- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04504825
A Study to Evaluate the Efficacy and Safety of CAEL-101 in Patients With Mayo Stage IIIb AL Amyloidosis
A Phase 3, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of CAEL-101 and Plasma Cell Dyscrasia Treatment Versus Placebo and Plasma Cell Dyscrasia Treatment in Plasma Cell Dyscrasia Treatment Naïve Patients With Mayo Stage IIIb AL Amyloidosis
AL (or light chain) amyloidosis begins in the bone marrow where abnormal proteins misfold and create free light chains that cannot be broken down. These free light chains bind together to form amyloid fibrils that build up in the extracellular space of organs, affecting the kidneys, heart, liver, spleen, nervous system and digestive tract.
The primary purpose of this study is to determine whether CAEL-101, a monoclonal antibody that removes AL amyloid deposits from tissues and organs, improves overall survival and it is safe and well tolerated in patients with stage IIIb AL amyloidosis.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a double-blind, randomized, multicenter international Phase 3 study of CAEL-101 combined with standard of care (SoC) plasma cell dyscrasia (PCD) treatment versus placebo combined with SoC PCD treatment in Mayo stage IIIb PCD treatment-naïve AL amyloidosis patients. As this is an event-driven study, the study will enroll until at least 101 deaths have been observed. Approximately 124 patients will be enrolled using a 2:1 randomization ratio. Stratification will be based on geographic region across investigator sites. An interim analysis (IA) may be performed when approximately 75% (76/101) of the expected deaths has been observed.
Patients in both study intervention groups will be followed from randomization until death from any cause or until the end of study.
Study Type
Enrollment (Estimated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Alexion Pharmaceuticals, Inc
- Phone Number: 1-855-752-2356
- Email: clinicaltrials@alexion.com
Study Locations
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Adelaide, Australia, SA 5000
- Clinical Trial Site
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Brisbane, Australia, QLD 4102
- Clinical Trial Site
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Murdoch, Australia, WA 6150
- Clinical Trial Site
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Sydney, Australia, NSW 2145
- Clinical Trial Site
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Linz, Austria, 1090
- Clinical Trial Site
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Linz, Austria, 4020
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Bruxelles, Belgium, 1000
- Clinical Trial Site
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Bruxelles, Belgium, 1200
- Clinical Trial Site
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Leuven, Belgium, 3000
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Porto Alegre, Brazil, 901110
- Clinical Trial Site
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Recife, Brazil, 50040
- Clinical Trial Site
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Ribeirao Preto, Brazil, 14051
- Clinical Trial Site
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Santo Amaro, Brazil, 50040-000
- Clinical Trial Site
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Sao Paulo, Brazil, 05652-900
- Clinical Trial Site
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São José do Rio Preto, Brazil, 15090
- Clinical Trial Site
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São Paulo, Brazil, 41253-190
- Clinical Trail Site
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Alberta
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Calgary, Alberta, Canada, T2N 4N2
- Clinical Trial Site
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Edmonton, Alberta, Canada, T6G 1Z2
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Ontario
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Toronto, Ontario, Canada, M5G 2M9
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Beijing, China, 100034
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Beijing, China, 100730
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Hangzhou, China, 310009
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Shanghai, China, 200011
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Suzhou, China, 215004
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Wenzhou, China, 325015
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Wuhan, China, 430000
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Beijing
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Beijing, Beijing, China, 100191
- Clinical Trial Site
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Guangzhou
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Guangzhou, Guangzhou, China, 510317
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Hangzhou
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Hangzhou, Hangzhou, China, 310003
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Ostrava, Czechia
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Caen, France, 14033
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Créteil, France, 94010
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Dijon, France, 21079
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Lille, France, 59037
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Limoges, France, 87042
- Clinical Trial Site
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Marseille, France, 13009
- Clinical Trial Site
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Paris, France, 75010
- Clinical Trial Site
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Pessac, France, 33604
- Clincal Trial Site
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Pierre-Bénite, France, 69310
- Clinical Trial Site
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Poitiers, France, 86021
- Clinical Trial Site
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Rennes, France, 35033
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Toulouse, France, 31059
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Tours, France, 37000
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Berlin, Germany, 12203
- Clinical Trial Site
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Düsseldorf, Germany, 40225
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Essen, Germany, 45147
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Hamburg, Germany, 22767
- Clinical Trial Site
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Heidelberg, Germany, 69120
- Clinical Trial Site
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Würzburg, Germany, 97080
- Clinical Trial Site
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Athens, Greece, 11528
- Clinical Trial Site
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Patras, Greece, 26504
- Clinical Trial Site
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Thessaloníki, Greece, 546 36
- Clinical Trial Site
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Haifa, Israel, 31999
- Clinical Trial Site
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Jerusalem, Israel, 911200
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Petah Tikva, Israel
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Ramat Gan, Israel
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Tel Aviv, Israel, 6423906
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Brescia, Italy, 25123
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Naples, Italy, 80131
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Pavia, Italy, 27100
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Rome, Italy, 00128
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Fukushima, Japan, 960-1295
- Clinical Trial Site
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Nagoya, Japan, 467-8602
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Tokyo, Japan, 150-8935
- Clinical Trial Site
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Kumamoto
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Kumamoto-shi, Kumamoto, Japan, 860-8556
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Seoul, Korea, Republic of, 3080
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Seoul, Korea, Republic of, 3722
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Seoul, Korea, Republic of, 6351
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Seoul, Korea, Republic of, 6591
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Amsterdam, Netherlands, 1105
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Groningen, Netherlands, 9713
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Utrecht, Netherlands, 3584
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Gdansk, Poland, 80-214
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Poznan, Poland, 60-569
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Warszawa, Poland, 02-097
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Moscow, Russian Federation, 125167
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Saint Petersburg, Russian Federation, 197022
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Saint Petersburg, Russian Federation, 197341
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Barcelona, Spain, 08035
- Clinical Trial Site
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Barcelona, Spain, 08036
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Gijon, Spain, 33203
- Clinical Trial Site
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Granada, Spain, 18014
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Madrid, Spain, 28040
- Clinical Trial Site
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Madrid, Spain, 28222
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Madrid, Spain, 28003
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Pamplona, Spain, 31008
- Clinical Trial Site
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Salamanca, Spain, 37007
- Clinical Trial Site
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Sevilla, Spain, 41013
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Valencia, Spain, 46009
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Bern, Switzerland, 3010
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Glasgow, United Kingdom, G12 0YN
- Clinical Trial Site
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London, United Kingdom, NW1 2PG
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Arizona
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Phoenix, Arizona, United States, 85054
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Scottsdale, Arizona, United States, 85054
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California
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Duarte, California, United States, 91010
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San Francisco, California, United States, 94143
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Stanford, California, United States, 94305
- Clinical Trial Site
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Florida
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Jacksonville, Florida, United States, 32224
- Clinical Trial Site
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Weston, Florida, United States, 33331
- Clinical Trial Site
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Indiana
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Indianapolis, Indiana, United States, 46202
- Clinical Trial Site
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Louisiana
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New Orleans, Louisiana, United States, 70112
- Clinical Trial Site
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Maryland
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Baltimore, Maryland, United States, 21201
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Massachusetts
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Boston, Massachusetts, United States, 02118
- Clinical Trial Site
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Boston, Massachusetts, United States, 02111
- Clinical Trial Site
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Boston, Massachusetts, United States, 02215
- Clinical Trial Site
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Michigan
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Detroit, Michigan, United States, 48201
- Clinical Trial Site
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Minnesota
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Rochester, Minnesota, United States, 55905
- Clinical Trial Site
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Missouri
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Saint Louis, Missouri, United States, 63110
- Clinical Trial Site
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New York
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New York, New York, United States, 10032
- Clinical Trial Site
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New York, New York, United States, 10021
- Clinical Trial Site
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New York, New York, United States, 10065
- Clinical Trial Site
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Rochester, New York, United States, 14642
- Clinical Trial Site
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North Carolina
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Chapel Hill, North Carolina, United States, 27599-7295
- Clinical Trial Site
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Durham, North Carolina, United States, 27705
- Clinical Trial Site
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Winston-Salem, North Carolina, United States, 27157
- Clinical Trial Site
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Ohio
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Cleveland, Ohio, United States, 44195
- Clinical Trial Site
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Columbus, Ohio, United States, 43210
- Clinical Trial Site
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Oregon
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Portland, Oregon, United States, 97239
- Clinical Trial Site
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Clinical Trial Site
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Tennessee
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Nashville, Tennessee, United States, 37232
- Clinical Trial Site
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Texas
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Dallas, Texas, United States, 75390
- Clinical Trial Site
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Houston, Texas, United States, 77030
- Clinical Trial Site
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Utah
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Salt Lake City, Utah, United States, 84112
- Clinical Trial Site
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Washington
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Seattle, Washington, United States, 98109
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Wisconsin
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Milwaukee, Wisconsin, United States, 53226
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Key Inclusion Criteria:
- AL amyloidosis stage IIIb based on the European Modification of the 2004 Standard Mayo Clinic Staging (NT-proBNP > 8,500 ng/L) at the time of Screening
Measurable hematologic disease at Screening as defined by at least one of the following:
- Involved/uninvolved free light chain difference (dFLC) > 4 mg/dL or
- Involved free light chain (iFLC) > 4 mg/dL with abnormal Kappa/Lambda ratio or
- Serum protein electrophoresis (SPEP) m-spike > 0.5 g/dL
Histopathological diagnosis of amyloidosis based on polarizing light microscopy of green bi-refringent material in Congo red stained tissue specimens AND confirmation of AL derived amyloid deposits by at least one of the following:
- Immunohistochemistry/Immunofluorescence or
- Mass spectrometry or
- Characteristic electron microscopy appearance/Immunoelectron microscopy
Cardiac involvement as defined by:
- Documented clinical signs and symptoms supportive of a diagnosis of heart failure in the setting of a confirmed diagnosis of AL amyloidosis in the absence of an alternative explanation for heart failure AND
- At least one of the following:
i. Endomyocardial biopsy demonstrating AL cardiac amyloidosis or ii. Echocardiogram demonstrating a mean left ventricular wall thickness (calculated as [IVSd+LPWd]/2) of > 12 mm at diastole in the absence of other causes (e.g., severe hypertension, aortic stenosis), which would adequately explain the degree of wall thickening or iii. Cardiac magnetic resonance imaging (MRI) with gadolinium contrast agent diagnostic of cardiac amyloidosis
- Planned first-line treatment for plasma cell dyscrasia is cyclophosphamide-bortezomib-dexamethasone (CyBorD)-based regimen administered as SoC
- Women of childbearing potential (WOCBP) must have a negative pregnancy test during Screening and must agree to use highly effective contraception from Screening to at least 5 months following the last study drug administration or 12 months following the last dose of her PCD therapy, whichever is longer
- Men must be surgically sterile or must agree to use highly effective contraception and refrain from donating sperm from Screening to at least 5 months following the last study drug administration or 12 months following the last dose of their PCD therapy, whichever is longer
Key Exclusion Criteria:
- Have any other form of amyloidosis other than AL amyloidosis
- Received prior therapy for AL amyloidosis or multiple myeloma. A maximum exposure of 2 weeks of a CyBorD-based PCD treatment after Screening laboratory samples are obtained and prior to randomization is allowed
Has POEMS (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes) syndrome or multiple myeloma defined as clonal bone marrow plasma cells > 10% from a bone marrow biopsy (performed ≤ 3 months prior to signing the ICF) or biopsy-proven (performed ≤ 3 months prior to signing the ICF) bony or extramedullary plasmacytoma AND one or more of the following CRAB features:
a. Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder (e.g., multiple myeloma and POEMS syndrome), specifically: i. Hypercalcemia: serum calcium > 0.25 mmol/L (> 1 mg/dL) higher than the ULN or > 2.75 mmol/L (> 11 mg/dL) OR ii. Renal insufficiency: creatinine clearance < 40 mL per minute or serum creatinine > 177 mol/L (> 2 mg/dL) OR iii. Anemia: hemoglobin value of > 20 g/L below the lowest limit of normal, or a hemoglobin value < 100 g/L OR iv. Bone lesions: one or more osteolytic lesion on imaging tests (performed ≤ 3 months prior to signing the ICF): skeletal radiography, CT, or PET/CT, or MRI. If bone marrow has < 10% clonal plasma cells, more than one bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement OR b. Any one of the following biomarkers of malignancy: i. 60% or greater clonal plasma cells on bone marrow examination OR ii. More than one focal lesion on MRI that is at least 5mm or greater in size
- Have supine systolic blood pressure < 90 mmHg or symptomatic orthostatic hypotension, defined as a decrease in systolic blood pressure upon standing of > 30 mmHg despite medical management (e.g., midodrine, fludrocortisones) in the absence of volume depletion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Placebo Comparator: Placebo combined with SoC plasma cell dyscrasia
Patients randomized to receive placebo will receive 0.9% normal saline in an equivalent volume to a CAEL-101 infusion (approximately 250 cc).
The minimum planned treatment time for each patient will be at least 50 weeks or until the patient's death.
It is planned that all patients will continue their double-blind treatment until the last patient completes at least 50 weeks of treatment.
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According to institutional standard of care.
Commercially available 0.9% Normal Saline will be used as the placebo.
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Experimental: CAEL-101 combined with SoC plasma cell dyscrasia
CAEL-101 is administered as an intravenous (IV) infusion over approximately 2 hours.
The minimum planned treatment time for each patient will be at least 50 weeks or until the patient's death.
It is planned that all patients will continue their double-blind treatment until the last patient completes at least 50 weeks of treatment.
The study is divided into 2 parts, the Primary Evaluation Treatment period part and the Open-Label Extension period of Study.
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The investigational product, CAEL-101, is formulated as a sterile liquid solution of protein plus excipients for dilution in a single-use, stoppered, glass vial.
Each 10 mL vial contains 300 mg of CAEL-101 at a concentration of 30 mg/mL.
CAEL-101 will be diluted with commercially available 0.9% Normal Saline.
According to institutional standard of care.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Time to All-cause Mortality or to the end of the PETP
Time Frame: Up to week 52
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Up to week 52
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Number of Participants with Treatment Emergent Adverse Events (TEAEs)
Time Frame: Up to week 52
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Up to week 52
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change from Baseline to week 50 in the Kansas City Cardiomyopathy Questionnaire-Overall Score (KCCQ-OS)
Time Frame: Baseline, Week 50
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A 23-item self-administered questionnaire that quantifies physical function, symptoms, social function, self-efficacy and knowledge and quality of life.
It requires an average of 4-6 minutes to complete and uses an ordinal, adjectival (Likert) scale
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Baseline, Week 50
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Change from Baseline to Week 50 in Cardiac Improvement by Global Longitudinal Strain (GLS%)
Time Frame: Baseline, Week 50
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To assess improvement in heart function as measured by percent Global Longitudinal Strain (GLS%).
GLS% is a non-invasive imaging technique to assess heart function where a higher/lower percentage is indicative of improvement.
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Baseline, Week 50
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Change from Baseline to Week 50 in distance walked (in meters) during a six-minute walk test (6MWT)
Time Frame: Baseline, Week 50
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Baseline, Week 50
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Change from Baseline to Week 50 the Short Form-36 (SF-36) v2 Physical Component Score (PCS)
Time Frame: Baseline, Week 50
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A self-administered questionnaire containing 36 items that measures health on functional status, well-being and overall evaluation of health in 8 domains.
It requires approximately 5 minutes to complete and uses scaled, ordinal responses (e.g., All of the time, Most of the time, A good bit of the time, etc.)
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Baseline, Week 50
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Measure of N-terminal pro b-type natriuretic peptide (NT-proBNP) in blood samples
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for NT-proBNP, comparing the subject's baseline value over time to assess improvement in the heart by reduced amyloidosis as measured by an increase or decrease in amyloidosis-related biomarkers: NT-proBNP.
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50 weeks
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Measure of Cardiac troponin (cTnT) in blood samples
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for cTnT, comparing the subject's baseline value over time to assess improvement in the heart by reduced amyloidosis as measured by changes in amyloidosis-related biomarkers: cTnT.
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50 weeks
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Measure of involved/uninvolved free light chain difference (dFLC)
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for dFLC, comparing the subject's baseline value over time to assess improvement in the heart by reduced amyloidosis as measured by changes in amyloidosis-related biomarkers: dFLC
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50 weeks
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Measure of C-reactive protein (CRP) in blood samples
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for CRP, comparing the subject's baseline value over time to assess improvement in the heart by reduced amyloidosis as measured by changes in amyloidosis-related biomarkers: CRP.
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50 weeks
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Measure of aspartate aminotransferase (AST)
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for AST to determine effects on liver function relative to normal values.
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50 weeks
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Measure of alanine aminotransferase (ALT)
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for ALT to determine effects on liver function relative to normal values.
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50 weeks
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Measure of alkaline phosphatase (ALP)
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for ALP to determine effects on liver function relative to normal values.
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50 weeks
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Measure of Kidney Glomerular Filtration Rate
Time Frame: 50 weeks
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For each subject, blood sample will be tested for creatine level that is used to calculate an estimate of how much blood filters through the kidney.
A glomeruli filtration rate above 60 mL/min is considered normal.
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50 weeks
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Measure of Serum Creatinine
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for creatinine to determine changes during treatment that reflect kidney function.
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50 weeks
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24-hour Urine Protein Measure
Time Frame: 50 weeks
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For each subject, urine samples will be collected over a period of 24 hours to determine how much protein is in your urine.
Increasing levels of protein suggest decreasing kidney function.
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50 weeks
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Quality of Life (QoL) by Short Form-36 (SF-36) v2 scaled domain scores
Time Frame: 50 weeks
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A self-administered questionnaire containing 36 items that measures health on functional status, well-being and overall evaluation of health in 8 domains.
It requires approximately 5 minutes to complete and uses scaled, ordinal responses (e.g., All of the time, Most of the time, A good bit of the time, etc.).
Changes in the different domains can help assess the benefit or challenges of the disease and your treatment.
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50 weeks
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EuroQual 5-dimension health survey (EQ-5D-5L™)
Time Frame: 50 weeks
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The EQ-5D-5L™ is a descriptive system assessing mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Patients are asked to indicate the status of each of the dimensions by selecting one of the three levels (no problems, some problems, and extreme problems).
The responses are compiled to create a 5-digit number that describe the patient's health state.
The EQ-5D-5L™ includes a visual analogue scale for the patient to rate their health that reflects the patient's judgement of their own health.
Changes in the different dimensions can help assess the benefit or challenges of the disease and your treatment.
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50 weeks
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Measure of Plasma Levels of CAEL-101
Time Frame: 50 weeks
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For each subject, blood sample will be assayed for the plasma levels of CAEL-101 to determine how much is in the blood and how long it stays in the blood.
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50 weeks
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Determination of immunogenicity of CAEL-101
Time Frame: 50 weeks
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The presence of anti-drug antibodies will be assayed and, if present, further evaluation will confirm positivity for anti-drug antibodies and determine specificity, neutralizing ability, cell-mediated immune response and correlation with clinical responses.
These data will help inform the overall treatment assessment.
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50 weeks
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Assessment of limitation during physical activity
Time Frame: 50 weeks
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Patients will be assessed for the NYHA Functional Classification.
The NYHA Functional Classification classifies patients in one of four categories based on their limitations during physical activity; the limitations/symptoms are in regard to normal breathing and varying degrees of shortness of breath and/or angina pain.
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50 weeks
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Collaborators and Investigators
Sponsor
Investigators
- Study Director: Scott Swenson, MD, Alexion, AstraZeneca Rare Disease
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Metabolic Diseases
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Hematologic Diseases
- Blood Protein Disorders
- Proteostasis Deficiencies
- Neoplasms, Plasma Cell
- Immunoglobulin Light-chain Amyloidosis
- Amyloidosis
- Paraproteinemias
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Dexamethasone
- Cyclophosphamide
- Bortezomib
Other Study ID Numbers
- CAEL101-301
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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