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:LMP1 CAR-T for Patients With LMP1 Positive Infectious Diseases and Hematological Malignancies
⚠ 该试验的登记信息已有 71 个月未更新, 页面上显示的「尚未开始招募」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。
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗血液系统恶性肿瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 144 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT04657965。
不限性别
纳入标准(按疾病类型适用): **慢性活动性EB病毒感染(CAEBV)** • 按日本厚生劳动省难治病防治研究组Okano修订标准确诊CAEBV。 • 尚未完全缓解,包括活动期(外周血单个核细胞EBV DNA>10²·⁵ copies/μg DNA,伴发热、肝脾大、肝功能异常、三系血细胞减少、淋巴结肿大或皮肤病变进展等活动性疾病体征)或非活动期(EBV DNA同样升高但无活动性疾病症状/体征)。 • 尚未进展为噬血细胞性淋巴组织细胞增多症(HLH)。 **LMP1阳性结外NK/T细胞淋巴瘤(ENKTL)** • 按WHO 2016分类,经组织病理确诊鼻型结外NK/T细胞淋巴瘤,且肿瘤组织LMP1阳性。 • 复发/难治,符合以下之一:二线或更高线化疗/放化疗后未缓解或进展;原发耐药;自体/异体造血干细胞移植后复发。 • 按Lugano 2014标准至少有1个可评估病灶。 **LMP1阳性霍奇金淋巴瘤(HL)** • 按WHO 2016分类经组织病理确诊,且肿瘤组织LMP1阳性。 • 二线或更高线化疗后未缓解/进展、原发耐药,或自体造血干细胞移植后复发。 • 按Lugano 2014标准至少有1个可评估病灶。 **LMP1阳性移植后淋巴增殖性疾病(PTLD)** • 仅纳入造血干细胞移植后PTLD;按WHO 2016分类组织病理确诊且肿瘤组织LMP1阳性,不包括早期PTLD。 • 利妥昔单抗标准治疗后未缓解/进展,或原发耐药;按Lugano 2014标准至少有1个可评估病灶。 排除标准: • 颅脑外伤、意识障碍、癫痫、脑缺血或脑出血等脑血管病史。 • 心电图QT间期延长或既往严重心脏病(如严重心律失常)。 • 妊娠或哺乳期。 • 严重活动性感染(单纯尿路感染和细菌性咽炎除外);活动性乙肝或丙肝;HIV感染。 • 筛选前2周内同时接受全身性类固醇(近期/当前吸入性类固醇除外)。 • 既往接受任何CAR-T产品或其他基因修饰T细胞治疗。 • 肌酐>2.5 mg/dL、ALT/AST>ULN的3倍或胆红素>2.0 mg/dL。 • 其他不适合参加本试验的未控制疾病。 • 研究者认为可能增加受试者风险或干扰研究结果的其他情况。
Inclusion Criteria: Only applicable to the inclusion criteria of CAEBV 1. Subjects who are diagnosed with CAEBV according to the Okano revised standard proposed by the Japanese Ministry of Health, Labour and Welfare Research Group for the Prevention of Refractory Diseases; 2. All CAEBV patients who have not achieved complete remission, including: 1. Active phase: EBV-DNA level in PBMC is higher than 1×10\^2.5 copies/μg DNA, with symptoms and signs of active diseases such as fever, hepatomegaly, splenomegaly, abnormal liver function, decrease of blood three lines, lymphadenopathy, and progressive skin lesions with increased EBV titer in peripheral blood; 2. inactive phase: EBV-DNA level in PBMC is higher than 1×10\^2.5 copies/μg DNA, without symptoms and signs of active diseases; 3. The disease has not yet progressed to hematopoietic lymphohistiocytosis (HLH); Only applicable to the inclusion criteria of LMP1-positive ENKTL: 1. According to the 2016 WHO classification criteria for lymphocytic tumors: Subjects diagnosed by histopathology as extranodal NK/T cell lymphoma, nasal type (ENKTL) with LMP1 positive in tumor tissue; 2. R/R ENKTL (meets one of the following prerequisites) 1. Without remission or with progression after receiving second-line or higher-line chemotherapy/chemotherapy + radiotherapy; 2. Primary drug resistance; 3. With recurrence after receiving autologous/allogeneic hematopoietic stem cell transplantation; 3. According to 2014 Lugano standard, there should be at least one evaluable tumor lesion. Only applicable to the inclusion criteria for LMP1-positive HL: 1. According to the 2016 WHO classification criteria for lymphocytic tumors, subjects with Hodgkin lymphoma diagnosed by histopathology (HD) and LMP1 positive in tumor tissue; 2. R/R HD (meets one of the following prerequisites): 1. Without remission or with progression after receiving second-line or higher-line chemotherapy; 2. Primary resistance Drugs; 3. With recurrence after receiving autologous hematopoietic stem cell transplantation; 3. According to the Lugano 2014 standard, there should be at least one evaluable tumor lesion; Only applicable to the inclusion criteria for LMP1-positive PTLD: 1. Only PTLD after hematopoietic stem cell transplantation; 2. According to the 2016 WHO classification criteria for lymphocytic tumors, subjects with PTLD diagnosed by histopathology and LMP1 positive in tumor tissue; 3. Excluding PTLD of early-stage 4. R/R PTLD (meets one of the following prerequisites): 1. Without remission or with progression after receiving rituximab-based standard treatment; 2. Primary drug resistance; 5. According to the Lugano 2014 standard, there should be at least one evaluable tumor lesion 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 urinary tract infection and 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 in haled 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, or bilirubin\>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 LMP1 targeted 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 LMP1 targeted CAR T-cells infusion
次要终点:Chronic active EB virus infection (CAEBV), Overall response rate (ORR);CAEBV,Duration of remission(DOR);CAEBV, Overall survival (OS);CAEBV, Relapse rate(RR);CAEBV, Event-free survival (EFS);Hodgkin's lymphoma(HL), Extranodal NK/T cell lymphoma(ENKTL),Nasal type, Lymphoproliferative disease after hematopoietic stem cell transplantation, (post-HSCT PTLD),Overall response rate (ORR);HL, ENKTL, PTLD, OS;HL, ENKTL, PTLD, EFS
所有受试者均通过静脉输注接受LMP1 CAR-T细胞。
本研究评估LMP1 CAR-T治疗LMP1阳性感染性疾病和血液系统恶性肿瘤患者的安全性和疗效。
A study of LMP1 CAR-T for patients with LMP1 positive infectious diseases and hematological malignancies
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