CD19-BCMA Dual Nanobody Based CAR-T Cells for Patients With DSA

Clinical Trial of CD19-BCMA Dual Nanobody Based CAR-T Cells for Patients With Donor-specific Antibodies

This is an early-stage, open-label clinical study of CD19-BCMA dual nanobody based CAR-T Cell desensitization therapy for patients positive for Donor-Specific Antibodies. Enrolled subjects will participate in an early clinical study using the traditional "3+3" dose escalation design to determine the Maximum Tolerated Dose (MTD) of CAR-T cell infusion (i.e., three escalating dose levels: 0.5x10^6 CAR+ T cells/kg, 1x10^6 CAR+ T cells/kg, 2x10^6 CAR+ T cells/kg). The investigators and the sponsor will jointly form a Safety Review Committee (SRC). The final decision on whether to continue increasing the dose levels or to conduct an expansion study at a specific dose level will be based on the safety and efficacy data obtained from the three dose groups. Assessments will be performed every 4 weeks after cell infusion, with a total planned enrollment of 9-18 subjects.

Study Overview

• Status: Not yet recruiting
• Conditions: Transplantation Candidates With Hematological Diseases
• Intervention / Treatment: Biological: CD19-BCMA dual nanobody based CAR-T Cells

• Study Type: Interventional
• Enrollment (Estimated): 18
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Ying-Jun Chang; Phone Number: 86-13520536738; Email: rmcyj@bjmu.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. The subject or their legal guardian understands and voluntarily signs the Informed Consent Form (ICF).
2. Male or female, aged 3 years or older (inclusive) at the time of signing the ICF.
3. Expected survival period is not less than 12 weeks.
4. Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2 at the time of signing the ICF.

5. At the time of signing the ICF, the following must be satisfied:

   1. Meets the indications for allogeneic hematopoietic stem cell transplantation, is at a suitable stage for transplantation, and is planned to receive a haploidentical related donor allogeneic hematopoietic stem cell transplant.
   2. The patient has no available HLA-matched sibling donor, no other HLA-matched unrelated donor, and no related donor who is DSA-negative.
   3. The patient has a DSA level ≥5000 MFI.

6. Major organ function must meet the following requirements:

   1. Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 5 × Upper Limit of Normal (ULN).
   2. Total bilirubin ≤ 2 × ULN.
   3. For adult subjects: Creatinine clearance ≥ 60 mL/min (Cockcroft-Gault formula) OR Serum creatinine ≤ 1.5 × ULN.
   4. For pediatric subjects: Serum creatinine must not exceed: 1.2 mg/dL for ages 12-13; 1.5 mg/dL for males aged 13-16; 1.4 mg/dL for females aged >13; 1.7 mg/dL for males aged >16.
   5. HBV-DNA, HCV-RNA, Syphilis antibody, HIV antibody, CMV/EBV DNA must be negative; no active infection.
7. Oxygen saturation > 92%.
8. Men and women of childbearing potential must agree to use effective contraception from the time of signing the ICF until 2 years after administration of the study drug. Women of childbearing potential include premenopausal women and women within 2 years of menopause. A negative blood pregnancy test is required for women of childbearing potential at screening.

Exclusion Criteria:

1. History of central nervous system (CNS) diseases, including but not limited to epilepsy, paralysis, aphasia, stroke, severe brain injury, dementia, Parkinson's disease, neuropathy. Subjects with a history of conditions like lacunar infarction without related neurological symptoms before screening may be considered for exclusion based on the investigator's judgment.
2. Other severe, progressive, or uncontrolled gastrointestinal, urinary, endocrine, or respiratory diseases, deemed by the investigator as unsuitable for enrollment.
3. Participation in another clinical trial within 2 weeks prior to screening.
4. Other factors that may influence DSA levels: Received proteasome inhibitors or BTK inhibitors, rituximab, or other monoclonal antibodies targeting B cells or plasma cells (e.g., belimumab, telitacicept, daratumumab) within 2 weeks prior to signing the ICF.
5. Presence of any uncontrolled active infection at the time of signing the ICF or within 4 weeks prior to leukapheresis.
6. Positive HBsAg or positive HBcAb with detectable HBV DNA at screening; Positive HCV antibody with detectable HCV RNA at screening; Positive HIV antibody; Positive CMV DNA; Positive EBV DNA; Positive for both treponemal and non-treponemal syphilis antibodies.

7. Clinically significant cardiovascular diseases, including any of the following:

   1. QTc interval ≥ 480 ms (corrected using Fridericia's formula).
   2. New York Heart Association (NYHA) Class II or higher heart failure.
   3. Unstable angina or acute myocardial infarction within 6 months prior to signing the ICF.
   4. Left Ventricular Ejection Fraction (LVEF) < 50%.
   5. Poorly controlled hypertension (judged by the investigator based on the subject's individual condition).
   6. Clinically significant arrhythmias requiring antiarrhythmic treatment (e.g., sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes, complete left bundle branch block, etc.).
8. Allergy to any component of the drugs used in this study.
9. Received large-field radiotherapy within 4 weeks prior to signing the ICF, except for palliative radiotherapy for non-target lesions during the study period.

10. Requirement for systemic corticosteroids (at a dose equivalent to or higher than prednisone 10 mg/day) or other immunosuppressive drugs within 3 days prior to leukapheresis or anticipated during the study period, except for the following:

    1. Nasal, inhaled, topical steroids, or local steroid injections (e.g., intra-articular).
    2. Systemic corticosteroid therapy not exceeding prednisone 10 mg/day or an equivalent physiological dose.
    3. Steroids used as premedication for allergic reactions (e.g., pre-CT scan).
    4. Used for managing adverse reactions post-infusion.
11. Major surgical procedure within 4 weeks prior to signing the ICF (excluding routine biopsy surgery), or anticipated major surgery during the study period.
12. History of active tuberculosis infection within 1 year prior to signing the ICF (subjects with a history of active tuberculosis more than 1 year ago may be included if the investigator judges there is no current evidence of active tuberculosis).
13. Administration of live/attenuated or inactivated vaccines within 4 weeks prior to signing the ICF, or planned administration during the screening period.
14. Pregnant or lactating women.
15. Men or women who refuse to use contraception from the time of signing the ICF until 12 months after study completion.
16. History of alcohol abuse, drug abuse, or psychiatric history.
17. Any comorbidities or other conditions that, in the investigator's opinion, may affect protocol compliance or make the subject unsuitable for participation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patients with DSA	Biological: CD19-BCMA dual nanobody based CAR-T Cells; Desensitization

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
• Incidence and severity of AEs and SAEs within 1 month after cell infusion	The primary safety endpoint is the incidence and severity of adverse events (AEs) and serious adverse events (SAEs) occurring within 30 days post-cell infusion. All events will be graded for severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. The analysis will summarize the frequency, severity (maximum grade), duration, and causality (as assessed by the investigator) of all reported AEs and SAEs. Special emphasis will be placed on the incidence of Grade ≥3 AEs, treatment-related SAEs, and AEs leading to discontinuation or death, providing a comprehensive assessment of the acute safety profile of the investigational cell product.	From enrollment to the end of treatment at 4-5 weeks
• Incidence and severity of ICANS	The primary safety endpoint is the incidence and severity of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), will be graded using the standardized American Society for Transplantation and Cellular Therapy (ASTCT) consensus criteria.	From enrollment to the end of treatment at 4-5 weeks
Incidence and severity of ICAHT	The primary safety endpoint is the incidence and severity of immune effector cell-associated hematotoxicity (ICAHT), will be graded using European Hematology Association/European Society for Blood and Marrow Transplantation (EHA/EBMT) guidelines.	From enrollment to the end of treatment at 4-5 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
DSA seroconversion rate (≤ 2000 MFI) at 3 months post-infusion	DSA seroconversion rate (≤ 2000 MFI) at 3 months post-infusion	From enrollment to the end of treatment at 12 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Day 30 neutrophil engraftment rate	Neutrophil engraftment was defined as the first of three consecutive days with an absolute neutrophil count (ANC) of ≥0.5×109/L.	From Day 0 to Day 30 after transplantation
Day 100 platelet engraftment rate	Platelet recovery was defined as the first of three consecutive days with a platelet count of ≥20×109/L in the absence of platelet transfusion support for the preceding seven consecutive days.	From Day 0 to Day 100 after transplantation
Incidence of PGF	Poor graft function (PGF) was defined as the presence of at least two cytopenias (ANC ≤0.5×109/L, platelet count ≤20×109/L and/or Hb ≤80 g/L) beyond day +28 with a transfusion requirement associated with hypoplastic-aplastic bone marrow in the presence of complete donor chimerism.	From Day 0 to Day 365 after transplantation
Incidence of GR	Graft rejection (GR) was defined as a failure to achieve neutrophil engraftment (ANC ≤0.5×109/L) by day +28 for three consecutive days, along with an absence of donor hematopoiesis.	From Day 0 to Day 365 after transplantation
1-year Overall Survival	Defined as the time from cell infusion (or randomization) to death from any cause.	From Day 0 to Day 365 after transplantation
1-year Disease-Free Survival	Defined as the time from cell infusion to the first occurrence of either disease relapse (or progression) or death from any cause, whichever occurs first. Patients alive without evidence of disease are censored at the last assessment.	From Day 0 to Day 365 after transplantation
1-year Graft-versus-Host Disease	The cumulative incidence of acute GVHD (occurring within the first 100 days, graded I-IV by standard criteria) or chronic GVHD (occurring later, graded as mild, moderate, or severe per NIH consensus criteria).	From day 0 to day 365 after transplantation
1-year GVHD-Free, Relapse-Free Survival	It is defined as the time from infusion to the first occurrence of any of the following events: Grade III-IV acute GVHD, chronic GVHD requiring systemic immunosuppression, disease relapse, or death from any cause. Patients who survive without experiencing any of these events are considered event-free.	From day 0 to day 365 after transplantation

Collaborators and Investigators

• Sponsor: Chang Yingjun

Study record dates

Study Major Dates

• Study Start (Estimated): March 18, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: February 22, 2026
• First Submitted That Met QC Criteria: February 27, 2026
• First Posted (Actual): March 5, 2026

Study Record Updates

• Last Update Posted (Actual): March 6, 2026
• Last Update Submitted That Met QC Criteria: March 4, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Allogeneic hematopoietic stem cell transplantation; Donor-Specific Antibody (DSA) ≥5000 MFI; CD19-BCMA dual nanobody based CAR-T Cells; Patients with hematological diseases
• Other Study ID Numbers: 2025PHD029

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No