EX-99.2 3 d808697dex992.htm EX-99.2 EX-99.2

Exhibit 99.2 CTX001 Clinical Data Update November 19, 2019 1Exhibit 99.2 CTX001 Clinical Data Update November 19, 2019 1


Hemoglobinopathies – sickle cell disease (SCD) and β-thalassemia (β-thal) Blood disorders caused by Significant worldwide burden mutations in the β-globin gene Annual births in 300,000 SCD and β-thal, respectively 60,000 Sickle Cell Normal β-thalassemia Cell High morbidity and mortality Heavy burden of patient care Frequent transfusions & hospitalizations Anemia Pain Early death 2Hemoglobinopathies – sickle cell disease (SCD) and β-thalassemia (β-thal) Blood disorders caused by Significant worldwide burden mutations in the β-globin gene Annual births in 300,000 SCD and β-thal, respectively 60,000 Sickle Cell Normal β-thalassemia Cell High morbidity and mortality Heavy burden of patient care Frequent transfusions & hospitalizations Anemia Pain Early death 2


Persistence of fetal hemoglobin alleviates symptoms REDUCED RISK OF EVENTS REDUCED SYMPTOMS 2 1 SYMPTOMS ARISE SHORTLY AFTER BIRTH WHEN HEMOGLOBIN IN β-THALASSEMIA IN SICKLE CELL DISEASE SWITCHES FROM FETAL TO ADULT 8 Aseptic necrosis 8 Stroke 7 2 R = 0.933 Hospitalization 6 Chest syndrome 6 Crisis 5 Meningitis 4 4 3 2 2 1 0 0 3 30 1 10 100 5 10 15 20 25 FETAL HEMOGLOBIN LEVEL (%) FETAL HEMOGLOBIN LEVEL (%) › Rare patients continue to express HbF into adulthood, a condition known as hereditary persistence of fetal hemoglobin (HPFH), and these patients experience reduced or no symptoms 1. Powars, et al. Blood 1984; 2. Musallam, et al. Blood 2012 3 CUMULATIVE RISK MORBIDITY SCOREPersistence of fetal hemoglobin alleviates symptoms REDUCED RISK OF EVENTS REDUCED SYMPTOMS 2 1 SYMPTOMS ARISE SHORTLY AFTER BIRTH WHEN HEMOGLOBIN IN β-THALASSEMIA IN SICKLE CELL DISEASE SWITCHES FROM FETAL TO ADULT 8 Aseptic necrosis 8 Stroke 7 2 R = 0.933 Hospitalization 6 Chest syndrome 6 Crisis 5 Meningitis 4 4 3 2 2 1 0 0 3 30 1 10 100 5 10 15 20 25 FETAL HEMOGLOBIN LEVEL (%) FETAL HEMOGLOBIN LEVEL (%) › Rare patients continue to express HbF into adulthood, a condition known as hereditary persistence of fetal hemoglobin (HPFH), and these patients experience reduced or no symptoms 1. Powars, et al. Blood 1984; 2. Musallam, et al. Blood 2012 3 CUMULATIVE RISK MORBIDITY SCORE


CTX001 edits the BCL11A erythroid enhancer region Cas9 DNA Guide RNA BCL11A gene (Chromosome 2) Erythroid enhancer Reduced BCL11A expression in erythroid lineage β-globin locus G A d ggb (Chromosome 11) Editing of the erythroid enhancer region of BCL11A causes induction of γ-globin, a subunit of fetal hemoglobin (HbF) 4CTX001 edits the BCL11A erythroid enhancer region Cas9 DNA Guide RNA BCL11A gene (Chromosome 2) Erythroid enhancer Reduced BCL11A expression in erythroid lineage β-globin locus G A d ggb (Chromosome 11) Editing of the erythroid enhancer region of BCL11A causes induction of γ-globin, a subunit of fetal hemoglobin (HbF) 4


CLIMB 111 and CLIMB 121: Phase 1/2 studies in patients with β-thal and SCD, respectively Phase 1 / 2, international, multi-center, Phase 1 / 2, international, multi-center, open-label, single arm study open-label, single arm study Design 45 patients between 18 – 35 years of age 45 patients between 18 – 35 years of age with Target with transfusion dependent thalassemia severe SCD and a history of ≥2 vaso-occlusive enrollment (TDT), including β0/β0 genotypes crises/yr over the previous two years Proportion of patients achieving sustained Proportion of patients with HbF ≥ 20%, Primary transfusion reduction for at least 6 months sustained for at least 3 months starting 6 endpoint starting 3 months after CTX001 infusion months after CTX001 infusion 5CLIMB 111 and CLIMB 121: Phase 1/2 studies in patients with β-thal and SCD, respectively Phase 1 / 2, international, multi-center, Phase 1 / 2, international, multi-center, open-label, single arm study open-label, single arm study Design 45 patients between 18 – 35 years of age 45 patients between 18 – 35 years of age with Target with transfusion dependent thalassemia severe SCD and a history of ≥2 vaso-occlusive enrollment (TDT), including β0/β0 genotypes crises/yr over the previous two years Proportion of patients achieving sustained Proportion of patients with HbF ≥ 20%, Primary transfusion reduction for at least 6 months sustained for at least 3 months starting 6 endpoint starting 3 months after CTX001 infusion months after CTX001 infusion 5


Trials involve a stem cell transplant using CTX001 – an investigational treatment Stage 1 Stage 2 Stage 3 Stage 4 STUDY SITE Myeloablative conditioning Screening (busulfan) Follow-up CD34+ HSPC CTX001 mobilized and collected infusion Engraftment and discharge CRISPR-Cas9 editing CENTRAL MANUFACTURING Processing of CTX001 FACILITY Shipment to study site 6Trials involve a stem cell transplant using CTX001 – an investigational treatment Stage 1 Stage 2 Stage 3 Stage 4 STUDY SITE Myeloablative conditioning Screening (busulfan) Follow-up CD34+ HSPC CTX001 mobilized and collected infusion Engraftment and discharge CRISPR-Cas9 editing CENTRAL MANUFACTURING Processing of CTX001 FACILITY Shipment to study site 6


CLIMB THAL-111: Patient baseline and treatment characteristics Patient baseline Treatment characteristics 1 0 ▪ Successful engraftment β /IVS-I- Genotype 110 – Neutrophil engraftment at study day 33 – Platelet engraftment at study day 37 Gender F ▪ Initial safety profile consistent with myeloablative busulfan conditioning and autologous HSCT ▪ 2 SAEs occurred, neither considered related to Age at consent, 19 CTX001 by study investigator, both resolved: years – Veno-occlusive liver disease attributed to busulfan conditioning Pre-study pRBC transfusions 16.5 2 Episodes/year – Pneumonia in the presence of neutropenia 1 Neutrophil engraftment defined as absolute neutrophil count ≥500 cells/µL for three consecutive days, and platelet engraftment defined as unsupported platelet count ≥ 20,000/µL 2 Annualized rate during the two years prior to consenting for the study 7CLIMB THAL-111: Patient baseline and treatment characteristics Patient baseline Treatment characteristics 1 0 ▪ Successful engraftment β /IVS-I- Genotype 110 – Neutrophil engraftment at study day 33 – Platelet engraftment at study day 37 Gender F ▪ Initial safety profile consistent with myeloablative busulfan conditioning and autologous HSCT ▪ 2 SAEs occurred, neither considered related to Age at consent, 19 CTX001 by study investigator, both resolved: years – Veno-occlusive liver disease attributed to busulfan conditioning Pre-study pRBC transfusions 16.5 2 Episodes/year – Pneumonia in the presence of neutropenia 1 Neutrophil engraftment defined as absolute neutrophil count ≥500 cells/µL for three consecutive days, and platelet engraftment defined as unsupported platelet count ≥ 20,000/µL 2 Annualized rate during the two years prior to consenting for the study 7


First TDT patient treated is transfusion free with sustained HbF > 10 g/dL Hemoglobin fractionation over time pre and post CTX001 infusion, Hemoglobin (g/dL) 1 HbF HbA HbA2 Hb Undefined CTX001 infusion 12.3 12.1 12.0 12.0 11.9 11.6 9.0 0.3 6.5 6.6 8.4 10.1 10.4 10.2 10.1 0.1 Baseline 1 2 3 4 5 6 9 Months post CTX001 infusion Patient receiving pRBC transfusions Patient not receiving pRBC transfusions Phlebotomy started Iron chelation restarted 1 Hb Undefined: Hb adducts and other variants. 8First TDT patient treated is transfusion free with sustained HbF > 10 g/dL Hemoglobin fractionation over time pre and post CTX001 infusion, Hemoglobin (g/dL) 1 HbF HbA HbA2 Hb Undefined CTX001 infusion 12.3 12.1 12.0 12.0 11.9 11.6 9.0 0.3 6.5 6.6 8.4 10.1 10.4 10.2 10.1 0.1 Baseline 1 2 3 4 5 6 9 Months post CTX001 infusion Patient receiving pRBC transfusions Patient not receiving pRBC transfusions Phlebotomy started Iron chelation restarted 1 Hb Undefined: Hb adducts and other variants. 8


HbF is highly pancellular in peripheral RBCs Peripheral RBC F-cells % F-cells (circulating RBCs expressing fetal hemoglobin) 99.7 99.8 CTX001 infusion 97.4 95.4 83.4 59.4 10.1 3.9 Baseline 1 2 3 4 5 6 9 Months post CTX001 infusion 9HbF is highly pancellular in peripheral RBCs Peripheral RBC F-cells % F-cells (circulating RBCs expressing fetal hemoglobin) 99.7 99.8 CTX001 infusion 97.4 95.4 83.4 59.4 10.1 3.9 Baseline 1 2 3 4 5 6 9 Months post CTX001 infusion 9


CLIMB SCD-121: Patient baseline and treatment characteristics Patient baseline Treatment characteristics 1 ▪ Successful engraftment S S Genotypeβ /β – Neutrophil engraftment at study day 30 – Platelet engraftment at study day 30 Gender F ▪ Initial safety profile consistent with myeloablative busulfan conditioning and autologous HSCT ▪ 3 SAEs occurred, none considered related to CTX001 Age at consent, 33 by study investigator, all resolved: years – Sepsis in the presence of neutropenia – Cholelithiasis Pre-study VOCs, 7 – Abdominal pain 2 VOCs / year 1 Neutrophil engraftment defined as absolute neutrophil count ≥500 cells/µL for three consecutive days, and platelet engraftment defined as unsupported platelet count ≥ 50,000/µL 2 Annualized rate during the two years prior to consenting for the study 10CLIMB SCD-121: Patient baseline and treatment characteristics Patient baseline Treatment characteristics 1 ▪ Successful engraftment S S Genotypeβ /β – Neutrophil engraftment at study day 30 – Platelet engraftment at study day 30 Gender F ▪ Initial safety profile consistent with myeloablative busulfan conditioning and autologous HSCT ▪ 3 SAEs occurred, none considered related to CTX001 Age at consent, 33 by study investigator, all resolved: years – Sepsis in the presence of neutropenia – Cholelithiasis Pre-study VOCs, 7 – Abdominal pain 2 VOCs / year 1 Neutrophil engraftment defined as absolute neutrophil count ≥500 cells/µL for three consecutive days, and platelet engraftment defined as unsupported platelet count ≥ 50,000/µL 2 Annualized rate during the two years prior to consenting for the study 10


First patient treated in CLIMB SCD-121 had 46.6% HbF at 4 months after CTX001 infusion Hemoglobin fractionation over time pre and post CTX001 infusion, % of total g/dL hemoglobin 1 HbF HbS HbA HbA2 Hb Undefined 11.3 10.1 CTX001 infusion 8.9 8.3 46.6% 0.8% 37.2% 7.2 Patient has had 25.9% 9.1% no reported 21.3% VOCs since 32.6% CTX001 infusion 74.1% 41.2% Baseline 1 2 3 4 Months post CTX001 infusion Patient receiving pRBC transfusions Patient not receiving pRBC transfusions 1 Hb Undefined: Hb adducts and other variants. 11First patient treated in CLIMB SCD-121 had 46.6% HbF at 4 months after CTX001 infusion Hemoglobin fractionation over time pre and post CTX001 infusion, % of total g/dL hemoglobin 1 HbF HbS HbA HbA2 Hb Undefined 11.3 10.1 CTX001 infusion 8.9 8.3 46.6% 0.8% 37.2% 7.2 Patient has had 25.9% 9.1% no reported 21.3% VOCs since 32.6% CTX001 infusion 74.1% 41.2% Baseline 1 2 3 4 Months post CTX001 infusion Patient receiving pRBC transfusions Patient not receiving pRBC transfusions 1 Hb Undefined: Hb adducts and other variants. 11


HbF is highly pancellular in peripheral RBCs Peripheral RBC F-cells % F-cells (circulating RBCs expressing fetal hemoglobin) 94.7 CTX001 infusion 70.2 43.8 33.9 4.3 Baseline 1 2 3 4 Months post CTX001 infusion 12HbF is highly pancellular in peripheral RBCs Peripheral RBC F-cells % F-cells (circulating RBCs expressing fetal hemoglobin) 94.7 CTX001 infusion 70.2 43.8 33.9 4.3 Baseline 1 2 3 4 Months post CTX001 infusion 12


Conclusions ▪ Initial safety profile of CTX001 is consistent with myeloablative busulfan conditioning and autologous hematopoietic stem cell transplant 0 ▪ First patient with transfusion dependent β-thalassemia and β /IVS-I-110 genotype in CLIMB THAL-111 has stopped pRBC transfusions - HbF sustained >10 g/dL at 9 months post infusion ▪ First patient with severe sickle cell disease in CLIMB SCD-121 has had no vaso- occlusive crises (VOC) since CTX001 treatment and has stopped pRBC transfusions - HbF of 46.6% at 4 months post infusion 13Conclusions ▪ Initial safety profile of CTX001 is consistent with myeloablative busulfan conditioning and autologous hematopoietic stem cell transplant 0 ▪ First patient with transfusion dependent β-thalassemia and β /IVS-I-110 genotype in CLIMB THAL-111 has stopped pRBC transfusions - HbF sustained >10 g/dL at 9 months post infusion ▪ First patient with severe sickle cell disease in CLIMB SCD-121 has had no vaso- occlusive crises (VOC) since CTX001 treatment and has stopped pRBC transfusions - HbF of 46.6% at 4 months post infusion 13