignant conditions and frequently offers the only hope to patients and families for a lasting cure. However, it has become increasingly evident that pulmonary complications that occur in 25-55% of all pediatric HCT recipients cause significant mortality and morbidity, particularly during the first year after transplantation, representing the leading cause of death after HCT in these vulnerable children. These complications are, in part, related to the conditioning regimens, and are heterogeneous and often protean.

Pulmonary afflictions during the first year after HCT, such as Peri-engraftment Respiratory Distress Syndrome (PERDS), Idiopathic and Infectious Pneumonia Syndromes, Diffuse Alveolar Hemorrhage (DAH), Thrombotic Microangiopathy (TMA), graft versus host disease (GVHD)/Bronchiolitis obliterans and interstitial lung disease progressing to pulmonary fibrosis are varied and complex. The co-occurrence of cardiovascular dysfunction, which could result from prior chemotherapy, fluid overload due to conditioning regimens, shock due to bacterial, viral and fungal sepsis, and right heart dysfunction due to thrombotic microangiopathy and its associated pulmonary hypertension, among other causes, pose further unique challenges and beg elucidation. It is also apparent that immune- mediated vascular complications, specifically endothelial injury and the associated inflammation, play an important role in progression of some of the life threatening and preterminal lung diseases and require further study.

Assessment of these pulmonary risks before and after HCT also remains an important hurdle in the clinical setting. Early, accurate diagnosis of lung injury is key to optimizing treatment, mitigating pulmonary morbidity and improving survival, yet is hampered by the lack of reliable monitoring techniques of lung function in young and/or critically ill children. Moreover, the intensive care of these patients is fraught with challenges and disappointment. Mortality from pediatric ARDS (PARDS) is 40%, considerably higher than in the general PARDS population (7-11%) Prospective discovery cohorts of children prior to and after HCT could provide a platform for observational and mechanistic human studies to better understand the etiology and pathophysiology of complications in the lung, identify novel diagnostics and therapeutic targets, and ultimately pave the way for clinical trials that seek to improve outcomes.

To begin to address this wide array of outstanding scientific questions involving post-HCT pulmonary complications, the NHLBI is interested in supporting observational. mechanistic, and discovery-based research studies that aim to elucidate mechanisms of acute airway, alveolar and vascular injury after HCT in children.

Research Areas that could be addressed in response to this Notice could include, but are not limited to, the following:

• Prospective observational and mechanistic studies of children before and after HCT, deeply phenotyped for pulmonary function
• Development and refinement of pediatric-specific definitions of pulmonary conditions associated with HCT
• Development of an algorithm for pulmonary risk prior to and for a year after HCT and the employment of emerging advances in machine learning, artificial intelligence, natural language processing, and bioinformatics to achieve this goal
• Identification of candidate genes and putative functional variants associated with risk of specific pulmonary complications post-HCT
• Identification of effective cytokine panels to assess risk for pulmonary complications at multiple points in the transplant process
• Development of novel, standardized pulmonary function testing in young children (6 months to 3 years)
• Development of novel imaging techniques to predict risk and trajectory of pulmonary conditions pre and post- HCT
• Improving mechanistic understanding- e.g.,
  • Endothelial and related signaling mechanisms in lung injury after HCT
  • Animal models to study pulmonary manifestations post HCT
  • The role of the microbiome in elucidating infectious versus non-infectious mechanisms of pneumonias after HCT
  • The role of cardiac dysfunction and pulmonary hypertension and their impact on pulmonary function post-HCT
• Assessment of Current Status and standardization of multidisciplinary clinical care
  • Clinical criteria and monitoring standards for PFTs to define and diagnose early Bronchiolitis Obliterans (BOS) in children after HCT
  • Identification of criteria to optimize the use of extra-corporeal membrane oxygenation (ECMO) in this population
  • Definition of patient-centered outcomes e.g., the timing/role/use of palliative care in pediatric HCT recipients

Application and Submission Information

This notice applies to due dates on or after June 5, 2019 and subsequent receipt dates through September 8, 2022.

Submit applications for this initiative using the following funding opportunity announcement (FOA) or any reissues of this announcement through the expiration date of this notice.

• PA-19-056 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• Applicants must use applicationFORMS-F.
• For funding consideration, applicants must include NOT-HL-20-761 (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Inquiries

Scientific/Research Contact(s)

Aruna Natarajan, MD, PhD
Division of Lung Diseases
Telephone: 301-827-0180
Email: [email protected]

Nancy DiFronzo, PhD
Division Blood Diseases Research
Telephone: 301-435-0065, or 301-827-8267
Email: [email protected]

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Laurel Kennedy
Office of Grants Management
Telephone: 301-827-4777
Email: [email protected]