Low-Dose TBI Plus CAR T-Cell Therapy for Relapsed/Refractory DLBCL and Multiple Myeloma (Prime REMIX)

A Phase Ib, Dose-Escalation Study of Augmented Lymphodepletion and CAR T-cell Priming With Low-dose Total Body Irradiation in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphomas and Multiple Myeloma Receiving Treatment With Commercial CD19 or BCMA-directed CAR T-cell Therapies

This is a clinical trial to evaluate the safety of combining CAR T-cell therapy with low-dose total body irradiation (LD-TBI) in patients with previously treated large B-cell lymphoma (LBCL) or multiple myeloma (MM). The investigators' hypothesis is that the combination will make the immune system more active in fighting cancer by increasing the display of antigens and activating pathways that lead to cell death, including death receptors like FAS and TRAIL2. This approach is expected to help the CAR T cells grow and last longer, leading to stronger anti-tumor effects and more cancer cell deaths. Participants will receive LDTBI treatment before their CAR T cell therapy and will be followed up for 2 years.

Study Overview

Detailed Description

This is a single-center, open-label, non-randomized, Phase Ib trial evaluating dose escalation of low-dose total body irradiation (LD-TBI) combined with standard-of-care CAR T-cell therapy in patients with relapsed or refractory large B-cell lymphoma (LBCL) or multiple myeloma (MM). The study includes two disease-specific cohorts: Cohort 1 (LBCL) receives commercial CD19-directed CAR T-cell therapy (axicabtagene ciloleucel or lisocabtagene maraleucel), and Cohort 2 (MM) receives commercial BCMA-directed CAR T-cell therapy (ciltacabtagene autoleucel). In CAR T-cell therapy, T-cells are removed via apheresis, modified to target the tumor, and infused back into the patient after lymphodepleting chemotherapy. On the same day as CAR T-cell infusion, prior to infusion, patients receive a single dose of LD-TBI.

Each cohort follows a standard 3+3 dose-escalation design (Part 1) to identify the maximum tolerated dose (MTD) across three planned dose levels (0.5 Gy, 1.0 Gy starting dose, and 2.0 Gy), based on dose-limiting toxicities occurring within 28 days of treatment. Once the MTD is identified, an expansion cohort (Part 2) of up to 10 additional participants per cohort will be randomized 1:1 to the MTD or a dose level below it to further evaluate safety and activity. Approximately 16-22 participants are anticipated per disease cohort. Participants will be followed for up to 2 years after treatment.

Study Type

Interventional

Enrollment (Estimated)

32

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

For Diffuse Large B-Cell Lymphoma (DLBCL) Cohort:

  • Diagnosis of DLBCL that is refractory to first-line chemoimmunotherapy, relapses within 12 months of first-line chemoimmunotherapy, relapses after 12 months in a transplant-ineligible patient, or is relapsed/refractory after two or more lines of systemic therapy. Eligible histologies include DLBCL not otherwise specified, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from indolent lymphoma (follicular lymphoma, marginal zone lymphoma, or chronic lymphocytic leukemia)
  • Age ≥18 years
  • ECOG performance status ≤2
  • Measurable disease on PET/CT or CT per Lugano Criteria
  • Adequate organ function: ANC ≥1000 cells/mm³; platelet count ≥75,000 cells/mm³; creatinine clearance or eGFR ≥45 mL/min; total bilirubin ≤2.0x ULN; AST or ALT ≤3.0x ULN; left ventricular ejection fraction >40%

For Multiple Myeloma (MM) Cohort:

  • Relapsed or refractory multiple myeloma after ≥1 prior line of therapy, including a proteasome inhibitor and an immunomodulatory agent, with disease refractory to lenalidomide (progression within 60 days of last lenalidomide dose)
  • Age ≥18 years
  • ECOG performance status ≤2
  • Adequate organ function: ANC ≥1000 cells/mm³; platelet count ≥75,000 cells/mm³; creatinine clearance or eGFR ≥30 mL/min; total bilirubin ≤2.0x ULN; AST or ALT ≤3.0x ULN; left ventricular ejection fraction >40%

Exclusion Criteria:

For DLBCL Cohort:

  • History of previous total body irradiation
  • Prior CAR T-cell therapy
  • Clonal cytopenia of uncertain significance (CCUS)
  • Prior history of myeloid malignancies (MDS/AML or MPN), T-cell lymphoblastic lymphoma/leukemia, or B-cell acute lymphoblastic leukemia
  • Current or prior CNS involvement by lymphoma
  • Significant cardiovascular impairment (CHF greater than NYHA Class II, uncontrolled hypertension, unstable angina, MI or stroke within 6 months, or cardiac ventricular arrhythmia)
  • Decompensated cirrhosis
  • Active HIV, hepatitis B, or hepatitis C infection
  • Active uncontrolled systemic fungal, bacterial, or viral infection
  • Pregnancy

For MM Cohort:

  • History of previous total body irradiation
  • History of myelodysplastic syndrome, CCUS, or concurrent active hematological malignancy with bone marrow involvement
  • Active HIV, hepatitis B, or hepatitis C infection
  • Active uncontrolled systemic fungal, bacterial, or viral infection
  • Prior CAR T-cell therapy
  • Active or history of CNS myeloma or leptomeningeal infiltration
  • Pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Part 1: LBCL: Dose Level -1 (0.5 Gy)
Participants with relapsed/refractory LBCL receive lymphodepletion followed by LD-TBI 0.5 Gy on Day 0, ≥4 hours before infusion of commercial CD19-directed CAR T-cell therapy. Used if de-escalation from Dose Level 0 is required due to dose-limiting toxicity.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Liso-cel; Breyanzi
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Axi-cel; Yescarta
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Experimental: Part 1: LBCL: Dose Level 0 (1.0 Gy, Starting Dose)
Participants with relapsed/refractory LBCL receive lymphodepletion followed by LD-TBI 1.0 Gy (starting dose) on Day 0, ≥4 hours before infusion of commercial CD19-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Liso-cel; Breyanzi
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Axi-cel; Yescarta
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Experimental: Part 1: LBCL: Dose Level +1 (2.0 Gy)
Participants with relapsed/refractory LBCL receive lymphodepletion followed by LD-TBI 2.0 Gy on Day 0, ≥4 hours before infusion of commercial CD19-directed CAR T-cell therapy. Used if Dose Level 0 is tolerated.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Liso-cel; Breyanzi
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Axi-cel; Yescarta
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Experimental: Part 1: MM: Dose Level -1 (0.5 Gy)
Participants with relapsed/refractory multiple myeloma receive lymphodepletion followed by LD-TBI 0.5 Gy on Day 0, ≥4 hours before infusion of commercial BCMA-directed CAR T-cell therapy. Used if de-escalation from Dose Level 0 is required.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Alternative lymphodepleting chemotherapy given on Days -5 to -4, for participants receiving ciltacabtagene autoleucel.
Commercial BCMA-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Cilta-cel; Carvykti
Experimental: Part 1: MM: Dose Level 0 (1.0 Gy, Starting Dose)
Participants with relapsed/refractory multiple myeloma receive lymphodepletion followed by LD-TBI 1.0 Gy (starting dose) on Day 0, ≥4 hours before infusion of commercial BCMA-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Alternative lymphodepleting chemotherapy given on Days -5 to -4, for participants receiving ciltacabtagene autoleucel.
Commercial BCMA-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Cilta-cel; Carvykti
Experimental: Part 1: MM: Dose Level +1 (2.0 Gy)
Participants with relapsed/refractory multiple myeloma receive lymphodepletion followed by LD-TBI 2.0 Gy on Day 0, ≥4 hours before infusion of commercial BCMA-directed CAR T-cell therapy. Used if Dose Level 0 is tolerated.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Alternative lymphodepleting chemotherapy given on Days -5 to -4, for participants receiving ciltacabtagene autoleucel.
Commercial BCMA-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Cilta-cel; Carvykti
Experimental: Part 2: LBCL: Expansion Cohort at MTD
Expansion-cohort participants with relapsed/refractory LBCL are randomized 1:1 to LD-TBI at the MTD or one dose level below. This arm receives LD-TBI at the MTD (single dose, Day 0), preceded by lymphodepletion and followed ≥4 hours later by commercial CD19-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Liso-cel; Breyanzi
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Axi-cel; Yescarta
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Experimental: Part 2: LBCL: Expansion Cohort Below MTD
Expansion-cohort participants with relapsed/refractory LBCL are randomized 1:1 to LD-TBI at the MTD or one dose level below. This arm receives LD-TBI one dose level below the MTD (single dose, Day 0), preceded by lymphodepletion and followed ≥4 hours later by commercial CD19-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Liso-cel; Breyanzi
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Axi-cel; Yescarta
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Experimental: Part 2: MM: Expansion Cohort at MTD
Expansion-cohort participants with relapsed/refractory multiple myeloma are randomized 1:1 to LD-TBI at the MTD or one dose level below. This arm receives LD-TBI at the MTD (single dose, Day 0), preceded by lymphodepletion and followed ≥4 hours later by commercial BCMA-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Alternative lymphodepleting chemotherapy given on Days -5 to -4, for participants receiving ciltacabtagene autoleucel.
Commercial BCMA-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Cilta-cel; Carvykti
Experimental: Part 2: MM: Expansion Cohort Below MTD
Expansion-cohort participants with relapsed/refractory multiple myeloma are randomized 1:1 to LD-TBI at the MTD or one dose level below. This arm receives LD-TBI one dose level below the MTD (single dose, Day 0), preceded by lymphodepletion and followed ≥4 hours later by commercial BCMA-directed CAR T-cell therapy.
Lymphodepleting chemotherapy given in combination with fludarabine on Days -5 to -3.
Lymphodepleting chemotherapy given in combination with cyclophosphamide on Days -5 to -3.
A single dose of total body irradiation administered on Day 0, at least 4 hours before the start of CAR T-cell infusion. Dose level (0.5 Gy, 1.0 Gy, or 2.0 Gy) is determined by the assigned dose cohort.
Other Names:
  • LD-TBI; TBI
Alternative lymphodepleting chemotherapy given on Days -5 to -4, for participants receiving ciltacabtagene autoleucel.
Commercial BCMA-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
  • Cilta-cel; Carvykti

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of Dose-Limiting Toxicities (DLTs)
Time Frame: Through Day 28 post-CAR T cell infusion
This outcome measures the number of participants experiencing a dose-limiting toxicity (DLT) at each LD-TBI dose level, within 28 days following CAR T-cell infusion. This measure is used to assess the safety and tolerability of the treatment regimen across escalating radiation dose levels and to determine the maximum tolerated dose (MTD).
Through Day 28 post-CAR T cell infusion

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence and Severity of Cytokine Release Syndrome (CRS)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the number of participants experiencing CRS of any grade, and the maximum CRS grade (1-4) observed per participant, per ASTCT Consensus Criteria. This measure is used to assess the incidence and severity of this expected immune-related toxicity following combined LD-TBI and CAR T-cell therapy.
12 months post-LDTBI and CAR T cell therapy combination
Incidence and Severity of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the number of participants experiencing ICANS of any grade, and the maximum ICANS grade (1-4) observed per participant, per ASTCT Consensus Criteria. This measure is used to assess the incidence and severity of neurologic toxicity following combined LD-TBI and CAR T-cell therapy.
12 months post-LDTBI and CAR T cell therapy combination
Incidence and Severity of Immune Effector Cell-Associated Hemophagocytic Syndrome (IEC-HS)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the number of participants experiencing IEC-HS of any grade, and the maximum IEC-HS grade (1-5) observed per participant, per ASTCT criteria. This measure is used to assess the incidence and severity of this rare but serious immune-related toxicity.
12 months post-LDTBI and CAR T cell therapy combination
Incidence of Delayed Immune Effector Cell-Associated Hematotoxicity (ICAHT)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the number of participants experiencing delayed ICAHT, per EHA/EBMT consensus criteria. This measure is used to assess the incidence of prolonged blood count abnormalities following CAR T-cell therapy.
12 months post-LDTBI and CAR T cell therapy combination
Incidence and Severity of Treatment-Related Adverse Events
Time Frame: From Lymphodepletion (Day -5) through Day 360
This outcome measures the number of participants experiencing at least one treatment-related adverse event, summarized by event term and maximum CTCAE v5.0 grade (1-5) per participant. This measure is used to characterize the overall safety profile of combined LD-TBI and CAR T-cell therapy.
From Lymphodepletion (Day -5) through Day 360
Overall Response Rate (ORR)
Time Frame: At Days +30, +90, +180, and +365 post-CAR T-cell infusion
This outcome measures the counts and proportion of response to treatment for participants achieving a partial response (PR), VGPR (for MM only) and complete response (CR), per Lugano Criteria (LBCL) or IMWG criteria (MM). This measure is used to estimate the preliminary anti-tumor activity of combined LD-TBI and CAR T-cell therapy.
At Days +30, +90, +180, and +365 post-CAR T-cell infusion
Overall Survival (OS)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the probability of survival over time, estimated by the Kaplan-Meier method, from start of treatment to death from any cause. This measure is used to estimate the overall survival associated with combined LD-TBI and CAR T-cell therapy.
12 months post-LDTBI and CAR T cell therapy combination
Progression-Free Survival (PFS)
Time Frame: 12 months post-LDTBI and CAR T cell therapy combination
This outcome measures the probability of remaining free of disease progression over time, estimated by the Kaplan-Meier method, from start of treatment to disease progression or death from any cause, whichever occurs first. This measure is used to estimate the durability of disease control with combined LD-TBI and CAR T-cell therapy.
12 months post-LDTBI and CAR T cell therapy combination
Duration of Response (DoR)
Time Frame: Assessed throughout study follow-up (up to 2 years)
This outcome measures the median duration of response, estimated by the Kaplan-Meier method, from first documentation of complete or partial response until disease progression or relapse. This measure is used to estimate how durable a response to combined LD-TBI and CAR T-cell therapy is among participants who respond.
Assessed throughout study follow-up (up to 2 years)
Adverse Event of Interest
Time Frame: From CAR T-cell infusion (Day 0) through Day 360
This outcome measures the incidence of pre-specified adverse events of interest following combined LD-TBI and CAR T-cell therapy. Adverse events of interest include parkinsonism (in participants receiving ciltacabtagene autoleucel), prolonged cytopenias, infections after Day +28, and immune effector cell-associated hemophagocytic syndrome (IEC-HS).
From CAR T-cell infusion (Day 0) through Day 360

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Caitlin Gribbin, MD, Weill Medical College of Cornell University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 1, 2026

Primary Completion (Estimated)

August 1, 2028

Study Completion (Estimated)

August 31, 2033

Study Registration Dates

First Submitted

July 21, 2026

First Submitted That Met QC Criteria

July 21, 2026

First Posted (Actual)

July 24, 2026

Study Record Updates

Last Update Posted (Actual)

July 24, 2026

Last Update Submitted That Met QC Criteria

July 21, 2026

Last Verified

July 1, 2026

More Information

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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