Study of Therapeutic Efficacy of Anti-CD19 CAR-T Cells in Children With Refractory Systemic Lupus Erythematosus

Systemic Lupus Erythematosus Clinical Trial

Official title:

A Clinical Study on the Safety and Efficacy of Chimeric Antigen Receptor T Cell Injection Targeting CD19 Gene in the Treatment of Refractory Systemic Lupus Erythematosus in Children

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06222853
• Other study ID #: STEAM
• Status: Recruiting
• Phase: Phase 1
• Start date: January 4, 2024
• Est. completion date: December 30, 2026

Study information

• Verified date: January 2024
• Source: The Children's Hospital of Zhejiang University School of Medicine
• Contact: Jiahua Mao, MD
• Phone: 13516819071
• Email: maojh88[@]zju.edu.cn
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an investigator-initiated trial aimed at assessing the safety and efficacy of anti-CD19 CAR-T cells in the treatment of childhood-onset refractory systemic lupus erythematosus.

Description:

Systemic lupus erythematosus (SLE) is a serious autoimmune disease that can lead to extensive damage in multiple organs and systems, ultimately resulting in disability and even death. Children with SLE are particularly at risk of organ damage, especially to the kidneys, and tend to have a more severe and protracted course of the disease compared to adults.

Currently, the primary treatment for SLE relies on glucocorticoids and immunosuppressants to alleviate symptoms. However, due to the absence of a curative treatment, patients often require lifelong medication. In recent years, biological agents such as belimumab and rituximab have been introduced for the treatment of SLE, but these agents cannot completely eliminate autoimmune B cells in the bone marrow, leading to unsatisfactory overall outcomes. Furthermore, stopping the drugs can lead to relapse, and there is still no cure for SLE, leaving patients facing the challenges of lifelong medication and an incurable disease.

Since 2019, CAR-T cell therapy has been successfully applied to autoimmune diseases. Clinical studies have demonstrated that targeted CD19 CAR-T cells hold significant therapeutic potential for SLE. These cells effectively slow down the pathological progression of SLE and can also effectively treat severe cases. Furthermore, targeted CD19 CAR-T cells are also expected to restore the immune system in SLE patients, potentially allowing them to discontinue lifelong medication and avoid serious long-term side effects of drugs like hormones and immunosuppressants. The purpose of this study is to assess the safety and efficacy of the anti-CD19 CAR-T cells in the treatment of childhood-onset refractory SLE.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 19
• Est. completion date: December 30, 2026
• Est. primary completion date: December 30, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 5 Years to 18 Years

Eligibility

Inclusion Criteria:

1. Age:5-18 years old(including threshold);

2. Diagnosed with SLE according to the 2019 EULAR/ACR SLE classification criteria;Still in moderate to severe disease activity despite =3M of high dose glucocorticoids(prednisone=1mg/kg/d or other equivalent amount of other steriod ), hydroxychloroquine and at least 2 of the following treatments(cyclophosphamide, MMF, azathioprine, methotrexate, cyclosporin, tacrolimus, sirolimus, leflunomide, telitacicept, Beliumab, and rituximab); or Intolerant to standard treatments;

3. SLEDAI 2K score=8 points;

4. The functions of important organs are basically normal:

Cardiac function: Left ventricular ejection fraction (LVEF) =55% with no obvious abnormality in electrocardiogram; Renal function: eGFR=30ML/min/1.73m2; Liver function: Asparagus cochinchinensis transase (AST) and Alanine Aminotransferase (ALT)=3.0 ULN, Total Bilirubin (TBIL) in serum =2.0×ULN; Lung function: No serious lung lesions, SpO2=92%;

5. Met the standards of leukapheresis or intravenous blood collection, No contraindication for cell collection;

6. Negative pregnancy test for female Subjects of childbearing age, agree to take effective contraceptive measures the first year after CAR-T infusion;

7. Participants or their guardians agrees to participate in the clinical trial and sign the informed consent form which indicating that he/she understands the purpose and procedure of the clinical trial and is willing to participate in the study.

Exclusion Criteria:

1. Received CAR T cell therapy previously;

2. Central nervous system (CNS) disease: CNS neurolupus requires intervention within 60 days);

3. Severe acute nephritis: Patients who have accepted or was undergoing renal replacement therapy within 3 months prior to transfusion; Or in the investgator's opinion, patients who is likely to have significant kidney disease within 3 moths of the study which need high dose glucocorticoid (prednisone dose=1mg/kg/day or equivalent amount of other steriod), cyclophosphamide, or MMF treatment;

4. Have a history of congenital heart disease or acute myocardial infarction within 6 months prior to screening; Or severe arrhythmias (including multisource frequent supraventricular tachycardia, ventricular tachycardia, etc.); Or combined with moderate to massive pericardial effusion, serious myocarditis, etc; Or patients with unstable vital signs who need hypertensive drugs;

5. Suffer from other diseases that require long-term use of glucocorticoid or high-dose of immunosuppressive agents;

6. Uncontrollable infection, or active infection that requires systemic treatment within 1 week prior to screening;

7. History of organ transplantation or hematopoietic stem cell transplantation, or =Grade 2 GVHD within 2 weeks prior to screening;

8. Hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive and peripheral blood hepatitis B virus (HBV) DNA titer greater than the normal reference value range; Or hepatitis C virus (HCV) antibody positive and peripheral blood hepatitis C virus (HCV) RNA titer greater than the normal reference value range; Or positive for human immunodeficiency virus (HIV) antibodies; Or syphilis test positive; Or cytomegalovirus (CMV) DNA test positive;

9. Received live vaccine within 4 weeks before screening;

10. Tested positive in Blood pregnancy test;

11. Previous or concurrent malignancy;

12. Patients who participated in other clinical study within 3 months prior to enrollment;

13. Any other conditions that the investigators deem it unsuitable for the study.

Related Conditions & MeSH terms

• CAR-T Cell Therapy
• Lupus Erythematosus, Systemic
• Systemic Lupus Erythematosus

Intervention

Biological:
• anti-CD19-CAR-T cells
Three dose groups (1×105/kg, 3×105/kg, 5×105/kg) were set up, starting from the low dose group climbing to explore the safe and effective dose.

Locations

Country	Name	City	State
China	Children's Hospital, Zhejiang University School of Medicine	Hangzhou	Zhejiang

Sponsors (2)

Lead Sponsor	Collaborator
The Children's Hospital of Zhejiang University School of Medicine	Chongqing Precision Biotech Co., Ltd

Country where clinical trial is conducted

China, 

References & Publications (7)

Anders HJ, Saxena R, Zhao MH, Parodis I, Salmon JE, Mohan C. Lupus nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7. doi: 10.1038/s41572-019-0141-9. — View Citation

Jin X, Xu Q, Pu C, Zhu K, Lu C, Jiang Y, Xiao L, Han Y, Lu L. Therapeutic efficacy of anti-CD19 CAR-T cells in a mouse model of systemic lupus erythematosus. Cell Mol Immunol. 2021 Aug;18(8):1896-1903. doi: 10.1038/s41423-020-0472-1. Epub 2020 May 29. — View Citation

Kansal R, Richardson N, Neeli I, Khawaja S, Chamberlain D, Ghani M, Ghani QU, Balazs L, Beranova-Giorgianni S, Giorgianni F, Kochenderfer JN, Marion T, Albritton LM, Radic M. Sustained B cell depletion by CD19-targeted CAR T cells is a highly effective tr — View Citation

Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS. ASTCT Consen — View Citation

Mackensen A, Muller F, Mougiakakos D, Boltz S, Wilhelm A, Aigner M, Volkl S, Simon D, Kleyer A, Munoz L, Kretschmann S, Kharboutli S, Gary R, Reimann H, Rosler W, Uderhardt S, Bang H, Herrmann M, Ekici AB, Buettner C, Habenicht KM, Winkler TH, Kronke G, S — View Citation

Mougiakakos D, Kronke G, Volkl S, Kretschmann S, Aigner M, Kharboutli S, Boltz S, Manger B, Mackensen A, Schett G. CD19-Targeted CAR T Cells in Refractory Systemic Lupus Erythematosus. N Engl J Med. 2021 Aug 5;385(6):567-569. doi: 10.1056/NEJMc2107725. No — View Citation

Neelapu SS, Tummala S, Kebriaei P, Wierda W, Gutierrez C, Locke FL, Komanduri KV, Lin Y, Jain N, Daver N, Westin J, Gulbis AM, Loghin ME, de Groot JF, Adkins S, Davis SE, Rezvani K, Hwu P, Shpall EJ. Chimeric antigen receptor T-cell therapy - assessment a — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The safety of CAR-T cell in refractory childhood-onset Systemic Lupus Erythematosus	Incidence and severity of AEs and SAEs, including changes in laboratory values, ECG and vital signs as assessed by CTCAE v5.0.	3 Months
Secondary	The efficiency of CAR-T cell in refractory childhood-onset Systemic lupus Erythematosus.	Number of patients with SRI-4 response: including SLEDAI-2K = 4-Point improvement, PGA with no worsening (<0.3-point increase), BILAG 2004 with no new A domain score and no more than 1 new B domain scores.	3 Months
Secondary	Cellular kinetics	CAR transgene levels by quantitative polymerase chain reaction (qPCR) in peripheral blood.	6 Months
Secondary	Autoantibody detection	Autoantibody detection up after CD19 CAR-T cells infusion.	24 Months
Secondary	Duration of disease response (DOR)	The time between the first investigator assessment of remission and the first investigator assessment of progression or death from any cause.	24 Months