A Study of Bortezomib, Lenalidomide and Dexamethasone (VRd) Followed by BCMA CAR-T Therapy in Transplant-Ineligible Patients With Primary Plasma Cell Leukemia

Phase 2

Recruiting

• Conditions: Plasma Cell Leukemia
• Interventions: Biological: anti-BCMA CAR-T; Drug: VRD-based regimen

• Registration Number: NCT05979363
• Lead Sponsor: Institute of Hematology & Blood Diseases Hospital, China

Brief Summary

This is a single-arm, open-label study to evaluate the efficacy and safety of VRD-based regimen combined with BCMA CAR-T in transplant-ineligible patients with primary plasma cell leukemia

Detailed Description

The study is a prospective, single-arm, single-centre, phase II study designed to evaluate the efficacy and safety of treatment with VRD-based regimen combined with BCMA CAR-T in transplant-ineligible patients with primary plasma cell leukemia. Patients received 3 courses of induction therapy with VRD-based regimen followed by infusion of BCMA CAR-T cells. Patients then received 3 courses of VR consolidation therapy, followed by VR maintenance therapy.

Study Timeline

• Study Start: 2023-07-01
• Study First Submitted: 2023-07-29
• Study First Submitted QC: 2023-07-29
• Status Verified: 2023-08
• Last Update Submitted: 2023-08-04
• Study First Posted: 2023-08-07
• Last Update Posted: 2023-08-08
• Primary Completion: 2025-07-01
• Study Completion: 2028-07-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

1. Age ≥ 18 years and ≤ 75 years.
2. Participants with documented primary plasma cell leukemia according to IMWG diagnostic criteria (circulating plasma cells ≥5%, determined by morphology on peripheral blood smear; or absolute value of peripheral blood tumorigenic plasma cells exceeds 2×10^9/L).
3. Measurable disease, at screening as defined by any of the following: Serum monoclonal paraprotein (M-protein) level ≥1.0 g/dL or urine M-protein level ≥200 mg/24 hours; or Light chain MM without measurable disease in serum or urine: serum Ig free-light chain (FLC) ≥10 mg/dL and abnormal serum Ig kappa lambda FLC ratio.
4. Not considered for high-dose chemotherapy with Autologous Stem Cell Transplant (ASCT) due to: Ineligible due to advanced age (≥65); or Ineligible evaluated by researchers; or Eastern Cooperative Oncology Group Performance Status grade of 3 or 4; or Repeated hematopoietic stem cell mobilization failure； or Deferral of high-dose chemotherapy with ASCT as initial treatment.
5. Bone marrow sample is confirmed as BCMA-positive by flow cytometry or pathological examination.
6. All screening blood biochemistry: tests should be performed according to the protocol and within 14 days before enrollment. Screening laboratory values must meet the following criteria: a.TBIL<2 x upper limit of normal (ULN) (<3 x ULN in patients with Gilbert's syndrome); b.AST and ALT <3 x ULN.; c. Creatinine clearance ≥ 30mL/min (calculated using Cockroft-Gault formula).
7. Routine blood tests (performed within 7 days, no RBC transfusion, no G-CSF/GM-CSF/platelet agonists, no drug correction within 14 days before screening, no PLT transfusion within 7 days) : WBC ≥ 1.5 x 109/L, ANC ≥ 1.0 x 109/L, Hb ≥ 70 g/L PLT ≥ 75 x 109/L (if BMPC < 50%) or PLT ≥ 50 x 109/L (if BMPC ≥ 50%).
8. Patients must be able to take prophylactic anticoagulant therapy as recommended by the study.
9. The woman is not breastfeeding, is not pregnant and agrees not to be pregnant during the study period and for the following 12 months. Male patients agreed that their spouse would not become pregnant during the study period and for 12 months thereafter.

Exclusion Criteria

1. Documented active amyloidosis.
2. Documented with central nervous system (CNS) invasion.
3. Prior exposure to any BCMA-targeted therapy or CAR-T therapy.
4. Patients with peripheral neuropathy greater than grade 2 or peripheral neuropathy greater than grade 2 with pain at baseline, regardless of whether they were currently receiving medical therapy.
5. Known intolerance, hypersensitivity, or contraindication to glucocorticoids, bortezomib, lenalidomide, and BCMA-CART cellular products.
6. Seropositive for human immunodeficiency virus (HIV)
7. Hepatitis B infection
8. Hepatitis C infection
9. Life expectancy of <6 months
10. Women who are pregnant or breastfeeding
11. Any active gastrointestinal dysfunction that affects the patient's ability to swallow tablets, or any active gastrointestinal dysfunction that may affect the absorption of the studied treatment medication
12. Subjects had major surgery within 2 weeks before randomization (for example, general anesthesia), or is not fully recovered from the surgery, or surgery is arranged during study period.
13. Received live attenuated vaccine within 4 weeks prior to study treatment.
14. According to the researcher's judgment, any condition including but not limited to serious mental illness, medical illness, or other symptoms/conditions that may affect study treatment, compliance, or the capability of providing informed consent.
15. Necessary medication or supportive therapy is contraindicated with study treatment.
16. Any diseases or complications that may interfere with the study.
17. Patients are not willing to or cannot comply with study scheme.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
VRD-based Regimen Combined With BCMA CART	anti-BCMA CAR-T	VRD：Bortezomib, Lenalidomide and Dexamethasone Bortezomib SC 1.3mg/sqm on day 1,8,15,22, Lenalidomide oral 25 mg on day 1-21, and Dexamethasone 40mg on day 1,8,15,22 in a 28-day cycle. Autologous BCMA-directed CAR-T cells, infusion intravenously at a target dose of 2-4 x 10\^6 anti-BCMA CAR+T cells/kg. Participants will receive VRD-based induction, BCMA CAR-T infusion, VR consolidation, VR maintenance.
VRD-based Regimen Combined With BCMA CART	VRD-based regimen	VRD：Bortezomib, Lenalidomide and Dexamethasone Bortezomib SC 1.3mg/sqm on day 1,8,15,22, Lenalidomide oral 25 mg on day 1-21, and Dexamethasone 40mg on day 1,8,15,22 in a 28-day cycle. Autologous BCMA-directed CAR-T cells, infusion intravenously at a target dose of 2-4 x 10\^6 anti-BCMA CAR+T cells/kg. Participants will receive VRD-based induction, BCMA CAR-T infusion, VR consolidation, VR maintenance.

Primary Outcome Measures

Name	Time	Method
Safety and Tolerability	Up to 2 year	The incidence of treatment-emergent adverse events (TEAEs)
MRD-negative rate	within 1 week after consolidation treatment	achieving MRD-negative, as determined by NGS/NGF after consolidation treatment

Secondary Outcome Measures

Name	Time	Method
Progression free survival (PFS)	Up to 2 year	Progression free survival is defined as the time from the date of diagnosis to the date of first documented PD, as defined in the IMWG criteria, or death due to any cause, whichever occurs first
Overall Survival (OS)	Up to 5 year	Overall survival is measured from the date of diagnosis to the date of the participant's death.
Duration of Remission(DOR)	Up to 2 year	Duration from the first evaluation of at least partial remission (PR) to the onset of disease progression or death due to disease progression (whichever occurs first)
Complete response rate (CRR)	within 1 week after induction therapy, 1 month after the CAR-T cell transfusion, within 1 week after consolidation therapy	CR or better is defined as percentage of participants who achieve a CR response or Stringent Complete Response (sCR) response accoording to the IMWG criteria

Trial Locations

Locations (1)

Institute of Hematology and Blood Diseases Hospital Chinese Academy of Medical Sciences; 🇨🇳 Tianjin, China