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APRIL CAR T Cells (AUTO2) Targeting BCMA and TACI for the Treatment of Multiple Myeloma (APRIL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03287804
Recruitment Status : Terminated (Preliminary efficacy seen to date following treatment with AUTO2 has been determined not sufficient to warrant further development)
First Posted : September 19, 2017
Results First Posted : October 23, 2020
Last Update Posted : October 23, 2020
Information provided by (Responsible Party):
Autolus Limited

Brief Summary:
The purpose of this study is to test the safety and efficacy of AUTO2, a CAR T Cell Treatment Targeting BCMA and TACI, in Patients with Relapsed or Refractory Multiple Myeloma.

Condition or disease Intervention/treatment Phase
Multiple Myeloma Biological: AUTO2 Phase 1 Phase 2

Detailed Description:
The study will consist of 2 phases, a Phase I/dose escalation phase and a Phase II/expansion phase. Patients with relapsed and relapsed or refractory multiple myeloma will be enrolled in both phases of the study. Eligible patients will undergo leukapheresis in order to harvest T cells, which is the starting material for the manufacture of the autologous CAR T product AUTO2. AUTO2 has a dual target BCMA (B cell maturation antigen) and TACI (Transmembrane activator and calcium modulator and cyclophilin ligand interactor). Following pre-conditioning by a chemotherapeutic regimen, the patient will receive AUTO2 intravenously as a single or split dose and will then enter a 12-month follow-up period.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 12 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Single-Arm, Open-Label, Multi-Centre, Phase I/II Study Evaluating the Safety and Clinical Activity of AUTO2, a CAR T Cell Treatment Targeting BCMA and TACI, in Patients With Relapsed or Refractory Multiple Myeloma
Actual Study Start Date : May 5, 2017
Actual Primary Completion Date : September 5, 2019
Actual Study Completion Date : September 5, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arm Intervention/treatment
Experimental: AUTO2
Relapsed or refractory Myeloma patients
Biological: AUTO2

AUTO2 (APRIL CAR T Cells) Following preconditioning with chemotherapy (cyclophosphamide and fludarabine) patients will be treated with doses from 15 x 10⁶ to 350 x 10⁶ APRIL CAR T Cells.

Following Phase 2 dose determination patients will be treated with selected dose of APRIL CAR T Cells

Primary Outcome Measures :
  1. Phase I - Number of Subjects With Grade 3 to 5 Toxicity During the Dose Limiting Toxicity (DLT) Period [ Time Frame: Up to 28 days post-infusion ]
  2. Phase I - Number of Subjects With a Dose Limiting Toxicity (DLT) [ Time Frame: Up to 28 days post-infusion ]

    Dose limiting toxicity was defined as:

    Any new non-hematological AE of Grade 3 or higher toxicity using the NCI CTCAE (Version 4.03), which is probably or definitely related to AUTO2 therapy, which occurs within the DLT evaluation period, and which fails to resolve to Grade 2 or better within 14 days, despite appropriate supportive measures; A Grade 4 CRS; Any other reason for activation of the safety switch after receiving AUTO2; Any other fatal event (Grade 5) or life-threatening event (Grade 4) that cannot be managed with conventional supportive measures or which in the opinion of the SEC necessitates dose reduction or other modification to trial treatment to avoid a similar hazard in future patients. Effort should be made to perform an autopsy in case of fatal event where the aetiology is unclear; Any event that in the opinion of treating investigators and/or Medical Monitor puts the patient at undue risk may also be considered a DLT.

  3. Number of Infused Patients With Best Overall Response [ Time Frame: Up to 2 years ]
    Best overall response was defined as stringent complete response + complete response + very good partial response + partial response following treatment with AUTO2. Response Criteria Per IMWG Consensus Recommendations

Secondary Outcome Measures :
  1. Proportion of Patients for Whom an AUTO2 Product Can be Generated [ Time Frame: Up to 2 years ]
    Feasibility of product generation was examined by assessing the number of AUTO2 successfully manufactured as a fraction of the number of patients undergoing leukapheresis (all patients registered).

  2. Clinical Benefit Rate [ Time Frame: Up to 2 years ]
    Number of subjects exhibiting stringent complete response, complete response, very good partial response, partial response or minor response following treatment with AUTO2

  3. Duration of Response [ Time Frame: Up to 2 years ]
    Calculated from the date of first observation of sCR, CR, VGPR or PR to the date of disease progression, relapse or death, for patients who were considered responders (achieved at least PR). Patients who had not progressed, relapsed or died will be censored at the last adequate disease assessment.

  4. Time to Disease Progression [ Time Frame: Up to 2 years ]
    Calculated from the date of AUTO2 treatment to the date of progression. Patients who had not progressed, relapsed or died without progression/relapse will be censored at the last adequate disease assessment.

  5. Progression-free Survival [ Time Frame: Up to 2 years ]
    Calculated from the date of AUTO2 treatment to the date of progression or death. Patients who have not progressed or relapsed was censored at the last adequate disease assessment

  6. Overall Survival [ Time Frame: Up to 2 years ]
    Descriptive analysis based on number of patients alive at database lock (1-May-2020).

  7. Number of Patients With Expansion Followed by Persistence of RQR8/APRIL CAR Positive T Cells in the Peripheral Blood [ Time Frame: Up to 2 years ]
    Expansion and persistence of RQR8/APRIL CAR positive T cells as determined by quantitative polymerase chain reaction and/or flow cytometry.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Key Inclusion Criteria:

  1. Male or female patients, aged ≥ 18.
  2. Willing and able to give written, informed consent.
  3. Confirmed diagnosis of MM.
  4. Measurable disease as defined by IMWG.
  5. Relapse or refractory disease and have had at least 3 different prior lines of therapy including proteasome inhibitor, alkylator and immunomodulatory therapy (IMiD), or have "double refractory" disease to a proteasome inhibitor and IMiD.
  6. For females of childbearing potential, a negative serum or urine pregnancy test must be documented at screening and confirmed before receiving study treatment.
  7. Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 1.
  8. Peripheral blood total lymphocyte count > 0.5 x 10⁹/L.

Key Exclusion Criteria:

  1. Women who are pregnant or lactating.
  2. Prior treatment with investigational or approved gene therapy or cell therapy products.
  3. Patient has previously received an allogenic stem cell transplant.
  4. Clinically significant, uncontrolled heart disease or a recent (within 6 months) cardiac event.
  5. Left Ventricular Ejection fraction < 50 unless the institutional lower limit of normal is lower.
  6. Significant liver disease: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 3 × ULN, or total bilirubin > 2.0 mg/dL or evidence of end stage liver disease (e.g. ascites, hepatic encephalopathy).
  7. Chronic renal impairment requiring dialysis, or calculated creatinine clearance < 30 mL/min
  8. Active infectious bacterial or viral disease (hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human T-lymphotropic virus or syphilis) requiring treatmenUse of rituximab within the last 3 months.
  9. Active autoimmune disease requiring immunosuppression.
  10. Received any anti-myeloma therapy within the last 21 days prior to preconditioning or 10 days prior to leukapheresis; steroids of up to 160 mg of dexamethasone are permitted so long as > 7 days post-dose prior to pre-conditioning or leukapheresis.
  11. Known allergy to albumin, dimethyl sulfoxide (DMSO), cyclophosphamide or fludarabine.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03287804

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VU University Medical Centre Amsterdam
Amsterdam, Netherlands
United Kingdom
University College London Hospitals NHS Foundation Trust
London, United Kingdom
The Christie NHS Foundation Trust
Manchester, United Kingdom, M20 4BX
Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust
Newcastle upon Tyne, United Kingdom
Sponsors and Collaborators
Autolus Limited
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Study Director: Autolus Limited Sponsor GmbH
  Study Documents (Full-Text)

Documents provided by Autolus Limited:
Study Protocol  [PDF] June 27, 2018
Statistical Analysis Plan  [PDF] April 21, 2020

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Responsible Party: Autolus Limited Identifier: NCT03287804    
Other Study ID Numbers: AUTO2-MM1
2016-003893-42 ( EudraCT Number )
First Posted: September 19, 2017    Key Record Dates
Results First Posted: October 23, 2020
Last Update Posted: October 23, 2020
Last Verified: September 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Autolus Limited:
Multiple Myeloma
Relapsed Multiple Myeloma
Refractory Multiple Myeloma
Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases