英文原题:TCR Alpha Beta T-cell Depleted Haploidentical HCT in the Treatment of Primary Immunodeficiency and Inherited Metabolic Disorders in Children
TCR Alpha Beta T-cell Depleted Haploidentical HCT in the Treatment of Primary Immunodeficiency and Inherited Metabolic Disorders in Children
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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:招募中。计划入组 17 例。试验地点:美国 · 圣彼得堡(共 1 个中心)。登记号:NCT04414046。
不限性别 · ≤ 21 Years
纳入标准: 1. 患者患有原发性免疫缺陷/免疫失调性疾病,表现为免疫功能异常、造血异常、全身或器官特异性自身免疫,和/或非恶性淋巴增殖。包括但不限于: I. 吞噬细胞疾病:慢性肉芽肿病、白细胞黏附缺陷、IL-10通路缺陷、MonoMac综合征。 II. 细胞免疫和体液免疫缺陷:重症联合免疫缺陷(经典型SCID婴儿如≤2岁,因另有开放方案而排除)、X连锁高IgM综合征、DOCK8缺陷、ZAP70缺陷、常见变异型免疫缺陷(CVID)、Wiskott-Aldrich综合征、NEMO缺陷。 III. 免疫失调性疾病:X连锁免疫失调-多内分泌腺病-肠病综合征(IPEX)、CTLA4缺陷、LRBA缺陷、STAT1功能获得性突变、STAT3功能获得性突变、X连锁淋巴增殖性疾病等。 IV. 其他原发性免疫缺陷或免疫失调性疾病,经主要研究者(PI)和主治免疫科医师判断可从造血细胞移植(HCT)中获益。 2. 组织细胞疾病,包括噬血细胞性淋巴组织细胞增多症(家族性HLH 1–5型、难治或反复高炎症发作的继发性HLH)以及多系统难治性朗格汉斯细胞组织细胞增多症。 3. 可能在干细胞移植后改善或稳定的代谢性疾病,例如黏多糖贮积症、神经退行性疾病、骨硬化症等。 4. 供者与患者适合度为5/10。经高分辨率分型,供者和受者须在以下每个基因位点至少有一个等位基因相同:HLA-A、HLA-B、HLA-C、HLA-DRB1和HLA-DQB1。 5. 器官功能充分: * 心脏:无症状;如有症状,静息LVEF须≥40%或缩短分数(SF)≥26%。 * 肺部:无症状;如有症状,DLCO(按血红蛋白校正)须≥预测值的40%;无法完成肺功能检查者,室内空气下脉搏血氧饱和度须≥92%。 * 肾脏:肌酐清除率(CrCl)或肾小球滤过率(GFR)须>50 mL/min/1.73 m²。 * 肝脏:血清结合(直接)胆红素<该年龄组ULN的2.0倍,AST和ALT<该年龄组ULN的5.0倍。 * Karnofsky或Lansky(按年龄适用)体能状态评分≥50。 6. 已签署书面知情同意书。 排除标准: 1. 有能够且愿意捐献骨髓的HLA匹配同胞供者者。存在HLA匹配无关供者不构成排除。 2. 妊娠或哺乳期女性。 3. HIV感染,或未控制的真菌、细菌或病毒感染。 4. 既往接受过实体器官移植。 5. 入组时存在活动性>II级GVHD,或既往移植物导致的广泛型慢性GVHD。
Inclusion Criteria: 1. Patient with any form of primary immune deficiency/dysregulatory disorders characterized by aberrant immune function, abnormal hematopoiesis, systemic or organ specific autoimmunity and/or non-malignant lymphoproliferation. This includes, but not limited to: I. Disorders of phagocytes: Chronic granulomatous disease, Leukocyte adhesion deficiency, defects of IL-10 pathway, MonoMac syndrome II. Defects of cellular and humoral immunity: Severe Combined Immunodeficiency Disorder (infants with classic SCID up to 2 years of age will be excluded due to other open protocol), X-linked hyper-IgM syndrome, DOCK8 deficiency, ZAP70 deficiency, common variable immunodeficiency (CVID), Wiskott-Aldrich syndrome, NEMO deficiency. III. Disorder of immune dysregulation: Immunodysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome, CTLA4 deficiency, LRBA deficiency, STAT1 GOF, STAT3 GOF, X-linked lymphoproliferative disease etc. IV. Other PIDs and immune dysregulatory disorders who can be benefitted by HCT as deemed appropriate by the PI and the treating immunologist. 2. Histiocytic disorders including hemophagocytic lymphohistiocytosis (familial HLH (types 1-5), secondary HLH (refractory to therapy or with recurrent episodes of hyper inflammation) and multisystem refractory Langerhans cell histiocytosis. 3. Metabolic disorders that could improve or stabilize after stem cell transplantation such as mucopolysaccharidoses, neurodegenerative disorders, osteopetrosis, etc. Inclusion Criteria: 1. Patient has a suitable genotypic identical match of 5/10. The donor and recipient must be identical, as determined by high resolution typing, at least one allele of each of the following genetic loci: HLA-A, HLA-B, HLA-C, HLA-DRB1 and HLA-DQB1. 2. Patients must have adequate organ function measured by: 1. Cardiac: asymptomatic or if symptomatic then LVEF at rest must be ≥ 40% or SF ≥ 26% 2. Pulmonary: asymptomatic or if symptomatic DLCO ≥ 40% of predicted (corrected for hemoglobin) or pulse oximetry ≥ 92% on room air if the patient is unable to perform pulmonary function testing. 3. Renal: Creatinine clearance (CrCl) or glomerular filtration rate (GFR) must be \> 50 mL/min/1.73 m2. 4. Hepatic: Serum conjugated (direct) bilirubin \< 2.0 x ULN for age; AST and ALT \< 5.0 x ULN for age. 5. Karnofsky or Lansky (age-dependent) performance score ≥ 50 3. Signed written informed consent Exclusion Criteria: 1. Participants who have an HLA-matched sibling who is able and willing to donate bone marrow. Patients with a HLA-matched unrelated donors are not excluded. 2. Pregnant or breastfeeding females. 3. Patient has HIV or uncontrolled fungal, bacterial or viral infections. 4. Patient has received prior solid organ transplant. 5. Patient has active GVHD (\> grade II) or chronic extensive GVHD due to a previous allograft at the time of inclusion.
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:Incidence of successful donor engraftment · The incidence of engraftment at day 100 will be described based on donor chimerism in the whole blood and or fractions sorted for T-cell and myeloid subsets. The donor chimerism will be scored as autologous reconstitution (\< 5% donor), mixed chimerism (5-49%=low mixed, 50-95%=high mixed), \> 95%=full donor chimerism. · Day 100 after transplantation
次要终点:Overall survival and Event-free survival;Kinetics of neutrophil engraftment;Kinetics of platelet engraftment;Transplant-related mortality;Acute grade II-IV GvHD;Chronic GvHD;Primary graft failure;Secondary graft failure
按照标准化方案对单采所得细胞进行TCRαβ阴性选择。
以上邮箱 / 电话是登记库里的申办方联系方式,通常不直达某家医院。中国中心的联系方式请以医院或登记平台最新公示为准。
本研究评估一种新的半相合移植方法:对供者来源的造血干细胞移植物去除TCRαβ阳性T细胞和CD19阳性细胞,以治疗患者的基础疾病。干细胞取自父母或其他半相合亲属供者的外周血或骨髓,并使用被视为研究性设备的CliniMACS系统处理。研究旨在了解该方法的安全性和疗效。
This research is being done to learn if a new type of haploidentical transplantation using TCR alpha beta and CD19 depleted stem cell graft from the donor is safe and effective to treat the patient's underlying condition. This study will use stem cells obtained via peripheral blood or bone marrow from parent or other half-matched family member donor. These will be processed through a special device called CliniMACS, which is considered investigational.
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