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:To Evaluate the Safety and Efficacy of Human Derived Anti-BCMA CAR-T Injection for Subjects with R/R MM
To Evaluate the Safety and Efficacy of Human Derived Anti-BCMA CAR-T Injection for Subjects with R/R MM
⚠ 该试验的登记信息已有 21 个月未更新, 页面上显示的「进行中(不再招募)」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,评估人源 CAR-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 18 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT05302648。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 受试者须符合以下全部条件: * 自愿参加临床试验,了解并知悉试验内容,签署知情同意书且愿意完成全部试验程序; * 年龄18–75岁(含界值),男女均可; * 预期生存期>12周; * 按IMWG 2014年修订标准确诊多发性骨髓瘤; * 符合以下至少一项指标:①血清M蛋白:IgG型≥10 g/L,IgA型>5 g/L,或IgD型IgD高于正常值上限;②尿M蛋白≥200 mg/24小时;③血清游离轻链≥100 mg/L且血清游离轻链比值异常; * 复发/难治性多发性骨髓瘤。复发定义:至少接受3线治疗后疾病进展,且既往至少接受3种不同作用机制的多发性骨髓瘤方案,包括蛋白酶体抑制剂和免疫调节剂。难治定义:既往治疗从未达到微小缓解(MR)或更佳;或曾达到MR及以上,但后续治疗期间或末次治疗后60天内疾病进展; * ECOG评分0–2分; * 肝、肾及心肺功能符合:按Cockcroft-Gault公式估算的肌酐清除率≥40 mL/min;左心室射血分数>50%;基线外周血氧饱和度>95%;总胆红素≤2×ULN,ALT和AST≤2.5×ULN; * 研究者判断有可建立的静脉通路以进行白细胞单采。 排除标准: 符合以下任一条件者不得入选: * 合并其他未控制的恶性肿瘤; * HBsAg或HBcAb阳性且外周血HBV DNA≥500 IU/mL;HCV抗体阳性且外周血HCV RNA阳性;HIV抗体阳性;梅毒初筛抗体阳性; * 任何不稳定的全身性疾病,包括但不限于不稳定型心绞痛、筛查前6个月内脑血管意外或短暂性脑缺血、筛查前6个月内心肌梗死、充血性心力衰竭(NYHA≥III级)、需要药物治疗的严重心律失常、肝肾或代谢性疾病; * 研究者判断不适合参加试验; * 妊娠或哺乳期女性;女性受试者计划在细胞输注后1年内妊娠,或男性受试者的伴侣计划在细胞输注后1年内妊娠; * 入组前接受过CAR-T治疗或其他基因治疗; * 未签署知情同意书、不遵守研究程序或不愿/不能遵从研究要求; * 对本研究使用的任何药物有严重速发型超敏反应史; * 入组前14天内有需要全身治疗的活动性或未控制感染; * 过去2年内自身免疫性疾病(如克罗恩病、类风湿关节炎、系统性红斑狼疮)导致终末器官损伤,或需要全身免疫抑制/其他全身疾病控制药物; * 有中枢神经系统受累症状。
Inclusion Criteria: Subjects must meet all of the following criteria to be enrolled: * Subjects volunteer to participate in clinical trails, understand and inform the trials and sign informed consent form, be willing to complete all the trial procedures; * 18 to 75 years old (including cut-off value), Male and female; * Expected survival \> 12 weeks; * Previously diagnosed as multiple myeloma by IMWG updated criteria (2014); * One of the following indicators is satisfied: 1. Serum M protein: for immunoglobulin G (IgG) type , M protein≥ 10 g/L, or for immunoglobulin A (IgA) type , M protein \> 5g/L, or for immunoglobulin D (IgD) type , M protein, IgD exceeds upper limit of normal range. 2. Urine M protein ≥ 200 mg/24h; 3. Serum free light chain ≥ 100 mg/L and Serum free light chain ratio is abnormal ; * Patients with relapsed/refractory multiple myeloma. Relapsed is defined as: Patients have disease progression after at least three-line treatment regimens. Patients previously received at least 3 different mechanisms treatment regimens for multiple myeloma, including protease inhibitors and immunomodulators; Refractory is defined as: Patients who achieved minimal response(MR) or above was never achieved in previous treatment; MR or above was achieved in previous treatment, but disease progression occurred during subsequent treatment or within 60 days after the last treatment. * ECOG score 0-2; * Liver, kidney and cardiopulmonary functions meet the following requirements: 1. Creatinine clearance (estimated by Cockcroft Gault formula) ≥ 40 mL/min; 2. Left ventricular ejection fraction \>50%; 3. Baseline peripheral oxygen saturation \>95%; 4. Total bilirubin ≤ 2×ULN; Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 × ULN; * The venous access required for collection can be established and leukepheresis can be carriedaccording to the judgement of investigators. Exclusion Criteria: Any one of the following conditions cannot be selected as a subject: * Accompanied by other uncontrolled malignancies; * Subjects with positive Hepatitis B surface antigen (HBsAg) or Hepatitis B core antibody (HBcAb) and peripheral blood Hepatitis B virus(HBV) DNA titer is ≥500IU/mL; hepatitis C virus (HCV) antibody positive and peripheral blood HCV RNA positive; human immunodeficiency virus(HIV) antibody positive; syphilis primary screening antibody positive; * Any instability of systemic disease, including but not limited to unstable angina, cerebrovascular accident, or transient cerebral ischemic (within 6 months prior to screening), myocardial infarction (within 6 months prior to screening), congestive heart failure (New York heart association (NYHA) classification ≥ III), need drug therapy of severe arrhythmia, liver, kidney, or metabolic disease; * Patients who are accounted to be not appropriate for this trail by investigator; * Pregnant or lactating woman, and female subject who plans to have a pregnancy within 1 year after cell transfusion, or male subject whose partner plans to have a pregnancy within 1 year after cell transfusion; * Received CAR-T treatment or other gene therapies before enrollment; * Those who failed to sign informed consent form or comply with the research procedures; Unwilling or unable to comply with research requirements; * Have had severe immediate hypersensitivity reactions to any drugs used in this research; * Active or uncontrollable infection requiring systemic therapy within 14 days prior to enrollment; * In the past two years, the terminal organ was damaged due to autoimmune diseases (such as Crohn's disease, rheumatoid arthritis, systemic lupus erythematosus), or the systemic use of immunosuppressive or other systemic disease control drugs was required; * Patients with symptoms of central nervous system.
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 limited toxicity(DLT) · Safety Indicator · 28 days post infusion
次要终点:Pharmacokinetics parameters - Maximum CAR level in blood and CAR level in bone marrow(Cmax);Pharmacokinetics parameters -Time to peak CAR level in blood (Tmax);Pharmacokinetics parameters - 28-day Area under the curve of the CAR level in blood(AUC0-28);Pharmacodynamics characteristics - Cytokines Concentrations,cytokines level in blood;Pharmacodynamics characteristics -Clonal bone marrow plasma cells level;Overall Response Rate (ORR) at 3 month post infusion;Percentage of Subjects With Negative Minimal Residual Disease (MRD);Duration of Subjects With Negative Minimal Residual Disease (MRD)
单次给药剂量:1.0×10⁶、3.0×10⁶或6.0×10⁶个CAR阳性T细胞。
这是一项单臂、开放标签、剂量递增试验,旨在探索人源抗BCMA CAR-T注射剂治疗复发/难治性多发性骨髓瘤患者的安全性、耐受性、药代动力学/药效学特征,并初步观察其疗效。
This study is a single-arm, open-label, dose-escalation trial to explore the safety, tolerability and pharmacokinetic/pharmacodynamics characteristics of Human Derived anti-BCMA CAR-T Injection , and to preliminarily observe the efficacy of the trial drug in patients with relapsed/refractory multiple myeloma.
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