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:P-BCMA-ALLO1 Allogeneic CAR-T Cells in the Treatment of Subjects With Multiple Myeloma
P-BCMA-ALLO1 Allogeneic CAR-T Cells in the Treatment of Subjects With Multiple Myeloma
这是一项 I 期注册临床试验,评估 BCMACAR-T 细胞治疗多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 275 例。试验地点:美国 · 古德伊尔、圣迭戈、旧金山、亚特兰大(共 23 个中心)。登记号:NCT04960579。
不限性别 · ≥ 18 Years
纳入标准: 1. 必须已签署书面知情同意书。 2. 男性或女性,≥18岁。 3. 必须确诊为活动性MM。 4. 必须具有可测量的MM。 5. 必须为复发/难治性MM,既往接受过蛋白酶体抑制剂、免疫调节剂(IMiD)和抗CD38治疗。 6. 必须愿意从筛选时起至P-BCMA-ALLO1给药后研究第一年期间采取避孕措施。 7. 筛选时血清妊娠试验必须为阴性,且在开始淋巴细胞清除治疗方案前3天内尿妊娠试验为阴性(育龄女性)。 8. 如曾接受自体干细胞移植,必须距移植至少90天。 9. 必须在预定参数范围内具有足够的生命器官功能。 10. 必须已从既往治疗所致的毒性中恢复。 11. 必须具有0至1的东部肿瘤协作组(ECOG)体能状态评分。 排除标准: 1. 处于妊娠期或哺乳期。 2. 静脉通路不足。 3. 患有活动性溶血性贫血、浆细胞白血病、Waldenstrom巨球蛋白血症、POEMS综合征、弥散性血管内凝血、白细胞淤滞症或淀粉样变性。 4. 除MM外还患有活动性第二恶性肿瘤(无病生存未达至少5年),但低风险肿瘤除外,如非转移性基底细胞或鳞状细胞皮肤癌。 5. 患有活动性自身免疫性疾病。 6. 有重大中枢神经系统(CNS)疾病史,如卒中、癫痫等。 7. 患有活动性全身性感染。 8. 有乙型肝炎、丙型肝炎病毒、人类免疫缺陷病毒(HIV)或人类T淋巴细胞病毒(HTLV)感染史,或任何免疫缺陷综合征。有丙型肝炎治疗史且多次丙型肝炎PCR检测均为阴性的受试者可入组。 9. 巨细胞病毒(CMV)PCR、CMV免疫球蛋白M(IgM)抗体或2019冠状病毒病(COVID-19)PCR检测为阳性。 10. 患有纽约心脏病协会(NYHA)III级或IV级心力衰竭、不稳定型心绞痛,或有心肌梗死或重大心律失常史。 11. 患有任何会妨碍安全参与和/或遵守方案的精神或医学疾病。 12. 既往接受过异基因细胞治疗或基因治疗。 13. 在开始预处理LD治疗时2周内接受过抗肿瘤药物。 14. 在开始预处理LD治疗时4周内接受过单克隆抗体治疗。 15. 在给予P-BCMA-ALLO1时2周内接受过免疫抑制药物,和/或预期在研究期间需要此类药物。 16. 在给予P-BCMA-ALLO1时1周或5个半衰期(以较短者为准)内接受过全身性皮质类固醇治疗,或预期在研究过程中需要此类治疗。 17. 存在CNS转移或骨髓瘤的症状性CNS受累。 18. 对本研究中所使用的任何药物有严重速发型超敏反应史。 19. 有接受过异基因干细胞移植、或任何其他异基因或异种移植的病史,或在90天内接受过自体移植。 20. 仅限R、RS、RP1、RP1.5和RP2组:a) 在首次给予R组或RS组所用药物前28天内接种过活疫苗,b) 对R组或RS组所用药物有任何已知的超敏反应或严重反应或毒性。 21. 在开始预处理LD治疗前1周内接受过放疗。 22. 在给予LD治疗前28天内接种过活疫苗。
Inclusion Criteria: 1. Must have signed written, informed consent. 2. Males or females, ≥18 years of age. 3. Must have a confirmed diagnosis of active MM. 4. Must have measurable MM. 5. Must have relapsed / refractory MM, having received treatment with a proteasome inhibitor, immunomodulatory agent (IMiD), and anti-CD38 therapy. 6. Must be willing to practice birth control from the time of Screening and throughout the first year of the study after P-BCMA-ALLO1 administration. 7. Must have a negative serum pregnancy test at Screening and a negative urine pregnancy test within 3 days prior to initiating the lymphodepletion therapy regimen (females of childbearing potential). 8. Must be at least 90 days since autologous stem cell transplant, if performed. 9. Must have adequate vital organ function within pre-determined parameters. 10. Must have recovered from toxicities due to prior therapies. 11. Must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Exclusion Criteria: 1. Is pregnant or lactating. 2. Has inadequate venous access. 3. Has active hemolytic anemia, plasma cell leukemia, Waldenstrom\'s macroglobulinemia, POEMS syndrome, disseminated intravascular coagulation, leukostasis, or amyloidosis. 4. Has an active second malignancy (not disease-free for at least 5 years) in addition to MM, excluding low-risk neoplasms such as non-metastatic basal cell or squamous cell skin carcinoma. 5. Has active autoimmune disease. 6. Has a history of significant central nervous system (CNS) disease, such as stroke, epilepsy, etc. 7. Has an active systemic infection. 8. Has a history of hepatitis B, hepatitis C virus, human immunodeficiency virus (HIV), or human T-lymphotropic virus (HTLV) infection, or any immunodeficiency syndrome. Subjects with a history of treated hepatitis C can be enrolled if negative by Hepatitis C PCR on multiple occasions. 9. Is positive for cytomegalovirus (CMV) by PCR, CMV immunoglobulin M (IgM) antibody, or Coronavirus disease 2019 (COVID-19) by PCR. 10. Has New York Heart Association (NYHA) Class III or IV heart failure, unstable angina, or a history of myocardial infarction or significant arrhythmia. 11. Has any psychiatric or medical disorder that would preclude safe participation in and/or adherence to the protocol. 12. Has received prior allogeneic cellular therapy or gene therapy. 13. Has received anti-cancer medications within 2 weeks of the time of initiating conditioning LD therapy. 14. Has received monoclonal antibody therapy within 4 weeks of initiating conditioning LD therapy. 15. Has received immunosuppressive medications within 2 weeks of the time of administration of P-BCMA-ALLO1, and/or expected to require them while on study. 16. Has received systemic corticosteroid therapy within 1 week or 5 half-lives (whichever is shorter) of the administration of P-BCMA-ALLO1 or is expected to require it during the course of the study. 17. Has CNS metastases or symptomatic CNS involvement of their myeloma. 18. Has a history of severe immediate hypersensitivity reaction to any of the agents used in this study. 19. Has a history of having undergone allogeneic stem cell transplantation, or any other allogeneic or xenogeneic transplant, or has undergone autologous transplantation within 90 days. 20. Arms R, RS, RP1, RP1.5 and RP2 Only: a) Has received a live vaccine within the last 28 days of the first administration of agents used in Arm R or RS, b) Has any known hypersensitivity or severe reactions or toxicity to agents used in Arms R or RS. 21. Has received radiation within 1 week of initiating conditioning LD therapy. 22. Administration of a live vaccine within the last 28 days prior to administration of LD therapy.
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:Phase 1 Part 1: Assess the safety and maximum tolerated dose (MTD) of P-BCMA-ALLO1 based on dose limiting toxicities (DLT) · Rate of dose limiting toxicities (DLT) · Baseline through Day 28;Phase 1 Part 2: Assess the safety and tolerability of P-BCMA-ALLO1 when administered as a fixed dose of cells. · Frequency and severity of adverse events, including cytokine release syndrome. · Baseline through 36 months;Phase 1b: The effect of cell dose and study arm · Overall response rate (ORR) based on International Myeloma Working Group (IMWG) uniform response criteria · Baseline through 36 months
次要终点:The safety of P-BCMA-ALLO1;The anti-myeloma effect of P-BCMA-ALLO1 (ORR) in Phase 1 Parts 1 and 2;Safety and Efficacy (anti-myeloma effect) will be used to guide the selection of RP2D
在预处理化疗方案 S 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
在预处理化疗方案 F 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
单次基于体重的静脉注射 P-BCMA-ALLO1。可根据指征给予 Rimiducid。
在预处理化疗方案 P1 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
在预处理化疗方案 P2 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
在预处理化疗方案 R 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
在预处理化疗方案 RS 后,单次基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
在预处理化疗方案 C 后,循环基于体重的静脉注射 P-BCMA-ALLO1。 可根据指征给予 Rimiducid。
1期研究,采用开放标签、剂量递增、多队列设计,评估P-BCMA-ALLO1异体T干细胞记忆(Tscm)CAR-T细胞在复发/难治性多发性骨髓瘤(RRMM)受试者中的应用。
Phase 1 study comprised of open-label, dose escalation, multiple cohorts of P-BCMA-ALLO1 allogeneic T stem cell memory (Tscm) CAR-T cells in subjects with relapsed / refractory Multiple Myeloma (RRMM).
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