APR-2020: The drug product (DP) is designated as APR-2020 and is composed of autologous human CD34+ cells derived from each clinical patient with RPS19-deficient DBA that have been transduced ex vivo with the drug substance.
Study summary
Brief summary
The goal of this clinical trial is to learn if APR-2020 is safe and can help treat Diamond-Blackfan Anemia (DBA) in adolescents and children. The main questions it aims to answer are:
* Is APR-2020 safe and well tolerated?
* Does APR-2020 modify or correct an underlying genetic condition which causes DBA?
* Does APR-2020 reduce or eliminate the need for blood transfusions and/or restore certain blood counts affected by DBA?
Participants will:
* Take the drug one time as an infusion.
* Undergo two rounds of a cellular harvest procedure in which their own cells will be used in the manufacturing of their own participant-specific product.
* Initially return to the clinic for two years of follow up at increasingly sparse intervals.
Eligibility
Sex
ALL
Min age
2 Years
Max age
25 Years
Healthy volunteers
No
Key Inclusion Criteria:
1. Confirmed diagnosis of RPS19-deficient DBA.
2. Signed informed consent by the subject or legally authorized representative.
3. Bone marrow analysis demonstrates normal cytogenetics except for RPS19-deficient DBA.
4. Between 2 and 25 years of age, inclusive.
5. Eligible for allogeneic marrow or stem cell transplant for DBA (noncritical cardiac and hepatic iron overload).
6. Corticosteroid resistance
7. Transfusion-dependent anemia
8. Willingness to return for long-term follow-up
9. Adequate renal and pulmonary function
10. Able to undergo hematopoietic stem cell transplant (HSCT) mobilization and apheresis procedures.
Key Exclusion Criteria:
1. Availability of a suitable, consenting HLA-identical sibling donor.
2. Positive viral serology.
3. Clinically significant, active bacterial, viral, or fungal infection.
4. Any prior or current malignancy, myeloproliferative disorder, or myelodysplastic syndrome, except where therapy was curative excision (ie, in situ squamous cell carcinoma).
5. Any concerning cytogenetic abnormalities in hematopoietic cells.
6. Previous receipt of an allogeneic transplant or gene therapy.
7. Immediate family member with a known or suspected Familial Cancer Syndrome (including, but not limited to breast, colorectal, ovarian, prostate, and pancreatic cancers, excluding DBA).
8. Diagnosis of significant psychiatric disorder that could impact the subject's ability to participate in the study, in the opinion of the Investigator.
9. History of complex allo-immunization, as determined by the Investigator.
10. Female subjects who are lactating/breast feeding or who plan to breastfeed within 6 months following APR-2020 infusion.
11. Male and female subjects of childbearing potential who are unwilling to practice highly effective methods of birth control from screening until ≥ 6 months after APR-2020 infusion.
12. Female subjects with a positive serum pregnancy test at Screening or who are planning to become pregnant during the study period.
13. Liver disease, as evidenced by critical iron overload with magnetic resonance imaging (MRI)
14. Heart disease or Type 1 diabetes.
15. Evidence of significant pulmonary hypertension, per Investigator assessment.
16. Any other condition that would render the subject ineligible for HSCT, as determined by the Investigator.
17. Contraindication to stem cell or bone marrow aspiration, mobilization or collection including allergies to filgrastim or plerixafor.
18. Currently enrolled in another investigational drug study or received an investigational study drug or procedure within 90 days of study enrollment.
19. A physical, functional, or emotional status that would prevent giving informed consent, protocol compliance, or adequate follow-up.
20. An assessment by the Investigator that the subject or parents of the subject will not comply with the study procedures outlined in the study protocol.
21. Taking prohibited medications.
22. Has insufficient personal history of RBC transfusions over the 13 weeks prior to the end of screening.
Primary outcome measure(s)
Incidence of protocol-defined dose limiting toxicities (DLTs) for APR-2020 — 30 Days
Incidence and severity of treatment emergent adverse events (TEAEs), assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) — 24 Months
Monitoring laboratory parameters, frequency and severity of TEAEs, assessed by the NCI CTCAE — 24 Months
Fraction of reticulocytes greater than the baseline value where reticulocyte increases are sustained over 3 consecutive measurements within 4 weeks — 24 Months Baseline is defined as the average of 3 measurements prior to APR-2020 infusion
Proportion of subjects with a hemoglobin level of ≥ 8 g/dL starting 90 days after the last RBC transfusion, sustained over 2 consecutive measurements that are approximately 1 month apart — 24 Months
Trial sites (2)
Facility
City
Region
Status
Stanford University - Stanford Children's Health
Stanford
California
Recruiting
Boston Children's Hospital
Boston
Massachusetts
Recruiting
Official registry record
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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