Safety and Efficacy of Gene Modified Autologous Hematopoietic Stem Cells to Treat Transfusion-dependent β-thalassemia

Official title

Safety and Efficacy of Lentiviral Vector Transduction of β-globin Genetically Modified Autologous CD34+ Hematopoietic Stem Cells in Patients With Transfusion-dependent β-thalassemia

Overview

This study will be intented to evaluate the safety, tolerability, and engraftment efficacy after myeloablative preconditioning and transplantation of autologous CD34+ hematopoietic stem cells transduced with a lentiviral vector encoding the human βA-T87Q-globin gene in patients with transfusion-dependent (TDT) β-thalassemia.

Detailed description

This is an open-label, single-dose study of BD211 in patients with transfusion-dependent β-thalassemia aged 6 to 35 years. It is estimated that 10 subjects will be enrolled. BD211 is a gene modified gene therapy product designed to produce healthy β-globin in red blood cells in beta-thalassemia patients. The total follow-up duration was 24 months, the safe endpoints and effectiveness endpoints will be used to assess the safety and efficacy profiles in patients with transfusion-dependent β-thalassemia.

Interventions

• Genetic BD211
  Genetically modified CD34+ autologous stem cells were transfused intravenously with single dosing.

Primary outcome measures

• Red blood cell (RBCs) transfusion requirements, whether reaching TI [Time frame: 24 months]
• Total hospitalizing days at 6, 12, and 24 months (discharge after transplant) [Time frame: 24 months]

Secondary outcome measures (10)

• Percentage of treated participants with Transfusion-Dependent β-Thalassemia (TDT) who achieved transfusion independence for at least 6 months [Time frame: 24 months]
• Change in RBCs infusion from baseline at 6 to 24 months [Time frame: 24 months]
• Mean Hb (g/dL) at 6, 12 and 24 months after treatment [Time frame: 24 months]
• Change in ferritin/liver iron levels from baseline [Time frame: 24 months]
• Neutrophil engraftment, platelet engraftment and vector copy number [Time frame: 24 months]
• Transplant-related mortality in 3 months and 12 months [Time frame: 12 months]
• Overall survival [Time frame: 24 months]
• RCL incidence [Time frame: 24 months]
• Characterized insertion mutagenesis events that lead to clonal dominance or leukemia [Time frame: 24 months]
• Frequency and severity of AE [Time frame: 24 months]

Eligibility criteria

Inclusion criteria

• Ages 6 to 35 years old, including:

Subjects should be able to provide an ICF. Diagnosed as Transfusion Dependent β-thalassemia with any genotype (β0, β+, βE/β0, βS/S, βS/β0, βS/β+), confirmed the Hb analysis. No alfa chain genetic abnormalities. Subjects must stabilize and maintain an appropriate iron chelation regimen. Transfusion-dependent types are defined as requiring at least 100 mL/kg/ year of red blood cells (pRBCs).

• The tumor genes chip detection results about acute leukemia and myeloid tumor gene mutations (panel) showed no abnormality.
• There were candidates for HLA gene semi-compatible hematopoietic stem cell transplantation.
• No eligiblity for allogeneic hematopoietic stem cell transplantation.
• The treatment of erythrocyte maturation agent luspatercept cannot be financially supported.
• The investigator confirmed that subject was willing to follow the research procedures.
• Having complete medical records including a history of blood transfusions testified subject received treatment and followed up for at least two years prior to screening.

Exclusion criteria

• Availability of voluntary, fully HLA-matched hematopoietic cell donors, unless recommended for inclusion by the Monitoring Committee.
• HIV-1 and HIV-2 were positive, and / or HTLV-1, HTLV-2 and VSV-G antibodies were positive.
• An active bacterial, viral, fungal or parasitic infection.
• Contraindicated for the extraction of bone marrow under anesthesia.
• Any malignancy, myeloproliferative, or immunodeficient disease and relevant medical history.
• Peripheral blood white blood cell (WBC) count < 3×10\^9/L or platelet count < 120×10\^9/L.
• A history of allo-transplantation.
• Erythropoietin was used within 3 months prior to HSC cell collection.
• Immediate family members with known or suspected familial cancer syndromes (including but not limited to breast, colorectal, ovarian, prostate, and pancreatic cancers).
• Subjects with a diagnosis of major mental illness may had a serious disability to participate in the study.
• Active recurrent malaria.
• Pregnant or postpartum nursing or unable to use contraception.
• History of major organ injury including:

Liver disease, transaminase > 3 times the upper limit of normal. (If the liver biopsy does not reveal evidence of widespread bridging fibrosis, cirrhosis, or acute hepatitis, this indicator will not be used as a criterion for the exclusion); Widely bridging fibrosis, histopathological evidence of acute hepatitis or cirrhosis showed in liver biopsy Heart disease, left ventricular ejection fraction < 25%; Kidney disease, creatinine clearance < 30% normal level; Of severe iron overload, confirmed by the study doctor; An heart MRI detection of T2 \* < 10 ms; Significant pulmonary hypertension needing clinical medical intervention.

• Any other conditions being ineligible for HSC transplantation determined by the investigator.
• The subject involved with another clinical study in a 30-day screening period.
• Subjects who expected to become parents during the 27-month study period.
• Prior treatment with any type of gene and/or cell therapy.
• As assessed by the investigator, the subjects or their parents are unable to comply well with the study procedures per protocol.
• Hydroxyurea treatment within 3 months prior to hematopoietic stem cell collection.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• Shanghai Ruijin Hospital — Shanghai

Identifiers

NCT: NCT05776173 · BD-TDT-211002

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗