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Relapsed/refractory (R/R) light chain cardiac amyloidosis is associated with a poor prognosis, and cellular immunotherapy constitutes a crucial therapeutic modality for these patients. The efficacy and safety of CAR-T therapy have been reported in relevant studies; however, CAR-T manufacturing requires a lengthy timeline, and the leukapheresis procedure places an additional cardiac burden on patients. CAR-NK therapy boasts superior safety profiles compared with CAR-T therapy, and natural killer (NK) cells feature a wide range of sources. Investigators have accumulated prior experience in the clinical application of CAR-NK therapy, and has also achieved the successful development and preclinical application of CD19/BCMA dual-target CAR-T products. Furthermore, in the institution of the Investigator, there are dozens of newly diagnosed and more than 100 follow-up patients with AL cardiac amyloidosis each year. Investigators propose to initiate a phase I/II prospective clinical study to assess the safety and efficacy of umbilical cord blood-derived BCMA/CD19-targeted CAR-NK cell therapy for participants with relapsed/refractory light chain cardiac amyloidosis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental arm | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CAR-NK | Procedure | R/R AL cardiac amyloidosis patients in the CD19/BCMA dual-target CAR-NK therapy arm |
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| Measure | Description | Time Frame |
|---|---|---|
| safty and efficacy | The overall incidence and severity of all adverse events were calculated using CTCAE Version 5.0. The incidence of treatment-emergent adverse events (TEAEs) and abnormal laboratory findings possibly or definitely related to CB CAR-NK-BCMA/CD19, as well as dose-limiting toxicities (DLTs), were assessed for any occurrence from the initiation of study treatment up to Day 28. Definition of Dose-Limiting Toxicity (DLT):Toxic events related to CB CAR-NK-BCMA/CD19 treatment occurring within 28 days post-infusion include: Grade ≥4 cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS); Grade 3 CRS or ICANS with a duration of ≥7 days; Other Grade ≥3 hematological or non-hematological toxic reactions. The treatment efficacy in participants is evaluated in accordance with the LYRIC Efficacy Evaluation Criteria (2016). | Starting on Day 0 (CB CAR-NK-BCMA/CD19 infusion), participants will return to the outpatient clinic at the following intervals:• Days 1, 4, 7, 10, 14, 21, 28• Month 2 (±1 week)• Month 3 (±1 week) |
| the safety and efficacy of umbilical cord blood-derived CAR-NK cells targeting BCMA/CD19 (CB CAR-NK-BCMA/CD19) in the treatment of patients with light chain cardiac amyloidosis | General condition of participants, ECOG performance status, symptoms and physical signs, complete blood count (CBC), serum biochemistry, ferritin, coagulation function, immunofixation electrophoresis (IFE), free light chains (FLC), cardiac biomarker tests (high-sensitivity troponin, BNP or NT-proBNP), electrocardiogram (ECG), echocardiography, immune function tests, etc.; peripheral blood collection for detection of B-cell, cytokine and CAR expansion; efficacy assessments on Days 14 and 28 including IFE, κ/λ free light chains (κ/λ FLC), and cardiac biomarker tests (high-sensitivity troponin, BNP or NT-proBNP).peripheral blood collection for detection of T-cell, cytokine and CAR expansion; assessment of comorbidities. | 1.Follow-up visits will be conducted on Days 1, 4, 7, 10, 14, 21, and 28 post-infusion (treatment phase). 2. Within the first year: Assessments will be performed once monthly From Year 1 to Year 2: Assessments will be performed once every 3 months |
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Inclusion Criteria:
1)Serum M-protein ≥ 0.5 g/dL (detected by routine serum protein electrophoresis and immunofixation electrophoresis).
2)Abnormal κ/λ ratio, with the difference between involved and uninvolved free light chains (dFLC) ≥ 50 mg/L.
5. Confirmed cardiac involvement by amyloidosis, meeting at least one of the following criteria; extramyocardial organ involvement is permitted:
6. Having received at least one course of first-line therapy based on bortezomib or CD38 monoclonal antibody with suboptimal hematological response, meeting at least one of the following criteria:
9. Sufficient organ function reserve excluding the heart, meeting all the following criteria:
11. At least 3 weeks have elapsed since the completion of approved therapeutic interventions for AL cardiac amyloidosis (e.g., systemic chemotherapy, immunotherapy) prior to the administration of the study drug.
12. Female subjects of childbearing potential must have a negative pregnancy test and agree to adopt effective contraceptive measures during the trial period.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yang Xu | Contact | 0571-87783679 | yxu@zju.edu.cn |
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