The aim of this study is to assess the safety and efficacy of autologous transplantation of hematopoietic stem cells (CD34+ cells) from mobilized peripheral blood (mPB) of ADA-deficient SCID infants and children following human ADA gene transfer by the EFS-ADA lentiviral vector. The level of gene transfer in blood cells and immune function will be measured as endpoints.
The study is open to twenty (20) infants and children diagnosed with ADA-deficient SCID who did not have a medically eligible, human leukocyte antigen (HLA)-identical sibling donor for bone marrow transplantation. The EFS-ADA lentiviral vector with the human ADA complementary DNA (cDNA) will be used to transduce autologous CD34+ cells from Granulocyte Colony Stimulating Factor (G-CSF)/Plerixafor mobilized Peripheral Blood (mPB) of these subjects. The subjects will receive pharmacokinetically-adjusted busulfan reduced intensity conditioning prior to re-infusion of their gene-modified cells. Overall survival at two years is the primary endpoint. During the follow-up phase, the investigators aim to determine whether the cells could engraft and produce mature cells that contain and express the corrected ADA gene in the absence of pegylated adenosine deaminase (PEG-ADA) enzyme replacement therapy (ERT), which will be withheld starting on Day +30 following transplant. Efficacy studies to evaluate the level of immune reconstitution, will be performed in the two years of the study. Patients will be asked to enroll into a long-term follow-up study to reach a total of 15 years follow-up after gene therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Autologous transplantation of EFS-ADA lentiviral vector transduced, mPB CD34+ cells by central venous infusion, following reduced intensity conditioning with busulfan
University of California, Los Angeles (UCLA)
Los Angeles, California, United States
RECRUITINGSurvival
The primary study outcome will be to determine survival for all subjects 2 years after gene therapy
Time frame: 24 months
Evaluate Safety from clinical adverse events.
Evaluate safety of the treatment by recording clinical adverse events (AE).
Time frame: 24 months
Evaluate Safety from replication competent lentivirus by quantitative polymerase chain reaction (qPCR) assay.
Evaluate safety by recording incidents of replication competent lentivirus by qPCR assay..
Time frame: 24 months
Evaluate Safety from vector-related clonal expansion by non-restrictive Linear Amplification Polymerase Chain Reaction (nrLAM-PCR)
Evaluate safety by recording incidence of vector-related clonal expansion by nrLAM-PCR
Time frame: 24 months
Record event free survival at 24 months
Record Event Free Survival as a definition of "failure" of the therapy. Event-free survival is defined as the proportion of subjects alive with no "event", an "event" being the resumption of PEG-ADA ERT or the need for a rescue allogeneic hematopoietic stem cell transplant (HSCT), or death.
Time frame: 24 months
Determine incidence of Infection over two years after gene therapy
Determine the incidence and severity of infections post-gene therapy (subsequent to hematopoietic reconstitution). Over 2 years, record the incidence of hospitalizations or outpatient-based treatments for systemic bacterial, fungal, or viral infections (including, but not limited to Cytomegalovirus (CMV) infections).
Time frame: 24 months
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Neuro-developmental Outcomes by neurodevelopmental testing (subjects 5-7 yeas of age)
Measure neuro-developmental status post-gene therapy. Perform age-appropriate neuro-developmental assessments testing (5- 7 years of age) at baseline and 2 years post-gene therapy - Wechsler Scale of Intelligence
Time frame: 24 months
Neuro-developmental Outcomes by neurodevelopmental testing (subjects 1 year -42 month of age)
Measure neuro-developmental status post-gene therapy. Perform age-appropriate neuro-developmental assessments testing (1 year to 42 months of age) at baseline and 2 years post-gene therapy - : Bayley Scale of Infant Development
Time frame: 24 months
Neuro-developmental Outcomes by Brain Stem Evoked Response (BAER) testing
Measure neuro-developmental status post-gene therapy - Perform Brainstem Auditory Evoked Response test at baseline and at 2 years.
Time frame: 24 months
Cessation of immunoglobulin replacement therapy (IgRT).
Record time post-gene therapy that immunoglobulin replacement therapy (IgRT) is stopped based on defined criteria.
Time frame: 24 months