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:A Study of JNJ-68284528, a Chimeric Antigen Receptor T Cell (CAR-T) Therapy Directed Against B-cell Maturation Antigen (BCMA) in Participants With Multiple Myeloma
这是一项 II 期注册临床试验,评估细胞治疗用于多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 208 例。试验地点:美国 · 圣迭戈、旧金山、纽黑文、坦帕(共 47 个中心)。登记号:NCT04133636。
不限性别 · ≥ 18 Years
纳入标准: * 队列A:既往接受过至少1线至最多3线治疗,包括蛋白酶体抑制剂(PI)和免疫调节治疗(IMiD),且根据国际骨髓瘤工作组(IMWG)指南判定为来那度胺难治 * 队列B:既往接受过一线治疗,包括PI和IMiD,且根据IMWG标准,接受自体干细胞移植(ASCT)后疾病进展时间小于或等于(<=)12个月,或未接受ASCT的受试者自抗骨髓瘤治疗开始起<=12个月出现疾病进展 * 队列C:既往接受过PI、IMiD、抗CD38单克隆抗体和B细胞成熟抗原(BCMA)靶向治疗 * 队列D:根据IMWG标准新诊断的多发性骨髓瘤,初始治疗(包括诱导治疗、大剂量治疗和ASCT,伴或不伴巩固治疗)总疗程为4至8个周期 * Cohort E:新诊断的多发性骨髓瘤且未经既往治疗(入组前接受过1个周期的既往治疗是可以接受的),并归类为高风险,定义为以下任一情况:1) 符合国际分期系统(ISS)III期标准,β2微球蛋白大于或等于(>=)5.5毫克/升(mg/L)(经本地或中心实验室评估),或 2) 至少20%(%)的总浆细胞群中存在高风险细胞遗传学特征 del(17/17p)、t(14;16)、t(14;20)、1q扩增(至少4个总拷贝) * Cohort F: * 受试者必须有记录的疗效反应达到非常好的部分缓解(VGPR)或更好,且入组前无疾病进展,依据IMWG 2016标准评估 * 接受过如下规定的初始治疗。所给药周期的剂量/方案将按照标准治疗执行。方案规定的方案中最多允许1个周期缺少所列药物中的一种(例如,因毒性而暂停)。可接受的联合方案包括:至少5至8个周期的初始治疗,使用daratumumab、bortezomib、lenalidomide和dexamethasone(D-VRd),所给药周期的剂量/方案将按照标准治疗执行;或至少4至8个周期的初始治疗,使用daratumumab、lenalidomide和dexamethasone(D-Rd);或至少4至8个周期的初始治疗,使用以carfilzomib为基础的三联或四联方案 * 仅限美国研究中心:Cohort G:因以下原因未考虑接受大剂量化疗联合自体干细胞移植(ASCT):a) 因高龄而不适合;或 b) 因存在可能对大剂量化疗联合ASCT的耐受性产生负面影响的合并症而不适合;或 c) 受试者拒绝将大剂量化疗联合ASCT作为初始治疗 * Cohorts A、B、C、E 和 Cohort G(仅限美国研究中心): * 血清单克隆副蛋白(M-protein)水平大于或等于(>=)1.0 克/分升(g/dL),或尿 M-protein 水平 >=200 毫克(mg)/24 小时 * 轻链型多发性骨髓瘤且仅能通过血清游离轻链(FLC)水平评估可测量疾病者:血清免疫球蛋白 FLC >=10 mg/dL 且血清免疫球蛋白 kappa/lambda FLC 比值异常 * 队列 A:对于血清和尿均无可测量疾病的受试者,可采用基线正电子发射断层扫描/计算机断层扫描(PET/CT)或全身磁共振成像(MRI)来满足可测量疾病标准。要求至少有一个病灶的双径测量至少为 1 厘米(cm)*1 cm * 队列 B、C:对于血清和尿均无可测量疾病的受试者,可采用基线正电子发射断层扫描/计算机断层扫描(PET/CT)或全身磁共振成像(MRI)来满足可测量疾病标准 * 队列 A、B、C、D、E、F 及队列 G(仅限美国研究中心):美国东部肿瘤协作组(ECOG)体能状态评分为 0 或 1 排除标准: * Cohorts A、B、D、F:任何靶向BCMA的治疗 * Cohorts A、B、C、D、F:既往接受过针对任何靶点的嵌合抗原受体T细胞(CAR-T)治疗 * Cohorts A、B、C、D、F: * 既往抗肿瘤治疗引起的持续性毒性必须恢复至基线水平或≤1级,脱发或周围神经病变除外 * 在单采前7天(Cohort A、B、C、F)或14天(Cohort D)内接受过相当于>=70 mg泼尼松的累积剂量皮质类固醇治疗 * 存在严重的潜在疾病,例如 (a) 有证据表明存在需要全身性抗微生物治疗的活动性病毒或细菌感染,或未控制的全身性真菌感染;(b) 活动性自身免疫性疾病或3年内有自身免疫性疾病史;(c) 有明显的痴呆或精神状态改变的临床证据;(d) 任何帕金森病或其他神经退行性疾病史 * Cohorts A、B、C、D、E、F:已知有活动性或既往有中枢神经系统(CNS)受累史,或表现出多发性骨髓瘤脑膜受累的临床体征 * Cohort F 和 Cohort G(仅限美国研究中心):除本研究正在治疗的疾病以外的活动性恶性肿瘤(即在过去24个月内进展或需要改变治疗)。唯一允许的例外包括:a) 过去24个月内接受治疗且被认为已完全治愈的非肌层浸润性膀胱癌;b) 过去24个月内接受治疗且被认为已完全治愈的皮肤癌(非黑色素瘤或黑色素瘤);c) 过去24个月内接受治疗且被认为已完全治愈的非浸润性宫颈癌;d) 局限性前列腺癌(N0M0):Gleason 评分大于或等于(=>)6,在过去24个月内接受治疗或未治疗且处于监测中,Gleason 评分为 3+4 且在全面研究筛选前6个多月已接受治疗并被认为复发风险极低,或有局限性前列腺癌病史并正在接受雄激素剥夺治疗且被认为复发风险极低;e) 乳腺癌:已充分治疗的导管原位癌或小叶原位癌,或有局限性乳腺癌病史并正在接受抗激素药物治疗且被认为复发风险极低;f) 被认为已治愈且复发风险极低的恶性肿瘤 * Cohort E 和 Cohort G(仅限美国研究中心):根据 Myeloma Geriatric Assessment 评分,衰弱指数 >= 2
Inclusion Criteria: * Cohort A: Received a minimum of 1 to a maximum of 3 prior lines of therapy including a proteasome inhibitor (PI) and immunomodulatory therapy (IMiD), and lenalidomide refractory per International Myeloma Working Group (IMWG) guidelines * Cohort B: Received one line of prior therapy including a PI and an IMiD, and disease progression per IMWG criteria less than or equal to (\<=) 12 months after treatment with autologous stem cell transplantation (ASCT) or \<=12 months from the start of anti-myeloma therapy for participants who have not had an ASCT * Cohort C: Previously treated with a PI, an IMiD, an anti-CD38 monoclonal antibody and B-cell maturation antigen (BCMA)-directed therapy * Cohort D: Newly diagnosed multiple myeloma per IMWG with a history of 4 to 8 total cycles of initial therapy, including induction, high-dose therapy, and ASCT with or without consolidation * Cohort E: Have newly diagnosed multiple myeloma without prior therapy (one cycle of prior therapy before enrollment is acceptable) and classified as high risk defined as either: 1) International Staging System (ISS) stage III criteria, Beta 2 microglobulin greater than or equal to (\>=) 5.5 milligrams per liter (mg/L) (via local or central laboratory assessment) or 2) high risk cytogenetic features del(17/17p), t (14;16), t(14;20), 1q amplification (at least 4 total copies) in at least 20 percent (%) of the total plasma cell population * Cohort F: * Participant must have a documented efficacy response of very good partial response (VGPR) or better, without progressive disease prior to enrollment, as assessed per IMWG 2016 criteria * Received initial therapy as specified below. The dose/schedule of cycles administered will be as per standard of care. It is acceptable for up to 1 cycle of the protocol-specified regimens to be missing one of the listed agents (example, held due to toxicity). Acceptable combinations include: At least 5 to 8 cycles of initial therapy with daratumumab, bortezomib, lenalidomide and dexamethasone (D-VRd). The dose/schedule of cycles administered will be as per standard of care or; at least 4 to 8 cycles of initial therapy with daratumumab, lenalidomide and dexamethasone (D-Rd) or; at least 4 to 8 cycles of initial therapy with a carfilzomib-based triplet or quadruplet regimen * For US sites only: Cohort G: Not considered for high-dose chemotherapy with autologous stem cell transplantation (ASCT) due to: a) Ineligibility due to advanced age; or b) Ineligibility due to presence of comorbid condition(s) likely to have a negative impact on tolerability of high-dose chemotherapy with ASCT; or c) Subject refusal of high-dose chemotherapy with ASCT as initial treatment * Cohorts A, B, C, E and Cohort G (for US sites only): * Serum monoclonal paraprotein (M-protein) level greater than or equal to (\>=) 1.0 gram per deciliter (g/dL) or urine M-protein level \>=200 milligrams (mg)/24 hours * Light chain multiple myeloma in whom only measurable disease is by serum free light chain (FLC) levels in the serum: Serum immunoglobulin FLC \>=10 mg/dL and abnormal serum immunoglobulin kappa lambda FLC ratio * Cohort A: For participants with neither serum nor urine measurable disease, baseline positron emission tomography/ computed tomography (PET/CT) or whole -body magnetic resonance imaging (MRI) may be used to satisfy the measurable disease criteria. A minimum of one lesion with a bi-dimensional measurement of at least 1 centimeter (cm)\*1 cm is required * Cohorts B, C: For participants with neither serum nor urine measurable disease, baseline positron emission tomography/ computed tomography (PET/CT) or whole body magnetic resonance imaging (MRI) may be used to satisfy the measurable disease criteria * Cohorts A, B, C, D, E, F and Cohort G (for US sites only): Eastern Cooperative Oncology Group (ECOG) performance status grade of 0 or 1 Exclusion Criteria: * Cohorts A, B, D, F: Any therapy that is targeted to BCMA * Cohorts A, B, C, D, F: Prior treatment with chimeric antigen receptor T (CAR-T) therapy directed at any target * Cohorts A, B, C, D, F: * Ongoing toxicity from previous anticancer therapy must resolve to baseline levels or to Grade 1 or less except for alopecia or peripheral neuropathy * Received a cumulative dose of corticosteroids equivalent to \>=70 mg of prednisone within the 7 days (Cohort A, B, C, F) or 14 days (Cohort D) prior to apheresis * Serious underlying medical condition, such as (a) evidence of active viral or bacterial infection requiring systemic antimicrobial therapy, or uncontrolled systemic fungal infection; (b) active autoimmune disease or a history of autoimmune disease within 3 years; (c) overt clinical evidence of dementia or altered mental status; (d) any history of Parkinson's disease or other neurodegenerative disorder * Cohorts A, B, C, D, E, F: Known active, or prior history of central nervous system (CNS) involvement or exhibits clinical signs of meningeal involvement of multiple myeloma * Cohort F and Cohort G (for US sites only): Active malignancies (that is, progressing or requiring treatment change in the last 24 months) other than the disease being treated under study. The only allowed exceptions are: a) non-muscle invasive bladder cancer treated within the last 24 months that is considered completely cured; b) skin cancer (non-melanoma or melanoma) treated within the last 24 months that is considered completely cured; c) non-invasive cervical cancer treated within the last 24 months that is considered completely cured; d) localized prostate cancer (N0M0): with a Gleason score of greater than or equal to (=\>)6, treated within the last 24 months or untreated and under surveillance, with a Gleason score of 3+4 that has been treated more than 6 months prior to full study screening and considered to have a very low risk of recurrence, or history of localized prostate cancer and receiving androgen deprivation therapy and considered to have a very low risk of recurrence, e) breast cancer: adequately treated lobular carcinoma in situ or ductal carcinoma in situ, or history of localized breast cancer and receiving antihormonal agents and considered to have a very low risk of recurrence; f) malignancy that is considered cured with minimal risk of recurrence * Cohort E and Cohort G (for US sites only): Frailty index of \>= 2 according to Myeloma Geriatric Assessment score
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:Cohorts A, B, C, D, E, and F: Percentage of Participants with Negative Minimal Residual Disease (MRD) · MRD negative rate is the percentage of participants who achieve MRD negative status by evaluation of bone marrow aspirate as defined by the International Myeloma Working Group (IMWG) criteria. · At least 1 year after JNJ-68284528 infusion on Day 1;For US sites only: Cohort G: Percentage of Participants with Sustained MRD Negative Complete Response (CR) · Sustained MRD-negative CR is defined as participants with CR or better who sustain MRD-negative status, as determined by next-generation sequencing (NGS) or next generation flowcytometry (NGF) with sensitivity of 10\^-5, for at least 12 months without any examination showing MRD positive status or progressive disease in between. · At least 1 year after JNJ-68284528 infusion on Day 1
次要终点:Overall Response Rate (ORR);Cohorts A, B, C, D, E, and F: VGPR or Better Rate;Cohorts A, B, C, D, E, and F: Clinical Benefit Rate (CBR);Duration of Response (DOR);Time to Response (TTR);Cohorts A, B, C, D, E, and F: MRD Negative Rate at 12 Months for Participants who Achieve a Complete Response (CR);Time to MRD Negativity;Duration of MRD Negativity
单组分配-淋巴细胞清除术后,A部分受试者接受JNJ-68284528单次输注:队列A(既往1-3线治疗后疾病进展)、队列B(一线治疗后早期复发)、队列C(PI、IMiD、抗CD38、抗BCMA治疗后复发/难治性多发性骨髓瘤)、队列D(一线ASCT治疗后未达CR,部分受试者将先接受JNJ-68284528随后接受来那度胺)、队列F(新诊断多发性骨髓瘤[NDMM],标准风险[国际分期系统I/II期]且已完成初始治疗);队列E(NDMM,未计划移植,高危疾病)将首先接受达雷妥尤单抗、硼替佐米、来那度胺和地塞米松四联诱导方案(D-VRd),然后进行淋巴细胞清除并输注JNJ-68284528,随后接受来那度胺巩固治疗。队列A、B、C、D、E和F的入组已关闭。仅限美国研究中心:B部分:队列G(NDMM,未计划移植)将接受达雷妥尤单抗、来那度胺和地塞米松治疗,随后接受cilta-cel。
本研究的目的是评估接受 JNJ-68284528 治疗的受试者的总体微小残留病(MRD)阴性率。
The purpose of this study is to evaluate the overall minimal residual disease (MRD) negative rate of participants who receive JNJ-68284528.
MEMBER ACCOUNT
登录成功会直接打开下一页。