Using CAR-T cells to treat children with severe ANCA-Associated Vasculitis

Study of Therapeutic Efficacy of Anti-CD19 CAR-T Cells in Children With Refractory ANCA-Associated Vasculitis

This study is testing if a new treatment using CAR-T cells can help children with severe ANCA-Associated Vasculitis who haven’t responded to other therapies.

Quick facts

• Study type: Observational
• Enrollment: 12 (estimated)
• Ages: 5 Years to 25 Years
• Sex: All
• Sponsor: The Children's Hospital of Zhejiang University School of Medicine (Academic / other)
• Drugs / interventions: rituximab, beliuzumab, CAR-T, CAR T, methotrexate, cyclophosphamide
• Locations: 1 site (Hangzhou, Zhejiang)
• Trial ID: NCT06508346 on ClinicalTrials.gov

What this trial studies

This observational trial investigates the safety and efficacy of anti-CD19 CAR-T cells in children aged 5-25 with refractory ANCA-Associated Vasculitis (AAV). The study aims to provide a potential curative treatment for AAV, which currently relies on lifelong immunosuppressive therapies that often fail to achieve sustained remission. Participants will be selected based on specific criteria, including previous treatment failures and severity of their condition. The trial is being conducted at The Children's Hospital of Zhejiang University School of Medicine and aims to assess the therapeutic potential of CAR-T cell therapy in this vulnerable population.

Who should consider this trial

Good fit: Ideal candidates are children and young adults aged 5-25 who have been diagnosed with refractory ANCA-Associated Vasculitis and have not responded to standard treatments.

Not a fit: Patients who have not been diagnosed with ANCA-Associated Vasculitis or those who have not undergone prior treatments may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a curative option for children suffering from refractory AAV, significantly improving their quality of life.

How similar studies have performed: While CAR-T cell therapy has shown promise in treating autoimmune diseases, this specific application for AAV is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

1. Age:5-25 years old(including threshold);
2. Diagnosed with AAV according to the 2022EULAR/ACR AAV classification criteria；despite of the Treatment with glucocorticoids (more than 1mg/kg/ day), cyclophosphamide, and rituximab for at least 3 months, still cannot achieve sustained response or disease recurred after response; Or use glucocorticoid combined with cyclophosphamide/rituximab plus more than one of the other immunosuppressants (including azathioprine, moxophenolate, methotrexate, leflunomide, tacrolimus, cyclosporine, beliuzumab, etc.) ≥3months，still failed to achieve sustained remission or relapsed after remission; Or meet the diagnostic criteria for severe vasculitis, clinical routine treatment is ineffective, the benefit is judged by the investigator to outweigh the risk, and the patient or guardian has fully informed consent, can be considered for inclusion。
3. patient \<18 years old：PVAS≥15（total 63）；≥18 years old: BVAS≥15(total 63)
4. The functions of important organs are basically normal: Cardiac function: Left ventricular ejection fraction (LVEF) ≥55% with no obvious abnormality in electrocardiogram; Renal function: eGFR≥30ML/min/1.73m2； Liver function: Asparagus cochinchinensis transase (AST) and Alanine Aminotransferase (ALT)≤3.0 ULN, Total Bilirubin (TBIL) in serum ≤2.0×ULN; Lung function: No serious lung lesions, SpO2≥92%;
5. Met the standards of leukapheresis or intravenous blood collection, No contraindication for cell collection;
6. Negative pregnancy test for female Subjects of childbearing age, agree to take effective contraceptive measures the first year after CAR-T infusion;
7. Participants or their guardians agrees to participate in the clinical trial and sign the informed consent form which indicating that he/she understands the purpose and procedure of the clinical trial and is willing to participate in the study.

Exclusion Criteria:

1. Received CAR T cell therapy previously;
2. Central nervous system (CNS) disease: CNS neurolupus requires intervention within 60 days);
3. Pulmonary hemorrhage that need for pulmonary ventilation support for more than 1 week;
4. Have a history of congenital heart disease or acute myocardial infarction within 6 months prior to screening; Or severe arrhythmias (including multisource frequent supraventricular tachycardia, ventricular tachycardia, etc.); Or combined with moderate to massive pericardial effusion, serious myocarditis, etc; Or patients with unstable vital signs who need hypertensive drugs；
5. Suffer from other diseases that require long-term use of glucocorticoid or high-dose of immunosuppressive agents;
6. Uncontrollable infection, or active infection that requires systemic treatment within 1 week prior to screening；
7. History of organ transplantation or hematopoietic stem cell transplantation, or ≥Grade 2 GVHD within 2 weeks prior to screening；
8. Hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive and peripheral blood hepatitis B virus (HBV) DNA titer greater than the normal reference value range; Or hepatitis C virus (HCV) antibody positive and peripheral blood hepatitis C virus (HCV) RNA titer greater than the normal reference value range; Or positive for human immunodeficiency virus (HIV) antibodies; Or syphilis test positive; Or cytomegalovirus (CMV) DNA test positive;
9. Received live vaccine within 4 weeks before screening;
10. Tested positive in Blood pregnancy test；
11. Previous or concurrent malignancy；
12. Patients who participated in other clinical study within 3 months prior to enrollment;
13. Any other conditions that the investigators deem it unsuitable for the study

Where this trial is running

Hangzhou, Zhejiang

• Children's Hospital, Zhejiang University School of Medicine — Hangzhou, Zhejiang, China (Recruiting)

Study contacts

• Principal investigator: Jianhua Mao, PhD — The Children's Hospital of Zhejiang University School of Medicine
• Study coordinator: Jianhua Mao, PhD

Conditions ANCA Associated Vasculitis; CAR-T Cell Therapy; AAV; CAR-T cell therapy