BAFF‑R CAR T‑cell treatment for refractory neuroimmune diseases

Safety and Efficacy of BAFF-R CART for Refractory Neuroimmune Diseases

This trial will try personalized BAFF‑R CAR T cells to reduce disease activity in people with hard‑to‑treat conditions such as CIDP, NMOSD, myasthenia gravis, and inflammatory myopathies.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 27 (estimated)
• Ages: 18 Years to 60 Years
• Sex: All
• Sponsor: Tianjin Medical University General Hospital (Academic / other)
• Drugs / interventions: rituximab, tolizumab, eculizumab, CART, immunotherapy, chimeric antigen receptor
• Locations: 1 site (Tianjin, Tianjin Municipality)
• Trial ID: NCT07022197 on ClinicalTrials.gov

What this trial studies

This is a phase Ib/IIa open‑label, dose‑escalation and expansion trial administering autologous T cells engineered to express a CAR targeting the BAFF receptor. In Phase I three escalating dose levels will be given to establish the maximum tolerated dose, with about 12 patients per disease cohort; Phase II will expand each disease cohort to about 15 patients at the selected dose to characterize efficacy. Primary assessments include safety and tolerability in the first 4 weeks and recurrence rate at 52 weeks, with secondary measures of CAR T cell expansion, B cell/ASC depletion, disease scores, MRI lesion counts where applicable, and antibody titers. All treatment and follow‑up visits are conducted at the single trial site with serial blood and, when indicated, CSF or bone marrow sampling for pharmacodynamic analyses.

Who should consider this trial

Good fit: Ideal candidates are adults with CIDP, NMOSD, myasthenia gravis, or idiopathic inflammatory myopathies judged refractory—having poor symptom control despite three or more immunosuppressive drugs for over a year and multiple relapses in the prior 12–24 months.

Not a fit: Patients with active uncontrolled medical or psychiatric conditions, pregnancy, or other exclusionary risks such as severe organ dysfunction are unlikely to benefit or be eligible for this protocol.

Why it matters

Potential benefit: If successful, the treatment could durably reduce relapses by depleting pathogenic B cells and antibody‑producing cells in patients who have failed standard immunosuppression.

How similar studies have performed: Other B‑cell–targeting CAR‑T approaches (for example anti‑CD19) have shown promising results in some refractory autoimmune diseases, but BAFF‑R–targeted CAR‑T is a newer approach with limited clinical data to date.

Eligibility criteria

Inclusion Criteria:

1\. Assessed by the investigator as having a refractory neuroimmune disease;

Refractory neuroimmune diseases were defined as:

1. Poor symptom control on at least three immunosuppressive agents for more than one year;
2. Clinical evidence of at least two relapses within 12 months or three relapses within 24 months and one relapse within 12 months prior to screening.

2\. Male study participants must agree to use contraception during the treatment period for 1 year after receiving study treatment, and sperm donation is prohibited throughout the study period;

3\. In the case of females with childbearing potential, need to agree to use contraception during the treatment period and for at least 1 year after receiving study treatment. Participants must have a negative serum pregnancy test result at screening and a confirmed negative urine pregnancy test result prior to first CART treatment.

Exclusion Criteria:

1. Any medical or psychiatric condition that, in the opinion of the investigator, may jeopardize the study participant or affect the study participant's ability to participate in this study;
2. A history of drug or alcohol abuse within the 12 months prior to baseline, or any condition that in the opinion of the investigator is associated with poor adherence;
3. Women who are breastfeeding or pregnant, or who plan to become pregnant at any time during the 12-month time period following treatment with CART, or a history of spontaneous or induced abortion within 4 weeks prior to screening;
4. Study participants with a clinically relevant active infection (e.g., sepsis, pneumonia, or abscess) or serious infection (resulting in hospitalization or requiring antibiotic therapy) within 4 weeks prior to baseline;
5. The study participant has received a live attenuated vaccination within 8 weeks prior to baseline; or is scheduled to receive a live vaccination (including COVID-19 vaccine) within 8 weeks after treatment;
6. Study participants who have received prior treatment with rituximab within 6 months prior to baseline;
7. Study participants had received tolizumab, eculizumab within 3 months prior to baseline;
8. Study participants who have received intravenous human immunoglobulin, plasma exchange, undergone immunotherapy within 4 weeks prior to baseline;
9. Known concomitant serious underlying diseases, such as hepatic and renal impairment, hematologic disorders, previous severe cardiovascular disease, severe hypertension, diabetes mellitus, poor control of blood pressure and blood glucose;
10. Comorbid mental illness, suicidal ideation (affirmative answer (yes) to question 4 or question 5 of the Colombian Suicide Severity Rating Scale (C-SSRS) indicating a suicide attempt within the last 6 months);
11. Any of the following laboratory abnormalities during the screening period (a repeat measurement may be taken during the screening period prior to randomization to confirm results); (1) Elevated liver enzymes: aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> 3 times the upper limit of normal (ULN); (2) Total bilirubin \> 1.5 times the ULN; (3) Estimated glomerular filtration rate (eGFR) \<45 mL/min/1.73 m2; (4) CD19 + B cell count \<40 cells/µL;
12. Presence of a history of tuberculosis infection, high risk of acquired tuberculosis infection;
13. known immunodeficiency diseases, including human immunodeficiency virus (HIV) infection;
14. Viral hepatitis B surface antigen (HBsAg) positivity during the screening period;
15. Receiving blood transfusion therapy 4 weeks prior to baseline or during the screening period;
16. Any other condition that the investigator deems inappropriate for participation in the study.

Where this trial is running

Tianjin, Tianjin Municipality

• Tianjin Medical University General Hospital — Tianjin, Tianjin Municipality, China (Recruiting)

Study contacts

• Principal investigator: Qiang Liu, M.D.,Ph.D — Tianjin Medical University General Hospital
• Study coordinator: Qiang Liu, M.D.,Ph.D

Conditions Chronic Inflammatory Demyelinating Polyradiculoneuropathy; NMO Spectrum Disorder; Myasthenia Gravis; Idiopathic Inflammatory Myopathies