Naive HBI0101 CAR-T therapy for adults with relapsed or refractory multiple myeloma.

A Phase 1a/1b Open-Label Study With Dose Escalation and Expansion Phases to Evaluate Safety and Preliminary Efficacy of Naïve HBI0101 CART Therapy for the Treatment of Relapsed/Refractory Multiple Myeloma

This trial will try Naive HBI0101 CAR-T cell therapy to see if it is safe and helps adults whose multiple myeloma has come back or not responded to prior treatments.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Hadassah Medical Organization (Academic / other)
• Drugs / interventions: CART
• Locations: 1 site (Jerusalem)
• Trial ID: NCT07333430 on ClinicalTrials.gov

What this trial studies

This Phase 1a/1b open-label trial uses dose escalation followed by expansion cohorts to characterize safety and preliminary efficacy of Naive HBI0101 CAR-T in adults with relapsed/refractory multiple myeloma. Eligible participants must have measurable disease and typically have received at least three prior lines of therapy. Participants will undergo leukapheresis to collect T cells that are engineered to express the HBI0101 chimeric antigen receptor, receive protocol-specified lymphodepleting chemotherapy, and then be infused with escalating doses of the CAR-T product. Primary endpoints focus on safety and tolerability with secondary endpoints including response rates and duration of response, with treatment and follow-up conducted at Hadassah Medical Organization in Jerusalem.

Who should consider this trial

Good fit: Adults (≥18) with relapsed or refractory multiple myeloma, measurable disease at screening, and typically at least three prior lines of therapy are the intended candidates.

Not a fit: Patients who cannot undergo leukapheresis or lymphodepleting chemotherapy, have poor organ function or active infections, or whose disease is not measurable are unlikely to benefit.

Why it matters

Potential benefit: If successful, the therapy could induce deep and durable remissions for patients with relapsed or refractory multiple myeloma who have exhausted standard treatments.

How similar studies have performed: Other CAR-T therapies for multiple myeloma, particularly BCMA-targeted products, have produced high response rates and durable remissions in relapsed/refractory disease, so the approach is promising though this specific product is novel.

Eligibility criteria

Inclusion Criteria:

1. ≥18 years of age at the time of signing informed consent.
2. Voluntarily signed informed consent form.
3. Diagnosis of relapsed/refractory multiple myeloma (Parts 1a and 1b), with measurable disease at screening visit as follows:

   Multiple Myeloma (at least one of the criteria below):
   1. Serum M-protein greater or equal to 0.5 g/dL.
   2. Urine M-protein greater or equal to 200 mg/24 h.
   3. Serum free light chain (FLC) assay: involved FLC level greater or equal to 3 mg/dL (30 mg/L) provided serum FLC ratio is abnormal.
   4. A biopsy-proven evaluable plasmacytoma\*.
   5. Bone marrow plasma cells \> 10% of total bone marrow cells\*.
   6. Non secretory patient will be allowed provided they have measurable disease by PET-CT or bone marrow aspiration, as designated\*.

      * Results pre-dating the Screening visit by up to 28 days may be used to establish eligibility.
4. R/R MM subjects must have been exposed to at least three prior lines of therapy including the following agents:

   1. proteasome inhibitor
   2. immunomodulatory (IMiDs) agent
   3. anti-CD38 antibody
5. For part 1a: At least one of the following risk factors: a. Extra-medullary disease (EMD) - defined as a MM lesion that is not connected to a bone. b. previous exposure to an anti-BCMA therapy.
6. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2.
7. Women of child-bearing potential (WCBP), defined as a sexually mature woman who has not undergone a hysterectomy or tubal ligation or who has not been naturally postmenopausal for at least 24 consecutive months, must have a negative serum pregnancy test prior to treatment. All sexually active WCBP and all sexually active male subjects must agree to use effective methods of birth control throughout the study.
8. Recovery to ≤ Grade 2 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 3 neuropathy, and toxicities that are irreversible and not expected to interfere with study treatment or pose safety concerns, per investigator judgement.
9. Ability and willingness to adhere to the study visit schedule and all protocol requirements.
10. For subjects with relapsed multiple myeloma who have previously undergone allogenic stem cell transplantation: no evidence of graft versus host disease after cessation of any immunosuppressive therapy for at least one month before recruitment to the study.

Exclusion Criteria:

1. Contraindication to a study treatment/procedure or is anticipated to receive treatment/procedure that may preclude performance of study procedures.
2. Known bulky central nervous system disease.
3. Inadequate hepatic function defined by aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) \> 2.5 x upper limit of normal (ULN) and/or direct bilirubin \> 4x ULN.
4. Inadequate renal function defined by estimated clearance of \<20(ml/min).
5. International ratio (INR) or partial thromboplastin time (PTT) \> 2 x ULN, unless on a stable dose of anticoagulant for a thromboembolic event (provided this event is not an exclusion criteria).
6. Inadequate bone marrow function defined by absolute neutrophil count (ANC) \< 1000 cells/mm3, platelet count \< 30,000 mm3, or hemoglobin \< 8 g/dL. Subjects with absolute lymphocyte count \< 300 cells/mm3 may be excluded (due to potential challenges with producing CART), per investigator judgement.
7. Left ventricular ejection fraction \< 40%.
8. Ongoing treatment with chronic immunosuppressant such as cyclosporine or systemic steroids (physiological replacement doses of steroids are allowed up to 12 mg/m2/d hydrocortisone or equivalent)
9. Significant co-morbid condition or disease which in the judgment of the Investigator would place the subject at undue risk or interfere with the study; examples include, but are not limited to, cirrhotic liver disease, sepsis, recent significant traumatic injury, and other conditions.
10. Known human immunodeficiency virus (HIV) positive status.
11. Active Hepatitis B active infection (defined as HBS-antigen and HBV DNA positive) or Hepatitis C active infection (defined as anti-HCV and HCV RNA positive).
12. Active CMV infection.
13. Known history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia requiring medication or mechanical control within 3 months.
14. Chronic atrial fibrillation with uncontrolled heart rate.
15. Second primary malignancy that has required therapy in the last 2 years or is not in complete remission. This exclusion criterion does not exclude the following subjects: successfully treated non- metastatic basal cell or squamous cell skin carcinoma, or prostate cancer under control with hormonal therapy
16. Subjects who have had a venous thromboembolic event (e.g., pulmonary embolism or deep vein thrombosis) requiring anticoagulation and who meet any of the following criteria:

    1. Have been on a stable dose of anticoagulation for \< 1 month (except for acute line insertion induced thrombosis.
    2. Have had a Grade 2, 3, or 4 hemorrhage in the last 30 days
    3. Are experiencing continued symptoms from their venous thromboembolic event (e.g. continued dyspnea or oxygen requirement).
17. Pregnant or lactating women.

Where this trial is running

Jerusalem

• Hadassah MO, Jerusalem, 9574869 — Jerusalem, Israel (Recruiting)

Study contacts

• Study coordinator: Polina Stepensky, MD

Conditions Relapsed/Refractory Multiple Myeloma; Multiple Myeloma