Autologous Ex Vivo Lentiviral Gene Therapy for Adenosine Deaminase Deficiency.
Adenosine Deaminase
/ deficiency
Adolescent
Agammaglobulinemia
/ therapy
Child
Child, Preschool
Genetic Therapy
/ adverse effects
Genetic Vectors
Hematopoietic Stem Cell Transplantation
Humans
Infant
Lentivirus
/ genetics
Lymphocyte Count
Progression-Free Survival
Prospective Studies
Severe Combined Immunodeficiency
/ therapy
Transplantation, Autologous
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
27 05 2021
27 05 2021
Historique:
pubmed:
12
5
2021
medline:
11
6
2021
entrez:
11
5
2021
Statut:
ppublish
Résumé
Severe combined immunodeficiency due to adenosine deaminase (ADA) deficiency (ADA-SCID) is a rare and life-threatening primary immunodeficiency. We treated 50 patients with ADA-SCID (30 in the United States and 20 in the United Kingdom) with an investigational gene therapy composed of autologous CD34+ hematopoietic stem and progenitor cells (HSPCs) transduced ex vivo with a self-inactivating lentiviral vector encoding human Overall survival was 100% in all studies up to 24 and 36 months. Event-free survival (in the absence of reinitiation of enzyme-replacement therapy or rescue allogeneic hematopoietic stem-cell transplantation) was 97% (U.S. studies) and 100% (U.K. study) at 12 months; 97% and 95%, respectively, at 24 months; and 95% (U.K. study) at 36 months. Engraftment of genetically modified HSPCs persisted in 29 of 30 patients in the U.S. studies and in 19 of 20 patients in the U.K. study. Patients had sustained metabolic detoxification and normalization of ADA activity levels. Immune reconstitution was robust, with 90% of the patients in the U.S. studies and 100% of those in the U.K. study discontinuing immunoglobulin-replacement therapy by 24 months and 36 months, respectively. No evidence of monoclonal expansion, leukoproliferative complications, or emergence of replication-competent lentivirus was noted, and no events of autoimmunity or graft-versus-host disease occurred. Most adverse events were of low grade. Treatment of ADA-SCID with ex vivo lentiviral HSPC gene therapy resulted in high overall and event-free survival with sustained
Sections du résumé
BACKGROUND
Severe combined immunodeficiency due to adenosine deaminase (ADA) deficiency (ADA-SCID) is a rare and life-threatening primary immunodeficiency.
METHODS
We treated 50 patients with ADA-SCID (30 in the United States and 20 in the United Kingdom) with an investigational gene therapy composed of autologous CD34+ hematopoietic stem and progenitor cells (HSPCs) transduced ex vivo with a self-inactivating lentiviral vector encoding human
RESULTS
Overall survival was 100% in all studies up to 24 and 36 months. Event-free survival (in the absence of reinitiation of enzyme-replacement therapy or rescue allogeneic hematopoietic stem-cell transplantation) was 97% (U.S. studies) and 100% (U.K. study) at 12 months; 97% and 95%, respectively, at 24 months; and 95% (U.K. study) at 36 months. Engraftment of genetically modified HSPCs persisted in 29 of 30 patients in the U.S. studies and in 19 of 20 patients in the U.K. study. Patients had sustained metabolic detoxification and normalization of ADA activity levels. Immune reconstitution was robust, with 90% of the patients in the U.S. studies and 100% of those in the U.K. study discontinuing immunoglobulin-replacement therapy by 24 months and 36 months, respectively. No evidence of monoclonal expansion, leukoproliferative complications, or emergence of replication-competent lentivirus was noted, and no events of autoimmunity or graft-versus-host disease occurred. Most adverse events were of low grade.
CONCLUSIONS
Treatment of ADA-SCID with ex vivo lentiviral HSPC gene therapy resulted in high overall and event-free survival with sustained
Identifiants
pubmed: 33974366
doi: 10.1056/NEJMoa2027675
pmc: PMC8240285
mid: NIHMS1711277
doi:
Substances chimiques
Adenosine Deaminase
EC 3.5.4.4
Banques de données
ClinicalTrials.gov
['NCT01852071', 'NCT02999984', 'NCT01380990']
Types de publication
Clinical Trial, Phase I
Clinical Trial, Phase II
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2002-2013Subventions
Organisme : California Institute for Regenerative Medicine
ID : AC1-07675
Organisme : NIH HHS
ID : 2P01 HL073104
Pays : United States
Organisme : NHLBI NIH HHS
ID : Gene Therapy Resource Program [GTRP] Request for S
Pays : United States
Organisme : National Institute of Allergy and Infectious Diseases
ID : Intramural program
Organisme : NHLBI NIH HHS
ID : 75N92019D00018
Pays : United States
Organisme : NIH HHS
ID : U01 AI100801
Pays : United States
Organisme : University College London
ID : AC1-07675
Organisme : California Institute for Regenerative Medicine
ID : CL1-00505
Organisme : Medical Research Council
ID : G80248
Pays : United Kingdom
Organisme : California Institute for Regenerative Medicine
ID : CLIN2-09339
Organisme : Medical Research Council
ID : MR/K015427/1
Pays : United Kingdom
Organisme : NHLBI NIH HHS
ID : NHLBI Contract No. 75N92019D00018
Pays : United States
Organisme : NHGRI NIH HHS
ID : Intramural program
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : U01 AI100801
Pays : United States
Organisme : California Institute for Regenerative Medicine
ID : FA1-00613
Organisme : NHLBI NIH HHS
ID : P01 HL073104
Pays : United States
Informations de copyright
Copyright © 2021 Massachusetts Medical Society.
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