A single-center, open-label, off-label use investigator-initiated clinical study with safety run-in to explore the clinical activity and safety of Anti-CD38 Antibody in adult ES patients who have not responded adequately or relapsed after first-line treatment and at least one second-line therapy including immunosuppressive agents, Anti-CD20 Antibody and/or TPO-RA, or those in whom no other second-line treatment options are suitable.
Evans' syndrome (ES) is defined as the concomitant or sequential association of warm auto-immune haemolytic anaemia (AIHA) with immune thrombocytopenia (ITP), and less frequently autoimmune neutropenia. ES is a rare situation that represents up to 7% of AIHA and around 2% of ITP. Due to the rarity of the disease, the treatment of ES is mostly extrapolated from what is recommended for isolated auto-immune cytopenia (AIC) and mostly relies on corticosteroids, rituximab, splenectomy, and supportive therapies.Despite continuous progress in the management of AIC and a gradual increase in ES survival, the mortality due to ES remains higher than the ones of isolated AIC, supporting the need for an improvement in ES management. A branch of pathogenesis for ES has been revealed that plasma cells secrete pathogenic antibodies directed against platelet and red blood cell antigens. Antiplatelet specific plasma cells have been detected in the spleen of patients with rituximab refractory ITP. In those refractory cases, persistent autoreactive long-lived plasma cells in the bone marrow could explain treatment failure. Anti-CD38 antibody, such as Daratumumab, has been developed to target tumoral plasma cells in multiple myeloma, was recently found to be effective in antibody-mediated diseases, such as autoimmune cytopenia following hematopoietic stem cell transplantation, systemic lupus and also ES. This study will evaluate the safety and biologic activity of Anti-CD38 antibody in r/r primary ES who fail to respond to at least one previous second-line therapy or those who cannot chose suitable second-line therapy. The study will enroll approximately 10 participants. This trial will be conducted in China. All participants will be followed for at least 16 weeks after the 8 weeks of treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
intravenous Anti-CD38 antibody administration This study adopts a prospective, single arm, open design method. Ten subjects were enrolled in the study and were treated with Anti-CD38 antibody (16mg/kg/w) for 8 weeks. The first stage is the main research stage (d1-w8), which is the core treatment period. The subjects will receive intravenous infusion of 16mg/kg Anti-CD38 antibody once a week for 8 weeks to observe the safety and efficacy during treatment. The second stage (w9-w24) is the stage of withdrawal from the visit, mainly to observe the safety and continuous efficacy of Anti-CD38 antibody after treatment.
Chinese Academy of Medical Science and Blood Disease Hospital
Tianjin, Tianjin Municipality, China
RECRUITINGEvaluation of overall efficacy response after Anti-CD38 antibody treatment within 8 weeks
Overall response rate defined as improvement in any cytopenias by at least one grade, without worsening any other cytopenias or stable disease at least once within 8 weeks after the first dose.
Time frame: 8 weeks
Safety of Anti-CD38 antibody treatment
Incidence, severity, and relationship of treatment emergent adverse events after Anti-CD38 antibody treatment
Time frame: 24 weeks
Evaluation of stable sustained response after Anti-CD38 antibody treatment at week 8
Stable sustained response rate defined as improvement in any cytopenias by at least one grade, without worsening any other cytopenias or stable disease in 3 consecutive accessible assessments at least 7 days apart 8 weeks after the first dose.
Time frame: 8 weeks
Number of Participants With ES Response to Anti-CD38 antibody treatment
Complete response (CR) is complete resolution in all autoimmune cytopenias (neutropenia, anemia thrombocytopenia) maintained for more than two months, combined with an ability to wean off corticosteroids and/or other immunosuppressive medication. Partial response (PR) is improvement in any cytopenias by at least one grade, lasting more than two months, without worsening any other cytopenias or stable disease with the ability to wean corticosteroids and/or immunosuppressive medications by at least 50%. No response (NR) is no change in cytopenias with treatment, and the inability to wean corticosteroids or other immunosuppressive medications. Progressive disease (PD) refers to obtaining a CR or PR by the 3 month observation and relapsing or progressing by the 6 month observation, leading to cessation of study drug.
Time frame: 24 weeks
Measurements of platelet count at each visit time point
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Masking
NONE
Enrollment
10
Platelet count at each visit time point
Time frame: 24 weeks
Measurements of Hb value at each visit time point
Hb value at each visit time point
Time frame: 24 weeks
Measurements of hemolytic marker reticulocyte count at each visit time point
hemolytic marker reticulocyte count at each visit time point
Time frame: 24 weeks
Measurements of hemolytic marker LDH at each visit time point
hemolytic marker LDH at each visit time point
Time frame: 24 weeks
Measurements of hemolytic marker haptoglobin at each visit time point
hemolytic marker haptoglobin at each visit time point
Time frame: 24 weeks
Measurements of hemolytic marker total bilirubin at each visit time point
hemolytic marker total bilirubin at each visit time point
Time frame: 24 weeks
Emergency treatment
Percentage of subjects who received emergency treatment
Time frame: 24 weeks
Duration of platelet response
The longest duration for which the subject sustained a platelet count ≥50×109/L and at least 2-fold from baseline at the meanwhile
Time frame: 24 weeks
Duration of Hb response
The longest duration for which the subject sustained a Hb level ≥100 g/L, or a Hb level increased more than 20g/L than baseline
Time frame: 24 weeks
Reduction of concomitant drug
Percentage of patients with reduced doses of corticosteroids and/or other concomitant immunosuppressive drugs at baseline by 8 weeks of treatment
Time frame: 8 weeks
Number of subjects with clinically significant bleeding as assessed using the world health organization (WHO) bleeding scale
Changes of the subjects' numbers in WHO bleeding score after Anti-CD38 antibody treatment according to the reported World Health Organization's Bleeding Scale. The WHO Bleeding Scale is a measure of bleeding severity with the following grades: grade 0 = no bleeding, grade 1= petechiae, grade 2= mild blood loss, grade 3 = gross blood loss, and grade 4 = debilitating blood loss.
Time frame: 24 weeks
Assessment of fatigue function in chronic disease treatment
The scores of Functional Assessment of Fatigue in Chronic Illness Therapy (FACIT-F) before and after Anti-CD38 antibody treatment
Time frame: 24 weeks
Health status survey
The change of Health status Questionnaire (SF-36) score before and after Anti-CD38 antibody treatment
Time frame: 24 weeks