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A Study Evaluating the Safety and Efficacy of LentiRed Drug Product in Transfusion-dependent β-Thalassemia [TDT]

Primary Purpose

Transfusion Dependent Beta-Thalassemia

Status
Recruiting
Phase
Early Phase 1
Locations
China
Study Type
Interventional
Intervention
GMCN-508B (LentiRed)
Sponsored by
First Affiliated Hospital of Guangxi Medical University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Transfusion Dependent Beta-Thalassemia focused on measuring LentiRed, Beta-Thalassemia, Human Hematopoietic Stem Cell, gene therapy, CD34+

Eligibility Criteria

5 Years - 35 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: The subject himself/herself or one legal guardian/agent of the subject is required to fully understand the study and voluntarily sign a written informed consent. Ages 5 to 35, no gender limitation. The clinical diagnosis of TDT includes β0/β0, β+/β0, βE/β0 and β+/β+ genotypes. TDT was defined as severe anemia in patients with thalassemia (Hb persistent <70 g/L), regular RBC transfusion and standard iron removal therapy to survive for life. Karnofsky Level of Performance (KPS) score ≥70 in adult subjects and Lansky Level of Performance (LPS) score ≥70 in children subjects. Subjects were determined to undergo autologous hematopoietic stem cell transplantation by the principle investigator. Subjects must have been treated and followed for at least the past 2 years in a specialized center that maintained detailed medical records, including transfusion history. Exclusion Criteria: Hepatitis B virus (HBV) : HbsAg or HbcAb positive, nucleic acid test positive; Hepatitis C virus (HCV) : HCAb positive, nucleic acid test positive; Positive for Human immunodeficiency virus (HIV) antibody or Treponema pallidum (TP) specific antibody; Tuberculosis: positive interferon gamma release test. A white blood cell (WBC) count <3×10^9/L and/or platelet count <100×10^9/L, splenectomy was performed before. Uncured bleeding abnormalities. Any previous or current malignancy, myeloproliferative disease, or immune deficiency disease. Immediate family member with a known or suspected Familial Cancer Syndrome (including but not limited to hereditary breast and ovarian cancer syndromes, hereditary non-polyposis colorectal cancer syndromes and familial adenomatous polyposis). Previous hematopoietic stem cell transplantation (HSCT). Advanced liver disease, defined as: 1) Baseline alanine aminotransferase (ALT) or direct bilirubin ≥3 normal upper limit (ULN), or 2) Liver biopsy demonstrating cirrhosis, any evidence of bridging fibrosis, or acute hepatitis. Baseline estimated glomerular filtration rate (eGFR) < 70 mL/min /1.73 m2, as determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation for ≥18 years of age, and Besides Schwartz Equation calculator < 18 years of age. Uncontrolled seizure disorder. Diffusion capacity of Carbon monoxide dispersion (DLco) <50% of predicted (corrected for hemoglobin and or alveolar ventilation, as clinically indicated ). A cardiac T2* <20 ms by magnetic resonance imaging (MRI). Severe iron overload, which in the opinion of the physician is grounds for exclusion. Clinically significant pulmonary hypertension. Participation in another clinical study with an investigational drug within 30 days of screening. Failure to obtain appropriate informed consent. Any other condition that would render the subject ineligible for HSCT, as determined by the attending transplant physician or investigator. Contraindications to the conditioning regimen. Prior receipt of genetic stem cell therapy. Diagnosis of significant psychiatric disorder of the subject that could seriously impede the ability to participate in the study. Pregnancy or breastfeeding in a postpartum female or absence of adequate contraception for fertile subjects. Females of child-bearing potential are required to use effective contraception from the screening period until at least 6 months after drug product infusion. Male subjects are also required to use effective contraception (including condoms) from the screening period until at least 6 months after drug product infusion. Live vaccines were administered within 6 weeks prior to screening. Known history of hypersensitivity to the ingredients used in the trial. An assessment by the investigator that the subject would not comply with the study procedures outlined in the protocol.

Sites / Locations

  • The affiliated hospital of guangxi medical universityRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

LentiRed

Arm Description

LentiRed Drug Product

Outcomes

Primary Outcome Measures

Proportion of subjects who achieved transfusion independence, defined as an average Hb ≥ 9 g/dL without any pRBC transfusions for a continuous period of ≥ 6 months at any time during the study after LentiRed Drug Product infusion.
TI was defined as an average hemoglobin (Hb) >= 9 g/dL without any packed red blood cells (pRBC) transfusions for a continuous period of >=6 months at any time during the study after Drug Product infusion.
Number and proportion of subjects who maintained βA-T87Q-globin(HbAT87Q) at ≥2.0 g/dL for ≥ 6 months after LentiRed Drug Product infusion.
Percentage of participants with sustained production of >=2.0 grams per deciliter (g/dL) of hemoglobin A (HbA) containing βA-T87Q-globin (HbAT87Q) for 6 months was reported.
Proportion of subjects whose red blood cells (RBC) transfusion requirement was reduced for ≥6 months after LentiRed Drug Product infusion, compared to previous 2-year transfusion records.
The annualized number of pRBC transfusions over the 2 year period prior to drug product infusion was compared to the annualized number of pRBC transfusions post drug product infusion and the percentage change was reported.

Secondary Outcome Measures

Proportion of subjects who achieved transfusion independence, defined as an average Hb ≥ 9 g/dL without any pRBC transfusions for a continuous period of ≥ 3 months at any time during the study after LentiRed Drug Product infusion.
TI was defined as an average hemoglobin (Hb) >= 9 g/dL without any packed red blood cells (pRBC) transfusions for a continuous period of >=3 months at any time during the study after Drug Product infusion.
Proportion of subjects who achieved Neutrophil engraftment.
Neutrophil engraftment was defined as achieving 3 consecutive absolute neutrophil count (ANC) >= 0.5 × 10^9/L on different days after a post-transplant value of < 0.5 × 10^9/L within 42 days after drug product infusion.
Incidence of transplant-related mortality through 100 days post drug product infusion.
Transplant-related mortality was determined by the investigator (any deaths considered related to the transplant.)
Overall survival.
Overall survival was defined as time from date of LentiRed Drug Product infusion (Day 0) to date of death.
Detection of vector-derived replication competent lentivirus (RCL) in any subject.
Blood samples were analyzed for detection of RCL
Characterization of events of insertional mutagenesis leading to clonal dominance or leukemia.
Linear amplification-mediated polymerase chain reaction (LAM-PCR) coupled with next generation sequencing and subsequent (semi-) automated data mining allowed high-throughput analysis of vector integration site (IS) in blood cells from treated participants at multiple time points. ISs detected in peripheral blood cells at early time points generally were due to the expansion of transduced short-term progenitor stem cell clones, and gradually shift to include sites detected due to expansion of transduced long-term stem cell clones. An efficient transduction procedure was anticipated to give rise to a polyclonal population in the participant, reflected by the detection of multiple IS. Additionally, ISA allowed monitoring of the relative contribution of individual clones over time. Number of participants who had IS that contributed to >=30% of the total clones at any time was used as a first step to investigating whether clonal dominance was achieved.
Monitor of frequency of clinical adverse events (AEs).
An AE was defined as any unfavorable and unintended sign (including abnormal laboratory findings), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
Therapeutic globin expression, as measured by assessing the ratio of βA-T87Q-globin to α -globin in whole blood, as well as the amount of βA-T87Q-globin to as a fraction of all β -chains in whole blood.
globin expression measured by HPLC
Average vector copy number (VCN) in cell populations from peripheral blood and bone marrow containing the integrated LentiRed lentiviral vector.
VCN will be monitored after drug product transfusion

Full Information

First Posted
January 6, 2022
Last Updated
May 5, 2023
Sponsor
First Affiliated Hospital of Guangxi Medical University
Collaborators
Genmedicn Biopharma Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT05762510
Brief Title
A Study Evaluating the Safety and Efficacy of LentiRed Drug Product in Transfusion-dependent β-Thalassemia [TDT]
Official Title
An Open Label Study Evaluating the Safety and Efficacy of Gene Therapy for Transfusion-dependent β-Thalassemia by Transplantation of Autologous CD34+ Stem Cells Transduced Ex Vivo With a LentiRed Lentiviral Vector (GMCN-508B Drug Product, Also Called LentiRed)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 22, 2023 (Actual)
Primary Completion Date
April 1, 2028 (Anticipated)
Study Completion Date
October 31, 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
First Affiliated Hospital of Guangxi Medical University
Collaborators
Genmedicn Biopharma Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This is a single-arm, open label, single-dose study in subjects with transfusion dependent β-thalassaemia. The study will evaluate the safety and efficacy of autologous CD34+ Human Hematopoietic Stem Cells that was transduced with LentiRed Lentivrial vector.
Detailed Description
Subject participation for this study will be 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Transfusion Dependent Beta-Thalassemia
Keywords
LentiRed, Beta-Thalassemia, Human Hematopoietic Stem Cell, gene therapy, CD34+

7. Study Design

Primary Purpose
Treatment
Study Phase
Early 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
LentiRed
Arm Type
Experimental
Arm Description
LentiRed Drug Product
Intervention Type
Genetic
Intervention Name(s)
GMCN-508B (LentiRed)
Intervention Description
LentiRed Drug Product is administered by intravenous infusion following myeloablative conditioning with busulfan.
Primary Outcome Measure Information:
Title
Proportion of subjects who achieved transfusion independence, defined as an average Hb ≥ 9 g/dL without any pRBC transfusions for a continuous period of ≥ 6 months at any time during the study after LentiRed Drug Product infusion.
Description
TI was defined as an average hemoglobin (Hb) >= 9 g/dL without any packed red blood cells (pRBC) transfusions for a continuous period of >=6 months at any time during the study after Drug Product infusion.
Time Frame
From time of drug product infusion up to 24 months
Title
Number and proportion of subjects who maintained βA-T87Q-globin(HbAT87Q) at ≥2.0 g/dL for ≥ 6 months after LentiRed Drug Product infusion.
Description
Percentage of participants with sustained production of >=2.0 grams per deciliter (g/dL) of hemoglobin A (HbA) containing βA-T87Q-globin (HbAT87Q) for 6 months was reported.
Time Frame
From time of drug product infusion up to 24 months
Title
Proportion of subjects whose red blood cells (RBC) transfusion requirement was reduced for ≥6 months after LentiRed Drug Product infusion, compared to previous 2-year transfusion records.
Description
The annualized number of pRBC transfusions over the 2 year period prior to drug product infusion was compared to the annualized number of pRBC transfusions post drug product infusion and the percentage change was reported.
Time Frame
From time of drug product infusion up to 24 months
Secondary Outcome Measure Information:
Title
Proportion of subjects who achieved transfusion independence, defined as an average Hb ≥ 9 g/dL without any pRBC transfusions for a continuous period of ≥ 3 months at any time during the study after LentiRed Drug Product infusion.
Description
TI was defined as an average hemoglobin (Hb) >= 9 g/dL without any packed red blood cells (pRBC) transfusions for a continuous period of >=3 months at any time during the study after Drug Product infusion.
Time Frame
From time of drug product infusion up to 24 months
Title
Proportion of subjects who achieved Neutrophil engraftment.
Description
Neutrophil engraftment was defined as achieving 3 consecutive absolute neutrophil count (ANC) >= 0.5 × 10^9/L on different days after a post-transplant value of < 0.5 × 10^9/L within 42 days after drug product infusion.
Time Frame
From time of drug product infusion up to 24 months
Title
Incidence of transplant-related mortality through 100 days post drug product infusion.
Description
Transplant-related mortality was determined by the investigator (any deaths considered related to the transplant.)
Time Frame
Through 100 days post-Drug Product infusion
Title
Overall survival.
Description
Overall survival was defined as time from date of LentiRed Drug Product infusion (Day 0) to date of death.
Time Frame
From time of drug product infusion up to 24 months
Title
Detection of vector-derived replication competent lentivirus (RCL) in any subject.
Description
Blood samples were analyzed for detection of RCL
Time Frame
From time of drug product infusion up to 24 months
Title
Characterization of events of insertional mutagenesis leading to clonal dominance or leukemia.
Description
Linear amplification-mediated polymerase chain reaction (LAM-PCR) coupled with next generation sequencing and subsequent (semi-) automated data mining allowed high-throughput analysis of vector integration site (IS) in blood cells from treated participants at multiple time points. ISs detected in peripheral blood cells at early time points generally were due to the expansion of transduced short-term progenitor stem cell clones, and gradually shift to include sites detected due to expansion of transduced long-term stem cell clones. An efficient transduction procedure was anticipated to give rise to a polyclonal population in the participant, reflected by the detection of multiple IS. Additionally, ISA allowed monitoring of the relative contribution of individual clones over time. Number of participants who had IS that contributed to >=30% of the total clones at any time was used as a first step to investigating whether clonal dominance was achieved.
Time Frame
From time of drug product infusion up to 24 months
Title
Monitor of frequency of clinical adverse events (AEs).
Description
An AE was defined as any unfavorable and unintended sign (including abnormal laboratory findings), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
Time Frame
From signing of informed consent to 24 months after the drug product infusion
Title
Therapeutic globin expression, as measured by assessing the ratio of βA-T87Q-globin to α -globin in whole blood, as well as the amount of βA-T87Q-globin to as a fraction of all β -chains in whole blood.
Description
globin expression measured by HPLC
Time Frame
From time of drug product infusion up to 24 months
Title
Average vector copy number (VCN) in cell populations from peripheral blood and bone marrow containing the integrated LentiRed lentiviral vector.
Description
VCN will be monitored after drug product transfusion
Time Frame
From time of drug product infusion up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject himself/herself or one legal guardian/agent of the subject is required to fully understand the study and voluntarily sign a written informed consent. Ages 5 to 35, no gender limitation. The clinical diagnosis of TDT includes β0/β0, β+/β0, βE/β0 and β+/β+ genotypes. TDT was defined as severe anemia in patients with thalassemia (Hb persistent <70 g/L), regular RBC transfusion and standard iron removal therapy to survive for life. Karnofsky Level of Performance (KPS) score ≥70 in adult subjects and Lansky Level of Performance (LPS) score ≥70 in children subjects. Subjects were determined to undergo autologous hematopoietic stem cell transplantation by the principle investigator. Subjects must have been treated and followed for at least the past 2 years in a specialized center that maintained detailed medical records, including transfusion history. Exclusion Criteria: Hepatitis B virus (HBV) : HbsAg or HbcAb positive, nucleic acid test positive; Hepatitis C virus (HCV) : HCAb positive, nucleic acid test positive; Positive for Human immunodeficiency virus (HIV) antibody or Treponema pallidum (TP) specific antibody; Tuberculosis: positive interferon gamma release test. A white blood cell (WBC) count <3×10^9/L and/or platelet count <100×10^9/L, splenectomy was performed before. Uncured bleeding abnormalities. Any previous or current malignancy, myeloproliferative disease, or immune deficiency disease. Immediate family member with a known or suspected Familial Cancer Syndrome (including but not limited to hereditary breast and ovarian cancer syndromes, hereditary non-polyposis colorectal cancer syndromes and familial adenomatous polyposis). Previous hematopoietic stem cell transplantation (HSCT). Advanced liver disease, defined as: 1) Baseline alanine aminotransferase (ALT) or direct bilirubin ≥3 normal upper limit (ULN), or 2) Liver biopsy demonstrating cirrhosis, any evidence of bridging fibrosis, or acute hepatitis. Baseline estimated glomerular filtration rate (eGFR) < 70 mL/min /1.73 m2, as determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation for ≥18 years of age, and Besides Schwartz Equation calculator < 18 years of age. Uncontrolled seizure disorder. Diffusion capacity of Carbon monoxide dispersion (DLco) <50% of predicted (corrected for hemoglobin and or alveolar ventilation, as clinically indicated ). A cardiac T2* <20 ms by magnetic resonance imaging (MRI). Severe iron overload, which in the opinion of the physician is grounds for exclusion. Clinically significant pulmonary hypertension. Participation in another clinical study with an investigational drug within 30 days of screening. Failure to obtain appropriate informed consent. Any other condition that would render the subject ineligible for HSCT, as determined by the attending transplant physician or investigator. Contraindications to the conditioning regimen. Prior receipt of genetic stem cell therapy. Diagnosis of significant psychiatric disorder of the subject that could seriously impede the ability to participate in the study. Pregnancy or breastfeeding in a postpartum female or absence of adequate contraception for fertile subjects. Females of child-bearing potential are required to use effective contraception from the screening period until at least 6 months after drug product infusion. Male subjects are also required to use effective contraception (including condoms) from the screening period until at least 6 months after drug product infusion. Live vaccines were administered within 6 weeks prior to screening. Known history of hypersensitivity to the ingredients used in the trial. An assessment by the investigator that the subject would not comply with the study procedures outlined in the protocol.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yongrong Lai, PhD
Phone
86-771-5356746
Email
laiyongrong@hotmail.com
Facility Information:
Facility Name
The affiliated hospital of guangxi medical university
City
Nanning
State/Province
Guangxi
ZIP/Postal Code
530021
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
yongrong lai, PhD
Phone
86-771-5356746
Email
laiyongrong@hotmail.com
First Name & Middle Initial & Last Name & Degree
yongrong lai, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Study Evaluating the Safety and Efficacy of LentiRed Drug Product in Transfusion-dependent β-Thalassemia [TDT]

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