A Phase 1b clinical trial to evaluate the safety and efficacy of BCMA-targeted CAR T-cell therapy in Thai patients with relapsed or refractory multiple myeloma.
The investigational product used in this study is a chimeric antigen receptor T-cell, also known as "CAR T-cell," engineered to specifically target B-cell maturation antigen (BCMA) protein. The patient's own T-lymphocytes are genetically modified ex vivo to express receptors capable of binding to BCMA protein expressed on the surface of malignant cells. These CAR T-cells are then expanded and infused back into each patient for the treatment of relapsed or refractory multiple myeloma. Previous clinical research has demonstrated promising outcomes in the treatment of multiple myeloma with CAR T-cell therapy. For example, a clinical trial conducted by Bluebird Bio in 128 patients reported an overall response rate of 73% and a complete response rate of 33%, leading to approval by the United States Food and Drug Administration (FDA) in March 2021. Additionally, a clinical trial by Nanjing Legend Biotech in China, evaluating the investigational CAR T-cell product LCAR-B38M in 97 patients, demonstrated an overall response rate of 97.9% and a complete response rate of 80.4%. The investigational product used in the current study has previously undergone a Phase 1 clinical trial in 15 patients with relapsed or refractory multiple myeloma, evaluating three dose levels: low (0.25 × 10⁷ cells/kg body weight), intermediate (0.5 × 10⁷ cells/kg body weight), and high (0.75 × 10⁷ cells/kg body weight). The study demonstrated an overall response rate of 100% and a complete response rate of 66.7%. Furthermore, patients who had previously received anti-CD38 monoclonal antibody immunotherapy and/or those with extramedullary disease also achieved an overall response rate of 100%. Regarding safety, the most notable adverse event associated with BCMA-directed CAR T-cell gene therapy was cytokine release syndrome (CRS), which was observed in all patients and tended to be more severe in the high-dose cohort. However, all adverse events were manageable and clinically controllable. No treatment-related study discontinuations or deaths were reported. Based on the efficacy and safety data, the high dose level (0.75 × 10⁷ cells/kg) was found to be associated with dose-limiting toxicity. Therefore, the intermediate dose (0.5 × 10⁷ cells/kg) - which demonstrated favorable therapeutic efficacy with an acceptable safety profile - was selected for the Phase 1b clinical trial in Thailand, in order to maximize benefit while minimizing risk to participants. For the aforementioned reasons, this research project aims to further evaluate the safety and efficacy of BCMA-targeted CAR T-cell therapy in Thai patients with relapsed or refractory multiple myeloma. This Phase 1b study represents the first-in-Thai-patient clinical investigation of this approach. The research team anticipates that this therapy will demonstrate a high safety profile and effective disease control in patients with relapsed or refractory multiple myeloma.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
3
This product is a CAR T-cell therapy utilizing the participant's own autologous T-lymphocytes, which are collected via apheresis, processed in a laboratory setting, and subsequently reinfused intravenously through a peripheral vein at a rate of 2-5 mL/min. Participants will undergo cell collection via apheresis for product preparation, followed by lymphodepleting chemotherapy. This process includes pre-chemotherapy and pre-infusion assessments prior to the administration of CART-BCMA cells.
King Chulalongkorn Memorial Hospital
Bangkok, Pathumwan, Thailand
The safety of CART-BCMA in patients with relapsed or refractory multiple myeloma.
Number and percentage of participants experiencing treatment-emergent adverse events (AEs) and serious adverse events (SAEs) after CART-BCMA cell infusion. AEs will be graded according to CTCAE version 5.0
Time frame: Day 1 to Day 8, Day 14, Day 21, Day 28, Day 60, Day 90, Day 120, Day 180, Day 270, Day 360, and every 90 days from Day 450 to Day 720 after CART-BCMA cell infusion
Incidence of Dose-Limiting Toxicities (DLTs)
Number and percentage of participants experiencing dose-limiting toxicities (DLTs) during the DLT evaluation period following CART-BCMA cell infusion. DLTs will be defined according to protocol-specified criteria and graded using Common Terminology Criteria for Adverse Events (CTCAE), version 5.0
Time frame: From Day 1 to Day 28 after CART-BCMA cell infusion (DLT evaluation period)
The overall response rate (ORR, at least PR or better) per IMWG 2016 Criteria
Percentage of participants achieving at least Partial Response (PR) or better (PR, VGPR, CR, or sCR) as assessed according to the International Myeloma Working Group (IMWG) 2016 response criteria.
Time frame: Day 28, Day 60, Day 90, Day 120, Day 180, Day 270, Day 360, and every 90 days from Day 450 to Day 720 after CART-BCMA cell infusion
Complete Response (CR) or Stringent Complete Response (sCR) Rate per IMWG 2016 Criteria
Percentage of participants achieving Complete Response (CR) or Stringent Complete Response (sCR) according to IMWG 2016 criteria.
Time frame: Day 28, Day 60, Day 90, Day 120, Day 180, Day 270, Day 360, and every 90 days from Day 450 to Day 720 after CART-BCMA cell infusion
Very Good Partial Response (VGPR) or Better Rate per IMWG 2016 Criteria
Percentage of participants achieving VGPR or better (VGPR, CR, or sCR) according to IMWG 2016 criteria.
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Time frame: Day 28, Day 60, Day 90, Day 120, Day 180, Day 270, Day 360, and every 90 days from Day 450 to Day 720 after CART-BCMA cell infusion
Time to First Documented Response (≥PR) per IMWG 2016 Criteria
Time from CART-BCMA cell infusion to first documented response of PR or better according to IMWG 2016 criteria.
Time frame: From infusion date up to Day 720 (approximately 24 months)
Duration of Response per IMWG 2016 Criteria
Time from first documented response (≥PR) to disease progression or death from any cause, whichever occurs first, according to IMWG 2016 criteria.
Time frame: From first documented response up to Day 720 (approximately 24 months)
Progression-Free Survival per IMWG 2016 Criteria
Time from CART-BCMA cell infusion to first documented disease progression or death from any cause, whichever occurs first, as defined by IMWG 2016 criteria.
Time frame: From infusion date up to Day 720 (approximately 24 months)
Overall Survival (OS)
Time from CART-BCMA cell infusion to death from any cause.
Time frame: From infusion date up to Day 720 (approximately 24 months)