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| ID | Type | Description | Link |
|---|---|---|---|
| 2023-507334-24-00 | EU Trial (CTIS) Number |
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| Name | Class |
|---|---|
| URC-CIC Paris Descartes Necker Cochin | OTHER |
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The investigators propose to replace HLA- partially compatible allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for FHL type 3 patients, with autologous transplantation of immunoselected gene-modified CD34+ cells, combined with transduced autologous T-cell each time this is possible and also to propose this alternative treatment as salvage in case of failure of a previous allogeneic HSCT. This approach should avoid the severe immunological complications (failure to engraft, acute or chronic graft versus host disease (GVHD)) and conditioning toxicities such as severe Veno-Occlusive Disease (VOD). As the clinical manifestations of FHL type 3 patients are triggered by opportunistic viral infections (often EBV) and can be poorly controlled or only transiently controlled by the available drugs , providing the patient after the conditioning with immediately functional autologous cytotoxic T-cells could be key to maintain the control of the viral infection and hopefully its eradication awaiting for the hematopoietic reconstitution . This procedure should avoid any reactivation of the viral infection and thus improving the patients' overall survival and event-free survival while clearing the ongoing triggering infections.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MUNC | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MUNC-CD34 | Genetic |
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| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Transplantation Related Mortality (TRM) | up to 6 months post treatment | |
| Frequency and severity of clinical AEs and laboratory parameters | Adverse event will be measured using CTCAE | throughout the whole period of the research, up to 60 months |
| Incidence of clinically detectable malignancy and/or abnormal clonal dominance assessed as related to study treatment | Bone marrow analysis and VISA | At 12 months post treatment |
| Detection of Replication -Competent Lentivirus (RCL) | at 3, 6 and 12 months post treatment, then yearly up to 60 months |
| Measure | Description | Time Frame |
|---|---|---|
| Neutrophil and platelet recovery | ANC> 500/µl, Platelets > 20.000/µl on two consecutive days without transfusion | throughout the whole period of the research, up to 60 months |
| Quantification of the transgene copy number (VCN) on drug substance at time of cryopreservation, on PBMC, sorted T-CD3+ and sorted NK cells |
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Inclusion Criteria:
Patient aged from 3 months up to 45 years old.
Patient with a FHL caused by mutation of the UNC13D gene.
Complete remission is defined by the normalization of clinical and laboratory parameters:
Patient eligible for an allogeneic HSCT in absence of an HLA geno-identical donor (at diagnostic or 6 months after failure of a previous HSCT (rejection or loss of the graft))
Patint or parental, guardian's patient signed informed consent.
For patients of childbearing age : willing to use an effective method of contraception* during the trial and for at least 12 months post-infusion
Affiliation to Social Security
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marina CAVAZZANA, MD, PhD | Contact | 01 44 49 50 68 | +33 | m.cavazzana@aphp.fr |
| Aline DECHANET, Project Manager | Contact | 01 71 19 61 69 | +33 | aline.dechanet@aphp.fr |
| Name | Affiliation | Role |
|---|---|---|
| Jean-Sébastien DIANA, MD, PhD | Assitance publique - Hôpitaux de Paris | Study Director |
| Chantal LAGRESLE, PHD | Inserm Institut Imagine | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Biotherapy, Hopital Necker Enfants Malades | Paris | 75015 | France |
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| MUNC-T3 | Genetic |
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| at 1, 2, 3, 6, 9, 12, 18 and 24 months post treatment |
| Quantification of the UNC13D RNA on PBMC | by Q-PCR | at 1, 2, 3, 6, 9, 12, 18 and 24 post treatment |
| Quantification of Munc13.4 protein level in the drug substance and on peripheral blood mononuclear cells and on sorted CD3+ and CD56+ cells in function of their number | by western blot | at 6, 12 and 24 months post treatment |
| Disease-free survival (DFS). evaluate the Persistent HLH remission | Disease-free survival (DFS). | at M6 and 24 months post treatment. |
| Vector Copy Number (VCN) in Peripheral Blood Mononuclear Cells (PBMC) | > 0.2. | At M6 and 24 months post treatment. |
| Determination of the total number of T-cells and distribution of different subpopulations. | Naïve and memory CD4+ and CD8+ T cells will be evaluated using CCR7/CD45RA/RO markers, and the quantification of activation marker will be performed by the expression of DR+, by flow cytometry. | At 1, 2, 3, 6, 12, 18 and 24 months post treatment |
| Correction of degranulation function in T-CD3 | at 6 months and 24 months post treatment |
| Integration site analyse study | at 24 months post treatment |
| Needs of PICU support | up to 24 months post treatment |
| Endothelial complications | up to 24 months post treatment |
| Infectious diseases | up to 24 months post treatment |
| Estimate of the cost of the complete procedure, from mobilisation to transplant | up to 24 months post treatment |
| Estimate of the 24 months total cost. | up to 24 months post treatment |