search
Back to results

Motixafortide and Natalizumab to Mobilize CD34+ Hematopoietic Stem Cells for Gene Therapies in Sickle Cell Disease (SCD)

Primary Purpose

Sickle Cell Disease

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Motixafortide
Natalizumab
Leukapheresis
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sickle Cell Disease focused on measuring sickle cell disease, gene therapy, hematopoietic stem cell mobilization, CXCR4 inhibition, VLA4 inhibition

Eligibility Criteria

18 Years - 40 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Adult patients aged 18-40 years old Diagnosis of sickle cell disease (hemoglobin SS or Sβ0 genotype) Receiving automated RBC exchanges via apheresis-capable central venous access Able to hold hydroxyurea, voxelotor, and/or crizanlizumab for at least 60 days prior to mobilization Able to hold iron chelation for at least 7 days prior to mobilization ECOG performance status ≤ 1 Normal bone marrow and organ function at screening as defined below: Leukocytes ≥ 2,000/uL Absolute neutrophil count ≥ 1,500/uL Platelets ≥ 75,000/uL AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN at time of screening Creatinine clearance ≥ 30 mL/min by Cockcroft-Gault Baseline oxygen saturation ≥ 92% on room air Left ventricular ejection fraction (LVEF) ≥ 45% (Of note, transthoracic echocardiogram (TTE) will not be required for study. However, if the treating physician has clinical concerns for active cardiac disease for which a TTE is clinically warranted as standard of care, then an EF of ≥ 45% will be required). The effects of motixafortide and natalizumab on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation, and 3 months after completion of the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study, and 3 months after completion of the study. Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Exclusion Criteria: Patients may not have a history of receiving the following therapies: prior HCT or prior gene therapy Currently receiving concomitant immunosuppressants including 6-mercaptopurine, azathioprine, cyclosporine, methotrexate or concomitant inhibitors of TNF-α. Patient may not have a history of significant alloantibodies which, in the opinion of the treating physician and study investigator, significantly increase the risk of participation in this clinical trial. Currently receiving any other investigational agents. A history of progressive multifocal leukoencephalopathy A history of allergic reactions attributed to compounds of similar chemical or biologic composition to motixafortide or natalizumab. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (including but not limited to HIV, active/untreated Hepatitis C and/or active/untreated Hepatitis B), ongoing/active vaso-occlusive pain crisis or uncontrolled SCD-related symptoms, symptomatic congestive heart failure, cerebrovascular accident, unstable angina pectoris, or cardiac arrhythmia. Pregnant and/or breastfeeding. Women of childbearing potential must have a negative serum/urine pregnancy test within 7 days of study entry and prior to each study agent administration/HSC mobilization. Determined by the investigator to be unable or unlikely to comply with the study procedures included in this protocol.

Sites / Locations

  • Washington University School of MedicineRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Motixafortide followed by Motixafortide + Natalizumab

Arm Description

Consenting and eligible patients will receive a single subcutaneous injection of motixafortide, followed by leukapheresis. Patient will then be followed for 8 weeks for adverse event monitoring. Following the 8-week monitoring period, patients will receive a single IV infusion natalizumab, then approximately 32 hours later, a single subcutaneous injection of motixafortide, followed by leukapheresis. Patients will then be followed for 8 weeks for adverse event monitoring.

Outcomes

Primary Outcome Measures

Safety and tolerability as assessed by the incidence of dose-limiting toxicities (DLTs)
All toxicities will be graded using NCI-CTCAE Version 5.0 A DLT is an event occurring during the DLT period of 28 days following administration of either motixafortide and/or natalizumab that is considered to be at least possibly, probably or definitely related to study treatment by the investigator, and that meets the criteria below: Hematologic criteria Any Grade 5 adverse event Any Grade 4 adverse event, excluding Grade 4 hemolysis, bilirubin increase, leukocytosis, erythrocytosis, thrombocytosis, anemia, leukopenia, or febrile neutropenia Non-hematologic criteria Any Grade 4 or 5 adverse event. Any Grade 3 or higher arterial or venous thromboembolic event Any Grade 2 or 3 adverse event that does not resolve within 4 weeks; with the exception of <grade 2 injection site reactions.

Secondary Outcome Measures

Number of CD34+ hematopoietic stem and progenitor cells (HSPCs) mobilized via leukapheresis per liter (L) of total volume (tV) processed following motixafortide alone and motixafortide + natalizumab
Number of CD34+ hematopoietic stem and progenitor cells (HSPCs) mobilized via leukapheresis per liter (L) of adjusted volume (aV) processed, following motixafortide alone and motixafortide + natalizumab
-The adjusted volume will be calculated as the total volume (tV) processed minus the volumes processed to establish/re-establish the HSC collection interface (iV) to yield an adjusted volume (aV) (i.e. tV-iV=aV). The number of apheresis alarms along with the amount of time, flow rate and volumes processed to establish the interface will be recorded during apheresis and entered into the eCRF. Use of aV will control for the effect of any apheresis alarms; which pause the centrifuge leading to loss of the collection interface.
Change in kinetics of CD34+ HSC mobilization in response to motixafortide alone and motixafortide + natalizumab in SCD patients, as assessed by CD34+ cells/ul in peripheral blood
Frequency of adverse events
-All adverse events will be graded using NCI-CTCAE Version 5.0
Change in peak CD34+ HSC mobilization in response to motixafortide alone and motixafortide + natalizumab in SCD patients, as assessed by CD34+ cells/ul in peripheral blood

Full Information

First Posted
November 8, 2022
Last Updated
August 21, 2023
Sponsor
Washington University School of Medicine
Collaborators
BioLineRx, Ltd., Biogen
search

1. Study Identification

Unique Protocol Identification Number
NCT05618301
Brief Title
Motixafortide and Natalizumab to Mobilize CD34+ Hematopoietic Stem Cells for Gene Therapies in Sickle Cell Disease (SCD)
Official Title
A Pilot Safety and Feasibility Study to Evaluate Motixafortide (CXCR4/SDF-1 Inhibition) and Natalizumab (VLA-4/VCAM-1 Inhibition) as a Novel Regimen to Mobilize CD34+ Hematopoietic Stem Cells for Gene Therapies in Sickle Cell Disease (SCD)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 7, 2023 (Actual)
Primary Completion Date
January 31, 2024 (Anticipated)
Study Completion Date
January 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
BioLineRx, Ltd., Biogen

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
No

5. Study Description

Brief Summary
Hematopoietic stem cell (HSC)-based gene therapies now offer curative potential for patients with sickle cell disease (SCD), with decreased toxicity compared to allogeneic hematopoietic cell transplantation. However, effective HSC-based gene therapy depends on collecting sufficient HSCs to generate the therapeutic product, and currently available mobilization regimens carry unacceptable risk for patients with SCD or do not reliably yield optimal numbers of HSCs for gene therapy. The investigators hypothesize that HSC mobilization with motixafortide (CXCR4i) alone and the combination of motixafortide plus natalizumab (VLA-4i) will be safe and tolerable in SCD patients. In addition, the investigators hypothesize that combined CXCR4 and VLA-4 blockade with motixafortide plus natalizumab will result in a rapid, robust, and synergistic increase in HSC mobilization to peripheral blood (PB) in patients with SCD, when compared to motixafortide alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sickle Cell Disease
Keywords
sickle cell disease, gene therapy, hematopoietic stem cell mobilization, CXCR4 inhibition, VLA4 inhibition

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Motixafortide followed by Motixafortide + Natalizumab
Arm Type
Experimental
Arm Description
Consenting and eligible patients will receive a single subcutaneous injection of motixafortide, followed by leukapheresis. Patient will then be followed for 8 weeks for adverse event monitoring. Following the 8-week monitoring period, patients will receive a single IV infusion natalizumab, then approximately 32 hours later, a single subcutaneous injection of motixafortide, followed by leukapheresis. Patients will then be followed for 8 weeks for adverse event monitoring.
Intervention Type
Drug
Intervention Name(s)
Motixafortide
Other Intervention Name(s)
BL-8040
Intervention Description
Motixafortide is to be administered as a subcutaneous injection at a dose of 1.25 mg/kg
Intervention Type
Drug
Intervention Name(s)
Natalizumab
Other Intervention Name(s)
Tysabri
Intervention Description
Natalizumab will be administered as an IV infusion at a flat dose of 300 mg
Intervention Type
Procedure
Intervention Name(s)
Leukapheresis
Intervention Description
Leukapheresis consisting of a 1 Blood Volume procedure
Primary Outcome Measure Information:
Title
Safety and tolerability as assessed by the incidence of dose-limiting toxicities (DLTs)
Description
All toxicities will be graded using NCI-CTCAE Version 5.0 A DLT is an event occurring during the DLT period of 28 days following administration of either motixafortide and/or natalizumab that is considered to be at least possibly, probably or definitely related to study treatment by the investigator, and that meets the criteria below: Hematologic criteria Any Grade 5 adverse event Any Grade 4 adverse event, excluding Grade 4 hemolysis, bilirubin increase, leukocytosis, erythrocytosis, thrombocytosis, anemia, leukopenia, or febrile neutropenia Non-hematologic criteria Any Grade 4 or 5 adverse event. Any Grade 3 or higher arterial or venous thromboembolic event Any Grade 2 or 3 adverse event that does not resolve within 4 weeks; with the exception of <grade 2 injection site reactions.
Time Frame
Through 28 days following administration of either motixafortide and/or natalizumab (estimated to be 8 weeks and 4 days)
Secondary Outcome Measure Information:
Title
Number of CD34+ hematopoietic stem and progenitor cells (HSPCs) mobilized via leukapheresis per liter (L) of total volume (tV) processed following motixafortide alone and motixafortide + natalizumab
Time Frame
Day 2 and Day 60
Title
Number of CD34+ hematopoietic stem and progenitor cells (HSPCs) mobilized via leukapheresis per liter (L) of adjusted volume (aV) processed, following motixafortide alone and motixafortide + natalizumab
Description
-The adjusted volume will be calculated as the total volume (tV) processed minus the volumes processed to establish/re-establish the HSC collection interface (iV) to yield an adjusted volume (aV) (i.e. tV-iV=aV). The number of apheresis alarms along with the amount of time, flow rate and volumes processed to establish the interface will be recorded during apheresis and entered into the eCRF. Use of aV will control for the effect of any apheresis alarms; which pause the centrifuge leading to loss of the collection interface.
Time Frame
Day 2 and Day 60
Title
Change in kinetics of CD34+ HSC mobilization in response to motixafortide alone and motixafortide + natalizumab in SCD patients, as assessed by CD34+ cells/ul in peripheral blood
Time Frame
From baseline through Day 60
Title
Frequency of adverse events
Description
-All adverse events will be graded using NCI-CTCAE Version 5.0
Time Frame
From start of treatment through 8 weeks following completion of all treatment (estimated to be 16 weeks and 4 days)
Title
Change in peak CD34+ HSC mobilization in response to motixafortide alone and motixafortide + natalizumab in SCD patients, as assessed by CD34+ cells/ul in peripheral blood
Time Frame
From baseline through Day 60

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult patients aged 18-40 years old Diagnosis of sickle cell disease (hemoglobin SS or Sβ0 genotype) Receiving automated RBC exchanges via apheresis-capable central venous access Able to hold hydroxyurea, voxelotor, and/or crizanlizumab for at least 60 days prior to mobilization Able to hold iron chelation for at least 7 days prior to mobilization ECOG performance status ≤ 1 Normal bone marrow and organ function at screening as defined below: Leukocytes ≥ 2,000/uL Absolute neutrophil count ≥ 1,500/uL Platelets ≥ 75,000/uL AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN at time of screening Creatinine clearance ≥ 30 mL/min by Cockcroft-Gault Baseline oxygen saturation ≥ 92% on room air Left ventricular ejection fraction (LVEF) ≥ 45% (Of note, transthoracic echocardiogram (TTE) will not be required for study. However, if the treating physician has clinical concerns for active cardiac disease for which a TTE is clinically warranted as standard of care, then an EF of ≥ 45% will be required). The effects of motixafortide and natalizumab on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation, and 3 months after completion of the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study, and 3 months after completion of the study. Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Exclusion Criteria: Patients may not have a history of receiving the following therapies: prior HCT or prior gene therapy Currently receiving concomitant immunosuppressants including 6-mercaptopurine, azathioprine, cyclosporine, methotrexate or concomitant inhibitors of TNF-α. Patient may not have a history of significant alloantibodies which, in the opinion of the treating physician and study investigator, significantly increase the risk of participation in this clinical trial. Currently receiving any other investigational agents. A history of progressive multifocal leukoencephalopathy A history of allergic reactions attributed to compounds of similar chemical or biologic composition to motixafortide or natalizumab. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection (including but not limited to HIV, active/untreated Hepatitis C and/or active/untreated Hepatitis B), ongoing/active vaso-occlusive pain crisis or uncontrolled SCD-related symptoms, symptomatic congestive heart failure, cerebrovascular accident, unstable angina pectoris, or cardiac arrhythmia. Pregnant and/or breastfeeding. Women of childbearing potential must have a negative serum/urine pregnancy test within 7 days of study entry and prior to each study agent administration/HSC mobilization. Determined by the investigator to be unable or unlikely to comply with the study procedures included in this protocol.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Zachary Crees, M.D.
Phone
314-747-8076
Email
zcrees@wustl.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zachary Crees, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zachary Crees, M.D.
Phone
314-747-8076
Email
zcrees@wustl.edu
First Name & Middle Initial & Last Name & Degree
Zachary Crees, M.D.
First Name & Middle Initial & Last Name & Degree
John DiPersio, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Allison King, M.D., MPH, Ph.D.
First Name & Middle Initial & Last Name & Degree
Michael Rettig, Ph.D.
First Name & Middle Initial & Last Name & Degree
Reyka Jayasinghe, Ph.D.
First Name & Middle Initial & Last Name & Degree
Brenda Grossman, M.D., MPH
First Name & Middle Initial & Last Name & Degree
Fei Wan, Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Motixafortide and Natalizumab to Mobilize CD34+ Hematopoietic Stem Cells for Gene Therapies in Sickle Cell Disease (SCD)

We'll reach out to this number within 24 hrs