SLE (Systemic Lupus)
Conditions
Brief summary
A Phase 1 clinical trial to evaluate the safety and efficacy of PiggyBac transposon-mediated Chimeric Antigen Receptor(CAR) T-cells targeting CD19 in refractory Systemic Lupus Erythematosus (SLE) patients who have not responded to standard immunosuppressive treatments.
Detailed description
This is a single-institution phase I study in adults with refractory SLE. Autologous Peripheral Blood Mononuclear Cells will be transduced with a chimeric antigen receptor targeting the B-cell surface antigen CD19 using the PiggyBac Transposon system. Subjects will receive a conditioning lymphodepletion chemotherapy regimen of fludarabine and cyclophosphamide, followed by the infusion of 1x10\^6 cells/kg CD-19 CAR T-cells. Subjects will be evaluated post-treatment for toxicity, SLE disease activity, and the persistence of CAR-expressing T cells in vivo.
Interventions
OTHERPiggyBac Transposon-Mediated CD19 CAR-T Therapy
PiggyBac Transposon-Mediated CD19 CAR-T Therapy (1-2 x 10\^6 cells/kg)
Sponsors
Chulalongkorn University
King Chulalongkorn Memorial Hospital
Health Systems Research Institute,Thailand
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Intervention: PiggyBac transposon-mediated CD-19 CAR T-cells (1x10\^6 cells/kg)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
1. Age between 18 and 60 years. 2. Diagnosis of Systemic Lupus Erythematosus (SLE), as defined by the American College of Rheumatology (ACR) 1997 criteria, The Systemic Lupus International Collaborating Clinics (SLICC) criteria, or the European Alliance of Associations for Rheumatology (EULAR)/ACR classification. 3. Refractory SLE, defined by one or more of the following: 3.1 Persistently active SLE requiring ongoing maintenance therapy (if not contraindicated) with: * Antimalarial drug. * Either mycophenolate (minimum daily dose of 1500 mg) or azathioprine (minimum daily dose of 1.5 mg/kg). * Patients must also need a minimum daily dose of 7.5 mg prednisolone for lower disease activity maintenance, or have a SLEDAI score of 8 or higher. 3.2 Biopsy-proven proliferative lupus nephritis after two standard induction therapies, including intravenous cyclophosphamide (cumulative dose of at least 1.5 g) and mycophenolate mofetil (administered for a minimum of 3 months), unless contraindicated. 3.3 Worsening of biopsy-proven lupus nephritis (activity index \> 6 and chronicity index \< 6 within 6 months), indicated by increased proteinuria and/or decreased estimated glomerular filtration rate, despite treatment with high-dose corticosteroids (prednisolone at least 0.7 mg/kg/day or equivalent) and either mycophenolate mofetil or cyclophosphamide for a minimum of 14 days. 4. Ability to understand and willingness to sign a written informed consent document. 5. Participants of child-bearing or child-fathering potential must agree to practice birth control from enrollment until four months after receiving CAR T-cell infusion.
Exclusion criteria
1. Pregnant or breastfeeding women. 2. History of active malignancy, excluding non-melanoma skin cancer and carcinoma in situ (e.g., cervix, bladder, breast). 3. History of vital organ transplantation (e.g., heart, lung, kidney, liver) or hematopoietic stem cell/bone marrow transplantation. 4. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, pulmonary abnormalities, cirrhosis, or psychiatric illness/social situations that limit compliance with study requirements. 5. Any other clinically significant disease history or current disease that, in the judgment of the research physician, may pose a risk to the safety of the subjects or interfere with the research procedure, or the evaluation of safety and efficacy. 6. Serologic status indicating active HIV, hepatitis B, or C infection. Participants positive for hepatitis B core antibody, hepatitis B surface antigen, or hepatitis C antibody must have a negative PCR prior to enrollment. 7. History of severe adverse drug reaction to Cyclophosphamide or Fludarabine. 8. Received a live vaccine within 30 days prior to CAR-T cell infusion. 9. eGFR CKD-EPI \< 30 ml/min/1.73m\^2. 10. Participation in other clinical investigations during the study period. 11. Prior receipt of CAR-T cell therapy outside this protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety of PiggyBac transposon-mediated CAR T-cell infusion targeting CD19 in adult patients with refractory SLE. | Up to 28 days after CD-19 CAR-T cell infusion | The incidence of adverse events assessed by the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE), Version 5.0 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease activity of SLE | 3, 6, and 12 months after CD-19 CAR-T cell infusion | The Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) - Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) |
| Complete response rate of lupus nephritis | 3, 6, and 12 months after CD-19 CAR-T cell infusion | Complete response defined as normal or ≤ 25% decline of estimated glomerular filtration rate (eGFR) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) from baseline and urinary protein to creatinine index (UPCI) or 24-hour urinary protein ≤ 0.5 g/g or g/day |
| Partial response rate of lupus nephritis | 3, 6, and 12 months after CD-19 CAR-T cell infusion | Partial response defined as normal or ≤25% decline of eGFR CKD-EPI from baseline and at least 50% reduction of proteinuria, with a UPCI or 24-hour urinary protein between 0.5 to 3 g/g or g/day |
Countries
Thailand
Contacts
PRINCIPAL_INVESTIGATORWonngarm Kittanamongkolchai, MD
Chulalongkorn University
Outcome results
None listed