Sustained Efficacy and Safety in Adult and Pediatric Patients with Transfusion-Dependent β-Thalassemia up to 9 Years Post Treatment with Betibeglogene Autotemcel (Beti-cel)

地中海贫血 医学 输血 儿科 内科学
作者
Mark C. Walters,Alexis A. Thompson,Timothy S. Olson,John B. Porter,Jennifer Schneiderman,Suradej Hongeng,Andreas E. Kulozik,Marina Cavazzana,Martin G. Sauer,Adrian J. Thrasher,Isabelle Thuret,Ashutosh Lal,John E.J. Rasko,Evangelia Yannaki,Shamshad Ali,Ge Tao,Himal L. Thakar,Ami A. Deora,Katiana Gruppioni,Richard A. Colvin,Franco Locatelli,Janet L. Kwiatkowski
标识
DOI:10.1016/j.jtct.2023.12.301
摘要

Beti-cel gene therapy addresses the underlying cause of transfusion-dependent β-thalassemia (TDT) via autologous transplantation of hematopoietic stem and progenitor cells transduced with a functional version of the β-globin gene to produce normal adult hemoglobin (Hb), HbAT87Q. Here, we report long-term outcomes from patients treated with beti-cel. Patients with TDT who completed either a phase 1/2 (HGB-204 [NCT01745120]; HGB-205 [NCT02151526]) or phase 3 (HGB-207 [NCT02906202]; HGB-212 [NCT03207009]) beti-cel parent study and subsequently participated in the long-term, 13-year follow-up study LTF-303 (NCT02633943) were included. Efficacy (including transfusion independence [TI], defined as a weighted average Hb ≥9 g/dL without packed red blood cell transfusions for ≥12 months) and safety are reported through last follow-up. Key outcomes were also examined based on patient age at enrollment (pediatric: <18 years; adult: ≥18 years). As of January 30, 2023, 63 patients (median [range] age: 17 [4-35] years) had received beti-cel and enrolled in LTF-303, with a median (range) follow-up of 60.1 (23.8-109.5) months. In phase 3 studies, which used the commercial drug product (DP) manufacturing process, 37/41 (90.2%) patients achieved and maintained TI through last follow-up (up to 6 years; Table). In phase 1/2 studies that used an older DP manufacturing process, 15/22 (68.2%) patients achieved TI, and 14/15 sustained TI through last follow-up (up to 9 years). One patient no longer meets protocol-defined TI as a result of Hb level <9g/dL at year 6 due to acute health events unrelated to β-thalassemia, which were not attributed to loss of beti-cel treatment effect. Among all 63 patients, ≈80% of pediatric and adult patients required only 1 mobilization cycle to achieve the DP dose. Median percentage of transduced DP cells was comparable between adult and pediatric populations (78% and 80%, respectively), as were month 6 median peripheral blood vector copy number (1.4 c/dg and 1.1 c/dg) and HbAT87Q (9.4 g/dL and 8.3 g/dL). Overall, 12/63 (19.0%) patients experienced ≥1 beti-cel–related adverse event (AE); beti-cel–related AEs occurring in ≥3 patients included abdominal pain (5/63 [7.9%]) and thrombocytopenia (3/63 [4.8%]). Five patients experienced serious veno-occlusive liver disease; all 5 received defibrotide and recovered. No malignancies, insertional oncogenesis, or vector-derived replication-competent lentivirus were reported. Beti-cel is a potentially curative gene therapy for patients with TDT across ages and genotypes through achievement of TI and normal or near-normal Hb. These data will inform real-world beti-cel treatment decisions for patients with TDT.
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