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Gene Therapy Trial for Platelet Derived Factor VIII Production in Hemophilia A

Primary Purpose

Hemophilia A

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Auto CD34+PBSC, transduced with a lentiviral vector encoding the B domain deleted from of human coagulation factor VIII
Sponsored by
Medical College of Wisconsin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemophilia A focused on measuring Gene Therapy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

Study population will include: adult males >18 years of age with a diagnosis of severe hemophilia A and currently active or a history of FVIII inhibitors (≥0.6 BU). Females will be excluded because hemophilia A is an X-linked disorder that is extremely rare in females.

  1. Confirmed diagnosis of severe hemophilia A by undetectable plasma factor VIII:C by a one-stage PTT-based assay and coatest chromogenic factor VIII assay. Subjects with currently active or a history of positive FVIII inhibitor titers (≥0.6 BU) irrespective of their titer or current inhibitor status will be included for enrollment.
  2. Subject may be prescribed prophylactic therapy with factor VIII bypassing agents or factor VIII mimetics prior to referral for inclusion in the study.
  3. Subjects who are treated on demand using factor VIII bypassing agents must have a history of four or more bleeding episodes requiring treatment in the six-month period prior to referral for inclusion in the study.
  4. Adequate bone marrow reserve as demonstrated by ANC >1.5/cu.mm; Hemoglobin >9g/dL; Platelets >100,000/microliter.
  5. Adequate renal function, defined as creatinine clearance>60 ml/min (Cockroft-Gault formula)
  6. Adequate liver function, defined as defined as total bilirubin ≤1.5 times the upper limit of normal (ULN) (excluding Gilbert's syndrome), both AST and ALT ≤3 times ULN at the time of screening, and no clinical signs or known laboratory/radiographic evidence consistent with cirrhosis.
  7. Subject must sign an informed consent after explanation of the study and having questions answered.
  8. Subject must be willing and able to document type of bleeding episodes and treatment in a paper or electronic diary during the study.
  9. Subject must be willing to return for regular follow-up visits during the 15-year study.

Exclusion Criteria:

  • A potential subject who meets any of the following exclusion criteria is ineligible to participate in the study.

    1. Therapy with factor VIII with the intent of immune tolerance induction within 30 days prior to inclusion within the study.
    2. Enrollment in another interventional clinical trial within 60 days prior to study inclusion.
    3. Medical contraindication to PBSC cytokine mobilization, use of GCSF, PBSC apheresis procedure or conditioning regimen.
    4. Medically significant organ dysfunction that would prevent compliance with conditioning or would severely limit the probability of survival based on clinical status.
    5. Those with a known co-existing clinically significant thrombophilic disorder, or as determined by the presence of any of the below identified on screening laboratory assessments:

      • FV Leiden
      • Protein S deficiency
      • Protein C deficiency
      • Prothrombin mutation (G20210A)
      • D-dimer >3 x the upper limit of normal (ULN) at Screening All known patients with the above and any patient with a personal or significant family history of thrombotic events (DVT, PE, arterial clots) as deemed by the principal investigator will be screened for the above disorders.
    6. Active invasive malignancy (Non-melanoma skin cancers and carcinoma in situ are not excluded).
    7. Known bone marrow disorders or abnormal bone marrow cytogenetics.
    8. Fertile males who are unwilling to use contraceptive techniques during and for the twelve months following treatment.
    9. Life expectancy severely limited by disease(s) other than hemophilia A.
    10. Patients with HIV, hepatitis B, hepatitis C (with an AST/ALT > 3 times the upper limit of normal).
    11. Other active infectious disease that is a contraindicat ion for immunosuppressive therapy.
    12. Patients who have elective surgery scheduled during the study period.

Sites / Locations

  • Froedtert Hospital and the Medical College of WisconsinRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Autologous CD34+PBSC transduced with a lentiviral vector

Arm Description

Patients will receive a patient specific (autologous) cytokine mobilized CD34+Peripheral Blood Stem Cells (PBSC) transduced ex vivo with a lentiviral vector containing cDNA encoding the human B-domain deleted FVIII protein.

Outcomes

Primary Outcome Measures

Number of enrolled participants with adequate gene transduced hematopoietic stem cells for FVIII gene therapy infusion
Assessed by availability of ≥4x106 transduced clinical grade CD34+PBSC per kg meeting release criteria for infusion; undetectable microbiological contamination and cell viability ≥70%.

Secondary Outcome Measures

Incidence of toxicity from gene therapy
Number of events meeting CTCAE criteria grade 3 or 4 toxicity

Full Information

First Posted
January 15, 2019
Last Updated
December 21, 2022
Sponsor
Medical College of Wisconsin
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1. Study Identification

Unique Protocol Identification Number
NCT03818763
Brief Title
Gene Therapy Trial for Platelet Derived Factor VIII Production in Hemophilia A
Official Title
Phase I Study Evaluating Safety and Feasibility of Hematopoietic Stem Cell Gene Transfer That Targets Factor VIII Delivery From Platelets for Patients With Hemophilia A
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 29, 2020 (Actual)
Primary Completion Date
May 1, 2023 (Anticipated)
Study Completion Date
May 1, 2033 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Medical College of Wisconsin

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a Phase I study. This research study is being conducted to find new ways to treat severe hemophilia A. This study is a gene therapy study. Gene therapy is an experimental way to introduce, into a person's cells, specific genetic material. A gene can be delivered/introduced into a cell using a carrier known as a "vector." In this study, a virus (lentivirus), the "vector", is used to introduce or deliver a gene that creates and stores a protein Factor VIII (FVIII) in your platelets. These platelets are made from stem cells (mother cells for your bone marrow) that are removed from your blood by a procedure called apheresis. This research study will take some of the patient's own stem cells, from the apheresis procedure, and genetically modify them using the vector in order to make them produce FVIII in platelets that arise from the stem cells. They will then give the genetically modified stem cells back to the patient so that they can possibly create platelets that produce and store Factor VIII on their own.
Detailed Description
This is an open label, nonrandomized, single center, phase I cohort study, involving reduced intensity conditioning, followed by a single infusion of autologous CD34+PBSC, transduced with a lentiviral vector (-889ITGA2B-BDDFVIII-WPTS (MUT6)(VSVg)) also known as (Pleightlet(MUT6)) encoding the B domain deleted from of human coagulation factor VIII (BDDFVIII) in up to five hemophilia A patients with a history of FVIII inhibitors (≥0.6BU) .

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hemophilia A
Keywords
Gene Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
Open-label, nonrandomized, single-center phase I cohort study
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Autologous CD34+PBSC transduced with a lentiviral vector
Arm Type
Experimental
Arm Description
Patients will receive a patient specific (autologous) cytokine mobilized CD34+Peripheral Blood Stem Cells (PBSC) transduced ex vivo with a lentiviral vector containing cDNA encoding the human B-domain deleted FVIII protein.
Intervention Type
Biological
Intervention Name(s)
Auto CD34+PBSC, transduced with a lentiviral vector encoding the B domain deleted from of human coagulation factor VIII
Intervention Description
Reduced intensity conditioning with melphalan and fludarabine, followed by a single infusion of autologous CD34+PBSC, transduced with a lentiviral vector (-889ITGA2B-BDDFVIII-WPTS(MUT6)(VSVg)) also known as (Pleightlet(MUT6)) encoding the B domain deleted from of human coagulation factor VIII (BDDFVIII) in up to five hemophilia A patients with a history of FVIII inhibitors (≥0.6BU). The infusion volume of transduced cells will not exceed 20 ml/kg body weight.
Primary Outcome Measure Information:
Title
Number of enrolled participants with adequate gene transduced hematopoietic stem cells for FVIII gene therapy infusion
Description
Assessed by availability of ≥4x106 transduced clinical grade CD34+PBSC per kg meeting release criteria for infusion; undetectable microbiological contamination and cell viability ≥70%.
Time Frame
Through study completion, an average of 4 years
Secondary Outcome Measure Information:
Title
Incidence of toxicity from gene therapy
Description
Number of events meeting CTCAE criteria grade 3 or 4 toxicity
Time Frame
Within 3 months of gene therapy infusion

10. Eligibility

Sex
Male
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Study population will include: adult males >18 years of age with a diagnosis of severe hemophilia A and currently active or a history of FVIII inhibitors (≥0.6 BU). Females will be excluded because hemophilia A is an X-linked disorder that is extremely rare in females. Confirmed diagnosis of severe hemophilia A by undetectable plasma factor VIII:C by a one-stage PTT-based assay and coatest chromogenic factor VIII assay. Subjects with currently active or a history of positive FVIII inhibitor titers (≥0.6 BU) irrespective of their titer or current inhibitor status will be included for enrollment. Subject may be prescribed prophylactic therapy with factor VIII bypassing agents or factor VIII mimetics prior to referral for inclusion in the study. Subjects who are treated on demand using factor VIII bypassing agents must have a history of four or more bleeding episodes requiring treatment in the six-month period prior to referral for inclusion in the study. Adequate bone marrow reserve as demonstrated by ANC >1.5/cu.mm; Hemoglobin >9g/dL; Platelets >100,000/microliter. Adequate renal function, defined as creatinine clearance>60 ml/min (Cockroft-Gault formula) Adequate liver function, defined as defined as total bilirubin ≤1.5 times the upper limit of normal (ULN) (excluding Gilbert's syndrome), both AST and ALT ≤3 times ULN at the time of screening, and no clinical signs or known laboratory/radiographic evidence consistent with cirrhosis. Subject must sign an informed consent after explanation of the study and having questions answered. Subject must be willing and able to document type of bleeding episodes and treatment in a paper or electronic diary during the study. Subject must be willing to return for regular follow-up visits during the 15-year study. Exclusion Criteria: A potential subject who meets any of the following exclusion criteria is ineligible to participate in the study. Therapy with factor VIII with the intent of immune tolerance induction within 30 days prior to inclusion within the study. Enrollment in another interventional clinical trial within 60 days prior to study inclusion. Medical contraindication to PBSC cytokine mobilization, use of GCSF, PBSC apheresis procedure or conditioning regimen. Medically significant organ dysfunction that would prevent compliance with conditioning or would severely limit the probability of survival based on clinical status. Those with a known co-existing clinically significant thrombophilic disorder, or as determined by the presence of any of the below identified on screening laboratory assessments: FV Leiden Protein S deficiency Protein C deficiency Prothrombin mutation (G20210A) D-dimer >3 x the upper limit of normal (ULN) at Screening All known patients with the above and any patient with a personal or significant family history of thrombotic events (DVT, PE, arterial clots) as deemed by the principal investigator will be screened for the above disorders. Active invasive malignancy (Non-melanoma skin cancers and carcinoma in situ are not excluded). Known bone marrow disorders or abnormal bone marrow cytogenetics. Fertile males who are unwilling to use contraceptive techniques during and for the twelve months following treatment. Life expectancy severely limited by disease(s) other than hemophilia A. Patients with HIV, hepatitis B, hepatitis C (with an AST/ALT > 3 times the upper limit of normal). Other active infectious disease that is a contraindicat ion for immunosuppressive therapy. Patients who have elective surgery scheduled during the study period.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Mary Eapen, MD
Phone
414-805-0700
Email
meapen@mcw.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Arielle Baim
Phone
414-805-8745
Email
abaim@mcw.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mary Eapen, MD
Organizational Affiliation
Froedtert Hosptial and Medical College of Wisconsin
Official's Role
Principal Investigator
Facility Information:
Facility Name
Froedtert Hospital and the Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mary Eapen, MD
Phone
414-805-0700
Email
meapen@mcw.edu
First Name & Middle Initial & Last Name & Degree
Arielle Baim
Phone
414-805-8745
Email
abaim@mcw.edu

12. IPD Sharing Statement

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Gene Therapy Trial for Platelet Derived Factor VIII Production in Hemophilia A

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