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NCT Number: NCT05982275

Trial of an Investigational Drug After Rejecting the Relapse of an Allogeneic Transplant

Most patients with multiple myeloma (MM) die due to relapse resistant to current treatment, including treatment with anti-B cell maturation antigen (BCMA) CAR-T cells. To overcome some of the potential limitations of this therapy, a new and optimized Anti-BCMA CAR-T has been developed, with the aim of using it in patients with MM who relapse after Allogeneic Haematopoietic Haematopoietic Progenitor. This trial is a prospective phase I/II trial with a 3+3 design. Once Dose Limiting Toxicity is identified, Phase II will begin to assess the efficacy of the procedure.

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 1 / Phase 2

Primary location

Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain

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About this study

This trial is a prospective phase I/II trial with a 3+3 design. Once Dose Limiting Toxicity is identified (up to a maximum dose of 6x106 CAR-T/kg divided over 2 days), phase II of the trial will begin to assess the efficacy of the procedure.

A number of 25 patients will be included to evaluate.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients > 18 years old with a diagnosis of post-allogeneic transplant relapse multiple myeloma.
  • Measurable disease at the time of screening
  • Previous treatment with ≥2 lines before and/or after allogeneic transplant.
  • Patients who are not receiving immunosuppressants at least 1 month before inclusion and who do not have active graft-versus-host disease.
  • Eastern Cooperative Oncology Group functional status from 0 to 1.
  • Life expectancy greater than 3 months (at the time of screening)
  • Patients who give their consent by signing the Informed Consent document.

Exclusion criteria

  • Active systemic immunosuppressive treatment
  • Patients who have previously received treatment with CAR-T Anti-BCMA.
  • Absolute lymphocyte count <0.2x109/L
  • Previous neoplasm, except if it has been in complete remission >3 years, with the exception of skin carcinoma (non-melanoma)
  • Active infection requiring treatment.
  • Active HIV, hepatitis B virus or hepatitis C virus infection.
  • Uncontrolled medical illness.
  • Severe organic disease that meets any of the following criteria: left ventricular ejection fraction <40%, carbon monoxide diffusion test <40%, glomerular filtration rate <50 ml/min, bilirubin >3 normal value (except Gilbert syndrome).
  • Previous diagnosis of symptomatic amyloid light chain or primary amyloidosis or POEMS Syndrome.
  • Pregnant or lactating women.
  • Women of childbearing age, unable or unwilling to use highly effective contraceptive methods.
  • Men who cannot or do not wish to use highly effective contraceptive methods. The partner of the male participants, if they are women of childbearing age, must also use highly effective contraceptive methods during the study period.
  • Contraindication to receive lymphodepleting chemotherapy.
  • Patients with known hypersensitivity to the active ingredients or any of the excipients of the product to be infused.

Treatment and study plan

CARTemis-1

Genetic

A dose escalation design will be applied in successive patient cohorts until identification of Dose Limiting Toxicity (maximum dose: 6x10^6 CAR-T/kg divided over 2 days).

Primary outcomes

  1. Purity of CARTemis-1

    Time frame: Immediately after infusion

    Number of cases in which, after performing apheresis, the manufacturing process is completed and CARTemis-1 cells are infused

  2. Maximum tolerated dose

    Time frame: Up to 30 days

    To determine the maximum tolerated dose of CarTemis-1

  3. Infusion reactions

    Time frame: Immediately after intravenous administration of CARTemis-1

    To appearance of any of the following symptoms after intravenous administration of CARTemis-1: cardiac events, chills, dyspnea, fatigue, sudden hypertension, hypotension, nausea, pain, fever, skin rash, and urticaria.

  4. Tumor lysis syndrome

    Time frame: Up to 30 days after treatment administration

    To increase nucleic acids, potassium, and phosphate in the blood

  5. Serious Adverse Event

    Time frame: Up to 36 months after treatment administration

    Type, incidence, severity (graded by the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0), timing, intensity, and relatedness of adverse events).

  6. Suspected Unexpected Serious Adverse Reaction

    Time frame: Up to 36 months after treatment administration

    Describe the adverse event that occurs in a clinical trial subject, which is assessed by the sponsor and or study investigator as being unexpected, serious and as having a reasonable possibility of a causal relationship with the study drug.

Secondary outcomes

  1. Number of Participants with cytopenias

    Time frame: During the first 90 days after administration of CARTemis-1

    Neutropenias or thrombopenias

  2. Number of Participants with prolonged cytopenias

    Time frame: Up to 12 months after treatment administration

    Neutropenias or thrombopenias (grade ≥3) for more than 6 weeks

  3. Duration of clinical response

    Time frame: Screening, day -5, -4, -3, +28, +56, +100 and months +4, +5, 6, +7, +8, +9, +10, +11, +12, +15 , +18, +21, +27, +30, +33, +36 or progression

    Duration of clinical response as assessed by Urinalysis (immunofixation, proteinuria and 24-h urine proteinogram), Blood tests (total immunoglobulin A, G and M, immunofixation and proteinogram (M component) in serum; serum free light chains), Bone Marrow Aspirate and Positron Emission Tomography.

  4. Overall response rate

    Time frame: 3, 6 and 12 months after CARTemis-1 infusion

    Overall response rate as assessed by criteria of the International Myeloma Working Group

  5. Time to complete remission

    Time frame: Up to 36 months after treatment administration

    Duration of clinical response as assessed by Urinalysis (immunofixation, proteinuria and 24-h urine proteinogram), Blood tests (total immunoglobulin A, G and M, immunofixation and proteinogram (M component) in serum; serum free light chains), Bone Marrow Aspirate and Positron Emission Tomography

  6. Time to best response

    Time frame: Up to 36 months after treatment administration

    Duration of clinical response as assessed by Urinalysis (immunofixation, proteinuria and 24-h urine proteinogram), Blood tests (total immunoglobulin A, G and M, immunofixation and proteinogram (M component) in serum; serum free light chains), Bone Marrow Aspirate and Positron Emission Tomography

  7. Negative Minimum Residual Disease Rate

    Time frame: 3, 6 and 12 months after CARTemis-1 infusion

    Residual amount of malignant cells in the bone marrow

  8. Response rate of extramedullary disease

    Time frame: 3 months after CARTemis-1 infusion

    To measure of the metabolic activity of the human body by Positron Emission Tomography

  9. Progression-free survival.

    Time frame: Up to 36 months after treatment administration

    Quantification of time between administration of CARTemis-1 and disease progression or death

  10. Overall survival

    Time frame: Up to 36 months after treatment administration

    the time elapsed between the infusion of CARTemis-1 and the patient's death from any cause.

  11. Persistence of CARTemis-1

    Time frame: Peripheral blood:days 3,7,10,14,17 (only in cohort 3 and 4),21,30,56,90,128 and 156, and months 6,9,12,15,18,24 and relapse or month 36 post-infusion; Marrow: 1,3,6,12,18 and 24 months post-infusion and in the progression or month

    Presence of CARTemis-1 in peripheral blood and bone marrow

  12. CART cell quality

    Time frame: During the manufacturing process, at the time of infusion and at Month+1, Month+3, Month+6, Month+12, Month+18 and Month+24 post-infusion

    Evaluation of the biological characteristics of CARTemis-1 performed by flow cytometry to identify the optimal time of expansion as well as to study the dynamics of CAR T cells during the manufacturing process and how the manufacturing impacts on CAR T cell features and, therefore, CAR T cell quality.

  13. Expression of B cell maturation antigen (BCMA)

    Time frame: Screening and at the time of follow up when a relapse occurs, an average after 1 year

    Genetic expression of BCMA at selection and at relapse in patients

  14. B cell maturation antigen (BCMA) levels

    Time frame: Screening, Day -5, Day 0, +1, +3, +7 y +28 and months +3, +6, +12, +18 and +24

    Serum soluble BCMA levels pre-treatment and during treatment

Study contacts

Contact information is provided by the study sponsor or research team.

Clara Rosso, MD-PhD

CONTACT

[email protected]

0034955013414

Jose-Antonio Perez-Simon, MD-PhD

CONTACT

[email protected]

0034955013414

Sponsors and collaborators

Lead sponsor

Fundación Pública Andaluza para la gestión de la Investigación en Sevilla

Other

Registry information

Official study title

Anti-BCMA Chimeric Antigen Receptor (CARTemis-1) T-lymphocyte Therapy in the Treatment of Patients With Multiple Myeloma in Relapse After Allogeneic Transplant: Endothelial Growth Factor Receptor Expression as a Control Mechanism of Treatment-derived Complications

Acronym: CARTemis-1

Important dates

Study start
2024
Primary completion
2029
Study completion
2029
First posted
Aug 8, 2023
Registry last updated
May 14, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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