This clinical trial will access the toxicity and efficacy of infusion of gene modified cells for patients with Fanconi anemia (FA). Infusion of autologous patient blood stem cells that have been corrected in the laboratory by introduction of the normal gene may improve blood counts in patients with FA.
OUTLINE: STEM CELL MOBILIZATION FOR CELL COLLECTION: Patients receive filgrastim subcutaneously (SC) twice daily (BID) for up to 6 days (on days 1-6 of mobilization). Patients receive plerixafor SC once daily (QD) on days 4-6 of mobilization. Peripheral blood stem cell (PBSC) count will be checked daily starting on day 4 of mobilization. Patients who have a PBSC count of \>= 5 CD34+ cells/mcL will undergo up to 2 apheresis collections on consecutive days. BONE MARROW HARVEST FOR CELL COLLECTION: Patients with inadequate PBSC counts undergo bone marrow harvest for collection of stem/progenitor cells. REINFUSION: Patients receive methylprednisolone intravenously (IV) or prednisone orally (PO) on days -1 to 7 followed by a rapid taper over approximately 1 week and undergo reinfusion of genetically modified hematopoietic stem/progenitor cells on day 0. After completion of study treatment, patients are followed up periodically for 15 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
3
Undergo bone marrow harvest
Given SC
Undergo infusion of genetically modified hematopoietic progenitor cell therapy
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Toxicity of gene transfer
Adverse events will be graded by Common Terminology Criteria for Adverse Events (CTCAE), version 4.
Time frame: Up to 15 years
Hematological and non-hematological organ toxicity
Adverse events will be graded by CTCAE, version 4.
Time frame: Up to 15 years
Development of insertional mutagenesis or hematologic malignancy
Adverse events will be graded by CTCAE, version 4.
Time frame: Up to 15 years
Development of replication competent lentivirus
Adverse events will be graded by CTCAE, version 4.
Time frame: Up to 15 years
Efficacy of G-CSF and plerixafor mobilization in Fanconi anemia (FA) patients
Time frame: Up to 6 days
Efficacy of lineage depletion of bone marrow or mobilized cell product
Time frame: Up to 15 years
Transduction efficiency
After completion of lentiviral transduction, the percent gene modified cells will be determined by molecular studies.
Time frame: Day 0
Detectable levels of transduced cells in blood and marrow
Blood and bone marrow samples will be assayed by real-time quantitative polymerase chain reaction.
Time frame: Up to 1 year
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Correlative studies
Undergo leukapheresis
Given IV
Given SC
Given PO
Improved blood counts
Complete blood counts will be monitored, initially weekly, then monthly during the first year, then quarterly during the 2nd year after infusion.
Time frame: Up to 15 years
Demonstrable functional expression by growth of recipient cells in mitomycin C
Blood and bone marrow cells will be assayed for viability of cultured cells and hematopoietic colonies in the presence of the chemotherapy drug and deoxyribonucleic acid crosslinking agent, mitomycin C.
Time frame: 3 months