The goal of this phase I/II clinical trial is to investigate anti-CD 19 chimeric antigen receptor T cell (CAR-T cell) therapy in patients with antineutrophil cytoplasmic antibodies (ANCA) immunoglobulin (IgG) positive ANCA associated vasculitis (AAV). The main questions it aims to answer are: * To assess the safety of anti-CD19 CAR-T cell therapy in subjects with active, treatment refractory, ANCA-IgG-positive AAV * To assess the clinical efficacy of anti-CD19 CAR-T cell therapy in subjects with active, treatment refractory ANCA-IgG-positive AAV * To assess the ANCA seroconversion rate in subjects with active, treatment refractory ANCA-IgG-positive AAV Participants will receive a single dose of KYV-101 i.v., an autologous fully-human anti-CD19 CAR-T cell immunotherapy. Follow-up time is 52 weeks with regular visits at the site.
This study aims to investigate the use of KYV101 (a fully human anti-CD19 CAR T cell therapy) in ANCA-IgG-positive AAV patients who are refractory to previous treatments. This study is designed to determine (i) the safety of this B-cell targeted therapy, (ii) the clinical efficacy, (iii) the impact on the immunological status of the patient and in particular on ANCA positivity, and (iv) the ability to induce long-term (deep) clinical and molecular remission and drug-free survival. The investigational product (IMP), KYV-101, is an autologous fully-human anti-CD19 CAR T-cell immunotherapy. Before IMP infusion, patients will receive a premedication of 4 mg Dimetindenmaleat iv or equivalent antihistamine and 1000 mg oral acetaminophene. Prophylactic doses of acyclovir of 400mg 2x daily as well as cotrimoxazole 960mg 3x weekly will be administered orally following CAR T cell infusion until week 24. Tocilizumab 8mg/kg will be administered intravenously when required for treatment of IMP-related cytokine release syndrome. Dexamethasone as needed will be administered intravenously when required for treatment of neurological adverse event (ICANS). Follow-up time is 52 weeks with regular visits at the site.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
A dosage of 1x10\^8 KYV-101 CAR+ T cells will be administered intravenously as a single infusion.
number of subjects experiencing a cytokine release syndrome
The primary safety outcome in Phase I variable will be measured as the number of subjects experiencing a cytokine release syndrome (CRS) or an immune cell-associated neurotoxicity syndrome (ICANS) as well as adverse events (AE) and serious adverse events (SAE) due to investigational medical product (IMP) within the first 4 weeks.
Time frame: Screening up to week 4
antineutrophil cytoplasmic antibodies (ANCA) seroconversion rate
The primary efficacy outcome variable of Phase II will be the antineutrophil cytoplasmic antibodies (ANCA) seroconversion rate in subjects with active, treatment refractory ANCA-IgG-positive AAV at week 24.
Time frame: week 24
adverse events and serious adverse events due to investigational medical product
The primary safety outcome variable of Phase II will be measured as adverse events (AE) and serious adverse events (SAE) due to investigational medical product (IMP) throughout the whole study.
Time frame: up to 52 weeks
immunoglobulin IgG
Change in total IgG immunoglobulins over time
Time frame: up to week 52
immunoglobulin IgG subclasses
Change in total IgG subclasses mmunoglobulins over time
Time frame: up to week 52
immunoglobulin IgA
Change in total IgA immunoglobulins over time
Time frame: up to week 52
immunoglobulin IgM
Change in total IgM immunoglobulins over time
Time frame: up to week 52
Change in PR3
Change in PR3 specific plasmablasts and B-cells
Time frame: up to week 52
Change in MPO
Change in MPO specific plasmablasts and B-cells
Time frame: up to week 52
number of plasmablasts
Change in the number of plasmablasts cell over time
Time frame: up to week 52
number of B cells
Change in the number of pB cells numbers over time
Time frame: up to week 52
number of T cells
Change in the number T cells numbers over time
Time frame: up to week 52
relapse/flare
Time to relapse/flare
Time frame: up to 52 weeks
time without immunosuppression
Survival time without immunosuppression
Time frame: up to 52 weeks
Vasculitis Damage Index
Change of Vasculitis Damage Index (VDI) compared to baseline
Time frame: up to 52 weeks
Flares
Number of flares
Time frame: up to 52 weeks
Birmingham Vasculitis Activity Score
Change in Birmingham Vasculitis Activity Score (BVAS) compared to baseline
Time frame: up to 52 weeks
B cell depletion
Duration of B cell depletion in the peripheral blood
Time frame: up to 52 weeks
persistence of CAR T cells
Duration of persistence of CAR T cells in the peripheral blood
Time frame: up to 52 weeks
Change in anti-PR3 antibodies
Change in anti-PR3 antibodies over time (GPA)
Time frame: up to 52 weeks
anti-MPO antibodies
Change in anti-MPO antibodies over time
Time frame: up to 52 weeks
anti-MPO antibodies
Percentage of subjects with normal anti-MPO antibodies (less than 10 AU/ml)
Time frame: up to week 52
normal anti-PR3 antibodies
Percentage of subjects with normal anti-PR3 antibodies (less than 20 AU/ml in CLIA)
Time frame: up to 52 weeks
EULAR sustained remission criteria
Percentage of patients who reach European Alliance of Associations for Rheumatology (EULAR) sustained remission criteria (absence of typical signs, symptoms, or other features of active ANCA associated vasculitis)
Time frame: up to week 52
reach EULAR response criteria
Percentage of patients who reach European Alliance of Associations for Rheumatology (EULAR) response criteria (≥ 50% reduction of Birmingham Vasculitis Activity Score (BVAS) compared to baseline
Time frame: up to 52 weeks
number of CAR-T cells
number of CAR-T cells in the patient over time
Time frame: up to 52 weeks
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.