Clinical trial NCT05776173: 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
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: β-thalassemia Major
Lead sponsor: Shanghai BDgene Co., Ltd.
Sponsor class: INDUSTRY
Collaborators: name: Ruijin Hospital
First posted: 2023-03-20
Enrollment: 10
Sex: ALL
Minimum age (years): 6
Maximum age (years): 35
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: 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.

Eligibility criteria: Inclusion Criteria:

1. 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).
2. The tumor genes chip detection results about acute leukemia and myeloid tumor gene mutations (panel) showed no abnormality.
3. There were candidates for HLA gene semi-compatible hematopoietic stem cell transplantation.
4. No eligiblity for allogeneic hematopoietic stem cell transplantation.
5. The treatment of erythrocyte maturation agent luspatercept cannot be financially supported.
6. The investigator confirmed that subject was willing to follow the research procedures.
7. 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:

1. Availability of voluntary, fully HLA-matched hematopoietic cell donors, unless recommended for inclusion by the Monitoring Committee.
2. HIV-1 and HIV-2 were positive, and / or HTLV-1, HTLV-2 and VSV-G antibodies were positive.
3. An active bacterial, viral, fungal or parasitic infection.
4. Contraindicated for the extraction of bone marrow under anesthesia.
5. Any malignancy, myeloproliferative, or immunodeficient disease and relevant medical history.
6. Peripheral blood white blood cell (WBC) count \< 3×10\^9/L or platelet count \< 120×10\^9/L.
7. A history of allo-transplantation.
8. Erythropoietin was used within 3 months prior to HSC cell collection.
9. Immediate family members with known or suspected familial cancer syndromes (including but not limited to breast, colorectal, ovarian, prostate, and pancreatic cancers).
10. Subjects with a diagnosis of major mental illness may had a serious disability to participate in the study.
11. Active recurrent malaria.
12. Pregnant or postpartum nursing or unable to use contraception.
13. 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.
14. Any other conditions being ineligible for HSC transplantation determined by the investigator.
15. The subject involved with another clinical study in a 30-day screening period.
16. Subjects who expected to become parents during the 27-month study period.
17. Prior treatment with any type of gene and/or cell therapy.
18. As assessed by the investigator, the subjects or their parents are unable to comply well with the study procedures per protocol.
19. Hydroxyurea treatment within 3 months prior to hematopoietic stem cell collection.

Primary outcomes:
measure: Red blood cell (RBCs) transfusion requirements, whether reaching TI
timeFrame: 24 months
measure: Total hospitalizing days at 6, 12, and 24 months (discharge after transplant)
timeFrame: 24 months
Secondary outcomes:
measure: Percentage of treated participants with Transfusion-Dependent β-Thalassemia (TDT) who achieved transfusion independence for at least 6 months
timeFrame: 24 months
measure: Change in RBCs infusion from baseline at 6 to 24 months
timeFrame: 24 months
measure: Mean Hb (g/dL) at 6, 12 and 24 months after treatment
timeFrame: 24 months
measure: Change in ferritin/liver iron levels from baseline
timeFrame: 24 months
measure: Neutrophil engraftment, platelet engraftment and vector copy number
timeFrame: 24 months
measure: Transplant-related mortality in 3 months and 12 months
timeFrame: 12 months
measure: Overall survival
timeFrame: 24 months
measure: RCL incidence
timeFrame: 24 months
measure: Characterized insertion mutagenesis events that lead to clonal dominance or leukemia
timeFrame: 24 months
measure: Frequency and severity of AE
timeFrame: 24 months
Other outcomes:
Locations:
city: Shanghai
country: China
facility: Shanghai Ruijin Hospital
Study officials:
affiliation: Ruijin Hospital, Shanghai, China
name: Sujiang Zhang, M.D.
role: PRINCIPAL_INVESTIGATOR
References: