The investigators propose to replace HLA- partially compatible allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for FHL type 3 patients, with autologous transplantation of immunoselected gene-modified CD34+ cells, combined with transduced autologous T-cell each time this is possible and also to propose this alternative treatment as salvage in case of failure of a previous allogeneic HSCT. This approach should avoid the severe immunological complications (failure to engraft, acute or chronic graft versus host disease (GVHD)) and conditioning toxicities such as severe Veno-Occlusive Disease (VOD). As the clinical manifestations of FHL type 3 patients are triggered by opportunistic viral infections (often EBV) and can be poorly controlled or only transiently controlled by the available drugs , providing the patient after the conditioning with immediately functional autologous cytotoxic T-cells could be key to maintain the control of the viral infection and hopefully its eradication awaiting for the hematopoietic reconstitution . This procedure should avoid any reactivation of the viral infection and thus improving the patients' overall survival and event-free survival while clearing the ongoing triggering infections.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
5
* Dosage: ≥ 2 x10e6 CD34/kg after thawing, dose limit: 20x10e6 CD34+ cells/kg * Route of administration: intravenous, on D0
* Dosage: \[1.10e4; 5.10e6\] T-CD3+/kg after thawing, * Route of administration: intravenous, on D14 post-GT +/- D28 In case of persistent circulating T-cell after the HLH remission at inclusion, the MUNC-CD34 will be completed by MUNC-T3 infusion
Hôpital Necker Enfant Malades
Paris, France
Incidence of Transplantation Related Mortality (TRM)
Time frame: up to 6 months post treatment
Frequency and severity of clinical AEs and laboratory parameters
Adverse event will be measured using CTCAE
Time frame: throughout the whole period of the research, up to 60 months
Incidence of clinically detectable malignancy and/or abnormal clonal dominance assessed as related to study treatment
Bone marrow analysis and VISA
Time frame: At 12 months post treatment
Detection of Replication -Competent Lentivirus (RCL)
Time frame: at 3, 6 and 12 months post treatment, then yearly up to 60 months
Neutrophil and platelet recovery
ANC\> 500/µl, Platelets \> 20.000/µl on two consecutive days without transfusion
Time frame: throughout the whole period of the research, up to 60 months
Quantification of the transgene copy number (VCN) on drug substance at time of cryopreservation, on PBMC, sorted T-CD3+ and sorted NK cells
Time frame: at 1, 2, 3, 6, 9, 12, 18 and 24 months post treatment
Quantification of the UNC13D RNA on PBMC
by Q-PCR
Time frame: at 1, 2, 3, 6, 9, 12, 18 and 24 post treatment
Quantification of Munc13.4 protein level in the drug substance and on peripheral blood mononuclear cells and on sorted CD3+ and CD56+ cells in function of their number
by western blot
Time frame: at 6, 12 and 24 months post treatment
Determination of the total number of T-cells and distribution of different subpopulations
Naïve and memory CD4+ and CD8+ T cells will be evaluated using CCR7/CD45RA/RO markers, and the quantification of activation marker will be performed by the expression of DR+. by flow cytometry
Time frame: at 1, 2, 3, 6, 12, 18 and 24 months post treatment
Correction of degranulation function in T-CD3
Time frame: at 6 months and 24 months post treatment
Integration site analyse study
Time frame: at 24 months post treatment
Needs of PICU support
Time frame: up to 24 months post treatment
Endothelial complications
Time frame: up to 24 months post treatment
Infectious diseases
Time frame: up to 24 months post treatment
Estimate of the cost of the complete procedure, from mobilisation to transplant
Time frame: up to 24 months post treatment
stimate of the 24 months total cost
Time frame: up to 24 months post treatment
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