FDA Expands Casgevy Approval to Children Ages 2+, Nashville Hospital Treats First Commercial Patient
Key Insights
The FDA has expanded approval of Casgevy gene therapy to children aged 2 and older with sickle cell disease (search) or transfusion-dependent β thalassemia (search).
A 13-year-old Nashville boy became TriStar Centennial Children's Hospital (search)'s first commercial patient to receive the gene-editing treatment outside clinical trials.
Dr. Haydar Frangoul called the therapy a "transformative game-changer," noting that 80% of sickle cell patients lack a matched family donor for transplant.
The Food and Drug Administration has expanded approval of Casgevy, a CRISPR-based gene-editing therapy, to include children as young as 2 years old with sickle cell disease (search) (SCD) and recurrent vaso-occlusive crises (VOCs) or transfusion-dependent β thalassemia (search) (TDT). The decision marks the first time a gene therapy has been approved for pediatric patients in this age group with these conditions, a milestone that one Nashville physician described as transformative.
The expanded approval builds on Casgevy's initial FDA authorization in 2023, which covered patients ages 12 and older. Now, the therapy is being delivered commercially at TriStar Centennial Children's Hospital (search) in Nashville, Tennessee, where a 13-year-old patient recently became the facility's first to receive the treatment outside of a clinical trial.
A Landmark Case in Nashville
Rickey "RJ" Buggs, who has lived with sickle cell disease (search) since infancy, spent 42 days hospitalized at TriStar Centennial Children's Hospital (search) undergoing the gene-editing procedure under the care of Dr. Haydar Frangoul, medical director of pediatric hematology/oncology for the Sarah Cannon Center for Blood Cancer (search) at The Children's Hospital at TriStar Centennial.
"This therapy can potentially change his life," Frangoul said. "This therapy was perfect for Rickey and his family because he doesn't have a match in the family."
Frangoul, who led the clinical trial for the therapy, emphasized the broader significance of the approach. "This is a transformative game-changer in my mind because it really offers this therapy to many people that have no other curative options for this really terrible chronic disorder," he said.
How the Gene-Editing Approach Works
Sickle cell disease (search) is characterized by misshapen red blood cells that can become trapped in blood vessels, cutting off oxygen from vital organs. This leads to severe pain episodes and can eventually cause lung, kidney, or bone damage. While bone marrow or stem cell transplantation can cure the disease, approximately 80% of patients lack a matched family donor.
The Casgevy approach circumvents this barrier. "Because we are using the patients' own stem cells that we collect, we gene edit, and we infuse, every person with sickle cell disease (search) now has a potential path to get the curative therapy for this devastating disease," Frangoul explained.
Disease Burden and Disparities
According to the Centers for Disease Control and Prevention, sickle cell disease (search) affects roughly 100,000 people across the United States. The disease occurs in approximately one out of every 365 Black or African American births, and about one in 13 Black or African American babies is born with the sickle cell trait.
Patient and Family Perspectives
RJ's mother, Lametra Scott, described the therapy as "a miracle" and "very life-changing." Both she and her husband are sickle cell trait carriers, and RJ was diagnosed with the disease at approximately six months of age.
"We don't have to worry about limitations of sickle cell disease (search) anymore, so now the sky is literally, it's wide open. I won't even say, 'The sky's the limit,' because there is no limit at this point. It's wide open to do and experience whatever it is that your heart desires," Scott said.
RJ himself described the decision to undergo treatment as "a leap of faith," adding, "If you're in pain every day like I was, then I would definitely take this chance."
Following his 42-day hospitalization, RJ was expected to be released and will continue his treatment on an outpatient basis. His mother noted that he has "gone through the fire" and expressed hope that he can serve as "a trailblazer in this space."