The objective of this study is to assess the therapeutic efficacy of a hematopoietic cell-based gene therapy for patients with Fanconi anemia, subtype A (FA-A). Hematopoietic stem cells from mobilized peripheral blood of patients with FA-A will be transduced ex vivo (outside the body) with a lentiviral vector carrying the FANCA gene. After transduction, the corrected stem cells will be infused intravenously back to the patient with the goal of preventing bone marrow failure.
This is a pediatric open-label Phase II clinical trial to assess the efficacy of a hematopoietic gene therapy consisting of autologous CD34+ enriched cells transduced with a lentiviral vector carrying the FANCA gene in subjects with FA-A. Enriched CD34+ hematopoietic stem cells will be transduced ex vivo with the therapeutic lentiviral vector and infused via intravenous infusion following transduction without any prior conditioning.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
5
CD34+ enriched cells from subjects with Fanconi anemia subtype A transduced ex vivo with a lentiviral vector carrying the FANCA gene
Stanford University
Stanford, California, United States
University of Minnesota
Minneapolis, Minnesota, United States
Bone Marrow (BM) Colony-Forming Cell (CFC) Mitomycin-C (MMC) resistance
Bone Marrow (BM) colony-forming cell (CFC) mitomycin-C (MMC) resistance ≥20% at 12 months post-infusion with a confirmatory result at 18 or 21 months (MMC at 10 nM concentration)
Time frame: 21 months
Genetic Correction
Evidence of genetic correction as demonstrated by ≥0.1 VCN level of FANCA-LV provirus in total PB cells at 18 months post-infusion with a confirmatory result at 21 or 24 months
Time frame: 24 months
Hematologic Stability- Hemoglobin
Hematologic stability demonstrated by hemoglobin levels remaining ≥75% of 6-month post-infusion nadir value, in the absence of Myelodysplastic Syndrome (MDS), Acute Myeloid Leukemia (AML), and/or progressive cytogenetic and/or molecular abnormalities known to be associated with MDS/AML at 18 months post-infusion with a confirmatory result at 21 or 24 months. In settings in which 6-month post-infusion neutrophil or platelet values are demonstrably increased relative to other values during the initial year post-infusion, especially in situations of documented infections or febrile episodes, the value from the most proximate prior visit at which there is no documented infection or febrile episode is used. Levels must exceed the following values at the latest documented assessment (≥18 months post-infusion): hemoglobin ≥8 g/dL (National Cancer Institute-Common Terminology Criteria Adverse Events (NCI-CTCAE) v5 Grade \<3).
Time frame: 24 months
Hematologic Stability- Neutrophils
Hematologic stability demonstrated by neutrophil count remaining ≥75% of 6-month post-infusion nadir value, in the absence of Myelodysplastic Syndrome (MDS), Acute Myeloid Leukemia (AML), and/or progressive cytogenetic and/or molecular abnormalities known to be associated with MDS/AML at 18 months post-infusion with a confirmatory result at 21 or 24 months. In settings in which 6-month post-infusion neutrophil or platelet values are demonstrably increased relative to other values during the initial year post-infusion, especially in situations of documented infections or febrile episodes, the value from the most proximate prior visit at which there is no documented infection or febrile episode is used. Levels must exceed the following values at the latest documented assessment (≥18 months post-infusion): neutrophils ≥500/µL (NCI-CTCAE v5 Grade \<4).
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Time frame: 24 months
Hematologic Stability- Platelets
Hematologic stability demonstrated by Platelet count remaining ≥75% of 6-month post-infusion nadir value, in the absence of Myelodysplastic Syndrome (MDS), Acute Myeloid Leukemia (AML), and/or progressive cytogenetic and/or molecular abnormalities known to be associated with MDS/AML at 18 months post-infusion with a confirmatory result at 21 or 24 months. In settings in which 6-month post-infusion neutrophil or platelet values are demonstrably increased relative to other values during the initial year post-infusion, especially in situations of documented infections or febrile episodes, the value from the most proximate prior visit at which there is no documented infection or febrile episode is used. Levels must exceed the following values at the latest documented assessment (≥18 months post-infusion): platelets ≥25,000/µL (NCI-CTCAE v5 Grade \<4).
Time frame: 24 months
Phenotypic Correction
In patients who were not mosaic in Peripheral Blood T-cells prior to gene therapy, the level of phenotypic correction of hematopoietic cells as determined by a T-lymphocyte chromosomal fragility assay targeting a decrease from ≥50% pre-infusion levels to \<50% in Peripheral Blood T-cells with DEB-induced aberrations and a ≥20% decrease from pre-treatment levels at ≥182 months post-infusion with a confirmatory result at 21 or 24 months
Time frame: 24 months
Safety of RP-L102
Analysis of Treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs), for the duration of the study.
Time frame: 3 years
Tolerability of RP-L102
Analysis of Treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs), for the duration of the study.
Time frame: 3 years
Overall survival
Survival at end of study
Time frame: 3 years
Bone Marrow Failure Free Survival
Bone Marrow Failure Free at end of study
Time frame: 3 years
Hematological Malignancy Free Survival
Lack of Myelodysplastic Syndrome or Acute Myeloid Leukemia at end of study
Time frame: 3 years