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.
英文原题:A Study of CAR-T Cells Therapy for Patients With Relapsed and/or Refractory Central Nervous System Hematological Malignancies
A Study of CAR-T Cells Therapy for Patients With Relapsed and/or Refractory Central Nervous System Hematological Malignancies
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⚠ 该试验的登记信息已有 72 个月未更新, 页面上显示的「招募中」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。
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗急性淋巴细胞白血病、淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 72 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT04532203。
不限性别 · ≥ 3 Years 且 ≤ 75 Years
纳入标准: 仅适用于B细胞急性淋巴细胞白血病(B-ALL)的纳入标准: 1. 男女均可,年龄3–70岁; 2. 按美国国家综合癌症网络(NCCN)《急性淋巴细胞白血病临床实践指南》(2016.v1)组织学确诊B-ALL; 3. 复发/难治性CD19阳性B-ALL(符合以下任一条件):标准化疗后未达到完全缓解(CR);首次诱导治疗后达到CR,但缓解持续时间<12个月;首次或多次挽救治疗效果不佳;或复发≥2次; 4. 骨髓原始细胞(淋巴母细胞和前淋巴细胞)形态学比例>5%和/或流式细胞术比例>1%; 5. 费城染色体阴性(Ph−),或费城染色体阳性(Ph+)但不能耐受TKI治疗或对2种TKI治疗无应答。 仅适用于B细胞非霍奇金淋巴瘤(B-NHL)的纳入标准: 1. 男女均可,年龄18–75岁; 2. 按WHO淋巴瘤分类标准(2016)组织学确诊DLBCL(NOS)、滤泡性淋巴瘤、由CLL/SLL转化的DLBCL、原发纵隔大B细胞淋巴瘤(PMBCL)或高级别B细胞淋巴瘤(HGBCL); 3. 复发/难治性B-NHL(符合以下任一条件):二线或以上化疗方案治疗后无应答或复发;原发性耐药;或自体造血干细胞移植后复发; 4. 按2014 Lugano标准至少有一个可评估肿瘤病灶。 B-ALL和B-NHL共同纳入标准: 1. 高度疑似或确诊血液系统恶性肿瘤累及中枢神经系统; 2. 总胆红素≤51 μmol/L,ALT和AST≤正常值上限的3倍,肌酐≤176.8 μmol/L; 3. 超声心动图显示左心室射血分数(LVEF)≥50%; 4. 无活动性肺部感染,室内空气下血氧饱和度≥92%; 5. 预期生存期≥3个月; 6. ECOG体能状态评分0–2分; 7. 患者或其法定监护人自愿参加研究并签署知情同意书。 排除标准: 符合以下任一项者不得参加: 1. 有颅脑创伤、意识障碍、癫痫、脑血管缺血或脑出血性疾病史; 2. 心电图显示QT间期延长,或既往有严重心脏病(如严重心律失常); 3. 妊娠期或哺乳期女性; 4. 严重活动性感染(单纯尿路感染及细菌性咽炎除外); 5. 活动性乙型肝炎或丙型肝炎感染; 6. 筛查前2周内同时使用全身性类固醇(近期或目前使用吸入性类固醇者除外); 7. 既往接受过任何CAR-T 细胞产品或其他基因修饰T细胞治疗; 8. 肌酐>2.5 mg/dL,或ALT/AST>正常值上限的3倍,或胆红素>2.0 mg/dL; 9. 存在其他不适合参加本试验的未控制疾病; 10. HIV感染; 11. 研究者认为可能增加患者风险或干扰研究结果的任何情况。
Inclusion Criteria:
* Inclusion criteria only for B-ALL:
1. Male or female aged 3-70 years;
2. Histologically confirmed diagnosis of B-ALL per the US National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Acute Lymphoblastic Leukemia (2016.v1);
3. Relapsed or refractory CD19+ B-ALL (meeting one of the followingconditions):
1. CR not achieved after standardized chemotherapy;
2. CR achieved following the first induction, but CR duration isless than 12 months;
3. Ineffectively after first or multiple remedial treatments;
4. 2 or more relapses;
4. The number of primordial cells (lymphoblast and prolymphocyte)in bone marrow is\>5% (by morphology), and/or \>1% (by flowcytometry);
5. Philadelphia-chromosome-negative (Ph-) patients; or Philadelphia-chromosome-positive (Ph+) patients who cannot tolerate TKI treatments or do not respond to 2 TKI treatments;
* Inclusion criteria only for B-NHL:
1. Male or female aged 18-75 years;
2. Histologically confirmed diagnosis of DLBCL (NOS), FL, DLBCL transformed from CLL/SLL, PMBCL, and HGBCL per the WHOClassification Criteria for Lymphoma (2016);
3. Relapsed or refractory B-NHL (meeting one of the followingconditions):
1. No response or relapse after second-line or abovechemotherapy regimens;
2. Primary drug resistance;
3. Relapse after auto-HSCT;
4. At least one assessable tumor lesion per Lugano 2014 criteria;
* Common inclusion criteria for B-ALL and B-NHL:
1. Highly suspected or confirmed central nervous system involvement of hematological malignancies;
2. Total bilirubin ≤ 51 umol/L, ALT and AST ≤ 3 times of upper limit ofnormal, creatinine ≤ 176.8 umol/L;
3. Echocardiogram shows left ventricular ejection fraction (LVEF) ≥50%;
4. No active infection in the lungs, blood oxygen saturation in indoorair is ≥ 92%;
5. Estimated survival time ≥ 3 months;
6. ECOG performance status 0 to 2;
7. Patients or their legal guardians volunteer to participate in the study and sign the informed consent.
Exclusion Criteria:
Subjects with any of the following exclusion criteria were not eligible for this trial:
1. History of craniocerebral trauma, conscious disturbance,epilepsy,cerebrovascular ischemia, and cerebrovascular hemorrhagic diseases;
2. Electrocardiogram shows prolonged QT interval, severe heart diseases such as severe arrhythmia in the past;
3. Pregnant (or lactating) women;
4. Patients with severe active infections (excluding simple urinarytractinfectionand bacterial pharyngitis);
5. Active infection of hepatitis B virus or hepatitis C virus;
6. Concurrent therapy with systemic steroids within 2 weeks prior to screening, except for the patients recently or currently receiving inhaled steroids;
7. Previously treated with any CAR-T cell product or other genetically-modified T cell therapies;
8. Creatinine\>2.5mg/dl, or ALT / AST \> 3 times of normal amounts,orbilirubin\>2.0 mg/dl;
9. Other uncontrolled diseases that were not suitable for this trial;
10. Patients with HIV infection;
11. Any situations that the investigator believes may increase the risk ofpatients or interfere with the results of study.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:Dose-limiting toxicity (DLT) · Adverse events assessed according to NCI-CTCAE v5.0 criteria · Baseline up to 28 days after CAR T-cells infusion;Incidence of treatment-emergent adverse events (TEAEs) · Incidence of treatment-emergent adverse events \[Safety and Tolerability\] · Up to 2 years after CAR T-cells infusion
次要终点:B-cell acute lymphocytic leukemia(B-ALL), Overall response rate (ORR);B-ALL, Overall survival (OS);B-ALL, Event-free survival (EFS);B cell non-hodgkin's lymphoma (B-NHL), Overall response rate (ORR);B-NHL, disease control rate (DCR);Quality of life;IADL score;ADL score
采用标准“3+3”剂量递增设计,共设置3个剂量水平。
以上邮箱 / 电话是登记库里的申办方联系方式(+86,中国),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CAR-T 细胞治疗复发和/或难治性中枢神经系统血液系统恶性肿瘤患者。
A Study of CAR-T Cells Therapy for Patients With Relapsed and/or Refractory Central Nervous System Hematological Malignancies
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