不适合移植的大 B 细胞淋巴瘤二线使用 axicabtagene ciloleucel:ALYCANTE 最终分析
Second-line axicabtagene ciloleucel in large B-cell lymphoma ineligible for transplantation: ALYCANTE final analysis.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Gene Therapy After Frontline Chemotherapy in Treating Patients With AIDS-Related Non-Hodgkin Lymphoma
Gene Therapy After Frontline Chemotherapy in Treating Patients With AIDS-Related Non-Hodgkin Lymphoma
分数与星级只用于站内排序 —— 不代表疗效、安全性或个人适用性。
这是一项 I 期注册临床试验,评估细胞治疗用于非霍奇金淋巴瘤、淋巴瘤的疗效与安全性。当前状态:进行中(不再招募)。计划入组 3 例。试验地点:美国 · 杜阿尔特(共 1 个中心)。登记号:NCT01961063。
不限性别 · ≥ 18 Years 且 ≤ 65 Years
纳入标准: * 淋巴瘤确诊时或之前HIV-1血清阳性。 * Karnofsky体能状态评分≥70%。 * 活检证实NHL,包括浆母细胞性淋巴瘤和原发性渗出性淋巴瘤,但不包括T细胞淋巴瘤;组织学由City of Hope(COH)复核。霍奇金淋巴瘤化疗后缓解>1年的患者也可入组。 * NHL一线化疗结束后至少28天。 * NHL缓解不足1年者,须在入组前3个月内通过CT或PET-CT证实完全缓解。 * 无会妨碍遵守研究要求和随访的已确诊心理社会问题。 * 治疗前SGOT/SGPT≤机构ULN的2.5倍。 * 治疗前血清胆红素≤机构ULN的2.5倍;若异常被认为由蛋白酶抑制剂治疗导致,则总胆红素<4.5 mg/dL且直接胆红素≤0.3 mg/dL。 * 血清肌酐<机构ULN的2倍。 * 无有临床意义的心肌病或充血性心力衰竭。 * 心脏射血分数≥50%。 * 肺一氧化碳弥散能力(DLCO)≥预测值的50%。 * 有生育能力女性须在研究药物治疗前7天内血清或尿液妊娠试验阴性;有生育能力女性及其伴侣可能生育的男性须愿意使用医学有效避孕方式(如避孕药、避孕套或隔膜),并持续至造血干/祖细胞(HSPC)输注后1年。 * 若CD4计数<200个/μL,受试者须正在接受肺孢子菌肺炎预防方案,或同意开始该治疗。 基因修饰HSPC输注的附加纳入标准: * 完成非格司亭(G-CSF)/普乐沙福动员外周血祖细胞,并至少采集7.5×10^6个CD34+细胞/kg,足以制备2.5×10^6个CD34+细胞/kg备用细胞及研究产品。 * 研究产品须通过所有放行检测。 * 有生育能力的女性和男性须同意在入组前及研究参与期间结束后6个月内采取充分避孕措施(激素或屏障避孕,或禁欲)。如女性受试者在研究期间妊娠或怀疑妊娠,应立即告知主治医师。 * 所有受试者须能理解并愿意签署书面知情同意书。 排除标准: * 过去1年内发生AIDS相关机会性感染且治疗失败;由主要研究者个案判断。 * 活动性巨细胞病毒(CMV)视网膜炎或其他CMV相关器官功能障碍;既往CMV感染已治疗者不排除。 * HCV抗体阳性且HCV RNA阳性,或乙肝表面抗原阳性且HBV DNA阳性。 * 妊娠或哺乳期女性。 * 活动性CNS淋巴瘤、HIV相关脑病史、任何类型痴呆或过去12个月内癫痫发作。既往脑脊液细胞学阳性但经鞘内化疗转阴且缓解至少12个月者可入组。 * 任何HIV-1相关脑病史、任何类型痴呆、过去12个月内癫痫发作,或研究者认为无法直接提供知情同意;不得由法定监护人代为同意。 * 存在医学/身体禁忌证,或因其他原因无法采集HSPC。 * 存在未控制疾病,包括持续或活动性感染。 * 正在接受其他研究性药物,或同时接受生物治疗、化疗或放疗。 * 对与G-CSF/非格司亭(大肠杆菌生产细胞系)、普乐沙福或白消安具有相似化学或生物组成的化合物有过敏反应史。 * 除皮肤癌外存在其他活动性恶性肿瘤。 * 研究者认为可能无法遵守安全监测要求。
Inclusion Criteria: * HIV-1 seropositive at or before the time of lymphoma diagnosis * Karnofsky performance status \>= 70% * Biopsy proven NHL, including plasmablastic lymphoma and primary effusion lymphoma but not T-cell lymphoma; tissue histology will be reviewed at City of Hope (COH); patients who have been in remission for \> 1 year post Hodgkin's lymphoma chemotherapy are also considered eligible * \>= 28 days from completion of frontline chemotherapy for NHL * If remission status \< 1 year for NHL, complete remission documented by computed tomography (CT) or positron emission tomography (PET)-CT scan within 3 months of study entry * No diagnosed psychosocial conditions that would hinder study compliance and follow-up * Pretreatment serum glutamic oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT) =\< 2.5 x institutional upper limit of normal (ULN) * Pretreatment serum bilirubin =\< 2.5 x institutional ULN or - Total bilirubin \< 4.5 mg/dl with direct fraction =\< 0.3 mg/dl in patients for whom these abnormalities are felt to be due to protease inhibitor therapy * Serum creatinine \< 2 x the institutional ULN * Absence of clinically significant cardiomyopathy, congestive heart failure * Cardiac ejection fraction has to be \>= 50% * Spirometry diffusion capacity (diffusion capacity of the lung for carbon monoxide \[DLCO\]) \>= 50% * If the subject is female and of child-bearing potential, subject must have negative serum or urine pregnancy test within 7 days of treatment with research agent; men with partners of child-bearing potential and women of child-bearing potential must be willing to use medically effective birth control methods, e.g. contraceptive pill, condom, or diaphragm and continue this for one year post HSPC infusion * Subjects must be on a prophylactic regimen for Pneumocystis carinii pneumonia, or agree to begin such treatment, if the cluster of differentiation (CD)4 counts are \< 200 cells/uL SECONDARY ELIGIBILITY CRITERIA FOR GENE-MODIFIED HSPC INFUSION: * Subjects must complete the filgrastim (G-CSF)/plerixafor mobilization of peripheral blood progenitor cells and must have collected at least 7.5 x 10\^6 CD34+ cells/kg, sufficient for preparation of both, a back-up of 2.5 x 10\^6 CD34+ cells and the research product * Research product must pass all release tests * Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for six months following duration of study participation; should a woman become pregnant or suspect that she is pregnant while participating on the trial, she should inform her treating physician immediately * All subjects must have the ability to understand and the willingness to sign a written informed consent Exclusion Criteria: * Any AIDS-related opportunistic infection occurring within the past year and for which treatment has been unsuccessful would be considered exclusionary, but this is done on a case-by-case basis as determined by the principal investigator * Active cytomegalovirus (CMV) retinitis or other active CMV-related organ dysfunction; patients with a history of treated CMV infection are not excluded * Patients who are hepatitis C virus (HCV) antibody positive and HCV ribonucleic acid (RNA) or hepatitis B virus (HBV) surface antigen positive and HBV DNA positive * Pregnant or nursing women * Active central nervous system (CNS) lymphoma, history of HIV-associated encephalopathy; dementia of any kind; seizures in the past 12 months; patients with a history of positive cerebrospinal fluid cytology that has become negative with intrathecal chemotherapy and the patient has been in remission for at least 12 months are eligible * Any history of HIV-1 associated encephalopathy; dementia of any kind; seizures in the past 12 months; any perceived inability to directly provide informed consent (note: consent may not be obtained by means of a legal guardian) * Any medical or physical contraindication or any other inability to undergo HSPC collection * Patients should not have any uncontrolled illness including ongoing or active infection * Patients may not be receiving any other investigational agents, or concurrent biological, chemotherapy, or radiation therapy * History of allergic reactions attributed to compounds of similar chemical or biologic composition to G-CSF/filgrastim (Escherichia \[E\] coli producing cell line), plerixafor or busulfan * Patients with other active malignancies other than skin cancers are ineligible for this study * Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study will be considered non-compliant
以上为辅助阅读译文。是否适合入组须由主治医生判断,最终以登记平台与研究者确认为准。
主要终点:Procedure related toxicity as determined by adverse events (AE) grading scale using the Common Terminology Criteria for Adverse Events (CTCAE) version v4.03 · Tables will be created to summarize these toxicities and side effects by dose · Up to 5 years;Time to Absolute Neutrophil Count (ANC) >= 500/uL · First 28 days;Time to platelet recovery to >= 50,000/uL · First 90 days
次要终点:Evidence for and duration of vector-marked PBMC/marrow cells assessed by PCR;Expression of the RNA transgenes in lineage-specific progeny of the transduced cells assessed by PCR;Effect of ATI on HIV markers and CD4 count;Pharmacokinetic parameters of busulfan;Ability to obtain suitable numbers of transduced HSPC for engraftment assessed by FACS;Feasibility of product manufacturing as evidenced by product release assessed by release assays
患者于第-2天静脉输注白消安,输注时间3小时;随后于第0天静脉输注经慢病毒载体rHIV7-shI-TAR-CCR5RZ转导的造血祖细胞。
这项试点临床试验研究在一线化疗后给予基因治疗,治疗AIDS相关非霍奇金淋巴瘤(NHL)。将抗人类免疫缺陷病毒(HIV)RNA基因导入干细胞/祖细胞,可能促使机体产生针对AIDS的免疫应答。基因治疗前使用白消安,有助于基因修饰细胞植入并发挥作用。
This pilot clinical trial studies gene therapy after frontline chemotherapy in treating patients with acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (NHL). Placing genes for anti-human immunodeficiency virus (HIV) ribonucleic acid (RNA) into stem/progenitor cells may make the body build an immune response to AIDS. Giving the chemotherapy drug busulfan before gene therapy can help gene-modified cells engraft and work better.
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