Study of PD-1Ab21-BCMA CAR-T Therapy for Consolidation of Multiple Myelomawith Renal Dysfunction

Exploratory Clinical Study on PD-1Ab21-BCMA CAR-T Cells (CD203) for First-line Consolidation Therapy of Multiple Myeloma With Renal Dysfunction

The purpose of this study is to determine the efficacy and safety of targeted BCMA CART cells secreting PD1 and interleukin 21 fusion protein immunotherapy for first-line consolidation therapy of multiple myeloma with renal dysfunction.

Study Overview

• Status: Recruiting
• Conditions: Multiple Myeloma
• Intervention / Treatment: Drug: PD-1Ab21-BCMA CAR-T cell immunotherapy

Detailed Description

Renal dysfunction is a poor prognostic factor for multiple myeloma（MM）. Compared with MM patients with normal renal function, MM patients with renal dysfunction have significantly reduced median overall survival. The clinical outcomes of MM patients with improved renal function after treatment have shown some improvement, but are still inferior to those of MM patients with normal renal function. Although renal dysfunction is not an absolute contraindication for autologous hematopoietic stem cell transplantation, the therapeutic effect is unsatisfactory. For MM patients with renal insufficiency, the dosage of transplant pre-treatment drugs should be reduced according to creatinine clearance rate, and renal insufficiency increases the incidence of transplant related toxic side effects such as mucositis, infections, and other complications. In recent years, CART cell therapy has achieved good therapeutic effects in MM patients with renal dysfunction.Xuzhou Medical University Affiliated Hospital has reported 7 patients with refractory or recurrent MM accompanied by severe renal dysfunction. These patients were treated with CART cell therapy targeting BCMA or in combination targeting CD19/BCMA, with 5 cases achieving complete remission and 2 cases achieving partial remission. It is worth noting that the renal remission rate reached 100%. The results from Tongji Hospital in Wuhan show that CART can significantly improve renal function in relapsed and refractory MM patients. In multiple myeloma with renal dysfunction, BCMA CART cell consolidation therapy after first-line induction therapy may achieve rapid and lasting hematological and renal remission.

Numerous studies have confirmed that the anti-tumor effect of T cells depends on their proliferation ability. The therapeutic effect of PD-1 antibody depends on the recovery of CD8+T cell function with proliferative ability, while terminal failure CD8+T cells lacking proliferative ability do not respond to PD-1 antibody treatment. In clinical trials of T cell therapy for solid tumors, IL-2 should be administered simultaneously with T cell infusion to promote T cell proliferation. There are also many research reports on CAR-T cells expressing and secreting various cytokines both domestically and internationally. The T cell cytokine IL-2/15/21 is the most effective T cell response enhancer, but due to its numerous target cells, it has significant side effects. This greatly limits their clinical application. To this end, we have established an immunotherapy strategy that targets tumor specific T cells with cytokines. The developed anti-PD-1 antibody and IL-21 fusion protein (PD-1Ab21) not only exert the therapeutic effect of PD-1 antibody, but also target PD-1 positive tumor specific T cells in vivo with IL-21, promoting the formation of memory T cells and greatly improving the effectiveness of tumor treatment. Based on the above research, we developed BCMA CAR-T cells (PD-1Ab21-BCMA CAR-T) expressing PD-1 single chain antibody and IL-21 fusion protein (PD-1Ab21). The supernatant of CAR-T cell culture contains high-level PD-1Ab21 fusion protein that can bind to PD-1 on the cell surface, block anti-PD-1 signaling, and enrich IL-21 on the surface of CAR-T cells, binding to its receptor. In preclinical mouse tumor model experiments, it has been confirmed that the therapeutic effect of PD-1Ab21-BCMA CAR-T cells is significantly better than that of ordinary BCMA CAR-T cells. A clinical trial initiated by researchers for the treatment of refractory/recurrent MM was conducted at the First Medical Center of the General Hospital of the People's Liberation Army. Ten patients have been treated, with six achieving complete remission (CR), including one relapse and three VGPR, including three extramedullary lesions. There are also three cases yet to be evaluated, demonstrating good therapeutic efficacy and safety.

This study plans to explore the effectiveness and safety of PD-1Ab21-BCMA CAR-T cell immunotherapy as first-line consolidation therapy for multiple myeloma with renal dysfunction after first-line induction therapy, in order to improve the prognosis of such patients and provide new treatment options for first-line consolidation therapy of multiple myeloma with renal dysfunction.

• Study Type: Interventional
• Enrollment (Estimated): 25
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Li-Ping Dou, Dr.; Phone Number: 86-010-66937232; Email: lipingruirui@163.com

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100853
      • Recruiting
      • Chinese PLA General Hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Age: Over 14 years old
2. Diagnosed with multiple myeloma accompanied by renal dysfunction, received ≥ 2 courses of clinical first-line treatment, evaluated efficacy above PR, and predicted survival of more than three months.

3. The hospital examination meets the following indicators:

   1. ECOG physical status score 0-2 or KPS score>80 points
   2. Having sufficient venous access for single or intravenous blood collection, and no other blood cells Separation contraindications
   3. WBC≥1×109/L，LY≥0.3×109/L，
   4. ALT and AST ≤ 2.5 ULN
   5. Serum total bilirubin ≤ 2.0mg/dL (34.2 μmol/L)
   6. PT:INR<1.7 or PT prolonged by<4s compared to normal value

Exclusion Criteria:

1. Pregnant or lactating women (the safety of this treatment for unborn babies is unknown, and the assessment of pregnancy status for female participants is negative in serum or urine pregnancy tests within 48 hours prior to infusion);
2. Any uncontrollable active infection;
3. Presence of active hepatitis B or C virus infection;
4. HIV/AIDS infection;
5. Has neurological disorders;
6. Within 2 weeks prior to signing the informed consent form, systemic use of steroid drugs (inhalable steroids may be used);
7. Allergies to immunotherapy and related drugs;
8. Currently, there are patients with heart disease or poorly controlled hypertension who require treatment;
9. Currently, patients with unstable or active ulcers or gastrointestinal bleeding;
10. Patients with a history of organ transplantation or waiting for organ transplantation;
11. Hyponatremia, blood sodium<125mmol/L;
12. Baseline blood potassium<3.5mmol/L (potassium can be supplemented before participating in the study to restore blood potassium levels above this level);
13. The patient needs anticoagulant therapy (such as warfarin or heparin);
14. The patient requires long-term antiplatelet therapy (aspirin, dose>300mg/d); Clopidogrel, dose>75mg/d).

Additionally,

1. Patients currently participating in other clinical trials;
2. Researchers believe that other reasons are not suitable for clinical trial participants.

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: multiple myeloma patients with renal dysfunction who accept PD- 1Ab21-BCMA CAR-T cell immunotherapy	Drug: PD-1Ab21-BCMA CAR-T cell immunotherapy; Consolidation therapy with PD-1 antibody and BCMA-targeting CAR-T in multiple myeloma patients with renal impairment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
1-year progression free survival rate (1-year-PFS)	The 1-year progression free survival rate (1-year-PFSR) of PD-1Ab21-BCMA CAR-T cell immunotherapy for first-line consolidation therapy of multiple myeloma with renal dysfunction refers to the proportion of disease progression that occurs within one year after treatment in patients.	1 year after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
overall survival (OS)	Overall survival (OS) refers to the time from the start of treatment to the death of the patient for any reason.	2 years after treatment
progression free survival (PFS)	Progression free survival (PFS) refers to the time from treatment to the first myeloma progression or death of the patient for any reason.	2 years after treatment
time to progression (TTP)	Time to progression (TTP) refers to the time from treatment to the first myeloma progression.	2 years after treatment
disease free survival (DFS)	Disease free survival (DFS) refers to the time from treatment to the first myeloma recurrence.	2 years after treatment
duration of response (DOR)	Duration of Response (DOR) refers to the time from the first assessment of a myeloma as a complete or partial response to the first assessment of PD (Progressive Disease) or death from any cause.	2 years after treatment
event free survival (EFS)	Event Free Survival (EFS) is a commonly used endpoint indicator in clinical trials to evaluate the survival time of patients without any adverse events during a specific time period. These adverse events include but are not limited to disease progression, death, treatment plan changes, and the occurrence of serious side effects.	2 years after treatment
recurrence rate	The recurrence rate refers to the proportion of patients with lymphoma recurrence after treatment.	2 years after treatment
safety	The safety of this PD-1Ab21-BCMA CAR-T immunotherapy.	2 years after treatment

Collaborators and Investigators

• Sponsor: Daihong Liu

Study record dates

Study Major Dates

• Study Start (Actual): September 29, 2025
• Primary Completion (Estimated): July 31, 2027
• Study Completion (Estimated): July 31, 2027

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 24, 2026

Study Record Updates

• Last Update Posted (Actual): March 24, 2026
• Last Update Submitted That Met QC Criteria: March 18, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: multiple myeloma; renal dysfunction; CART; fusion protein; consolidation therapy
• Additional Relevant MeSH Terms: Urogenital Diseases; Vascular Diseases; Cardiovascular Diseases; Neoplasms; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Immune System Diseases; Neoplasms by Histologic Type; Hematologic Diseases; Lymphoproliferative Disorders; Immunoproliferative Disorders; Neoplasms, Plasma Cell; Hemostatic Disorders; Paraproteinemias; Blood Protein Disorders; Hemorrhagic Disorders; Hemic and Lymphatic Diseases; Multiple Myeloma; Renal Insufficiency
• Other Study ID Numbers: S2025-670-01

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