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A Clinical Study to Assess the Efficacy and Safety of Gene Therapy for the Treatment of Cerebral Adrenoleukodystrophy (CALD)

Primary Purpose

Cerebral Adrenoleukodystrophy (CALD)

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Lenti-D
Sponsored by
bluebird bio
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cerebral Adrenoleukodystrophy (CALD) focused on measuring Adrenoleukodystrophy, X-linked adrenoleukodystrophy, Gene therapy, Hematopoietic stem cell

Eligibility Criteria

undefined - 17 Years (Child)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Informed consent is obtained from a competent custodial parent or guardian with legal capacity to execute a local Institutional Review Board (IRB)/independent ethics committee (IEC) approved consent. Informed assent will be sought from capable participants, in accordance with the directive of the IRB/IEC and with local requirements.
  2. Males aged 17 years and younger, at the time of parental/guardian consent and, where appropriate, participant assent.
  3. Active cerebral ALD as defined by:

    1. Elevated very long chain fatty acids (VLCFA) values, and
    2. Active central nervous system (CNS) disease established by central radiographic review of brain MRI demonstrating

    i. Loes score between 0.5 and 9 (inclusive) on the 34-point scale, and ii. Gadolinium enhancement on MRI of demyelinating lesions.

  4. NFS < or = 1.

Exclusion Criteria:

  1. Prior receipt of an allogeneic transplant or gene therapy.
  2. Use of statins, Lorenzo's Oil, or dietary regimens used to lower VLCFA levels. Note: participants must discontinue use of these medications at time of consent.
  3. Receipt of an investigational study drug or procedure within 3 months before Screening that might confound study outcomes. Use of investigational study drugs is prohibited throughout the course of the study.
  4. Any conditions that make it impossible to perform MRI studies (including allergies to anesthetics or contrast agents).
  5. Hematological compromise as evidenced by:

    1. Peripheral blood absolute neutrophil count (ANC) count <1500 cells/ cubic millimeter (mm^3), and either
    2. Platelet count <100,000 cells/mm^3, or
    3. Hemoglobin <10 gram per deciliter (g/dL).
  6. Hepatic compromise as evidenced by:

    1. Aspartate transaminase (AST) value greater than (>) 2.5 × upper limit of normal (ULN)
    2. Alanine transaminase (ALT) value >2.5 × ULN
    3. Total bilirubin value >3.0 milligram per deciliter (mg/dL), except if there is a diagnosis of Gilbert's Syndrome and the participant is otherwise stable
  7. Baseline estimated glomerular filtration rate <70 milliliter per minute (mL/min)/1.73 square meter (m^2).
  8. Cardiac compromise as evidenced by left ventricular ejection fraction <40 percent (%).
  9. Immediate family member with a known or suspected Familial Cancer Syndrome.
  10. Clinically significant uncontrolled, active bacterial, viral, fungal, parasitic, or prion associated infection.
  11. Positive for HIV, hepatitis B or C virus, or human T lymphotrophic virus 1 (HTLV-1).
  12. Any clinically significant cardiovascular, hematological, or pulmonary disease, or other disease or condition that would be contraindicated for any of the other study procedures.
  13. Absence of adequate contraception for fertile participants.
  14. Any contraindications to the use of Granulocyte colony-stimulating factor (G-CSF) or plerixafor during the mobilization of hematopoietic stem cells, and any contraindications to the use of busulfan or fludarabine, including known hypersensitivity to the active substances or to any of the excipients in their formulations.
  15. Known hypersensitivity to protamine sulfate.

Sites / Locations

  • Lucile Packard Children's Hospital
  • Boston Children's Hospital/Massachusetts General Hospital
  • University of Minnesota
  • Hôpital Robert Debré
  • Universitätsklinikum Leipzig AöR
  • Ospedale Pediatrico Bambino Gesù
  • Prinses Maxima Center
  • UCL-ICH/Great Ormond Street Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lenti-D Drug Product

Arm Description

Participants received a single intravenous (IV) infusion of Lenti-D Drug Product at a dose of > or = 5.0*10^6 CD34+ cells/kilogram (kg) (autologous CD34+ cell-enriched population that contains cells transduced with lentiviral vector encoding ABCD1 cDNA for human adrenoleukodystrophy protein, suspended in a cryopreservative solution) following myeloablative conditioning with busulfan and fludarabine on Day 1.

Outcomes

Primary Outcome Measures

Percentage of participants who are alive and have none of the 6 major functional disabilities (MFDs) at Month 24
The MFDs are loss of communication, cortical blindness, tube feeding, total incontinence, wheelchair dependence, complete loss of voluntary movement.
Percentage of participants with neutrophil engraftment after drug product infusion

Secondary Outcome Measures

Percentage of participants without gadolinium enhancement (GdE) at Month 24
Percentage of participants without gadolinium enhancement (that is [i.e.,] negative for GdE-) on Magnetic Resonance Imaging (MRI).
Change in total neurologic function Score (NFS) from baseline to protocol scheduled visits
The NFS is a 25-point score used to evaluate the severity of gross neurologic dysfunction in CALD by scoring 15 symptoms (functional domains) across 6 categories. Listed here are the 15 symptoms followed by their maximal score out of 25 points: a) Hearing / auditory processing problems-1, b) Aphasia / apraxia-1, c) Loss of communication-3, d) Vision impairment /field cut-1, e) Cortical blindness-2, f) Swallowing / other CNS dysfunctions-2, g) Tube feeding-2, h) Running difficulties / hyperreflexia-1, i) Walking difficulties / spasticity / spastic gait (no assistance)-1, j) Spastic gait (needs assistance)-2, k) Wheelchair dependence-2, l) Complete loss of voluntary movement-3, m) Episodes of incontinence -1, n) Total incontinence-2, o) Nonfebrile seizures-1. A score of "0" denotes absence of clinical signs of cerebral disease. Maximal signs within a domain score the total of all grades within that domain.
Major functional disability (MFD)-free survival over time
MFD-free survival over time is defined as time from drug product infusion to either a rescue cell administration or second transplant, MFD, or death due to any cause, whichever occurs first.
Overall survival
Detectable vector copy number (VCN) in peripheral blood cells by Month 6
Percentage of participants who experience either acute (greater than or equal to [> or =] Grade II) or chronic graft versus host disease (GVHD) at Month 24
Time to neutrophil engraftment post-drug product infusion
Percentage of participants with platelet engraftment by Month 24
Time to platelet engraftment post-drug product infusion
Percentage of participants with loss of neutrophil engraftment post-drug product infusion by Month 24
Percentage of participants who undergo a subsequent hematopoietic stem cell (HSC) infusion by Month 24
Percentage of participants who experience transplant-related mortality through 100 and 365 days post-drug product infusion
Percentage of participants with adverse events (AEs) in selected categories
Percentage of participants with clinical > or = Grade 3 AEs, drug product -related AEs, all serious adverse events (SAEs), AEs > or = Grade 3 infections by Month 24.
Percentage of participants with potentially clinically significant changes in laboratory parameters by Month 24
Laboratory parameters will include hematology, clinical chemistry, and liver function tests.
Percentage of participants who experience greater than or equal to (> or =) Grade II acute GVHD by Month 24
Percentage of participants who experience chronic GVHD by Month 24
Number of emergency room visits (post-neutrophil engraftment) by Month 24
Number of in-patient hospitalizations (post-neutrophil engraftment) by Month 24
Duration of in-patient hospitalizations (post-neutrophil engraftment) by Month 24
Number of intensive care units (ICU) stays (post-neutrophil engraftment) by Month 24
Duration of intensive care units (ICU) stays (post-neutrophil engraftment) by Month 24
Number of participants in which vector-derived replication competent lentivirus (RCL) is detected by Month 24
Number of participants with insertional oncogenesis by Month 24
Insertional oncogenesis including Myelodysplasia, Leukemia, Lymphoma by Month 24.

Full Information

First Posted
February 13, 2019
Last Updated
September 8, 2023
Sponsor
bluebird bio
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1. Study Identification

Unique Protocol Identification Number
NCT03852498
Brief Title
A Clinical Study to Assess the Efficacy and Safety of Gene Therapy for the Treatment of Cerebral Adrenoleukodystrophy (CALD)
Official Title
A Phase 3 Study of Lenti-D Drug Product After Myeloablative Conditioning Using Busulfan and Fludarabine in Subjects ≤17 Years of Age With Cerebral Adrenoleukodystrophy (CALD)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
January 24, 2019 (Actual)
Primary Completion Date
July 24, 2023 (Actual)
Study Completion Date
July 24, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
bluebird bio

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the efficacy and safety of Lenti-D Drug Product (also known as elivaldogene autotemcel or Skysona, hereafter referred to as eli-cel) after myeloablative conditioning with busulfan and fludarabine in participants with CALD. A participant's blood stem cells will be collected and modified (transduced) using the Lenti-D lentiviral vector encoding human adrenoleukodystrophy protein. After modification (transduction) with the Lenti-D lentiviral vector, the cells will be transplanted back into the participant following myeloablative conditioning. Enrollment and treatment in Study ALD-104 have been completed and further enrollment in this study is not expected, although participants follow-up remains ongoing.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cerebral Adrenoleukodystrophy (CALD)
Keywords
Adrenoleukodystrophy, X-linked adrenoleukodystrophy, Gene therapy, Hematopoietic stem cell

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lenti-D Drug Product
Arm Type
Experimental
Arm Description
Participants received a single intravenous (IV) infusion of Lenti-D Drug Product at a dose of > or = 5.0*10^6 CD34+ cells/kilogram (kg) (autologous CD34+ cell-enriched population that contains cells transduced with lentiviral vector encoding ABCD1 cDNA for human adrenoleukodystrophy protein, suspended in a cryopreservative solution) following myeloablative conditioning with busulfan and fludarabine on Day 1.
Intervention Type
Genetic
Intervention Name(s)
Lenti-D
Other Intervention Name(s)
elivaldogene autotemcel, eli-cel
Intervention Description
Participants received a single IV infusion of Lenti-D Drug Product.
Primary Outcome Measure Information:
Title
Percentage of participants who are alive and have none of the 6 major functional disabilities (MFDs) at Month 24
Description
The MFDs are loss of communication, cortical blindness, tube feeding, total incontinence, wheelchair dependence, complete loss of voluntary movement.
Time Frame
Month 24 post-transplant
Title
Percentage of participants with neutrophil engraftment after drug product infusion
Time Frame
42 days post-drug product infusion
Secondary Outcome Measure Information:
Title
Percentage of participants without gadolinium enhancement (GdE) at Month 24
Description
Percentage of participants without gadolinium enhancement (that is [i.e.,] negative for GdE-) on Magnetic Resonance Imaging (MRI).
Time Frame
Month 24 post-transplant
Title
Change in total neurologic function Score (NFS) from baseline to protocol scheduled visits
Description
The NFS is a 25-point score used to evaluate the severity of gross neurologic dysfunction in CALD by scoring 15 symptoms (functional domains) across 6 categories. Listed here are the 15 symptoms followed by their maximal score out of 25 points: a) Hearing / auditory processing problems-1, b) Aphasia / apraxia-1, c) Loss of communication-3, d) Vision impairment /field cut-1, e) Cortical blindness-2, f) Swallowing / other CNS dysfunctions-2, g) Tube feeding-2, h) Running difficulties / hyperreflexia-1, i) Walking difficulties / spasticity / spastic gait (no assistance)-1, j) Spastic gait (needs assistance)-2, k) Wheelchair dependence-2, l) Complete loss of voluntary movement-3, m) Episodes of incontinence -1, n) Total incontinence-2, o) Nonfebrile seizures-1. A score of "0" denotes absence of clinical signs of cerebral disease. Maximal signs within a domain score the total of all grades within that domain.
Time Frame
From Baseline through study completion (up to Month 24 [+or- 1 month] post-transplant)
Title
Major functional disability (MFD)-free survival over time
Description
MFD-free survival over time is defined as time from drug product infusion to either a rescue cell administration or second transplant, MFD, or death due to any cause, whichever occurs first.
Time Frame
up to Month 24 (+or- 1 month) post-transplant
Title
Overall survival
Time Frame
up to Month 24 (+or- 1 month) post-transplant
Title
Detectable vector copy number (VCN) in peripheral blood cells by Month 6
Time Frame
Month 6 post-transplant
Title
Percentage of participants who experience either acute (greater than or equal to [> or =] Grade II) or chronic graft versus host disease (GVHD) at Month 24
Time Frame
Month 24 post-transplant
Title
Time to neutrophil engraftment post-drug product infusion
Time Frame
42 days post-drug product infusion
Title
Percentage of participants with platelet engraftment by Month 24
Time Frame
Month 24 post-drug product infusion
Title
Time to platelet engraftment post-drug product infusion
Time Frame
up to Month 24 post-drug product infusion
Title
Percentage of participants with loss of neutrophil engraftment post-drug product infusion by Month 24
Time Frame
Month 24 post-drug product infusion
Title
Percentage of participants who undergo a subsequent hematopoietic stem cell (HSC) infusion by Month 24
Time Frame
Month 24 post-transplant
Title
Percentage of participants who experience transplant-related mortality through 100 and 365 days post-drug product infusion
Time Frame
Through 100 and 365 days post-drug product infusion
Title
Percentage of participants with adverse events (AEs) in selected categories
Description
Percentage of participants with clinical > or = Grade 3 AEs, drug product -related AEs, all serious adverse events (SAEs), AEs > or = Grade 3 infections by Month 24.
Time Frame
Month 24 post-transplant
Title
Percentage of participants with potentially clinically significant changes in laboratory parameters by Month 24
Description
Laboratory parameters will include hematology, clinical chemistry, and liver function tests.
Time Frame
Month 24 post-transplant
Title
Percentage of participants who experience greater than or equal to (> or =) Grade II acute GVHD by Month 24
Time Frame
Month 24 post-transplant
Title
Percentage of participants who experience chronic GVHD by Month 24
Time Frame
Month 24 post-transplant
Title
Number of emergency room visits (post-neutrophil engraftment) by Month 24
Time Frame
Month 24 post-transplant
Title
Number of in-patient hospitalizations (post-neutrophil engraftment) by Month 24
Time Frame
Month 24 post-transplant
Title
Duration of in-patient hospitalizations (post-neutrophil engraftment) by Month 24
Time Frame
Month 24 post-transplant
Title
Number of intensive care units (ICU) stays (post-neutrophil engraftment) by Month 24
Time Frame
Month 24 post-transplant
Title
Duration of intensive care units (ICU) stays (post-neutrophil engraftment) by Month 24
Time Frame
Month 24 post-transplant
Title
Number of participants in which vector-derived replication competent lentivirus (RCL) is detected by Month 24
Time Frame
Month 24 post-transplant
Title
Number of participants with insertional oncogenesis by Month 24
Description
Insertional oncogenesis including Myelodysplasia, Leukemia, Lymphoma by Month 24.
Time Frame
Month 24 post-transplant

10. Eligibility

Sex
Male
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed consent is obtained from a competent custodial parent or guardian with legal capacity to execute a local Institutional Review Board (IRB)/independent ethics committee (IEC) approved consent. Informed assent will be sought from capable participants, in accordance with the directive of the IRB/IEC and with local requirements. Males aged 17 years and younger, at the time of parental/guardian consent and, where appropriate, participant assent. Active CALD as defined by: Elevated very long chain fatty acids (VLCFA) values, and Active central nervous system (CNS) disease established by central radiographic review of brain MRI demonstrating i. Loes score between 0.5 and 9 (inclusive) on the 34-point scale, and ii. GdE on MRI of demyelinating lesions. NFS < or = 1. Exclusion Criteria: Prior receipt of an allogeneic transplant or gene therapy. Use of statins, Lorenzo's Oil, or dietary regimens used to lower VLCFA levels. Note: participants must discontinue use of these medications at time of consent. Receipt of an investigational study drug or procedure within 3 months before Screening that might confound study outcomes. Use of investigational study drugs is prohibited throughout the course of the study. Any conditions that make it impossible to perform MRI studies (including allergies to anesthetics or contrast agents). Hematological compromise as evidenced by: Peripheral blood absolute neutrophil count (ANC) count <1500 cells/ cubic millimeter (mm^3), and either Platelet count <100,000 cells/mm^3, or Hemoglobin <10 gram per deciliter (g/dL). Hepatic compromise as evidenced by: Aspartate transaminase (AST) value greater than (>) 2.5 × upper limit of normal (ULN) Alanine transaminase (ALT) value >2.5 × ULN Total bilirubin value >3.0 milligram per deciliter (mg/dL), except if there is a diagnosis of Gilbert's Syndrome and the participant is otherwise stable Baseline estimated glomerular filtration rate <70 milliliter per minute (mL/min)/1.73 square meter (m^2). Cardiac compromise as evidenced by left ventricular ejection fraction <40 percent (%). Immediate family member with a known or suspected Familial Cancer Syndrome. Clinically significant uncontrolled, active bacterial, viral, fungal, parasitic, or prion associated infection. Positive for human immunodeficiency virus type 1 or 2 (HIV-1, HIV-2); hepatitis B virus (HBV); hepatitis C virus (HCV); human T lymphotrophic virus 1 (HTLV-1). (Note that participants who have been vaccinated against HBV [positive for HBV surface antibodies] who are negative for other markers of prior HBV infection [e.g., negative for HBV core Ab] are eligible. Participants with past exposure to HBV [hepatitis B core antibody [HBcAb] -positive and/or hepatitis B e-antigen antibody [HBeAb]-positive] are also eligible for the study provided they have a negative test for HBV DNA. Also note that participants who are positive for anti-hepatitis C Ab are eligible as long as they have a negative hepatitis C viral load). Any clinically significant cardiovascular, hematological, or pulmonary disease, or other disease or condition that would be contraindicated for any of the other study procedures. Absence of adequate contraception for fertile participants. Any contraindications to the use of Granulocyte colony-stimulating factor (G-CSF) or plerixafor during the mobilization of HSCs, and any contraindications to the use of busulfan or fludarabine, including known hypersensitivity to the active substances or to any of the excipients in their formulations. Known hypersensitivity to protamine sulfate.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Himal Lal Thakar, MD
Organizational Affiliation
bluebird bio, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Lucile Packard Children's Hospital
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
Boston Children's Hospital/Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
Hôpital Robert Debré
City
Paris
ZIP/Postal Code
75019
Country
France
Facility Name
Universitätsklinikum Leipzig AöR
City
Leipzig
ZIP/Postal Code
04103
Country
Germany
Facility Name
Ospedale Pediatrico Bambino Gesù
City
Rome
ZIP/Postal Code
00165
Country
Italy
Facility Name
Prinses Maxima Center
City
Utrecht
ZIP/Postal Code
3508AB
Country
Netherlands
Facility Name
UCL-ICH/Great Ormond Street Hospital
City
London
ZIP/Postal Code
WC1N3JH
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Bluebird bio is committed to transparency and appropriately de-identified patient-level datasets and supporting documents may be shared following attainment of applicable marketing approvals associated with this study and consistent with criteria established by bluebird bio and/or industry best practices to maintain the privacy of study participants. For enquiries, please contact us at datasharing@bluebirdbio.com.

Learn more about this trial

A Clinical Study to Assess the Efficacy and Safety of Gene Therapy for the Treatment of Cerebral Adrenoleukodystrophy (CALD)

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