Clinical trial NCT02140554: A Study Evaluating the Safety and Efficacy of Lovo-cel in Severe Sickle Cell Disease
Official title: A Phase 1/2 Study Evaluating Gene Therapy by Transplantation of Autologous CD34+ Stem Cells Transduced Ex Vivo With the LentiGlobin BB305 Lentiviral Vector in Subjects With Severe Sickle Cell Disease
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Sickle Cell Disease
Lead sponsor: bluebird bio
Sponsor class: INDUSTRY
First posted: 2014-05-16
Enrollment: 54
Sex: ALL
Minimum age (years): 12
Maximum age (years): 50
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a non-randomized, open label, multi-site, single dose, Phase 1/2 study in approximately 50 adults and adolescents with severe SCD. The study will evaluate hematopoietic stem cell and progenitor stem cell (collectively referred to as hematopoietic stem and progenitor cells or HSPCs) transplantation using lovo-cel.

Detailed description: Subject participation for this study will be 2 years post-transplant. Subjects who enroll in this study will be asked to participate in a subsequent long-term follow up study that will monitor the safety and efficacy of the treatment they receive for an additional 13 years for a total of 15 years post-drug product infusion.

Eligibility criteria: Inclusion Criteria:

1. Be ≥12 and ≤50 of age at time of consent.
2. Diagnosis of sickle cell disease (SCD), with either βS/βS or βS/β0 or βS/β+ genotype.
3. Have severe SCD. i.e., in the setting of appropriate supportive care measures for SCD (e.g., pain management plan), have experienced at least 4 severe VOEs in the 24 months prior to informed consent.

   For the purposes of this study, a severe VOE is defined as an event with no medically determined cause other than a vaso-occlusion, requiring a ≥ 24-hour hospital or Emergency Room (ER) observation unit visit or at least 2 visits to a day unit or ER over 72 hours with both visits requiring intravenous treatment. Exception: priapism does not require hospital admission but does require a medical facility visit; 4 priapism episodes that require a visit to a medical facility (without inpatient admission) are sufficient to meet criterion.

   Severe VOEs include:
   1. an episode of acute pain with no medically determined cause other than a VOE
   2. Acute chest syndrome (ACS), defined by an acute event with pneumonia-like symptoms (e.g., chest pain, fever \[\> 38.5°C\], tachypnea, wheezing or cough, or findings upon lung auscultation) and the presence of a new pulmonary infiltrate consistent with ACS and requiring oxygen treatment and/or blood transfusion.
   3. Acute hepatic sequestration, defined by a sudden increase in liver size associated with pain in the right upper quadrant, abnormal results of liver-function test not due to biliary tract disease, and reduction in Hb concentration by at least 2 g/dL below the baseline value
   4. Acute splenic sequestration, defined as sudden enlargement of the spleen and reduction in Hb concentration by at least 2 g/dL below the baseline value.
   5. Acute priapism: defined as a sustained, unwanted painful erection lasting more than 2 hours and requiring care at a medical facility (with or without hospitalization)
4. Karnofsky performance status of ≥ 60 (≥16 years of age) or a Lansky performance status of ≥60 (\<16 years of age).
5. Have either experienced hydroxyurea (HU) failure at any point in the past or must have intolerance to HU (defined as patient being unable to continue to take HU per PI judgement).
6. Have been treated and followed for at least the past 24 months prior to Informed Consent in medical center(s) that maintained detailed records on SCD history.

Exclusion Criteria:

1. Positive for presence of human immunodeficiency virus type 1 or 2 (HIV-1 and HIV-2), hepatitis B virus (HBV), or hepatitis C (HCV).
2. Clinically significant and active bacterial, viral, fungal, or parasitic infection.
3. Inadequate bone marrow function, as defined by an absolute neutrophil count of \< 1000/µL (\< 500/µL for subjects on HU treatment) or a platelet count \< 100,000/µL.
4. Any history of severe cerebral vasculopathy: defined by overt or hemorrhagic stroke; abnormal transcranial Doppler \[≥200 cm/sec\] needing chronic transfusion; or occlusion or stenosis in the polygon of Willis; or presence of Moyamoya disease. Subjects with radiologic evidence of silent infarction in the absence of any of the above criteria would still be eligible
5. Baseline oxygen saturation \< 90% without supplemental oxygen (excluding periods of SCD crisis, severe anemia or infection).
6. Baseline carbon monoxide diffusing capacity (DLCO) \< 50% (corrected for Hb) in the absence of infection. If DLco cannot be assessed due to age or cognition-related restrictions, there must be a normal respiratory exam, chest radiograph without pulmonary infiltrates, and oxygen saturation by pulse oximetry ≥ 90% on room air.
7. Baseline left ventricular ejection fraction (LVEF) \< 45% measured by cardiac echography.
8. Clinically significant pulmonary hypertension at baseline, as defined by the requirement for ongoing pharmacologic treatment or the consistent or intermittent use of supplemental home oxygen.
9. Baseline estimated glomerular filtration rate (eGFR) \< 70 mL/min/1.73 m2, as determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (see http://www.kidney.org/professionals/kdoqi/gfr_calculator.cfm).
10. Advanced liver disease, defined as:

    1. Persistent aspartate transaminase, alanine transaminase, or direct bilirubin value \>3× the upper limit of normal (ULN), or
    2. Baseline prothrombin time or partial thromboplastin time \>1.5× ULN, suspected of arising from liver disease, or
    3. Magnetic Resonance Imaging (MRI) of the liver demonstrating clear evidence of cirrhosis, or
    4. MRI findings suggestive of active hepatitis, significant fibrosis, inconclusive evidence of cirrhosis, or liver iron concentration ≥15 mg/g require follow-up liver biopsy in subjects ≥18 years of age. In subjects \<18 years of age, these MRI findings are exclusionary, unless in the opinion of the Investigator, a liver biopsy could provide additional data to confirm eligibility and would be safe to perform. If a liver biopsy is performed based on MRI findings, any evidence of cirrhosis, bridging fibrosis, or significant active hepatitis will be exclusionary.
11. For subjects who have history of iron overload or serum ferritin levels \> 1000 ng/mL, a cardiac MRI is required. Cardiac T2\* \< 10 ms results in exclusion.
12. Contraindication to anesthesia.
13. Any contraindications to the use of plerixafor during the mobilization of hematopoietic stem cells and any contraindications to the use of busulfan and any other medicinal products required during the myeloablative conditioning, including hypersensitivity to the active substances or to any of the excipients.
14. Any prior or current malignancy or immunodeficiency disorder, except previously treated, non-life threatening, cured tumors such as squamous cell carcinoma of the skin.
15. Prior receipt of an allogeneic transplant.
16. Immediate family member with a known or suspected Familial Cancer Syndrome.
17. Diagnosis of significant psychiatric disorder of the subject that, in the Investigator's judgment, could seriously impede the ability to participate in the study.
18. Pregnancy or breastfeeding in a postpartum female or absence of adequate contraception for fertile subjects.
19. Participation in another clinical study with an investigational drug within 30 days of Screening.
20. Prior receipt of gene therapy.
21. An assessment by the Investigator that the subject or parents/caregivers (as required) will not be able to comply with the study procedures outlined in the study protocol.
22. Patients needing therapeutic anticoagulation treatment during the period of conditioning through platelet engraftment (patients on prophylactic doses of anticoagulants not excluded per this criteria).
23. Unable to receive Red Blood Cell (RBC) transfusion.
24. Any other condition that would render the subject ineligible for hematopoietic stem cell transplant (HSCT), as determined by the attending transplant physician.
25. Applicable to subjects \< 18 years of age only: Availability of a willing, matched HLA-identical sibling hematopoietic cell donor.

Primary outcomes:
measure: Percentage of Group C Participants Who Achieved Complete Resolution of Vaso-occlusive Events (VOE-CR)
timeFrame: From 6 months to 18 months post lovo-cel infusion
Secondary outcomes:
measure: Percentage of Group C Participants With Complete Resolution of Severe VOEs (sVOE-CR)
timeFrame: From 6 months to 18 months post lovo-cel infusion
measure: Percentage of Group C Participants Who Achieved Globin Response
timeFrame: From at least 60 days after last pRBC transfusion up to Month 24 post lovo-cel infusion
measure: Percentage of Group C Participants Who Meet the Definition of Globin Response at Month 24
timeFrame: From first date of Globin Response to Month 24 post lovo-cel infusion
measure: Duration of Globin Response in Group C Participants
timeFrame: From first date of Globin Response to Month 24 post lovo-cel infusion
measure: Change From Baseline in the Annualized Number of VOEs in Group C Participants
timeFrame: From Baseline up to 24 months post lovo-cel infusion
measure: Change From Baseline in the Annualized Number of sVOEs in Group C Participants
timeFrame: From Baseline up to 24 months post lovo-cel infusion
measure: Percentage of Group C Participants With Complete Resolution of VOE Between 6 and 24 Months Post Lovo-cel Infusion (VOE-CR24)
timeFrame: From 6 months to 24 months post lovo-cel infusion
measure: Percentage of Group C Participants With Complete Resolution of sVOEs Between 6 and 24 Months Post Lovo-cel Infusion (sVOE-CR24)
timeFrame: From 6 months to 24 months post lovo-cel infusion
measure: Percentage of Group C Participants With At Least 75% Reduction in Annualized sVOEs (sVOE-75)
timeFrame: Up to 24 months post lovo-cel infusion
measure: Change From Baseline in Annualized VOE-related Hospital Admissions in Group C Participants
timeFrame: From post hospital discharge to Month 24
measure: Change From Baseline in Annualized VOE-related Total Days Hospitalized in Group C Participants
timeFrame: From post hospital discharge to Month 24
measure: Weighted Average of Non-transfused Total Hb in Group C Participants
timeFrame: At Month 6, 12, 18, and 24 post lovo-cel infusion
measure: Weighted Average of HbS Percentage (%) in Non-transfused Total Hb in Group C Participants
timeFrame: At Month 6, 12, 18, and 24 post lovo-cel infusion
measure: Percentage of Group C Participants Who Achieved <= 70%, <= 60%, and <= 50% Weighted Average of HbS % in Non-transfused Total Hb
timeFrame: At Month 6, 12, 18, and 24 post lovo-cel infusion
measure: Weighted Average of HbAT87Q % in Non-transfused Total Hb in Group C Participants
timeFrame: At Month 6, 12, 18, and 24 post lovo-cel infusion
measure: Weighted Average of Non-HbS % in Non-transfused Total Hb in Group C Participants
timeFrame: At Month 6, 12, 18, and 24 post lovo-cel infusion
measure: Non-transfused Total Hb (g/dL) Over Time
timeFrame: From infusion up to Month 24
measure: HbS % in Non-transfused Total Hb Over Time
timeFrame: From infusion up to Month 24
measure: HbAT87Q % in Non-transfused Total Hb Over Time
timeFrame: From infusion up to Month 24
measure: Non-HbS % of Non-transfused Total Hb Over Time
timeFrame: From infusion up to Month 24
measure: Change From Baseline in Absolute Reticulocyte Count in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Percent (%) Reticulocyte/Erythrocytes in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Total Bilirubin in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Haptoglobin in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Lactate Dehydrogenase (LDH) in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Cardiac T2* on MRI in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Serum Ferritin in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Liver Iron Concentration (LIC) by Magnetic Resonance Imaging (MRI) in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Annualized Volume of pRBC Transfusions in Group C Participants
timeFrame: From 6 months through 24 months post lovo-cel infusion
measure: Change From Baseline in Annualized Number of Packed Red Blood Cell (pRBC) Transfusions in Group C Participants
timeFrame: From 6 months through 24 months post lovo-cel infusion
measure: Change From Baseline in Erythropoietin Levels in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Cardiac-pulmonary Function Via Left Ventricular Ejection Fraction (LVEF) in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Serum Transferrin Receptor in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Renal Function as Measured by Estimated Glomerular Filtration Rate (eGFR) in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Number of Participants With Shift From Baseline in Cardiac-pulmonary Function Via Echocardiogram (Tricuspid Regurgitant Jet Velocity [TRJV]) in Group C Participants
timeFrame: Baseline, Month 24
measure: Number of Participant With Shift From Baseline in Cardiac-pulmonary Function Via Pulmonary Function Tests (PFTs) in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Meters Walked During 6-minute Walk Test in Group C Participants
timeFrame: Baseline, Month 12 and Month 24
measure: Change From Baseline in Patient-reported Quality of Life as Measured by Patient Reported Outcomes Measurement Information System-57 (PROMIS-57): Domain (T- Score) in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Patient-reported Quality of Life as Measured by PROMIS-57: Pain Intensity Score in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Patient-reported Quality of Life as Measured by Patient Reported Outcomes Measurement Information System- 49 (PROMIS-49)): Domain (T- Score) in Group C Participants
timeFrame: Baseline, Month 24
measure: Change From Baseline in Patient-reported Quality of Life as Measured by PROMIS-49: Pain Intensity Score in Group C Participants
timeFrame: Baseline, Month 24
Other outcomes:
Locations:
city: Birmingham
country: United States
state: Alabama
city: Oakland
country: United States
state: California
city: Atlanta
country: United States
state: Georgia
city: Chicago
country: United States
state: Illinois
city: Bethesda
country: United States
state: Maryland
city: Hackensack
country: United States
state: New Jersey
city: New Hyde Park
country: United States
state: New York
city: New York
country: United States
state: New York
city: Chapel Hill
country: United States
state: North Carolina
city: Philadelphia
country: United States
state: Pennsylvania
city: Charleston
country: United States
state: South Carolina
Study officials:
affiliation: bluebird bio, Inc.
name: Anjulika Chawla, MD, FAAP
role: STUDY_DIRECTOR
References:
citation: Kanter J, Thompson AA, Pierciey FJ Jr, Hsieh M, Uchida N, Leboulch P, Schmidt M, Bonner M, Guo R, Miller A, Ribeil JA, Davidson D, Asmal M, Walters MC, Tisdale JF. Lovo-cel gene therapy for sickle cell disease: Treatment process evolution and outcomes in the initial groups of the HGB-206 study. Am J Hematol. 2023 Jan;98(1):11-22. doi: 10.1002/ajh.26741. Epub 2022 Oct 10.
citation: Del Pozo Martin Y. 2021 ASH annual meeting. Lancet Haematol. 2022 Feb;9(2):e92-e93. doi: 10.1016/S2352-3026(21)00384-7. Epub 2021 Dec 16. No abstract available.
citation: Kanter J, Walters MC, Krishnamurti L, Mapara MY, Kwiatkowski JL, Rifkin-Zenenberg S, Aygun B, Kasow KA, Pierciey FJ Jr, Bonner M, Miller A, Zhang X, Lynch J, Kim D, Ribeil JA, Asmal M, Goyal S, Thompson AA, Tisdale JF. Biologic and Clinical Efficacy of LentiGlobin for Sickle Cell Disease. N Engl J Med. 2022 Feb 17;386(7):617-628. doi: 10.1056/NEJMoa2117175. Epub 2021 Dec 12.
citation: Jones RJ, DeBaun MR. Leukemia after gene therapy for sickle cell disease: insertional mutagenesis, busulfan, both, or neither. Blood. 2021 Sep 16;138(11):942-947. doi: 10.1182/blood.2021011488.
citation: Del Pozo Martin Y. 47th Annual Meeting of the EBMT. Lancet Haematol. 2021 May;8(5):e317-e318. doi: 10.1016/S2352-3026(21)00104-6. Epub 2021 Mar 31. No abstract available.