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Safety and Efficacy of Gene Modified Autologous Hematopoietic Stem Cells to Treat Transfusion-dependent Beta-thalassemia

Primary Purpose

β-thalassemia

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
BD211
Sponsored by
Shanghai BDgene Co., Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for β-thalassemia

Eligibility Criteria

5 Years - 18 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Ages 5 to 18 years old, including: The parents or legal guardians must be able to understand and provide ICFs. If available, it is strongly recommended that children aged ≥8 years in treatment decisions and obtain written ICFs and be clearly documented; Diagnosed as Transfusion Dependent β-thalassemia with any genotype (β0, β+, βE/β0, βS/S, βS/β0, βS/β+), confirmed the Hb analysis. No alfa chain genetic abnormalities. Subjects must stabilize and maintain an appropriate iron chelation regimen. Transfusion-dependent types are defined as requiring at least 100 mL/kg/ year of red blood cells (pRBCs). No eligiblity for allogeneic hematopoietic stem cell transplantation. The treatment of erythrocyte maturation agent luspatercept cannot be financially supported. The subjects' parents/legal guardians must be willing and able to follow the study procedures in the study protocol. Good organs' functions. Having complete medical records including a history of blood transfusions testified subject received treatment and followed up for at least two years prior to screening . Exclusion Criteria: Availability of voluntary, fully HLA-matched hematopoietic cell donors, unless recommended for inclusion by the Monitoring Committee. HIV-1 and HIV-2 were positive, and / or HTLV-1, HTLV-2 and VSV-G antibodies were positive. An active bacterial, viral, fungal or parasitic infection. Contraindicated for the extraction of bone marrow under anesthesia. Any malignancy, myeloproliferative, or immunodeficient disease and relevant medical history. Peripheral blood white blood cell (WBC) count < 3×10^9/L or platelet count < 120×10^9/L. A history of allo-transplantation. Erythropoietin was used within 3 months prior to HSC cell collection. Immediate family members with known or suspected familial cancer syndromes (including but not limited to breast, colorectal, ovarian, prostate, and pancreatic cancers). Subjects with a diagnosis of major mental illness may had a serious disability to participate in the study. Active recurrent malaria. Had autoimmune diseases that may make blood transfusions difficult. History of major organ injury including: Liver disease, transaminase > 3 times the upper limit of normal. (If the liver biopsy does not reveal evidence of widespread bridging fibrosis, cirrhosis, or acute hepatitis, this indicator will not be used as a criterion for the exclusion); Widely bridging fibrosis, histopathological evidence of acute hepatitis or cirrhosis showed in liver biopsy Heart disease, left ventricular ejection fraction < 25%; Kidney disease, creatinine clearance < 30% normal level; Of severe iron overload, confirmed by the study doctor; An heart MRI detection of T2 * < 10 ms; Significant pulmonary hypertension needing clinical medical intervention. There are bleeding diseases that have not been cured. The subject involved with another clinical study in a 30-day screening period. Allergic to the research drug and its excipients. Prior treatment with any type of gene and/or cell therapy. As assessed by the investigator, the subjects or their parents are unable to comply well with the study procedures per protocol. Hydroxyurea treatment within 3 months prior to hematopoietic stem cell collection. Had diseases that interfere with hematopoietic stem cells collections. Any other conditions being ineligible for HSC transplantation determined by the investigator.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    BD211 Adult Single-Dose group

    Arm Description

    Route of Administrate: infusion intravenously. Dosage form: injection solution. Dose: 5×10*6 cells /kg ~ 10×10*6 cells /kg. Frequency of administration: One dosing intravenously. Intervention: Single dose of BD211 for adults

    Outcomes

    Primary Outcome Measures

    Red blood cell (RBCs) transfusion requirements, whether reaching TI
    The changes of blood transfusion requirements and frequency of packed red blood cells (PRBCS) during the 2 years after administrating BD211 were compared with baseline values at 6, 12, and 24 months after transfusing BD211.
    Total hospitalizing days at 6, 12, and 24 months (discharge after transplant)
    Total hospitalizing days at 6, 12, and 24 months after transplantation were counted.

    Secondary Outcome Measures

    Percentage of Treated Participants With Transfusion-Dependent β-Thalassemia (TDT) WhoAchieved Transfusion Independence for at least 6 months
    TI was defined as a weighted average hemoglobin (Hb) > or =9 grams per deciliter (g/dL) withoutany pRBC transfusions for a continuous period of > or =12 months at any time during the study after drug product infusion, where calculation of time period of TI starts when participantsachieve a Hb > or =9 g/dL with no transfusions in the preceding 60 days.
    Change in RBCs infusion from baseline at 6 to 24 months
    The quantity of RBCs transfusions at 6 to 24 months will be measured and compared with baseline level.
    Mean Hb (g/dL) at 6, 12 and 24 months after treatment
    Mean Hb (g/dL) in 6, 12, and 24 months after drug product infusion are tested and calculated.
    Change in ferritin/liver iron levels from baseline
    The Ferritin/liver iron levels are assayed per protocol plan, and evaluate the changes from those baseline level.
    Neutrophil engraftment, platelet engraftment and vector copy number
    Neutrophil engraftment was defined as the first of absolute neutrophil count (ANC) > or = 0.5 ×10^9/ L for 3 consecutive days (or 3 consecutive measurements done on separate days), after a post-transplant value less than (<) 0.5 × 10^9/L. Platelet engraftment was defined as the first of 3 consecutive platelet values > or =20 × 10^9/L for participants on different days with no platelet transfusionsadministered for 7 days immediately preceding. The day of engraftment is the first day of the 3 consecutive platelet measurements. Vector copy number will be detected per investigating time schedule.
    Transplant-related mortality in 3 months and 12 months
    Transplant related mortality was definedas any death occurring in the study post drug product infusion deemed related to the transplant bythe investigator.
    Overall survival
    Overall survival was defined as time from date of BD211 Drug Product infusion (Day 1) to date of death. Overall survival was censored at the date of last visit if the participant was still alive.
    RCL incidence
    Subjects blood RCL was detected with specific assay method, and the incidence was calculated at different scheduled timeslots.
    Characterized insertion mutagenesis events that lead to clonal dominance or leukemia
    The number of insertion mutagenesis events that characterized clonal dominance or leukemia was collected.
    Frequency and severity of AE
    An AE was any untoward medical occurrence associated with the use of a drug in participants, whether or not considered drug related. An AE may include a change in physical signs, symptoms, and/or clinically significant laboratory change occurring in any phase of a clinical study.

    Full Information

    First Posted
    March 3, 2023
    Last Updated
    March 15, 2023
    Sponsor
    Shanghai BDgene Co., Ltd.
    Collaborators
    Shanghai Children's Medical Center
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05773729
    Brief Title
    Safety and Efficacy of Gene Modified Autologous Hematopoietic Stem Cells to Treat Transfusion-dependent Beta-thalassemia
    Official Title
    Safety and Efficacy of Lentiviral Vector Transduction of β-globin Genetically Modified Autologous CD34+ Hematopoietic Stem Cells in Patients With Transfusion-dependent β-thalassemia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    March 2023 (Anticipated)
    Primary Completion Date
    March 2026 (Anticipated)
    Study Completion Date
    October 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Shanghai BDgene Co., Ltd.
    Collaborators
    Shanghai Children's Medical Center

    4. Oversight

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

    5. Study Description

    Brief Summary
    This study will be intented to evaluate the safety and efficacy of lentiviral vector transduction of β-globin genetically modified autologous CD34+ hematopoietic stem cells in patients with transfusion-dependent β-thalassemia.
    Detailed Description
    This is an open-label, single-dose study of BD211 in patients with transfusion-dependent β-thalassemia aged 14 to 35 years. It is estimated that 10 subjects will be enrolled. BD211 is a gene modified gene therapy product designed to produce healthy β-globin in red blood cells in beta-thalassemia patients. The total follow-up duration was 24 months, the safe endpoints and effectiveness endpoints will be used to assess the safety and efficacy profiles in patients with transfusion-dependent β-thalassemia.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    β-thalassemia

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    10 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    BD211 Adult Single-Dose group
    Arm Type
    Experimental
    Arm Description
    Route of Administrate: infusion intravenously. Dosage form: injection solution. Dose: 5×10*6 cells /kg ~ 10×10*6 cells /kg. Frequency of administration: One dosing intravenously. Intervention: Single dose of BD211 for adults
    Intervention Type
    Genetic
    Intervention Name(s)
    BD211
    Intervention Description
    Genetically modified CD34+ autologous stem cells were transfused intravenously with single dosing.
    Primary Outcome Measure Information:
    Title
    Red blood cell (RBCs) transfusion requirements, whether reaching TI
    Description
    The changes of blood transfusion requirements and frequency of packed red blood cells (PRBCS) during the 2 years after administrating BD211 were compared with baseline values at 6, 12, and 24 months after transfusing BD211.
    Time Frame
    24 months
    Title
    Total hospitalizing days at 6, 12, and 24 months (discharge after transplant)
    Description
    Total hospitalizing days at 6, 12, and 24 months after transplantation were counted.
    Time Frame
    24 months
    Secondary Outcome Measure Information:
    Title
    Percentage of Treated Participants With Transfusion-Dependent β-Thalassemia (TDT) WhoAchieved Transfusion Independence for at least 6 months
    Description
    TI was defined as a weighted average hemoglobin (Hb) > or =9 grams per deciliter (g/dL) withoutany pRBC transfusions for a continuous period of > or =12 months at any time during the study after drug product infusion, where calculation of time period of TI starts when participantsachieve a Hb > or =9 g/dL with no transfusions in the preceding 60 days.
    Time Frame
    24 months
    Title
    Change in RBCs infusion from baseline at 6 to 24 months
    Description
    The quantity of RBCs transfusions at 6 to 24 months will be measured and compared with baseline level.
    Time Frame
    24 months
    Title
    Mean Hb (g/dL) at 6, 12 and 24 months after treatment
    Description
    Mean Hb (g/dL) in 6, 12, and 24 months after drug product infusion are tested and calculated.
    Time Frame
    24 months
    Title
    Change in ferritin/liver iron levels from baseline
    Description
    The Ferritin/liver iron levels are assayed per protocol plan, and evaluate the changes from those baseline level.
    Time Frame
    24 months
    Title
    Neutrophil engraftment, platelet engraftment and vector copy number
    Description
    Neutrophil engraftment was defined as the first of absolute neutrophil count (ANC) > or = 0.5 ×10^9/ L for 3 consecutive days (or 3 consecutive measurements done on separate days), after a post-transplant value less than (<) 0.5 × 10^9/L. Platelet engraftment was defined as the first of 3 consecutive platelet values > or =20 × 10^9/L for participants on different days with no platelet transfusionsadministered for 7 days immediately preceding. The day of engraftment is the first day of the 3 consecutive platelet measurements. Vector copy number will be detected per investigating time schedule.
    Time Frame
    24 months
    Title
    Transplant-related mortality in 3 months and 12 months
    Description
    Transplant related mortality was definedas any death occurring in the study post drug product infusion deemed related to the transplant bythe investigator.
    Time Frame
    12 months
    Title
    Overall survival
    Description
    Overall survival was defined as time from date of BD211 Drug Product infusion (Day 1) to date of death. Overall survival was censored at the date of last visit if the participant was still alive.
    Time Frame
    24 months
    Title
    RCL incidence
    Description
    Subjects blood RCL was detected with specific assay method, and the incidence was calculated at different scheduled timeslots.
    Time Frame
    24 months
    Title
    Characterized insertion mutagenesis events that lead to clonal dominance or leukemia
    Description
    The number of insertion mutagenesis events that characterized clonal dominance or leukemia was collected.
    Time Frame
    24 months
    Title
    Frequency and severity of AE
    Description
    An AE was any untoward medical occurrence associated with the use of a drug in participants, whether or not considered drug related. An AE may include a change in physical signs, symptoms, and/or clinically significant laboratory change occurring in any phase of a clinical study.
    Time Frame
    24 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    5 Years
    Maximum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Ages 5 to 18 years old, including: The parents or legal guardians must be able to understand and provide ICFs. If available, it is strongly recommended that children aged ≥8 years in treatment decisions and obtain written ICFs and be clearly documented; Diagnosed as Transfusion Dependent β-thalassemia with any genotype (β0, β+, βE/β0, βS/S, βS/β0, βS/β+), confirmed the Hb analysis. No alfa chain genetic abnormalities. Subjects must stabilize and maintain an appropriate iron chelation regimen. Transfusion-dependent types are defined as requiring at least 100 mL/kg/ year of red blood cells (pRBCs). No eligiblity for allogeneic hematopoietic stem cell transplantation. The treatment of erythrocyte maturation agent luspatercept cannot be financially supported. The subjects' parents/legal guardians must be willing and able to follow the study procedures in the study protocol. Good organs' functions. Having complete medical records including a history of blood transfusions testified subject received treatment and followed up for at least two years prior to screening . Exclusion Criteria: Availability of voluntary, fully HLA-matched hematopoietic cell donors, unless recommended for inclusion by the Monitoring Committee. HIV-1 and HIV-2 were positive, and / or HTLV-1, HTLV-2 and VSV-G antibodies were positive. An active bacterial, viral, fungal or parasitic infection. Contraindicated for the extraction of bone marrow under anesthesia. Any malignancy, myeloproliferative, or immunodeficient disease and relevant medical history. Peripheral blood white blood cell (WBC) count < 3×10^9/L or platelet count < 120×10^9/L. A history of allo-transplantation. Erythropoietin was used within 3 months prior to HSC cell collection. Immediate family members with known or suspected familial cancer syndromes (including but not limited to breast, colorectal, ovarian, prostate, and pancreatic cancers). Subjects with a diagnosis of major mental illness may had a serious disability to participate in the study. Active recurrent malaria. Had autoimmune diseases that may make blood transfusions difficult. History of major organ injury including: Liver disease, transaminase > 3 times the upper limit of normal. (If the liver biopsy does not reveal evidence of widespread bridging fibrosis, cirrhosis, or acute hepatitis, this indicator will not be used as a criterion for the exclusion); Widely bridging fibrosis, histopathological evidence of acute hepatitis or cirrhosis showed in liver biopsy Heart disease, left ventricular ejection fraction < 25%; Kidney disease, creatinine clearance < 30% normal level; Of severe iron overload, confirmed by the study doctor; An heart MRI detection of T2 * < 10 ms; Significant pulmonary hypertension needing clinical medical intervention. There are bleeding diseases that have not been cured. The subject involved with another clinical study in a 30-day screening period. Allergic to the research drug and its excipients. Prior treatment with any type of gene and/or cell therapy. As assessed by the investigator, the subjects or their parents are unable to comply well with the study procedures per protocol. Hydroxyurea treatment within 3 months prior to hematopoietic stem cell collection. Had diseases that interfere with hematopoietic stem cells collections. Any other conditions being ineligible for HSC transplantation determined by the investigator.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    chen jing, MD.
    Phone
    18930830632
    Email
    chenjing@scmc.com.cn
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    chen jing, MD.
    Organizational Affiliation
    Shanghai Children's Medical Center
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Safety and Efficacy of Gene Modified Autologous Hematopoietic Stem Cells to Treat Transfusion-dependent Beta-thalassemia

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