Pilot and Feasibility Study of Hematopoietic Stem Cell Gene Transfer for the Wiskott-Aldrich Syndrome

Learn more about:
Related Clinical Trial
Romiplostim Treatment for Thrombocytopenia in Patients With Wiskott-Aldrich Syndrome. Efficacy and Safety of Romiplostim Versus Eltrombopag in the Treatment of Thrombocytopenia in Patients With Wiskott-Aldrich Syndrome Bone Marrow Transplant With Abatacept for Non-Malignant Diseases Sequential Cadaveric Lung and Bone Marrow Transplant for Immune Deficiency Diseases Fludarabine Phosphate, Cyclophosphamide, Total Body Irradiation, and Donor Stem Cell Transplant in Treating Patients With Blood Cancer Fludarabine Phosphate, Melphalan, and Low-Dose Total-Body Irradiation Followed by Donor Peripheral Blood Stem Cell Transplant in Treating Patients With Hematologic Malignancies Alpha/Beta T and CD19+ Depleted Peripheral Stem Cells for Patients With Primary Immunodeficiencies Rapid Infusion of Immune Globulin Intravenous (Human) In Primary Immunodeficiency Patients Alefacept and Allogeneic Hematopoietic Stem Cell Transplantation Long-term Study of Romiplostim in Thrombocytopenic Pediatric Patients With Immune Thrombocytopenia (ITP) Participation in a Research Registry for Immune Disorders Haploidentical Hematopoietic Stem Cell Transplantation Patients With Wiskott-Aldrich Syndrome Gene Therapy for Wiskott-Aldrich Syndrome (WAS) Study of Reduced Toxicity Myeloablative Conditioning Regimen for Wiskott-Aldrich Syndrome (WAS) Patients Treated for Wiskott-Aldrich Syndrome (WAS) Since 1990 A Clinical Study to Evaluate the Use of a Cryopreserved Formulation of OTL-103 in Subjects With Wiskott-Aldrich Syndrome Post-transplant Cyclophosphamide in Wiskott-Aldrich Syndrome Long Term Safety Follow up of Haematopoietic Stem Cell Gene Therapy for the Wiskott Aldrich Syndrome Thrombocytopenia and Bleeding in Wiskott-Aldrich Syndrome (WAS) Patients Pilot and Feasibility Study of Hematopoietic Stem Cell Gene Transfer for the Wiskott-Aldrich Syndrome Interleukin-2 Treatment for Wiskott-Aldrich Syndrome Gene Therapy for WAS Targeted Literature Review and Subject Interviews in Wiskott-Aldrich Syndrome (WAS) Molecular and Clinical Studies of Primary Immunodeficiency Diseases A Trial of Plerixafor/G-CSF as Additional Agents for Conditioning Before TCR Alpha/Beta Depleted HSCT in WAS Patients

Brief Title

Pilot and Feasibility Study of Hematopoietic Stem Cell Gene Transfer for the Wiskott-Aldrich Syndrome

Official Title

Pilot and Feasibility Study of Hematopoietic Stem Cell Gene Transfer for the Wiskott-Aldrich Syndrome

Brief Summary

      The Wiskott-Aldrich Syndrome (WAS) is an inherited disorder that results in defects of the
      blood and bone marrow. It affects boys because the genetic mistake is carried on the X
      chromosome. Normal people have blood cells called platelets that stop bleeding when blood
      vessels are damaged. Boys with WAS have low numbers of platelets that do not function
      correctly. Boys with WAS are thus at risk for severe life-threatening bleeding. A normal
      immune system is made of special blood cells called white blood cells, which protect against
      infection and also fight certain types of cancer. In WAS, these white blood cells don't work
      as well as they should, making these boys very susceptible to infections and to a form of
      blood cancer known as lymphoma. The abnormal white blood cells of patients with WAS also
      cause diseases such as eczema and arthritis. Although WAS can be mild, severe forms need
      treatment as early as possible to prevent life-threatening complications due to bleeding,
      infection and blood cancer.

      Over the past decade, investigators have developed new treatments based on the investigators
      knowledge of the defective gene causing WAS. The investigators can now use genes as a type of
      medicine that will correct the problem in the patient's own bone marrow. The investigators
      call this process gene transfer. The procedure is very similar to a normal bone marrow
      transplant, in that the old marrow is killed off using chemotherapy, but is different because
      the patient's own bone marrow is given back after it is treated by gene transfer. This
      approach can be used even if the patient does not have any matched donors available and will
      avoid problems such as GVHD and rejection. The investigators wish to test whether this
      approach is safe and whether gene transfer will lead to the development of a healthy immune
      and blood system.
    

Detailed Description

      Wiskott-Aldrich syndrome (WAS) (OMIM 301000) is a rare X-linked immunodeficiency caused by
      mutations in a single gene, WAS, mapping to Xp11.22-Xp11.3 and coding for the Wiskott-Aldrich
      Syndrome Protein (WASP) 1. WASP is a critical regulator of actin signaling with expression
      limited to hematopoietic cells, and thus is required for multiple functions including T cell
      activation, dendritic cell migration and podosome formation, and B cell terminal development
      and function. WAS is characterized by microthrombocytopenia, recurrent infections, eczema and
      associated with a high incidence of auto-immunity and of lymphoid malignancies. Classic or
      severe WAS, is generally observed in patients with nonsense mutations or insertions/deletions
      resulting in frameshift or splice-site mutations or missense mutations and resulting in
      unstable protein 2. With few exceptions, WASP-negative patients have classical disease.
      Affected patients have a severely reduced life expectancy.

      Currently, the only curative option for WAS patients is hematopoietic stem cell
      transplantation (HSCT). This treatment is most successful when an HLA-identical sibling or
      matched unrelated donor is available and results in correction of microthrombocytopenia and
      immune dysfunction, even when stable mixed chimerism occurs. However, even patients
      undergoing matched HSCT can suffer from considerable morbidity and mortality due to graft
      versus host disease (GVHD) and many patients lack an HLA-identical donor. The outcome of
      mismatched related HSCT is consistently poor with survival of approximately 50%. Gene
      transfer is an attractive alternative treatment for WAS. Successful gene transfer using
      autologous gene-corrected HSC would overcome clinical complications linked to GVHD and its
      treatment. Furthermore, in contrast to allogeneic HSCT, gene transfer would not be limited by
      the availability of compatible donors. Several lines of evidence indicate that partial
      reconstitution with gene corrected cells may be sufficient to ameliorate the disease.

      We propose here a Pilot and Feasibility study of ex vivo gene transfer using a lentiviral
      vector (LV) to transduce autologous bone marrow derived CD34+ HSC. Cells will be infused into
      patients conditioned with cytoreductive chemotherapy. Our collaborating investigators in
      Europe have developed a LV encoding the human WAS cDNA under control of the WAS promoter and
      pseudotyped with the Vesicular Stomatitis Virus glycoprotein (VSVg) envelope. This
      w1.6_hWASP_WPRE (VSVg) LV (abbreviated as w1.6W) has been shown to be efficacious in both in
      vitro and in vivo preclinical models. Safety including cellular toxicity, insertional
      mutagenesis and tumor formation has been studied by a number of methods including: 1) a
      sensitive in vitro transformation assay, 2) toxicity studies in transduced human CD34+ cells,
      3) examination of the insertional pattern in transduced murine cells, and 4) long-term
      observation and secondary transplant studies in mice. In the United States, we plan to enroll
      5 boys with classic WAS who lack a matched related or unrelated donor. Parallel studies (not
      under our Investigational New Drug application) using the same LV produced in the same
      facility, Genethon, will be conducted in London, UK (5 subjects) and Paris, France (5
      subjects). The primary objective will be to demonstrate feasibility and safety. The secondary
      objective will be to assess therapeutic efficacy.
    

Study Phase

Phase 1/Phase 2

Study Type

Interventional


Primary Outcome

Safety of infusion of transduced cells


Condition

Wiskott-Aldrich Syndrome

Intervention

Retrovirus-mediated gene transfer

Study Arms / Comparison Groups

 Gene transfer
Description:  Open label single arm study

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Biological

Estimated Enrollment

5

Start Date

July 2011

Completion Date

July 2023

Primary Completion Date

January 2022

Eligibility Criteria

        Inclusion Criteria:

          1. Confirmed molecular diagnosis by DNA sequencing and either

               1. absence of the WAS protein by flow cytometry OR

               2. clinical score 3-5

          2. Age 3 months to 35 years

          3. For subjects < 5 years of age:

               1. Lack of HLA-genotypically identical bone marrow donor.

               2. Lack of a 9/10 or 10/10 molecularly HLA-matched unrelated donor after 3 months of
                  searching.

               3. Lack of a 6/6 molecularly HLA-matched cord blood donor of adequate cell number
                  after 3 months of searching

          4. For subjects 5 years of age or older:

             a.Lack of HLA-genotypically identical bone marrow donor.

          5. Subjects who have undergone allogeneic transplant previously must additionally have:

               1. Failure defined as <5% donor T cell engraftment and

               2. Contraindication to re-use of the same donor due to severe GVHD or
                  non-availability.

          6. Parental/guardian/patient signed informed consent

          7. Willingness to return for follow-up during the 5 year study period.

          8. Adequate organ function and performance status

               1. Performance status ≥50% (Lansky play for age <16 years, Karnofsky for age ≥16
                  years)

               2. Left ventricular ejection fraction >40% or shortening fraction >25%

               3. Bilirubin ≤ 2.0 mg/dL

               4. Measured creatinine clearance or GFR by nuclear medicine study ≥40 ml/min/1.73 m2

               5. DLCO (corrected for hemoglobin), FEV1, FVC >50% of predicted; if age < 7 years,
                  then oxygen saturation >92% on room air

        Exclusion Criteria:

          1. Contraindication to bone marrow harvest, or to administration of conditioning
             medication.

          2. Known positive HIV serology or HIV nucleic acid testing.

          3. Other uncontrolled infection.

          4. Active malignancy other than EBV lymphoproliferative disease.

          5. Known myelodysplasia of the bone marrow or abnormal bone marrow cytogenetics

          6. Congenital cardiac disease with congestive heart failure

          7. Oxygen dependence at baseline

          8. Any other condition that, in the opinion of the Investigator, may compromise the
             safety or compliance of the patient or would preclude the patient from successful
             study completion. This may include but is not limited to:

               -  Severe deterioration of clinical condition after collection of cells but before
                  infusion of transduced cells

               -  Documented refusal or inability of the family to return for scheduled visits

               -  Other concerns about unwillingness or inability to comply with protocol
                  requirements

               -  Unforeseen rare circumstances such as sudden loss of legal guardianship
      

Gender

Male

Ages

3 Months - 35 Years

Accepts Healthy Volunteers

No

Contacts

Jennifer Whangbo, M.D., , 

Location Countries

United States

Location Countries

United States

Administrative Informations


NCT ID

NCT01410825

Organization ID

CHB-P00000148


Responsible Party

Sponsor-Investigator

Study Sponsor

David Williams


Study Sponsor

Jennifer Whangbo, M.D., Principal Investigator, Boston Children's Hospital


Verification Date

April 2021