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This is an early-stage, open-label clinical study of CD19-BCMA dual nanobody based CAR-T Cell desensitization therapy for patients positive for Donor-Specific Antibodies. Enrolled subjects will participate in an early clinical study using the traditional "3+3" dose escalation design to determine the Maximum Tolerated Dose (MTD) of CAR-T cell infusion (i.e., three escalating dose levels: 0.5x10^6 CAR+ T cells/kg, 1x10^6 CAR+ T cells/kg, 2x10^6 CAR+ T cells/kg). The investigators and the sponsor will jointly form a Safety Review Committee (SRC). The final decision on whether to continue increasing the dose levels or to conduct an expansion study at a specific dose level will be based on the safety and efficacy data obtained from the three dose groups. Assessments will be performed every 4 weeks after cell infusion, with a total planned enrollment of 9-18 subjects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with DSA | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CD19-BCMA dual nanobody based CAR-T Cells | Biological | Desensitization |
|
| Measure | Description | Time Frame |
|---|---|---|
| • Incidence and severity of AEs and SAEs within 1 month after cell infusion | The primary safety endpoint is the incidence and severity of adverse events (AEs) and serious adverse events (SAEs) occurring within 30 days post-cell infusion. All events will be graded for severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. The analysis will summarize the frequency, severity (maximum grade), duration, and causality (as assessed by the investigator) of all reported AEs and SAEs. Special emphasis will be placed on the incidence of Grade ≥3 AEs, treatment-related SAEs, and AEs leading to discontinuation or death, providing a comprehensive assessment of the acute safety profile of the investigational cell product. | From enrollment to the end of treatment at 4-5 weeks |
| • Incidence and severity of ICANS | The primary safety endpoint is the incidence and severity of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), will be graded using the standardized American Society for Transplantation and Cellular Therapy (ASTCT) consensus criteria. | From enrollment to the end of treatment at 4-5 weeks |
| Incidence and severity of ICAHT | The primary safety endpoint is the incidence and severity of immune effector cell-associated hematotoxicity (ICAHT), will be graded using European Hematology Association/European Society for Blood and Marrow Transplantation (EHA/EBMT) guidelines. | From enrollment to the end of treatment at 4-5 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| DSA seroconversion rate (≤ 2000 MFI) at 3 months post-infusion | DSA seroconversion rate (≤ 2000 MFI) at 3 months post-infusion | From enrollment to the end of treatment at 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Day 30 neutrophil engraftment rate | Neutrophil engraftment was defined as the first of three consecutive days with an absolute neutrophil count (ANC) of ≥0.5×109/L. | From Day 0 to Day 30 after transplantation |
| Day 100 platelet engraftment rate |
Inclusion Criteria:
The subject or their legal guardian understands and voluntarily signs the Informed Consent Form (ICF).
Male or female, aged 3 years or older (inclusive) at the time of signing the ICF.
Expected survival period is not less than 12 weeks.
Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2 at the time of signing the ICF.
At the time of signing the ICF, the following must be satisfied:
Major organ function must meet the following requirements:
Oxygen saturation > 92%.
Men and women of childbearing potential must agree to use effective contraception from the time of signing the ICF until 2 years after administration of the study drug. Women of childbearing potential include premenopausal women and women within 2 years of menopause. A negative blood pregnancy test is required for women of childbearing potential at screening.
Exclusion Criteria:
History of central nervous system (CNS) diseases, including but not limited to epilepsy, paralysis, aphasia, stroke, severe brain injury, dementia, Parkinson's disease, neuropathy. Subjects with a history of conditions like lacunar infarction without related neurological symptoms before screening may be considered for exclusion based on the investigator's judgment.
Other severe, progressive, or uncontrolled gastrointestinal, urinary, endocrine, or respiratory diseases, deemed by the investigator as unsuitable for enrollment.
Participation in another clinical trial within 2 weeks prior to screening.
Other factors that may influence DSA levels: Received proteasome inhibitors or BTK inhibitors, rituximab, or other monoclonal antibodies targeting B cells or plasma cells (e.g., belimumab, telitacicept, daratumumab) within 2 weeks prior to signing the ICF.
Presence of any uncontrolled active infection at the time of signing the ICF or within 4 weeks prior to leukapheresis.
Positive HBsAg or positive HBcAb with detectable HBV DNA at screening; Positive HCV antibody with detectable HCV RNA at screening; Positive HIV antibody; Positive CMV DNA; Positive EBV DNA; Positive for both treponemal and non-treponemal syphilis antibodies.
Clinically significant cardiovascular diseases, including any of the following:
Allergy to any component of the drugs used in this study.
Received large-field radiotherapy within 4 weeks prior to signing the ICF, except for palliative radiotherapy for non-target lesions during the study period.
Requirement for systemic corticosteroids (at a dose equivalent to or higher than prednisone 10 mg/day) or other immunosuppressive drugs within 3 days prior to leukapheresis or anticipated during the study period, except for the following:
Major surgical procedure within 4 weeks prior to signing the ICF (excluding routine biopsy surgery), or anticipated major surgery during the study period.
History of active tuberculosis infection within 1 year prior to signing the ICF (subjects with a history of active tuberculosis more than 1 year ago may be included if the investigator judges there is no current evidence of active tuberculosis).
Administration of live/attenuated or inactivated vaccines within 4 weeks prior to signing the ICF, or planned administration during the screening period.
Pregnant or lactating women.
Men or women who refuse to use contraception from the time of signing the ICF until 12 months after study completion.
History of alcohol abuse, drug abuse, or psychiatric history.
Any comorbidities or other conditions that, in the investigator's opinion, may affect protocol compliance or make the subject unsuitable for participation.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ying-Jun Chang | Contact | 86-13520536738 | rmcyj@bjmu.edu.cn |
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Platelet recovery was defined as the first of three consecutive days with a platelet count of ≥20×109/L in the absence of platelet transfusion support for the preceding seven consecutive days.
| From Day 0 to Day 100 after transplantation |
| Incidence of PGF | Poor graft function (PGF) was defined as the presence of at least two cytopenias (ANC ≤0.5×109/L, platelet count ≤20×109/L and/or Hb ≤80 g/L) beyond day +28 with a transfusion requirement associated with hypoplastic-aplastic bone marrow in the presence of complete donor chimerism. | From Day 0 to Day 365 after transplantation |
| Incidence of GR | Graft rejection (GR) was defined as a failure to achieve neutrophil engraftment (ANC ≤0.5×109/L) by day +28 for three consecutive days, along with an absence of donor hematopoiesis. | From Day 0 to Day 365 after transplantation |
| 1-year Overall Survival | Defined as the time from cell infusion (or randomization) to death from any cause. | From Day 0 to Day 365 after transplantation |
| 1-year Disease-Free Survival | Defined as the time from cell infusion to the first occurrence of either disease relapse (or progression) or death from any cause, whichever occurs first. Patients alive without evidence of disease are censored at the last assessment. | From Day 0 to Day 365 after transplantation |
| 1-year Graft-versus-Host Disease | The cumulative incidence of acute GVHD (occurring within the first 100 days, graded I-IV by standard criteria) or chronic GVHD (occurring later, graded as mild, moderate, or severe per NIH consensus criteria). | From day 0 to day 365 after transplantation |
| 1-year GVHD-Free, Relapse-Free Survival | It is defined as the time from infusion to the first occurrence of any of the following events: Grade III-IV acute GVHD, chronic GVHD requiring systemic immunosuppression, disease relapse, or death from any cause. Patients who survive without experiencing any of these events are considered event-free. | From day 0 to day 365 after transplantation |