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Nat Med. 2019 Feb;25(2):234-241. doi: 10.1038/s41591-018-0301-6. Epub 2019 Jan 21.

Intrabone hematopoietic stem cell gene therapy for adult and pediatric patients affected by transfusion-dependent ß-thalassemia.

Author information

1
San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy.
2
Haematology and BMT Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
3
Pediatric Immunohematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
4
Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
5
Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
6
Pediatric Department University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
7
Pediatric Clinic/DH, Fondazione IRCCS Ca' Granda, Milan, Italy.
8
Ospedale Pediatrico Microcitemico "A.Cao", A.O. "G.Brotzu", Cagliari, Italy.
9
Department of Woman, Child and General and Specialist Surgery, Università degli studi della Campania "Luigi Vanvitelli", Napoli, Italy.
10
Department of Chemical Pathology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
11
Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
12
Rare Disease Center, Fondazione IRCCS Ca' Granda, University of Milan, Milan, Italy.
13
Vita-Salute San Raffaele University, Milan, Italy.
14
San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy. ferrari.giuliana@hsr.it.
15
Vita-Salute San Raffaele University, Milan, Italy. ferrari.giuliana@hsr.it.

Abstract

ß-thalassemia is caused by ß-globin gene mutations resulting in reduced (β+) or absent (β0) hemoglobin production. Patient life expectancy has recently increased, but the need for chronic transfusions in transfusion-dependent thalassemia (TDT) and iron chelation impairs quality of life1. Allogeneic hematopoietic stem cell (HSC) transplantation represents the curative treatment, with thalassemia-free survival exceeding 80%. However, it is available to a minority of patients and is associated with morbidity, rejection and graft-versus-host disease2. Gene therapy with autologous HSCs modified to express ß-globin represents a potential therapeutic option. We treated three adults and six children with ß0 or severe ß+ mutations in a phase 1/2 trial ( NCT02453477 ) with an intrabone administration of HSCs transduced with the lentiviral vector GLOBE. Rapid hematopoietic recovery with polyclonal multilineage engraftment of vector-marked cells was achieved, with a median of 37.5% (range 12.6-76.4%) in hematopoietic progenitors and a vector copy number per cell (VCN) of 0.58 (range 0.10-1.97) in erythroid precursors at 1 year, in absence of clonal dominance. Transfusion requirement was reduced in the adults. Three out of four evaluable pediatric participants discontinued transfusions after gene therapy and were transfusion independent at the last follow-up. Younger age and persistence of higher VCN in the repopulating hematopoietic cells are associated with better outcome.

PMID:
30664781
DOI:
10.1038/s41591-018-0301-6
[Indexed for MEDLINE]

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