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 Pediatric and Young Adult Trial of Genetically Modified T Cells Directed Against CD22 for Relapsed/Refractory Leukemia or Lymphoma
这是一项 I/II 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 35 例。试验地点:美国 · 洛杉矶、印第安纳波利斯、休斯顿、西雅图(共 4 个中心)。登记号:NCT04571138。
不限性别 · ≤ 30 Years
纳入标准: * 男性或女性,年龄≤30岁;前2名入组受试者须为≥18且≤30岁。 * 有难治性或复发性CD22阳性白血病或淋巴瘤的证据。 * 能耐受单采术,或已有足量且可用于研究产品制备的单采产物/T细胞。 * 预期生存期≥8周。 * Lansky或Karnofsky评分(按适用情况)≥50。 * 既往化疗、免疫治疗和放疗的急性毒性均已恢复;若已有可接受且可用于CAR-T制备的单采产物,则不受此项限制。 * 距末次化疗及生物治疗≥7天;鞘内化疗和维持化疗除外。 * 距末次皮质类固醇治疗≥7天。 * 距末次酪氨酸激酶抑制剂(TKI)治疗≥3天。 * 距末次羟基脲治疗≥1天。 * 距最近一次CAR-T细胞输注≥30天。 * 器官功能充分。 * 实验室检查值符合要求,包括绝对淋巴细胞计数≥100个/μL。 * 有生育能力或可能使他人受孕的受试者,同意自签署知情同意书至研究产品输注后12个月采取高效避孕措施。 * 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,存在其他活动性恶性肿瘤。 * 有症状的中枢神经系统(CNS)疾病史或当前存在有症状的CNS疾病。 * 白血病或淋巴瘤累及CNS且有症状,并且研究者认为在入组至CAR-T输注期间无法控制。 * 恶性细胞均匀表达CD19、符合入组条件,但尚未尝试抗CD19 CAR-T治疗者。 * 既往接受干细胞移植者,在入组前4周内存在活动性移植物抗宿主病(GVHD),或正在接受GVHD预防/治疗的免疫抑制治疗。 * 存在活动性严重感染。 * 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。 * 如接受CAR-T治疗,受试者和/或法定授权代表不同意参加规定的15年随访。 * 研究者认为会妨碍受试者按本方案接受治疗的任何情况。
Inclusion Criteria: * Male and female subjects aged ≤ 30 years. First 2 enrolled subjects: age ≥ 18 and ≤ 30 years * Evidence of refractory or recurrent CD22+ leukemia or lymphoma * Able to tolerate apheresis, or subject with 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 * ≥ 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 * Subjects with uniform expression of CD19 on their malignant cells who are eligible but have not attempted CD19 directed CAR T cell therapy * For subjects having had a previous stem cell transplant: 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 subject 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:Dose Limiting Toxicities · Number of participants who experienced an adverse event meeting the dose-limiting toxicity definition · 28 days post-infusion;The Ability to Successfully Manufacture SCRI-CAR22v2 · Number of participants who have a releasable cell product generated · 28 days;The Leukemia Response to SCRI-CAR22v2 in Subjects With Relapsed or Refractory CD22+ Leukemia Will be Assessed · Number of participants with an MRD negative complete remission after initial CAR T cell infusion (by Day 28 post infusion assessment +/- 3 Days) · 28 days post-infusion
患者在Ⅰ期或Ⅱ期接受SCRI-CAR22v2治疗。
复发或难治性白血病/淋巴瘤患者往往对后续化疗仍不敏感。本研究拟采集患者自身T细胞并进行基因工程改造,使其表达可识别白血病和淋巴瘤细胞表面CD22的嵌合抗原受体(CAR)。Ⅰ期将确定CAR-T细胞的安全性和合适剂量,Ⅱ期将评估疗效。既往未接受或已接受过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 chimeric antigen receptor (CAR). The CAR used in this study can recognize CD22, a protein expressed on the surface of leukemia and lymphoma cells. The phase 1 part of this study will determine the safety and appropriate dose level 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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