Background: X-Linked Chronic Granulomatous Disease (X-CGD) is caused by a gene mutation that makes the immune system to not work properly. Researchers want to see if a lentiviral gene transfer treatment will have the ability to make the patient s immune system more normal, in particular reduce the risk of CGD related infections. The gene transfer takes a person s own stem cells, cultures them to put the normal gene in, then gives the cells back to the person. Objective: To test a gene transfer treatment for X-CGD. Eligibility: Participants aged 3-60 with X-CGD Design: Participants will be screened under protocol 05-I-0123. They will undergo: Medical history Physical exam Heart tests Imaging tests, as needed Blood tests Lung function tests, as needed Dental and audiology exams, if needed Quality of life questionnaire Bone marrow aspiration. A needle will be inserted into the hip bone or breastbone to collect bone marrow. Some screening tests will be repeated during the study. Participants will have an apheresis procedure under protocol 94-I-0073. Stem cells will be collected. Participants will get a series of drugs to prepare them for the gene transfer. Participants will stay at the NIH Clinical Center for a little over a month. They will get a central line. It is a large intravenous (IV) catheter that is placed into a vein of the neck, chest, or arm. They will get chemotherapy and their corrected stem cells through their IV line. Participants will have 12 follow-up outpatient visits in the 2 years after their gene transfer, as well as visits with their local doctor. Then they will enroll in another study for long-term follow-up visits that will last for 13 years....
Study Description: This is a Phase I/II, non-Randomized, Single site study, open-label study of a single infusion of autologous CD34+ cells transduced ex vivo with pCCLChimGp91/VSVg lentiviral vector in 10 patients with X-Linked CGD. Objectives: Primary Objective: To evaluate the safety, efficacy and stability by biochemical and functional reconstitution in progeny of engrafted cells at 12 months Secondary Objectives: Endpoints: * Clinical efficacy and longitudinal evaluation of clinical effect in terms of augmented immunity against bacterial and fungal infection * Determine the number of days of antibiotic usage before compared to after gene therapy * Transduction efficiency of CD34+ hematopoietic cells from XCGD patients by ex vivo lentivirus-mediated gene transfer * Evaluation of engraftment kinetics and stability Primary Endpoint: 1. The primary safety objective of this procedure will be assessed by recording the incidence of adverse events. 1. Record clinical adverse events and clinically significant laboratory abnormalities. 2. Evaluate overall incidence of adverse events for the study as a whole. 3. Monitor the incidence of serious adverse events. 2. The primary efficacy objective of this study will be determined by measuring the percentage of subjects who have \>= 10% oxidase positive granulocytes by dihydrorhodamine (DHR) flow cytometry at month 6 and 12 after transplant. Secondary Endpoints: 1. Assess immunological reconstitution: Restoration of neutrophil oxidase function (\> 10%) as measured by DHR flow cytometry (clinical), and/or cytochrome C (O2 production, research), at 24 months. The % DHR + neutrophils will be measured at week 4, 5, 6, 7, 8, 10, 12 and month 6, 9, 12, 18 and 24. 2. Assess hematopoietic stem cell (HSC) transduction and engraftment: 1. Determine the percentage of transduced CD34+ hematopoietic cells infused. 2. Measure the average vector copy number (VCN) in mature blood cells (at week 4, 6, 7, 8, 10, 12 and month 6, 9, 12, 18 and 24) by quantitative polymerase chain reaction (qPCR) or droplet digital polymerase chain reaction (ddPCR). 3. Assess health by: 1. The nutritional status (height, weight, serum albumin) at 24 months 2. Growth and development of pediatric subjects at 24 months 3. Frequency of severe infections or other health issues, including inflammatory complications (requiring intravenous \[IV\] antibiotics and/or hospitalization for treatment) 4. Measurement of inflammatory markers at 1, 2, 3, 6, 9, 12, 18, and 24 months, compared to baseline 5. Colitis assessment based on CDAI (Crohn s Disease Activity Index) and fecal calprotectin at 6, 12, and 24 months, compared to baseline 6. Quality of Life (QOL) questionnaire (baseline, 6, 12 and 24 months) Exploratory Endpoints: 1. Evaluation of the human microbiome during XCGD gene therapy 2. Evaluation of inflammatory cytokines and antibody development to Gp91, etc
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Conditioning drug
Monoclonal Antibody
Thrombopoietin Receptor Agonist
Post transplant immunosuppressant drug
Intervention Infusion on Day 0
National Institutes of Health Clinical Center
Bethesda, Maryland, United States
Safety
1\) The primary safety objective of this procedure will be assessed by recording the incidence of adverse events. a) Record clinical adverse events and clinically significant laboratory abnormalities. b) Evaluate overall incidence of adverse events for the study as a whole. c) Monitor the incidence of serious adverse events.
Time frame: Throughout the study
Efficacy
The primary efficacy objective of this study will be determined by measuring the percentage of subjects who have \>= 10% oxidase positive granulocytes by DHR flow cytometry at month 6 and 12 after transplant.
Time frame: 6 months and 1 year
Assess immunological reconstitution
Restoration of neutrophil oxidase function (\> 10%) as measured by DHR flow cytometry (clinical), and/or cytochrome C (O2 production, research), at 24 months. The % DHR + neutrophils will be measured at week 4, 5, 6, 7, 8, 10, 12 and months 6, 9, 12, 18 and 24 months.
Time frame: Week 4, 5, 6, 7, 8, 10, 12 and months 6, 9, 12, 18 and 24 months.
Assess HSC transduction and engraftment
a) Determine the percentage of transduced CD34+ hematopoietic cells infused. b) Measure the average vector copy number (VCN) in mature blood cells (at week 4, 6, 7, 8, 10, 12 and month 6, 9, 12, 18 and 24) by qPCR or ddPCR.
Time frame: Week 4, 6, 7, 8, 10, 12 and month 6, 9, 12, 18 and 24)
Assess health by
a) The nutritional status (height, weight, serum albumin) at 24 months b) Growth and development of pediatric subjects at 24 months c) Frequency of severe infections or other health issues, including inflammatory complications (requiring IV antibiotics and/or hospitalization for treatment) d) Measurement of inflammatory markers at 1, 2, 3, 6, 9, 12, 18, and 24 months, compared to baseline e) Colitis assessment based on CDAI (Crohn s Disease Activity Index) and fecal calprotectin at 6, 12, and 24 months, compared to baseline f) Quality of life questionnaire (baseline, 6, 12 and 24 months).
Time frame: 1, 2, 3, 6, 9, 12, 18, and 24 months, compared to baseline
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