Cited by 107Virus-based gene therapy researchLysosomal Storage Disorders ResearchCAR-T cell therapy research

The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index; none of the 19 sources its claims cite is checked for support yet.

Lentiviral Gene Therapy for Cerebral Adrenoleukodystrophy

Open access

Abstract

BACKGROUND: complementary DNA, is being tested in persons with cerebral adrenoleukodystrophy. METHODS: In a phase 2-3 study, we evaluated the efficacy and safety of eli-cel therapy in boys with early-stage cerebral adrenoleukodystrophy and evidence of active inflammation on magnetic resonance imaging (MRI). The primary efficacy end point was survival without any of six major functional disabilities at month 24. The secondary end points included overall survival at month 24 and the change from baseline to month 24 in the total neurologic function score. RESULTS: A total of 32 patients received eli-cel; 29 patients (91%) completed the 24-month study and are being monitored in the long-term follow-up study. At month 24, none of these 29 patients had major functional disabilities; overall survival was 94%. At the most recent assessment (median follow-up, 6 years), the neurologic function score was stable as compared with the baseline score in 30 of 32 patients (94%); 26 patients (81%) had no major functional disabilities. Four patients had adverse events that were directly related to eli-cel. Myelodysplastic syndrome (MDS) with excess blasts developed in 1 patient at month 92; the patient underwent allogeneic hematopoietic stem-cell transplantation and did not have MDS at the most recent follow-up. CONCLUSIONS: At a median follow-up of 6 years after lentiviral gene therapy, most patients with early cerebral adrenoleukodystrophy and MRI abnormalities had no major functional disabilities. However, insertional oncogenesis is an ongoing risk associated with the integration of viral vectors. (Funded by Bluebird Bio; ALD-102 and LTF-304 ClinicalTrials.gov numbers NCT01896102 and NCT02698579, respectively.).

Overview

CoChat Summary

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TL;DR

In boys with early-stage cerebral adrenoleukodystrophy and active MRI inflammation, elivaldogene autotemcel (eli-cel) lentiviral gene therapy preserved neurologic function and disability-free survival over a median follow-up of 6 years. However, insertional oncogenesis remains a risk, with one patient developing myelodysplastic syndrome at month 92.

Key findings

  • At month 24, 29 of 32 patients (91%; 95% CI, 75 to 98) had no major functional disabilities, and overall survival was 94%.
  • At the most recent assessment (median follow-up, 6 years), the neurologic function score was stable in 30 of 32 patients (94%), and 26 of 32 patients (81%) had no major functional disabilities.
  • Four of 32 patients (12%) had adverse events directly related to eli-cel; no graft-versus-host disease was observed.
  • MDS with excess blasts developed in 1 patient at month 92 and was considered related to Lenti-D lentiviral vector; the patient underwent allogeneic HSCT and had no MDS at most recent follow-up.

Methods

  • Phase 2–3, multicenter, open-label study of eli-cel in boys 17 years of age or younger with cerebral adrenoleukodystrophy confirmed by biochemical and genetic testing, early-stage cerebral disease with gadolinium enhancement on MRI, a neurologic function score of 0 or 1, and a Loes score of 0.5 to 9.
  • A total of 32 patients received eli-cel; the primary efficacy end point was survival without any of six major functional disabilities at month 24, with secondary end points including overall survival and change in total neurologic function score.
  • Statistical methods were primarily descriptive; the sample size was not determined by formal statistical methods, and confidence intervals were not adjusted for multiplicity.

Limitations

  • The paper states that a limitation is the small number of patients included who had a high baseline Loes score, and that additional longer-term follow-up, including neuropsychiatric testing outcomes, is needed.
  • Evident from the text: this was a single-arm, open-label study without a concurrent comparator, and the authors note that comparative inferences cannot be drawn from historical allogeneic HSCT data.
  • Evident from the text: insertional oncogenesis is an ongoing risk, and longer-term follow-up is needed to determine whether efficacy is maintained.

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Integrity signals

Registry

Crossref · 10.1056/nejmoa2400442

Cites

24 of 24 references verified0 citation errors · 0 not checkable

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Citations

Cites

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Research works printed but not linked: 2

  1. Raymond GV, Moser AB, Fatemi A. X-Linked adrenoleukodystrophy. In: Adam MP, Everman DB, Mirzaa GM, et al., eds. GeneReviews. Seattle: University of Washington, 1993 (http://www.ncbi.nlm.nih.gov/books/NBK1315/).
  2. Williams DA, Bledsoe JR, Duncan CN, et al. Myelodysplastic syndromes after eli-cel gene therapy for cerebral adrenoleukodystrophy (CALD). Mol Ther 2022;30:Suppl 1:6-6. abstract.

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Metadata

Authors
Eichler, F., Duncan, C. N., Musolino, P. L., Lund, T. C., Gupta, A. O., De Oliveira, S., Thrasher, A. J., Aubourg, P., Kühl, J.-S., Loes, D. J., Amartino, H., Smith, N., Folloni Fernandes, J., Sevin, C., Sankar, R., Hussain, S. A., Gissen, P., Dalle, J.-H., Platzbecker, U., Downey, G. F., McNeil, E., Demopoulos, L., Dietz, A. C., Thakar, H. L., Orchard, P. J., & Williams, D. A.
Affiliations
  • University of Minnesota (US)
  • From Massachusetts General Hospital and Harvard Medical School (F.E., P.L.M.) and Dana–Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School (C.N.D., D.A.W.), Boston, Bluebird Bio, Somerville (G.F.D., L.D., A.C.D., H.L.T.), and McNeil Pediatrics Consultancy, Sudbury (E.M.) — all in Massachusetts; the Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota (T.C.L., A.O.G., P.J.O.), and Midwest Radiology (D.J.L.) — both in Minneapolis; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (S.D.O., R.S., S.A.H.); University College London Great Ormond Street Hospital Institute of Child Health and Great Ormond Street Hospital NHS Trust, London (A.J.T., P.G.); INSERM, Université Paris–Saclay, Hôpital Kremlin-Bicêtre (P.A.), the Reference Center for Leukodystrophies, Hôpital Kremlin-Bicêtre, Assistance Publique–Hôpitaux de Paris, Université Paris–Saclay (C.S.), and Robert-Debre Hospital, GHU Nord-Université de Pari...
Venue
New England Journal of Medicine
Published
2024-10-10
Volume
391
Issue
14
Pages
1302-1312
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W4403262143
Cited by
107
References
24
Citations by year
2026: 50 · 2025: 50 · 2024: 7
FWCI
20.72
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Bluebird Bio
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
  • Health Sciences › Medicine › Genetics (clinical) › Lysosomal Storage Disorders Research
  • Health Sciences › Medicine › Oncology › CAR-T cell therapy research
Keywords
cerebral adrenoleukodystrophy, lentiviral gene therapy, insertional oncogenesis, myelodysplastic syndrome, neurological function, functional disability, long-term safety
MeSH terms
ATP Binding Cassette Transporter, Subfamily D, Member 1, Adolescent, Adrenoleukodystrophy, Brain, Child, Child, Preschool, Follow-Up Studies, Genetic Vectors, Humans, Magnetic Resonance Imaging, Male, Myelodysplastic Syndromes, Genetic Therapy, Lentivirus, Treatment Outcome, Hematopoietic Stem Cell Transplantation

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CoChat. (2026). Citation check: Lentiviral Gene Therapy for Cerebral Adrenoleukodystrophy. https://app.cochat.ai/papers/10.1056/nejmoa2400442
The paper
Eichler, F., Duncan, C. N., Musolino, P. L., Lund, T. C., Gupta, A. O., De Oliveira, S., Thrasher, A. J., Aubourg, P., Kühl, J.-S., Loes, D. J., Amartino, H., Smith, N., Folloni Fernandes, J., Sevin, C., Sankar, R., Hussain, S. A., Gissen, P., Dalle, J.-H., Platzbecker, U., . . . Williams, D. A. (2024). Lentiviral Gene Therapy for Cerebral Adrenoleukodystrophy. New England Journal of Medicine. https://doi.org/10.1056/nejmoa2400442