The purpose of the study is to explore the safety and efficacy of cluster of differentiation 19 (CD19)/B cell maturation antigen (BCMA) CAR-T cell therapy in refractory/moderate-to-severe systemic lupus erythematosus(SLE).
The prognosis of patients with refractory/moderate-to-severe systemic lupus erythematosus (SLE) remains poor, due to two major therapeutic obstacles: (1) current treatment strategies including glucocorticoids, immunosuppressive agents, biological agents, are still difficult to achieve disease control, making the disease condition of some patients continue to be active or even worse; (2) some patients are unable to wean themselves off glucocorticoid and face the risk of numerous adverse effects caused by long-term glucocorticoid dependence, such as glucocorticoid-related diabetes, femoral head necrosis, hypertension, stress ulcers, and infection, etc. Therefore, there is a strong unmet clinical need for more effective treatment for patients suffering from refractory/moderate-to-severe SLE. Several preclinical and clinical studies have shown the efficacy of chimeric antigen receptor T (CAR-T) cell therapy in SLE. The aim of this study is to investigate the safety, tolerability, preliminary efficacy, pharmacokinetics (PK), and pharmacodynamics (PD) of cluster of differentiation 19 (CD19)/B cell maturation antigen (BCMA) CAR-T cell therapy in refractory/moderate-to-severe SLE. Patients with refractory/moderate-to-severe SLE will be invited to participate in the study, to receive CD19/BCMA CAR-T cell intravenous infusion and follow-up visits of up to 1 years after enrollment. Given that the pretreatment chemotherapy (fludarabine,cyclophosphamide) of CAR-T therapy in current SLE clinical studies is mostly based on experiences in hematologic malignancies, which may cause severe complications such as infection, there is a lack of evidence-based rationale for patients with SLE to receive pretreatment chemotherapy. This study will explore the feasibility of CAR-T cell therapy without pretreatment chemotherapy in the treatment of refractory/moderate-to-severe systemic lupus erythematosus.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
CD19/BCMA CAR-T cell will be infused intravenously at 3 doses: Dose A, Dose B, Dose C.
Union Hospital Tongji Medical College HUAZHONG University of Science and Technology
Wuhan, China
RECRUITINGSafety and tolerability
Safety and tolerability will be assessed by incidence and severity of adverse events (AEs) and serious AEs (SAEs). Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are graded by ASTCT criteria, other AEs are assessed by CTCAE V5.0 criteria
Time frame: Within 1 years after CAR-T cell infusion
Proportion of subjects with SRI-4 response
SRI-4 response is defined as: 1) the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score decrease by no less than 4 points from baseline; 2) the British Isles Lupus Assessment Group (BILAG) score with no new A domain score and no more than 1 new B domain score compared to baseline; 3) the Physician Global Assessment (PGA) score increase less than 0.3 point from baseline.
Time frame: Within 1 years after CAR-T cell infusion(month 1, month 3, month 6, month 9, month 12)
Changes in the Safety of Estrogens in Lupus Erythematosus National Assessment - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score from baseline
Range \[0, 105\],higher score represents worse disease activity
Time frame: Within 1 years after CAR-T cell infusion(month 1, month 3, month 6, month 9, month 12)
Changes in the BILAG-2004 score from baseline
Range \[0, 72\],higher score represents worse disease activity
Time frame: Within 1 years after CAR-T cell infusion(month 1, month 3, month 6, month 9, month 12)
Changes in the Physician Global Assessment (PGA) score from baseline
Range \[0, 3\],higher score represents worse disease activity
Time frame: Within 1 years after CAR-T cell infusion(month 1, month 3, month 6, month 9, month 12)
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Pharmacokinetics (PK)
Concentration of CAR-T cell in peripheral blood will be evaluated
Time frame: Within 1 years after CAR-T cell infusion(per 3 days in month 1, per month in month 2 - month 12)
Pharmacodynamics (PD)
Pharmacodynamics (PD) will be assessed by levels of cytokines(IL-2、IL-6、IL-10、IFN-γ), changes of lymphocyte subsets, immunological indexes(IgG、IgM、IgA、IgE) in peripheral blood
Time frame: Within 1 years after CAR-T cell infusion(per 3 days in month 1, per month in month 2 - month 12)