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Clinical Study of CAR-BCMA T in Patients With Refractory or Relapsed Multiple Myeloma

Primary Purpose

Refractory or Relapsed Multiple Myeloma

Status
Unknown status
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
CAR-BCMA T cells
Fludarabine
Cyclophosphamide
Sponsored by
First Affiliated Hospital of Zhejiang University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Refractory or Relapsed Multiple Myeloma

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients aged between 18 ~ 70 with relapsed or refractory multiple myeloma.
  • Bone marrow sample is confirmed as BCMA-positive by flow cytometry or pathological examination.
  • Patients with relapsed or refractory multiple myeloma who meet the following conditions:

    1. Curative efficacy is little or disease progressed after 2 courses of standard treatment regimen;
    2. Disease relapsed after chemotherapy or HSCT. Curative efficacy is little or disease progressed after 2 courses of original treatment regimen;
    3. More than 60 days between last treatment and disease progression;
    4. Autologous or allogeneic SCT is not available at present, or patient refuses to receive SCT;
    5. No response to treatment is defined according to International Myeloma Working Group 2014 version as not achieving CR (including CR, sCR, ICR, MCR) or PR (including VGPR, PR, MR) after 2 consecutive cycles of treatment with current therapy, and the interval between the 2 cycles is no more than 60 days. Disease progression is defined as per 《Chinese Guidelines for Diagnosis and Treatment of Multiple Myeloma》 (Revision in 2015). At least one of the following conditions should be met:Serum M-protein increases ≥ 25% (absolute increase should be ≥ 5 g/L); If serum M protein is ≥ 50 g/L at baseline, increase of serum M protein can be ≥ 10 g/L; Urine M-protein increases ≥ 25% (absolute increase should be ≥ 200 mg/24 h); If the serum and urine M-protein are not detectable, a ≥ 25% increase in the difference between involved and uninvolved FLC levels is required (absolute increase should be ≥ 100 mg/L); Bone marrow plasma cell percentage increases ≥ 25% (absolute increase should be ≥ 10%); Size of existing bone lesions or soft tissue plasmacytomas increases by ≥ 25%, or development of new lytic bone lesions or soft tissue plasmacytomas; Development of hypercalcemia that can be attributed to plasma cell proliferative disorder (corrected calcium is > 2.8 mmol/L or 11.5 mg/dL); Disease progression must be confirmed by 2 sequential assessments.
  • Expected survival > 12 weeks.
  • Disease is measurable, and at least one of the following conditions should be satisfied:
  • Serum M-protein is ≥ 10 g/L;
  • 24-hour urine M-protein is ≥ 200 mg;
  • Serum FLC is ≥ 5 mg/dL;
  • Plasmacytomas that can be evaluated by tests or imaging;
  • Bone marrow plasma cell percentage is ≥ 20%.
  • ECOG scores 0 - 1.
  • Adequate venous access for apheresis and venous blood sampling, and no other contraindications for leukapheresis.
  • WBC ≥ 1.5×10^9/L;PLT ≥ 45×10^9/L; Hb≥9.0g/dL
  • Serum creatinine ≤ 1.5 ULN.
  • ALT ≤ 2.5 ULN;AST ≤ 2.5 ULN. The above lab results should not include those obtained from continuous supportive treatment that is ongoing.

Exclusion Criteria:

Patients with any of the following conditions are not eligible for this study.

  • Pregnant or lactating women.
  • HIV positive, or HCV positive
  • Uncontrolled active infection, including active tuberculosis and HBV DNA copies ≥ 1×10^3 copies/mL.
  • Concurrent use of systemic steroids. Recent or current use of inhaled steroids is not exclusionary.
  • Allergic to immunotherapies and related drugs.
  • Patients with heart disease for which treatment is needed or with poorly controlled hypertension.
  • Hyponatremia: serum sodium level < 125 mmol/L.
  • Baseline serum potassium < 3.5 mmol/L (taking potassium supplements before participating in the study to raise potassium level is acceptable).
  • Previous treatment with chemoradiotherapy, local treatment ,immunotherapy and tumor-targeting drug conducted 2 weeks prior to participation in this study or blood collection.
  • Patients have undertaken immunosuppressor for graft-versus-host disease (GVHD) within 4 weeks before participation in this study or blood collection, or the patient is diagnosed with acute or chronic GVHD.
  • Other severe disease that may restrain patients from participating in this study (e.g. diabetes, severe cardiac dysfunction, myocardial infarction or unstable arrhythmias or unstable angina in recent 6 months, gastric ulcer, active autoimmune disease, etc.).

Sites / Locations

  • First Affiliated Hospital of Zhejiang University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CAR-BCMA T cells

Arm Description

In this study, autologous T cells transduced with a BCMA-targeted chimeric antigen receptor (CAR-BCMA T cells) are used to treat patients with refractory or relapsed multiple myeloma. Route of administration: Intravenous injection. Lymphodepletion conditioning: Lymphodepletion will be conducted several days prior to CAR-BCMA T cells infusion. A combination of fludarabine and cyclophosphamide will be used for lymphodepletion.

Outcomes

Primary Outcome Measures

Safety and effectivity - Incidence of study related adverse events
Incidence of study related adverse events which are defined as laboratory toxicities and clinical events that are possible, likely or definitely related to study treatment at any time from the infusion until week 24, including infusion related toxicity and any toxicity possibly related to CAR-BCMA T cells.
Engraftment
Duration of in vivo survival of CAR-BCMA T cells is defined as "engraftment". After 24 hours of infusion, the CAR-BCMA DNA sequence was detected by PCR according to the follow-up time point, until the result of any two consecutive tests was negative and recorded as the "engraftment endpoint" of CAR-BCMA T cells.

Secondary Outcome Measures

Statistical parameter of efficacy assessment:PFS
Statistical parameter:Progression-free Survival (PFS)
Statistical parameter of efficacy assessment:DCR
Statistical parameter:Disease Control Rate (DCR)
Statistical parameter of efficacy assessment:ORR
Statistical parameter:Objective Remission Rate (ORR)
Statistical parameter of efficacy assessment:OS
Statistical parameter:Overall survival (OS)

Full Information

First Posted
September 27, 2018
Last Updated
October 6, 2020
Sponsor
First Affiliated Hospital of Zhejiang University
Collaborators
CARsgen Therapeutics Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03716856
Brief Title
Clinical Study of CAR-BCMA T in Patients With Refractory or Relapsed Multiple Myeloma
Official Title
Clinical Study of Redirected Autologous T Cells With a BCMA-targeted Chimeric Antigen Receptor in Patients With Refractory or Relapsed Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Unknown status
Study Start Date
March 23, 2018 (Actual)
Primary Completion Date
June 23, 2020 (Actual)
Study Completion Date
June 23, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
First Affiliated Hospital of Zhejiang University
Collaborators
CARsgen Therapeutics Co., Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
A single arm, open-label pilot study is designed to determine the safety, efficacy and cytokinetics of CAR-BCMA T cells in patients with BCMA-positive refractory or relapsed multiple myeloma.
Detailed Description
This study is designed to determine the safety, tolerability and engraftment potential of anti-BCMA lentivirus-transduced autologous T cells in patients with refractory or relapsed multiple myeloma. Primary objectives: Determine the safety and tolerability of CAR-BCMA T cells (autologous T cells transduced with chimeric antigen receptors recognizing BCMA) in patients with refractory or relapsed multiple myeloma. Observe the cytokinetics of CAR-BCMA T cells. Secondary objectives: Observe the anti-tumor response of CAR-BCMA T cells to refractory or relapsed multiple myeloma (evaluated by diagnostic criteria International Myeloma Working Group (IMWG2014 version) as CR, sCR, ICR, MCR or VGPR). Make an evaluation on the distribution and in vivo survival of CAR-BCMA T cells in peripheral blood, lymph node, and bone marrow. Observe the immunogenicity of CAR-BCMA T cells, and determine if there is anti-BCMA scFv cellular immune response and anti-BCMA scFv humoral immune response. Observe the change of T cell subsets relative to CAR-BCMA T。 (Tcm, central memory T lymphocytes; Tem, effector memory T lymphocytes; Treg, regulatory T lymphocytes).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Refractory or Relapsed Multiple Myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CAR-BCMA T cells
Arm Type
Experimental
Arm Description
In this study, autologous T cells transduced with a BCMA-targeted chimeric antigen receptor (CAR-BCMA T cells) are used to treat patients with refractory or relapsed multiple myeloma. Route of administration: Intravenous injection. Lymphodepletion conditioning: Lymphodepletion will be conducted several days prior to CAR-BCMA T cells infusion. A combination of fludarabine and cyclophosphamide will be used for lymphodepletion.
Intervention Type
Genetic
Intervention Name(s)
CAR-BCMA T cells
Other Intervention Name(s)
BCMA-redirected autologous T cells
Intervention Description
Single dose of CAR-BCMA T cells will be infused, and classic "3+3" dose escalation will be applied.
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Intervention Description
Fludarabine is used for lymphodepletion.
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
Cyclophosphamide is used for lymphodepletion
Primary Outcome Measure Information:
Title
Safety and effectivity - Incidence of study related adverse events
Description
Incidence of study related adverse events which are defined as laboratory toxicities and clinical events that are possible, likely or definitely related to study treatment at any time from the infusion until week 24, including infusion related toxicity and any toxicity possibly related to CAR-BCMA T cells.
Time Frame
24 weeks
Title
Engraftment
Description
Duration of in vivo survival of CAR-BCMA T cells is defined as "engraftment". After 24 hours of infusion, the CAR-BCMA DNA sequence was detected by PCR according to the follow-up time point, until the result of any two consecutive tests was negative and recorded as the "engraftment endpoint" of CAR-BCMA T cells.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Statistical parameter of efficacy assessment:PFS
Description
Statistical parameter:Progression-free Survival (PFS)
Time Frame
5 years
Title
Statistical parameter of efficacy assessment:DCR
Description
Statistical parameter:Disease Control Rate (DCR)
Time Frame
2 years
Title
Statistical parameter of efficacy assessment:ORR
Description
Statistical parameter:Objective Remission Rate (ORR)
Time Frame
2 years
Title
Statistical parameter of efficacy assessment:OS
Description
Statistical parameter:Overall survival (OS)
Time Frame
5 years
Other Pre-specified Outcome Measures:
Title
Number of DNA copies of CAR-BCMA T cells in tissue samples
Description
Number of DNA copies of CAR-BCMA T cells in lymph node samples or bone marrow samples at regular intervals from 24 hours after the initial infusion.
Time Frame
2 years
Title
Positive incidence of anti-drug antibody
Description
Positive incidence of anti-BCMA anti-drug antibody (ADA).
Time Frame
2 years
Title
Change of T cell subsets from baseline counts
Description
Change of T cell subsets from baseline counts after infusion(Tcm, central memory T lymphocytes; Tem, effector memory T lymphocytes; Treg, regulatory T lymphocytes).
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients aged between 18 ~ 70 with relapsed or refractory multiple myeloma. Bone marrow sample is confirmed as BCMA-positive by flow cytometry or pathological examination. Patients with relapsed or refractory multiple myeloma who meet the following conditions: Curative efficacy is little or disease progressed after 2 courses of standard treatment regimen; Disease relapsed after chemotherapy or HSCT. Curative efficacy is little or disease progressed after 2 courses of original treatment regimen; More than 60 days between last treatment and disease progression; Autologous or allogeneic SCT is not available at present, or patient refuses to receive SCT; No response to treatment is defined according to International Myeloma Working Group 2014 version as not achieving CR (including CR, sCR, ICR, MCR) or PR (including VGPR, PR, MR) after 2 consecutive cycles of treatment with current therapy, and the interval between the 2 cycles is no more than 60 days. Disease progression is defined as per 《Chinese Guidelines for Diagnosis and Treatment of Multiple Myeloma》 (Revision in 2015). At least one of the following conditions should be met:Serum M-protein increases ≥ 25% (absolute increase should be ≥ 5 g/L); If serum M protein is ≥ 50 g/L at baseline, increase of serum M protein can be ≥ 10 g/L; Urine M-protein increases ≥ 25% (absolute increase should be ≥ 200 mg/24 h); If the serum and urine M-protein are not detectable, a ≥ 25% increase in the difference between involved and uninvolved FLC levels is required (absolute increase should be ≥ 100 mg/L); Bone marrow plasma cell percentage increases ≥ 25% (absolute increase should be ≥ 10%); Size of existing bone lesions or soft tissue plasmacytomas increases by ≥ 25%, or development of new lytic bone lesions or soft tissue plasmacytomas; Development of hypercalcemia that can be attributed to plasma cell proliferative disorder (corrected calcium is > 2.8 mmol/L or 11.5 mg/dL); Disease progression must be confirmed by 2 sequential assessments. Expected survival > 12 weeks. Disease is measurable, and at least one of the following conditions should be satisfied: Serum M-protein is ≥ 10 g/L; 24-hour urine M-protein is ≥ 200 mg; Serum FLC is ≥ 5 mg/dL; Plasmacytomas that can be evaluated by tests or imaging; Bone marrow plasma cell percentage is ≥ 20%. ECOG scores 0 - 1. Adequate venous access for apheresis and venous blood sampling, and no other contraindications for leukapheresis. WBC ≥ 1.5×10^9/L;PLT ≥ 45×10^9/L; Hb≥9.0g/dL Serum creatinine ≤ 1.5 ULN. ALT ≤ 2.5 ULN;AST ≤ 2.5 ULN. The above lab results should not include those obtained from continuous supportive treatment that is ongoing. Exclusion Criteria: Patients with any of the following conditions are not eligible for this study. Pregnant or lactating women. HIV positive, or HCV positive Uncontrolled active infection, including active tuberculosis and HBV DNA copies ≥ 1×10^3 copies/mL. Concurrent use of systemic steroids. Recent or current use of inhaled steroids is not exclusionary. Allergic to immunotherapies and related drugs. Patients with heart disease for which treatment is needed or with poorly controlled hypertension. Hyponatremia: serum sodium level < 125 mmol/L. Baseline serum potassium < 3.5 mmol/L (taking potassium supplements before participating in the study to raise potassium level is acceptable). Previous treatment with chemoradiotherapy, local treatment ,immunotherapy and tumor-targeting drug conducted 2 weeks prior to participation in this study or blood collection. Patients have undertaken immunosuppressor for graft-versus-host disease (GVHD) within 4 weeks before participation in this study or blood collection, or the patient is diagnosed with acute or chronic GVHD. Other severe disease that may restrain patients from participating in this study (e.g. diabetes, severe cardiac dysfunction, myocardial infarction or unstable arrhythmias or unstable angina in recent 6 months, gastric ulcer, active autoimmune disease, etc.).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jie Jin, MD
Organizational Affiliation
First Affiliated Hospital of Zhejiang University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Haitao Meng, MD
Organizational Affiliation
First Affiliated Hospital of Zhejiang University
Official's Role
Principal Investigator
Facility Information:
Facility Name
First Affiliated Hospital of Zhejiang University
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310006,
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Clinical Study of CAR-BCMA T in Patients With Refractory or Relapsed Multiple Myeloma

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