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

Status: Recruiting
Phase: Phase 1/Phase 2
DFCI Protocol ID:

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.

Conducting Institutions:

Children's Hospital Boston, Dana-Farber Cancer Institute

Overall PI:

Sun-Yun Pai, MD,

Site-responsible Investigators:

Contacts:

Dana-Farber Cancer Institute: Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP, ctip@partners.org

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 1 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

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