抗 CD22/CD19 CAR-T 细胞疗法 CART2219.1 在成人和儿童复发/难治性 B-ALL 中的 I/II 期试验
A Phase I/II Trial of Anti-CD22/CD19 CAR-T Cell Therapy, CART2219.1, in Adult and Pediatric Relapsed/Refractory B-ALL.
在一项多中心I/II期试验中,所有患者(n=11;7名儿童,4名成人)在第28天均达到完全缓解(91%为微小残留病阴性)。
英文原题:A Phase 1/3 Study of T-Cell Receptor Engineered Donor T Cells in Subjects Undergoing Allogeneic Peripheral Blood Stem Cell Transplantation
这是一项 I 期注册临床试验,评估细胞治疗用于急性髓系白血病、骨髓增生异常综合征的安全性、可行性及初步疗效。当前状态:招募中。计划入组 310 例。试验地点:美国 · 杜阿尔特、奥罗拉、丹佛、纽黑文(共 21 个中心)。登记号:NCT05473910。
不限性别 · ≥ 18 Years
受试者入选标准 • 签署知情同意时年龄≥18岁;筛查时ECOG体能状态≤2。 • 受试者及捐者避孕须符合当地临床研究规定。男性同意在干预期及末次研究干预后至少12个月采取方案附录4规定的高效避孕,并不捐精。女性须未妊娠、未哺乳,且不属于有生育能力女性,或同意干预期及末次干预后至少12个月遵循避孕要求。 • 计划接受异基因HCT,适应疾病为AML、MDS或ALL。治疗组须表达HLA-A*0201;对照组HLA不限。接受TSC-100须为HA-1+/−或HA-1+/+(HA-1阳性)基因型;接受TSC-101须为HA-2+/−或HA-2+/+(HA-2阳性)基因型。 • 有单倍体相合、MMUD或MUD供者,按机构标准HLA匹配且符合供者入选标准。治疗研究者认为适合相应供者移植、减低强度预处理(RIC)及外周血干细胞移植。符合机构移植器官功能标准。 • 能签署知情同意并遵守ICF/方案要求,且同意骨髓活检及研究采血等强制程序。接受试验性T细胞输注者须同意自首次产品治疗后最长15年的长期随访。 捐者入选标准:签署知情同意时≥18岁;可接受外周血干细胞采集,并可进行最多2轮白细胞单采(治疗组供TSC-100/TSC-101制备,所有组供干细胞采集)。TSC-100受试者的匹配供者须HA-1阴性和/或所有HLA-A*02等位基因阴性;TSC-101供者须所有HLA-A*02等位基因阴性。须能签署知情同意并遵守方案要求。 排除标准(受试者):医学/心理状况使其不适合细胞治疗,包括合并未控制恶性肿瘤或活动性CNS疾病。器官毒性不必然排除,可由主要研究者决定,但研究者可延迟HA1/HA2 TCR-T输注。供者特异性HLA抗体高至研究者认为须脱敏且无替代供者者排除。符合TSC-101条件但同时HLA-A*02:07阳性者排除。临床显著感染或CMV、EBV、腺病毒、BK病毒、HHV-6未控制再激活者排除。活动性心脏病包括:过去3个月未控制/有症状心绞痛;临床显著心律失常史(如室速、室颤、尖端扭转型室速;治疗控制的房颤不排除);入组前<3个月心肌梗死;未控制/有症状心衰。既往异基因HCT;对鼠蛋白超敏;同时参加含新型试验药的临床试验;研究第-14日至结束期间使用抗胸腺细胞球蛋白、阿仑单抗或其他体内T细胞清除药。 捐者排除标准:TSC-100供者如任一HLA-A*02阳性,原则上排除,但HA-1阴性者除外;如考虑用于TSC-100患者,须检测HA-1并确认阴性。TSC-101供者任何HLA-A*02阳性均排除,不论HA-2状态。中央实验室检测HIV-1/2、HTLV-1/2血清阳性、活动性乙肝/丙肝或梅毒、西尼罗病毒阳性者排除。供者病史问卷提示克雅氏病或寨卡病毒感染风险者排除;既往CMV/EBV感染证据可接受。居住美国境外的亲属供者排除;若供者筛查、检测和单采均可在受试者治疗中心完成,则仍符合资格。
Inclusion Criteria: * Male or female aged ≥ 18 years at the time of signing the informed consent. * Eastern Cooperative Oncology Group (ECOG)-PS ≤ 2 at the time of the screening visit. * Contraceptive use by male and female participants must be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. * Male Participants: * A male participant must agree to use a highly effective contraceptive as detailed in Appendix 4 of this protocol during the intervention period and for at least 12 months after the last dose of study intervention and refrain from donating sperm during this period. * Female Participants: * A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies: * Not a woman of childbearing potential (WOCBP) OR * A WOCBP who agrees to follow the contraceptive guidance during the intervention period and for at least 12 months after the last dose of study intervention. * Preparing to undergo allogeneic HCT for either of the following: * AML, MDS, ALL * Participants in the treatment arms must express HLA-A\*0201. Participants in the control arm may express any HLA type. * Having the HA1+/- or HA-1+/+ (HA-1 positive) genotype to be eligible for TSC-100 treatment. * Having the HA2+/- HA-2+/+ (HA-2 positive) genotype to be eligible for TSC-101 treatment. * Having a haploidentical donor, MMUD, or MUD for HCT who is adequately HLA-matched by institutional standards and meets the donor inclusion criteria. Considered to be clinically indicated for haploidentical donor, MMUD, or MUD transplantation at the discretion of the treating investigator. Considered to be clinically indicated for RIC at the discretion of the treating investigator. Considered to be clinically indicated for peripheral blood stem cell transplantation at the discretion of the treating investigator. Organ function parameters for transplant eligibility are met per institutional standards. Capable of giving signed informed consent - which includes compliance with the requirements and restrictions listed in the ICF and in this protocol. Participants must provide consent for mandatory study procedures including bone marrow biopsy and blood sampling for research analyses in the ICF. Participants must agree to participate in long-term follow-up for up to 15 years post initial product treatment if they are enrolled in the study and receive the investigational Tcell infusion. Donor Inclusion Criteria : Male or female aged ≥ 18 years at the time of signing the informed consent. Able to undergo peripheral blood stem cell (PBSC) collection and up to 2 rounds of leukapheresis (for TSC-100 or TSC101 manufacturing for treatment arms only, and f for stem cell collection for both treatment arms and the control arm). Donors matched to TSC-100 participants should be HA-1-/- (negative) and/or negative for all HLA-A\*02 alleles Donors matched to TSC-101 participants should be negative for all HLA-A\*02 alleles Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the ICF and in this protocol. Exclusion Criteria: Medical or psychological conditions that would make the participant an unsuitable candidate for cell therapy including another concurrent uncontrolled malignancy or active CNS disease. The presence of organ toxicities will not necessarily exclude participants from enrolling on the protocol at the discretion of the PI; however, a delay in the infusion of HA1/HA2 TCRT cells may be required at the discretion of the treating investigator Participants with levels of donor-specific HLA antibodies that are considered by the treating investigator to be high enough to warrant desensitization protocols and who have no alternate donors. Participants who meet inclusion criteria for TSC-101 but who are also positive for HLAA\*02:07. Participants with evidence of clinically significant infection or uncontrolled viral r reactivation of cytomegalovirus (CMV), Epstein-Barr virus (EBV), Adenovirus, BK virus (BKV), or human herpesvirus 6 (HHV-6). Participants with active cardiac disease, defined as: Uncontrolled or symptomatic angina within the past 3 months. History of clinically significant arrhythmias (such as ventricular tachycardia, ventricular fibrillation, torsades de pointes). Atrial fibrillation with controlled ventricular response on treatment is not an exclusion. Myocardial infarction \< 3 months from study entry. Uncontrolled or symptomatic congestive heart failure. Prior allogeneic HCT. Participants who have a history of hypersensitivity to murine proteins. Enrollment on a concomitant trial with a novel investigational agent. Use of anti-thymocyte globulin, alemtuzumab, or other in vivo T-cell depleting agents from Day -14 through end of study. Donor Exclusion Criteria : Donors for TSC-100 positive for any HLA-A\*02 allele would be excluded unless they are HA-1 negative. If donors with any HLA-A\*02 allele are considered for patients eligible for TSC-100, the donor would undergo HA-1 testing to ensure that the donor is HA-1 negative (40% probability). Donors for TSC-101 positive for any HLA-A\*02 allele are excluded regardless of HA- 2 status. Donors who test positive for any of the following: HIV-1, HIV-2, human T-lymphotropic virus (HTLV)-1, HTLV-2 seropositive or with active hepatitis B or hepatitis C virus infection, syphilis, West Nile virus through central lab testing. Donors who screen positive for risk of CreutzfeldtJakob disease or Zika virus infection using donor history questionnaires will also be excluded. Donors with evidence of past CMV or EBV infections will be allowed. Related donor residing outside of the United States of America (USA). If the donor screening, testing and leukapheresis can be performed at the same site where the participant is being treated, the donor is considered eligible.
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:Occurrence of dose limiting toxicities · Number of DLTs observed in patients compared to the control arm · 2 years;Occurrence of adverse events · Number of adverse events in patients compared to control arm · 2 years
次要终点:Comparison of disease free survival in patients versus the control arm;Comparison of disease free survival in patients versus the control arm;Disease-free survival in patients versus the control arm at 18 months, defined as the time from date of transplant to death or relapse/progression, whichever comes first. Participants alive and disease free will be censored at the last follow-up.;Comparison of disease free survival in patients versus the control arm;Comparison of relapse rates between patients and control arm;Comparison of relapse rates between patients and control arm;Comparison of overall survival between patients and control arm;Anti TSC-100 antibodies
适用于HA-1阳性患者。
适用于HA-1阴性、HA-2阳性患者。
仅接受标准治疗(SOC)。
本多中心、非随机、同期对照、多臂、开放标签I期生物学分配伞式研究,评估AML、MDS或ALL患者在单倍体相合、MMUD或MUD异基因HCT后接受最多两剂递增TSC-100或TSC-101的可行性、安全性和初步疗效。TSC-100用于HA-1阳性患者,TSC-101用于HA-1阴性且HA-2阳性患者,并与标准治疗对照比较。
This is a multi-center, non-randomized, concurrent controlled, multi-arm, Phase 1 interventional, open-label, biologic assignment-based umbrella study evaluating the feasibility, safety and preliminary efficacy of an escalating dose regimen of up to 2 doses of TSC-100 and TSC-101 in patients with AML, MDS, or ALL following HCT from a haploidentical donor, MMUD, or MUD
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