决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:CD19-specific CAR T Cells With a Fully Human Binding Domain for CD19+ Leukemia or Lymphoma
CD19-specific CAR T Cells With a Fully Human Binding Domain for CD19+ Leukemia or 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。
⚠ 该试验的登记信息已有 14 个月未更新, 页面上显示的「进行中(不再招募)」可能已经失效。联系研究中心之前,建议先到 ClinicalTrials.gov 核对登记原文的最新状态与联系方式。
这是一项 I 期注册临床试验,评估细胞治疗用于白血病、淋巴瘤的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 16 例。试验地点:美国 · 洛杉矶、西雅图(共 2 个中心)。登记号:NCT03684889。
不限性别 · ≥ 1 Year 且 ≤ 30 Years
纳入标准 • 男性或女性,年龄≥1岁且≤30岁。 • 前2名入组受试者:年龄≥18岁且≤30岁。 • 疾病要求: • Ⅰ期:既往接受CAR-T 细胞免疫治疗后,CD19阳性白血病或淋巴瘤仍难治或复发; • Ⅱ期:CD19阳性白血病或淋巴瘤难治或复发。 • 能够耐受白细胞单采,或已有足够的单采产品/T细胞用于制备研究用产品。 • 预期寿命≥8周。 • 适用时,Lansky或Karnofsky评分≥50分。 • 已从既往化疗、免疫治疗及放疗的急性毒性中恢复;如受试者已有可用且符合CAR-T 制备要求的单采产品,则不受此项限制。 • 末次化疗和生物治疗后至少7天;鞘内化疗及维持化疗除外。 • 既往未接受病毒治疗。 • 末次糖皮质激素治疗后至少7天。 • 末次酪氨酸激酶抑制剂(TKI)治疗后至少3天。 • 末次羟基脲治疗后至少1天。 • 距最近一次CAR-T 细胞输注至少30天。 • 器官功能符合要求。 • 实验室检查指标符合要求,包括淋巴细胞绝对计数≥100个/μL。 • 有生育能力/可能使他人受孕的受试者须同意从签署同意书起至研究用产品输注后12个月内使用高效避孕措施。 • 受试者和/或其法定授权代表已签署本研究知情同意书。 排除标准 • 除本研究所针对疾病外,存在活动性恶性肿瘤。 • 有症状的CNS病变史或当前存在有症状的CNS病变。 • 白血病或淋巴瘤累及CNS并出现症状,且研究者认为在入组至CAR-T 输注期间无法控制。 • 存在活动性GVHD,或入组前4周内接受GVHD治疗/预防性免疫抑制治疗。 • 存在活动性重症感染。 • 存在原发性免疫缺陷综合征。 • 既往接受过病毒治疗。 • 妊娠或哺乳期。 • 受试者和/或其法定授权代表不愿为接受CAR-T 治疗后所要求的15年随访提供同意/同意参与。 • 研究者认为会妨碍患者接受本方案治疗的任何状况。
Inclusion Criteria: * Male and female subjects age ≥ 1 and ≤ 30 years * First 2 enrolled subjects: age ≥ 18 and ≤ 30 years * Disease requirements: * Phase 1: Evidence of refractory or recurrent CD19+ leukemia or lymphoma following previous CAR T cell immunotherapy * Phase 2: Evidence of refractory or recurrent CD19+ leukemia or lymphoma * Able to tolerate apheresis, or has sufficient existing apheresis product or T cells for manufacturing investigational product * Life expectancy ≥ 8 weeks * Lansky or Karnofsky, as applicable, score ≥ 50 * Recovered from acute toxic effects of all prior chemotherapy, immunotherapy, and radiotherapy, if the subject does not have a previously obtained apheresis product that is acceptable and available for manufacturing of CAR T cells * ≥ 7 days post last chemotherapy and biologic therapy, with the exception of intrathecal chemotherapy and maintenance chemotherapy * No prior virotherapy * ≥ 7 days post last corticosteroid therapy * ≥ 3 days post Tyrosine Kinase Inhibitor (TKI) use * ≥ 1 day post hydroxyurea * 30 days post most recent CAR T cell infusion * Adequate organ function * Adequate laboratory values, including absolute lymphocyte count ≥ 100 cells/uL * Subjects of childbearing or child-fathering potential must agree to use highly effective contraception from consent through 12 months following infusion of investigational product on trial * Subject and/or legally authorized representative has signed the informed consent form for this study Exclusion Criteria: * Presence of active malignancy other than disease under study * History of symptomatic CNS pathology or ongoing symptomatic CNS pathology * CNS involvement of leukemia or lymphoma that is symptomatic and in the opinion of the investigator, cannot be controlled during the interval between enrollment and CAR T cell infusion * Presence of active GVHD, or receiving immunosuppressive therapy for treatment or prevention of GVHD within 4 weeks prior to enrollment * Presence of active severe infection * Presence of primary immunodeficiency syndrome * Subject has received prior virotherapy * Pregnant or breastfeeding * Subject and/or legally authorized representative unwilling to provide consent/assent for participation in the 15-year follow up period, required if CAR T cell therapy is administered * Presence of any condition that, in the opinion of the investigator, would prohibit the patient from undergoing treatment under this protocol
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:The adverse events associated with CAR T cell product infusions will be assessed · The type, frequency, severity, and duration of adverse events will be summarized · 30 days;The leukemia response to SCRI-huCAR19 in subjects with relapsed or refractory CD19+ leukemia will be assessed · Response will be defined by standard bone marrow assessment and standard response criteria · 63 days
患者将在Ⅰ期或Ⅱ期部分接受SCRI-huCAR19v2治疗。
患者将在Ⅰ期或Ⅱ期部分接受SCRI-huCAR19v1治疗。本研究队列自2020年2月13日起永久关闭。
复发/难治性白血病或淋巴瘤患者常对后续化疗无应答。本研究拟使用直接从患者体内获取的T细胞,并通过基因工程改造,使其表达全人源嵌合抗原受体(CAR)。本研究CAR可识别CD19,该蛋白表达于白血病和淋巴瘤细胞表面。全人源CAR可能有助于减少CAR-T 细胞被排斥,进而带来对疾病复发的持久保护。本研究Ⅰ期部分将确定CAR-T 细胞的安全性,Ⅱ期部分将评估该疗法的有效性。既往未接受过CAR-T 治疗的患者和曾接受过CAR-T 治疗的患者均可能符合入组条件。
Patients with relapsed or refractory leukemia or lymphoma are often refractory to further chemotherapy. In this study, the investigators will attempt to use T cells obtained directly from the patient, which can be genetically engineered to express a fully human chimeric antigen receptor (CAR). The CAR used in this study can recognize CD19, a protein expressed on the surface of leukemia and lymphoma cells. The fully human CAR used in this study may help protect against rejection of the CAR T cells, which in turn could lead to lasting protection against return of the leukemia or lymphoma. The phase 1 part of this study will determine the safety of these CAR T cells, and the phase 2 part of the study will determine how effective this CAR T cell therapy is. Both patients who have never had prior CAR T cell therapy and those who have had prior CAR T cell therapy may be eligible to participate in this study.
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