A Phase 1/2 interventional study of Infusion of autologous cryopreserved EFS-ADA LV CD34+ cells (OTL-101) and busulfan in Severe Combined Immunodeficiency Due to ADA Deficiency, sponsored by University of California, Los Angeles. Completed at 1 site in United States. Open to participants aged 30 Days to 17 Years. Per ClinicalTrials.gov, last updated 2022-08-03.
Sponsored by University of California, Los Angeles · Phase 1/2, Interventional, and Treatment
This is a prospective, non-randomized, single-cohort, longitudinal, single-center, clinical study designed to assess the efficacy and safety of a cryopreserved formulation of OTL-101 (autologous CD34+ hematopoietic stem/progenitor cells transduced ex vivo with EFS (Elongation Factor 1α Short form) Lentiviral Vector (LV) encoding for the human ADA gene) administered to ADA-SCID subjects between the ages of 30 days and 17 years of age, who are not eligible for an Human Leukocyte Antigen (HLA) matched sibling/family donor and meeting the inclusion/exclusion criteria. The OTL-101 product is infused after a minimal interval of at least 24 hours following the completion of reduced intensity conditioning. For subjects who successfully receive the OTL-101 product, pegademase bovine (PEG-ADA) Enzyme Replacement Therapy (ERT) is discontinued at Day+30 (-3/+15) after the transplant. After their discharge from hospital, the subjects will be seen at regular intervals to review their history, perform examinations and draw blood samples to assess immunity and safety.
University of California, Los Angeles is the lead sponsor of 1,167 studies on the registry; 192 are open to participants now.
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With a diagnosis of ADA-SCID based on:
Evidence of ADA deficiency, defined as:
i. Decreased ADA enzymatic activity in erythrocytes, leukocytes, skin fibroblasts, or in cultured fetal cells to levels consistent with ADA-SCID as determined by the reference laboratory, or ii. Identified mutations in ADA alleles consistent with a severe reduction in ADA activity,
Evidence of ADA-SCID based on either:
i. Family history of a first order relative with ADA deficiency and clinical and laboratory evidence of severe immunologic deficiency, or ii. Evidence of severe immunologic deficiency in subjects prior to the institution of immune restorative therapy, based on
Exclusion Criteria:
Hematologic abnormality, defined as:
Pulmonary abnormality, defined as:
Cardiac abnormality, defined as:
Neurologic abnormality, defined as:
Renal abnormality, defined as:
Hepatic/gastrointestinal abnormality, defined as:
Oncologic disease, defined as:
Confirmation of an infectious disease by deoxyribonucleic acid (DNA) Polymerase chain reaction (PCR) positive at time of screening assessment for the following:
Infusion of autologous cryopreserved EFS-ADA LV CD34+ cells
Genetic: Infusion of autologous cryopreserved EFS-ADA LV CD34+ cells (OTL-101) · Drug: busulfan · Drug: PEG-ADA ERT
autologous cryopreserved EFS-ADA LV CD34+ cells (OTL-101) are infused intravenously
Also known as: OTL-101
Busulfan is used for non-myeloablative conditioning
PEG-ADA ERT is discontinued at Day +30 (-3/+15 days) after successful engraftment
Percentage of Participants With Treatment Efficacy After Treatment With OTL 101 (6 Months)
Efficacy of OTL-101 treatment at 6 months post OTL-101 infusion based on the following parameters and thresholds: 1. ADA enzyme activity in erythrocytes above baseline/pretreatment level (i.e., \>0 units). ADA enzyme activity is measured to assess the amount of functional gene product produced from the normal ADA transgene delivered by EFS-ADA LV. 2. Absolute CD3+ T cell counts ≥200 cells/μL. Increase in CD3+ T cell counts is a marker of immune reconstitution. 3. Granulocyte samples positive for vector sequences by quantitative Polymerase Chain Reaction (PCR) (≥1/10,000 cells). Vector copy number (VCN) in the Peripheral Blood (PB) Granulocytes fraction that was T cell depleted, is a surrogate for amount of engrafted genetically modified Hematopoietic stem cell (HSC) that are producing granulocytes every 3-5 days.
Time frame: 6 months
Overall Survival (OS) of Subjects Treated With Investigational Medicinal Product (IMP) (1 Year)
Overall survival is defined as the percentage of subjects alive at 12 months post- treatment with cryopreserved OTL-101.
Time frame: 12 Months
Event-free Survival (EvFS) of Subjects Treated With Investigational Medicinal Product (IMP) (1 Year)
Event-free survival is defined as the percentage 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: 12 Months
OS of Subjects Treated With Investigational Medicinal Product (IMP) (2 Years)
OS is defined as the percentage of subjects alive at 24 months post- treatment with cryopreserved OTL-101.
Time frame: 24 months
EvFS of Subjects Treated With Investigational Medicinal Product (IMP) (2 Years)
Event-free survival is defined as the percentage of subjects alive with no "event", an "event" being the resumption of PEG-ADA ERT or the need for a rescue allogenic Hematopoietic Stem Cell Transplant (HSCT), or death.
Time frame: 24 months
Change From Baseline in CD3+ T Cell Counts (2 Years)
Immune reconstitution was assessed by change in CD3+ T Cell counts over time.
Time frame: 24 months
Severe Infections Excluding First 3 Months After Treatment
The infections of interest in this study were severe infections or opportunistic infectious episodes, defined as infections requiring hospitalization or prolonging hospitalization and/or documented infections by opportunistic pathogens. Infections that took place in the first 3 months of follow-up post treatment were excluded from calculations to avoid possible bias introduced in the data by the effects of conditioning.
Time frame: 24 months
Change From Baseline in Quality of Life Measures (2 Years)
Assessment of quality of life was measured by the Lansky Performance Status Scale. The maximum score on the Lansky Performance Scale is 100 - the child is fully active and able to carry on normal activity with no special care needed. The minimum score is 10 - the child is completely disabled, not even passive play. The scores at baseline (pre-treatment with OTL-101) and scores at Month 24 post-treatment with OTL-101 were compared to establish if there were any changes in the child's score in this timeframe.
Time frame: 24 months
Percentage of Patients Who Stopped Immunoglobulin Replacement Therapy (IgRT) (2 Years)
Use of immunoglobulin replacement therapies prior to and after gene therapy were monitored. Indications for considering the discontinuation of immunoglobulin replacement therapy included: absolute CD4+ \>200, absolute B cell \>100/μl, IgA or IgM \> lower limit of normal for age or gene marking \>1% detectable in B cells.
Time frame: 24 months
Time to Cessation of IgRT for Those Who Stopped (2 Years)
Use of immunoglobulin replacement therapies prior to and after gene therapy were monitored. For subjects who stopped IgRT during the study, the time of cessation was recorded.
Time frame: 24 months
| Milestone | Gene Therapy |
|---|---|
| Started | 10 |
| Completed | 9 |
| Not completed | 1 |
| Withdrew: Treatment failure | 1 |
Efficacy of OTL-101 treatment at 6 months post OTL-101 infusion based on the following parameters and thresholds: 1. ADA enzyme activity in erythrocytes above baseline/pretreatment level (i.e., \>0 units). ADA enzyme activity is measured to assess the amount of functional gene product produced from the normal ADA transgene delivered by EFS-ADA LV. 2. Absolute CD3+ T cell counts ≥200 cells/μL. Increase in CD3+ T cell counts is a marker of immune reconstitution. 3. Granulocyte samples positive for vector sequences by quantitative Polymerase Chain Reaction (PCR) (≥1/10,000 cells). Vector copy number (VCN) in the Peripheral Blood (PB) Granulocytes fraction that was T cell depleted, is a surrogate for amount of engrafted genetically modified Hematopoietic stem cell (HSC) that are producing granulocytes every 3-5 days.
| percentage of participants | Gene Therapy |
|---|---|
| % of subjects with an increase from baseline in RBC ADA activity | 100 |
| % of subjects with CD3+ T-cell count >=200 cells/μL | 100 |
| % of subjects with detectable gene-marked granulocytes by quantitative PCR >=1/10,000 cells | 90 |
Overall survival is defined as the percentage of subjects alive at 12 months post- treatment with cryopreserved OTL-101.
| percentage of participants | Gene Therapy |
|---|---|
| Overall Survival (OS) of Subjects Treated With Investigational Medicinal Product (IMP) (1 Year) | 100 (66.37 to 100) |
Event-free survival is defined as the percentage 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.
| percentage of participants | Gene Therapy |
|---|---|
| Percentage event-free at 12 months | 90.00 (55.50 to 99.75) |
| Percentage without reinstitution of PEG-ADA by 12 months | 90.00 (55.50 to 99.75) |
| Percentage without rescue HSCT by 12 months | 100 (66.37 to 100) |
OS is defined as the percentage of subjects alive at 24 months post- treatment with cryopreserved OTL-101.
| percentage of participants | Gene Therapy |
|---|---|
| OS of Subjects Treated With Investigational Medicinal Product (IMP) (2 Years) | 100 (66.37 to 100) |
Event-free survival is defined as the percentage of subjects alive with no "event", an "event" being the resumption of PEG-ADA ERT or the need for a rescue allogenic Hematopoietic Stem Cell Transplant (HSCT), or death.
| percentage of participants | Gene Therapy |
|---|---|
| Percentage event-free at 24 months | 90.00 (55.50 to 99.75) |
| Percentage without reinstitution of PEG-ADA by 24 months | 90.00 (55.50 to 99.75) |
| Percentage without rescue HSCT by 24 months | 100 (66.37 to 100) |
Immune reconstitution was assessed by change in CD3+ T Cell counts over time.
| cells/μL | Gene Therapy |
|---|---|
| Change From Baseline in CD3+ T Cell Counts (2 Years) | 418.5 (-332 to 1976) |
The infections of interest in this study were severe infections or opportunistic infectious episodes, defined as infections requiring hospitalization or prolonging hospitalization and/or documented infections by opportunistic pathogens. Infections that took place in the first 3 months of follow-up post treatment were excluded from calculations to avoid possible bias introduced in the data by the effects of conditioning.
| Infections per person per year | Gene Therapy |
|---|---|
| Severe Infections Excluding First 3 Months After Treatment | 0.12 |
Assessment of quality of life was measured by the Lansky Performance Status Scale. The maximum score on the Lansky Performance Scale is 100 - the child is fully active and able to carry on normal activity with no special care needed. The minimum score is 10 - the child is completely disabled, not even passive play. The scores at baseline (pre-treatment with OTL-101) and scores at Month 24 post-treatment with OTL-101 were compared to establish if there were any changes in the child's score in this timeframe.
| Lansky Performance Score | Gene Therapy |
|---|---|
| Change From Baseline in Quality of Life Measures (2 Years) | 0 (0 to 0) |
Use of immunoglobulin replacement therapies prior to and after gene therapy were monitored. Indications for considering the discontinuation of immunoglobulin replacement therapy included: absolute CD4+ \>200, absolute B cell \>100/μl, IgA or IgM \> lower limit of normal for age or gene marking \>1% detectable in B cells.
| percentage of participants | Gene Therapy |
|---|---|
| Percentage of Patients Who Stopped Immunoglobulin Replacement Therapy (IgRT) (2 Years) | 78 |
Use of immunoglobulin replacement therapies prior to and after gene therapy were monitored. For subjects who stopped IgRT during the study, the time of cessation was recorded.
| months | Gene Therapy |
|---|---|
| Time to Cessation of IgRT for Those Who Stopped (2 Years) | 11.6 (9 to 20) |
Collected over Adverse events were reported from the time of participant consent, approximately 1-month pre-treatment, up until 2-years post-treatment with OTL-101.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Gene Therapy | 0/10 (0%) | 3/10 (30%) | 10/10 (100%) |
| Event | Gene Therapy |
|---|---|
| BacteraemiaInfections and infestations | 1/10 |
| BronchiolitisInfections and infestations | 1/10 |
| Respiratory tract infection viralInfections and infestations | 1/10 |
| LeukopeniaBlood and lymphatic system disorders | 1/10 |
| NeutropeniaBlood and lymphatic system disorders | 1/10 |
| DehydrationMetabolism and nutrition disorders | 1/10 |
| Event | Gene Therapy |
|---|---|
| LeukopeniaBlood and lymphatic system disorders | 10/10 |
| NeutropeniaBlood and lymphatic system disorders | 10/10 |
| AnaemiaBlood and lymphatic system disorders | 8/10 |
| Dermatitis diaperSkin and subcutaneous tissue disorders | 6/10 |
| Aspartate aminotransferase increasedInvestigations | 5/10 |
| Alanine aminotransferase increasedInvestigations | 5/10 |
| CoughRespiratory, thoracic and mediastinal disorders | 5/10 |
| Viral upper respiratory tract infectionInfections and infestations | 4/10 |
| ThrombocytopeniaBlood and lymphatic system disorders | 3/10 |
| Upper respiratory tract infectionInfections and infestations | 3/10 |
| Age, Categorical(Participants) | Gene Therapy |
|---|---|
| <=18 years | 10 |
| Between 18 and 65 years | 0 |
| >=65 years | 0 |
| Sex: Female, Male(Participants) | Gene Therapy |
|---|---|
| Female | 6 |
| Male | 4 |
| Race/Ethnicity, Customized(Participants) | Gene Therapy |
|---|---|
| Caucasian | 6 |
| Afro-American | 2 |
| Other | 1 |
| Unknown | 1 |
| Region of Enrollment(participants) | Gene Therapy |
|---|---|
| United States | 10 |
Documents are hosted by the registry — open the source record to download them.
Plan to share: No
Ran from Dec 2016 to primary completion in Oct 2018, 21 months.
Results were first posted in Jul 2022, 3 years 9 months after primary completion. A results delay was requested in Jan 2020.
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Studies of the drug tested here: Busulfan
Severe combined immunodeficiency due to adenosine deaminase deficiency
University of California, Los Angeles →