- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT07725406
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
Study Overview
Status
Conditions
Intervention / Treatment
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
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Nicole Santos, MPH
- Phone Number: 646-962-6827
- Email: nis7058@med.cornell.edu
Study Contact Backup
- Name: Caitlin Gribbin, MD
- Phone Number: 646-962-7950
- Email: ckg2001@med.cornell.edu
Study Locations
-
-
New York
-
New York, New York, United States, 10065
- Weill Cornell Medicine/NewYork-Presbyterian Hospital
-
Contact:
- Nicole Santos, MPH
- Phone Number: 646-962-6827
- Email: nis7058@med.cornell.edu
-
Contact:
- Caitlin K. Gribbin, MD
- Email: ckg2001@med.cornell.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
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
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:
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
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:
|
|
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:
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
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:
|
|
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:
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
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:
|
|
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:
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:
|
|
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:
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:
|
|
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:
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:
|
|
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:
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
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:
|
|
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:
Commercial CD19-directed CAR T-cell therapy administered intravenously on Day 0, at least 4 hours after completion of LD-TBI.
Other Names:
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:
|
|
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:
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:
|
|
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:
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:
|
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
Investigators
- Principal Investigator: Caitlin Gribbin, MD, Weill Medical College of Cornell University
Study record dates
Study Major Dates
Study Start (Estimated)
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
Additional Relevant MeSH Terms
- Vascular Diseases
- Cardiovascular Diseases
- Pathologic Processes
- Neoplasms
- Disease Attributes
- Immune System Diseases
- Neoplasms by Histologic Type
- Hematologic Diseases
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Lymphoma, Non-Hodgkin
- Lymphoma, B-Cell
- Lymphoma
- Neoplasms, Plasma Cell
- Hemostatic Disorders
- Paraproteinemias
- Blood Protein Disorders
- Hemorrhagic Disorders
- Pathological Conditions, Signs and Symptoms
- Hemic and Lymphatic Diseases
- Recurrence
- Lymphoma, Large B-Cell, Diffuse
- Multiple Myeloma
- Investigative Techniques
- Therapeutics
- Radiotherapy
- Whole-Body Irradiation
- axicabtagene ciloleucel
Other Study ID Numbers
- 23-10026672
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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