Depleted Donor Stem Cell Transplant in Children and Adults With Fanconi Anemia After Being Conditioned With a Regimen Containing JSP191 Antibody

• ClinicalTrials.gov Identifier: NCT04784052
• Recruitment Status: Recruiting
• First Posted: March 5, 2021
• Last Update Posted: February 15, 2023
• Sponsor: Rajni Agarwal
• Information provided by (Responsible Party): Rajni Agarwal, Stanford University

Study Description

Brief Summary:

The objective of this clinical trial is to develop a cell therapy for Fanconi Anemia which enables enhanced donor hematopoietic and immune reconstitution with decreased toxicity by transplanting depleted stem cells from a donor after using an experimental antibody treatment called JSP-191 as a part of conditioning. This experimental treatment will hopefully cause fewer side effects than chemotherapy (the current standard of care method).

Participants will be administered the conditioning regimen, are assessed until they receive the depleted stem cell infusion, and will be followed for up to 2 years after the cell infusion.

Condition or disease	Intervention/treatment	Phase
Fanconi Anemia	Drug: JSP191; Device: CliniMACS Prodigy System; Biological: Depleted Stem Cell Transplant; Biological: Rabbit Anti-Thymoglobulin (rATG); Drug: Cyclophosphamide; Drug: Fludarabine; Drug: Rituximab	Phase 1; Phase 2

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 12 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: TCRαβ+ T-cell/CD19+ B-cell Depleted Hematopoietic Grafts and a Reduced Intensity Preparative Conditioning Regimen Containing JSP191 to Achieve Engraftment and Blood Reconstitution in Patients With Fanconi Anemia
• Actual Study Start Date: December 7, 2021
• Estimated Primary Completion Date: April 2025
• Estimated Study Completion Date: April 2028

Arms and Interventions

Arm

Intervention/treatment

Experimental: Depleted Stem Cell Transplant with JSP-191 Conditioning; Participants will receive an infusion of donor stem cells which have been depleted of αβ+T cells using the CliniMACS System device. Before the stem cell transplant, they will receive a reduced-intensity preparative regimen containing JSP191 in combination with rATG, cyclophosphamide, fludarabine and rituximab.

Drug: JSP191; Participants will receive a single IV dose at start of conditioning; Device: CliniMACS Prodigy System; The device used to remove the αβ+T cells from donor stem cell transplant before being given to the recipient; Biological: Depleted Stem Cell Transplant; TCRαβ+ T-cell/CD19+ B-cell depleted hematopoietic cells will be administered by IV after completion of conditioning regimen.; Biological: Rabbit Anti-Thymoglobulin (rATG); 3 consecutive daily doses of rATG will be given by IV during conditioning; Drug: Cyclophosphamide; 4 consecutive daily doses of cyclophosphamid will be given by IV during conditioning; Other Name: Cytoxan; Drug: Fludarabine; 4 consecutive daily doses of fludarabine will be given by IV during conditioning; Drug: Rituximab; 1 dose of rituximab will be given at the end of conditioning

Outcome Measures

Primary Outcome Measures :

1. Number of participants without grade 3 and 4 treatment-emergent adverse events (TEAEs) (infusion related reactions) following administration of JSP191 [ Time Frame: From start of conditioning regimen administration until cell infusion (up to 30 days) ]
   Recorded and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0
2. Number of participants without grade 3 and 4 treatment-emergent adverse events (TEAEs) (infusion related reactions) following infusion of TCRαβ+ T-cell/CD19+ B-cell depleted hematopoietic graft transplantation [ Time Frame: Up to 2 years post-cell infusion ]
3. Number of participants able to achieve donor engraftment [ Time Frame: Assessed at Day +42 post-cell infusion ]
   Participants have achieved engraftment when absolute Neutrophil Count (ANC) is above 500/mm^3 for three consecutive laboratory values obtained on different days post cell transplantation with >1% CD15 donor chimerism
4. Number of participants who are able to have donor engraftment persist at the same rate or better compared to alternative hematopoietic cell transplant regimens for this patient population [ Time Frame: Assessed at Day +100 post-cell infusion ]

Secondary Outcome Measures :

1. Serum concentration of JSP191 [ Time Frame: Prior to start of conditioning regimen, and 5 minutes, 4 hours, +2, +3, +4, +6, +8, +10 days after start of conditioning regimen, and day of cell infusion ]
   Assessed as serum concentrations in the peripheral blood from administration until time of cell infusion
2. Serum concentration of rATG [ Time Frame: Prior to start of rATG infusion; 15 minutes after first, second, and third rATG infusion; day of cell infusion; and week +1, week +2 and week +12 post cell infusion ]
   Assessed as serum concentrations in the peripheral blood from administration until time of cell infusion
3. Serum concentration of fludarabine [ Time Frame: Prior to start of fludarabine infusion, and 15 minutes, 1 hour, 3 hours, and 6 hours after the fludarabine infusion ]
   Assessed as serum concentrations in the peripheral blood from administration until time of cell infusion
4. Participants who do not develop mucositis [ Time Frame: Start of conditioning regimen until +12 weeks post-cell infusion (up to 15 weeks) ]
   Mucositis incidence will be scored using the CTC criteria
5. Participants who do not develop veno-occlusive disease (VOD) [ Time Frame: Start of conditioning regimen until +12 weeks post-cell infusion (up to 15 weeks) ]
   VOD incidence will be scored using the Modified Seattle criteria
6. Number of participants who achieve hematopoietic recovery [ Time Frame: Up to 107 weeks (after start of conditioning regimen through Week +104 post-cell infusion) ]
   Hematopoietic recovery defined by hemoglobin >8g/dL and platelets >20k/dL without transfusion support achieved on 7 days post-graft transplantation documented on hematologic monitoring
7. Number of participants who achieve donor engraftment [ Time Frame: Weeks +1 through +104 post-cell infusion ]
   Engraftment measured as peripheral blood (total, CD15+, CD3+, CD19+, CD56+, and CD34+) and bone marrow (total and CD34+) chimerism by STR analysis
8. Number of participants who achieve immunologic recovery [ Time Frame: Weeks +1 through +104 post-cell infusion ]
   Immunologic recovery defined as >200/uL CD3+ T-cells and as assessed by percent and absolute numbers of T (CD3), B (CD19) and NK (CD56) cells by CBC differential studies and flow cytometry for lymphocyte lineages
9. Number of participants who develop Grade I-IV acute graft-vs-host disease (GvHD) [ Time Frame: Day +100 post-cell infusion ]
10. Number of participants who develop chronic graft-vs-host disease (GvHD) [ Time Frame: Day +100 through Week +104 post-cell infusion ]
11. Number of participants who achieve disease-free survival [ Time Frame: Up to 104 weeks (from time of cell infusion through Week +104) ]
    Disease-free defined by improved DEB-induced chromosomal breakage analysis in peripheral blood lymphocyte cultures

Eligibility Criteria

• Ages Eligible for Study: 2 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

All patients must have:

1. Fanconi Anemia diagnosis as demonstrated by abnormal chromosome breakage studies with increased sensitivity to mitomycin-C (MMC) or diepoxybutane (DEB) and at least one mutation in a known Fanconi-associated gene
2. Bone marrow failure (defined by reduction in at least one cell line on two separate occasions at least one month apart (e.g., platelet count of <100,000 per cubic millimeter, hemoglobin <9 gm/dl and/or absolute neutrophil count (ANC) of <1000/mm)
3. Age of ≥2 years
4. Consenting ≥5/10 HLA-matched related or unrelated donor available for apheresis

5. Organ function defined as:

   1. Serum Creatinine <2.0 mg/dL and corrected creatinine clearance/cystatin cL >60 mL/min/1.73m^2 without dialysis
   2. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) corrected for hemoglobin and volume, >50% predicted by pulmonary function tests (PFTs)
   3. For patients unable to cooperate for PFTs, criteria are no evidence of dyspnea at rest, no exercise intolerance, and no requirement for supplemental oxygen with spO2 >93%
   4. Shortening fraction of ≥29% or ejection fraction of ≥45% by echocardiogram
   5. Serum total bilirubin of <4 x ULN
   6. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) < 5 x ULN
   7. Prothrombin time international normalized ratio (PT INR) and partial thromboplastin time (PTT) <1.5 x ULN
6. Life expectancy of at least 2 years
7. Patients of childbearing potential must be willing to use an effective contraceptive method for the duration of the peri-transplant conditioning through hematopoietic recovery
8. Patients and/or parents or legal guardians must be able to provide written informed consent and authorize use and disclosure of personal health information in accordance with Health Insurance Portability and Accountability Act

Exclusion Criteria:

1. Patients with available and consenting 10/10 HLA-identical sibling donor for apheresis
2. Patients with any acute or uncontrolled infections at the time of enrollment, including bacterial, fungal or viral
3. Patients who are seropositive for HIV-I/II or HTLV-I/II.
4. Patients receiving any other investigational agents or other biological, chemotherapy, or radiation therapy within 14 days of enrollment
5. Patients with any active malignancies, myelodysplastic syndrome or other concerns for high-risk bone marrow disease
6. Patients who received androgens in last 3 months
7. Pregnant or lactating women
8. Women who are nursing and do not wish to discontinue breastfeeding
9. Lansky/Karnofsky performance score <50%.
10. Any other medical condition or history that, in the opinion of the Principal Investigator, could pose a significant safety risk to the participant or jeopardize the integrity of the study
11. Patients who, in the opinion of the Principal Investigator, may not be able to comply with the safety monitoring requirements of the study

Contacts and Locations

Locations

United States, California

Stanford University; Recruiting

Stanford, California, United States, 94305

Contact: Rajni Agarwal, MD 650-725-9250 scgt_clinical_trials_office@lists.stanford.edu

Sponsors and Collaborators

Rajni Agarwal

Investigators

• Principal Investigator: Rajni Agarwal, MD; Stanford University

More Information

• Responsible Party: Rajni Agarwal, Associate Professor of Pediatrics, Stanford University
• ClinicalTrials.gov Identifier: NCT04784052
• Other Study ID Numbers: IRB-60108
• First Posted: March 5, 2021
• Last Update Posted: February 15, 2023
• Last Verified: February 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Rajni Agarwal, Stanford University:

Cell Transplants; Grafts; Stem Cells

Additional relevant MeSH terms:

Fanconi Syndrome; Anemia; Fanconi Anemia; Anemia, Hypoplastic, Congenital; Anemia, Aplastic; Hematologic Diseases; Congenital Bone Marrow Failure Syndromes; Bone Marrow Failure Disorders; Bone Marrow Diseases; Genetic Diseases, Inborn; DNA Repair-Deficiency Disorders; Metabolic Diseases; Renal Tubular Transport, Inborn Errors; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Cyclophosphamide; Rituximab; Fludarabine; Thymoglobulin; Antilymphocyte Serum; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs; Antirheumatic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents