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:CD 70 CAR T for Patients With CD70 Positive Malignant Hematologic Diseases
CD 70 CAR T for Patients With CD70 Positive Malignant Hematologic Diseases
⚠ 该试验的登记信息已有 60 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 细胞治疗急性髓系白血病、淋巴瘤、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 108 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT04662294。
不限性别
纳入标准(按疾病类型适用): **急性髓系白血病(AML)** • 按美国NCCN 2016.v1 AML临床实践指南,组织学确诊CD70阳性AML。 • 复发/难治性,符合任一项:标准化疗后未达CR;首次诱导达CR但缓解持续<12个月;一次或多次挽救治疗无效;复发≥2次。骨髓原始细胞形态学>5%和/或流式细胞术>0.01%。 • 总胆红素≤51 μmol/L、ALT/AST≤ULN的3倍、肌酐≤176.8 μmol/L;超声心动图LVEF≥50%;无肺部活动性感染且室内空气血氧≥92%;预期生存期≥3个月;ECOG 0–2分。患者或法定监护人自愿参加并签署知情同意书。 **非霍奇金淋巴瘤(NHL)** • 年龄及性别不限。 • 按WHO 2016标准组织学确诊DLBCL-NOS、滤泡性淋巴瘤、CLL/SLL转化的DLBCL、原发纵隔大B细胞淋巴瘤或高级别B细胞淋巴瘤。 • 复发/难治CD70阳性NHL,二线及以上化疗后未缓解/复发、原发耐药或自体移植后复发;按Lugano 2014标准至少有1个可评估病灶。 **多发性骨髓瘤(MM)** • 组织学确诊CD70阳性MM,按IMWG标准诊断复发/难治性MM、复发后MRD持续阳性,或有难以通过化疗/放疗根除的髓外病灶。 • 年龄及性别不限。 • 总胆红素≤51 μmol/L、ALT/AST≤ULN的3倍、肌酐≤176.8 μmol/L;超声心动图LVEF≥50%;无肺部活动性感染且室内空气血氧≥92%;预期生存期≥3个月;ECOG 0–2分。患者或法定监护人自愿参加并签署知情同意书。 排除标准: • 颅脑外伤、意识障碍、癫痫、脑缺血或脑出血病史。 • 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周内同时使用全身性类固醇(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。 • 其他不适合参加试验的未控制疾病,或研究者认为可能增加风险/干扰研究结果的其他情况。
Inclusion Criteria: Inclusion criteria only for AML: 1. Histologically confirmed diagnosis of CD70 AML per the US National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Acute Myeloid Leukemia (2016.v1); 2. Relapsed or refractory CD70+ AML (meeting one of the following conditions): 1. CR not achieved after standardized chemotherapy; 2. CR achieved following the first induction, but CR duration is less than 12 months; 3. Ineffectively after first or multiple remedial treatments; 4. 2 or more relapses; 3. The number of primordial cells in bone marrow is \> 5% (by morphology), and/or \> 0.01% (by flowcytometry); 4. Total bilirubin ≤ 51 umol/L, ALT and AST ≤ 3 times of upper limit ofnormal, creatinine ≤ 176.8 umol/L; 5. Echocardiogram shows left ventricular ejection fraction (LVEF) ≥50%; 6. No active infection in the lungs, blood oxygen saturation in indoorair is ≥ 92%; 7. Estimated survival time ≥ 3 months; 8. ECOG performance status 0 to 2; 9. Patients or their legal guardians volunteer to participate in the studyand sign the informed consent. Inclusion criteria only for NHL: 1. No gender and age limit; 2. Histologically confirmed diagnosis of DLBCL (NOS), FL, DLBCL transformed from CLL/SLL, PMBCL, and HGBCL per the WHO Classification Criteria for Lymphoma (2016); 3. Relapsed or refractory CD70+ NHL (meeting one of the following conditions): 1. No response or relapse after second-line or above chemotherapy regimens; 2. Primary drug resistance; 3. Relapse after auto-HSCT; 4. At least one assessable tumor lesion per Lugano 2014 criteria Inclusion criteria only for MM: 1. Histologically confirmed diagnosis of CD70 multiple myeloma (MM): 1. According to the diagnostic criteria of IMWG multiple myeloma, the diagnosis was recurrent / refractory multiple myeloma 2. Cases with recurrent positive minimal residual disease; 3. Extramedullary leision which is hard to be eradicated by chemotherapy or radiotherapy. 2. No gender and age limit; 3. Total bilirubin ≤ 51 umol/L, ALT and AST ≤ 3 times of upper limit of normal, creatinine ≤ 176.8 umol/L; 4. Echocardiogram shows left ventricular ejection fraction (LVEF) ≥50%; 5. No active infection in the lungs, blood oxygen saturation in indoorair is ≥ 92%; 6. Estimated survival time ≥ 3 months; 7. ECOG performance status 0 to 2; 8. Patients or their legal guardians volunteer to participate in the studyand sign the informed consent. Common inclusion criteria : 1. Total bilirubin ≤ 51 umol/L, ALT and AST ≤ 3 times of upper limit of normal, creatinine ≤ 176.8 umol/L; 2. Echocardiogram shows left ventricular ejection fraction (LVEF) ≥ 50%; 3. No active infection in the lungs, blood oxygen saturation in indoor air is ≥ 92%; 4. Estimated survival time ≥ 3 months; 5. ECOG performance status 0 to 2; 6. Patients or their legal guardians volunteer to participate in the study and sign the informed consent - Exclusion Criteria: 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 inhaled steroids; 7. Previously treated with any CAR-T cell product or other geneticallymodified 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 of patients 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 CD70 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 CD70 targeted CAR T-cells infusion
次要终点:Acute Myeloid Leukemia (AML), Overall response rate (ORR);AML, Overall survival (OS);AML, Event-free survival (EFS);Non-Hodgkin's lymphoma (NHL), Overall response rate (ORR);NHL, Overall survival (OS);NHL, Event-free survival (EFS);Multiple myeloma (MM), Overall response rate (ORR);MM, Overall survival (OS)
本研究评估CD70 CAR-T治疗CD70阳性血液系统恶性肿瘤患者的安全性和疗效。
A Study of CD 70 CAR T for patients with CD70 positive malignant hematologic diseases
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