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:Human BCMA Targeted T Cells Injection(BCMA CAR-T)for Subjects With R/R MM
⚠ 该试验的登记信息已有 46 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 II 期注册临床试验,评估人源 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:招募中。计划入组 100 例。试验地点:中国 · 上海、温州(共 2 个中心,其中中国 2 个)。登记号:NCT05594797。
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方可入组: * 自愿参加临床试验,了解试验内容并签署知情同意书,愿意完成所有试验程序; * 年龄18至75岁(含界值),性别不限; * 预计生存期>12周; * 按照国际骨髓瘤工作组(IMWG)更新后的标准既往确诊为多发性骨髓瘤; * 符合以下任一指标: 1. 血清M蛋白≥5 g/L; 2. 尿M蛋白≥200 mg/24小时; 3. 受累血清游离轻链≥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患者还须符合: 1. 既往至少接受过3种多发性骨髓瘤治疗方案,其中至少包括一种蛋白酶体抑制剂和一种免疫调节剂; 2. 最近一次抗骨髓瘤治疗后12个月内有疾病进展记录,或疗效评估未达到微小缓解(MR)及以上,或最近一次抗骨髓瘤治疗结束后60天内出现进展。 * ECOG评分为0至2分; * 无法接受自体造血干细胞移植,或自体造血干细胞移植后复发且研究者判断需要进一步治疗; * 肝、肾及心肺功能符合以下要求: 1. 按Cockcroft-Gault公式估算的肌酐清除率≥40 mL/min; 2. 总胆红素≤正常值上限(ULN)的2倍;丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)均≤ULN的2.5倍; 3. 左心室射血分数>50%; 4. 基线外周血氧饱和度>95%。 * 能建立采集所需的静脉通路,无白细胞采集禁忌,且研究者判断可进行白细胞单采;同时血红蛋白≥70 g/L、血小板≥50×10^9/L、中性粒细胞≥1.0×10^9/L。 排除标准:符合以下任一情况者不得入组: * 有中枢神经系统(CNS)疾病史,如癫痫发作、瘫痪、失语、卒中、严重脑损伤、痴呆、帕金森病或精神病;已知存在或既往有活动性CNS受累,或有多发性骨髓瘤脑膜/脑膜受累表现; * 患有浆细胞白血病、华氏巨球蛋白血症、POEMS综合征或原发性轻链淀粉样变; * 合并其他未控制的恶性肿瘤,但已充分治疗的宫颈原位癌、皮肤基底细胞癌或鳞状细胞癌、根治性切除后的局限性前列腺癌、根治性切除后的乳腺导管原位癌及根治性切除后的甲状腺癌除外; * 存在任何无法控制的活动性感染,包括但不限于活动性结核;入组前14天内存在或疑似存在无法控制,或需要全身静脉治疗的真菌、细菌、病毒或其他感染; * 乙型肝炎表面抗原(HBsAg)或乙型肝炎核心抗体(HBcAb)阳性,且乙型肝炎病毒(HBV)DNA滴度高于研究中心正常范围下限;丙型肝炎病毒(HCV)抗体阳性且外周血HCV RNA阳性;人类免疫缺陷病毒(HIV)抗体阳性;梅毒阳性; * 存在未控制的全身性疾病,包括但不限于不稳定型心绞痛、筛选前6个月内发生脑血管意外或短暂性脑缺血、筛选前6个月内发生心肌梗死、充血性心力衰竭(纽约心脏协会[NYHA]分级≥III级)、未控制的糖尿病(筛选时糖化血红蛋白HbA1c>8%)、严重心律失常,或药物控制不佳的肝脏、肾脏或代谢性疾病; * 有起搏器或脑起搏器植入史; * 既往接受过CAR-T治疗、其他基因修饰细胞治疗或其他靶向BCMA的药物; * 筛选前2个月内接受过任何造血干细胞移植,或筛选期间因移植物抗宿主病接受过任何免疫抑制治疗; * 筛选前14天内接受全身类固醇治疗,且研究者判断治疗期间需要长期使用全身类固醇(吸入或局部用药除外);或接受过任何全身抗肿瘤治疗(局部抗肿瘤治疗除外); * 单采前4周内接种过减毒活疫苗; * 过去2年内因自身免疫性疾病(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,或需要全身使用免疫抑制剂或其他全身性疾病控制药物; * 妊娠或哺乳期女性;计划在治疗期间或治疗后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。具有生育能力的受试者愿意在研究治疗后1年内采用非常有效且可靠的避孕方法者除外; * 患有影响签署书面知情同意书的疾病,或无法遵守研究程序;或不愿意或无法遵守研究要求; * 对本研究使用的任何药物曾发生严重速发型超敏反应; * 研究者认为不适合参加本试验。
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),gender is not limited; * Expected survival \> 12 weeks; * Previously diagnosed as multiple myeloma by the International Myeloma Working Group(IMWG) updated criteria; * One of the following indicators is satisfied: 1. Serum M protein ≥ 5 g/L; 2. Urine M protein ≥ 200 mg/24h; 3. Affected serum free light chain ≥ 100 mg/L and Serum free light chain ratio is abnormal ; * Patients with relapsed/refractory multiple myeloma, satisfying: 1. Patients have received at least 3 prior MM treatment regimens containing at least one proteasome inhibitor and one immunomodulator; 2. Progress is documented within 12 months of the most recent antimyeloma treatment, or efficacy assessment does not reach minimal response(MR) or above or progression within 60 days of the most recent antimyeloma treatment; * ECOG score 0-2; * Autologous hematopoietic stem cell transplantation is not possible or relapses after autologous hematopoietic stem cell transplantation, but requires further treatment at the investigator's discretion; * Liver, kidney and cardiopulmonary functions meet the following requirements: 1. Creatinine clearance rate (estimated by CockcroftGault formula)≥40mL/min; 2. Total bilirubin≤2×ULN; Alanine aminotransferase (ALT) ≤2.5×ULN and aspartate aminotransferase (AST)≤2.5×ULN; 3. Left ventricular ejection fraction \>50%; 4. Baseline peripheral oxygen saturation\>95%; * The venous access required for collection can be established, no contraindications to leukocyte collection, and leukepheresis can be carried according to the judgement of investigators, satisfying hemoglobin≥70g/L,platelets ≥50×10\^9 / L, neutrophils ≥1.0×10\^9/L. Exclusion Criteria:Any one of the following conditions cannot be selected as a subject: * Subjects have a history of central nervous system (CNS) diseases such as seizures, paralysis, aphasia, stroke, severe brain injury, dementia, Parkinson's disease, psychosis; known or history of active central nervous system (CNS) involvement or presentation of multiple myeloma meninge/meningeal involvement; * Subjects with plasma cell leukemia, Waldenstrom's macroglobulinemia, POEMS syndrome, or primary light chain amyloidosis; * Accompanied by other uncontrolled malignancies, in addition to adequately treated cervical carcinoma in situ, basal cell or squamous cell skin cancer, localized prostate cancer after radical resection, ductal carcinoma in situ after radical resection and thyroid cancer after radical resection ; * Any uncontrollable active infection, including but not limited to active tuberculosis; fungal, bacterial, viral, or other infections that are uncontrollable or require systemic intravenous therapy are present or suspected within 14 days prior to enrollment; * Subjects with positive Hepatitis B surface antigen(HBsAg) or Hepatitis B core antibody (HBcAb) and hepatitis B virus (HBV) DNA titers higher than the lower limit of the normal range of the investigative site); Hepatitis C virus (HCV) antibody positive and peripheral blood HCV RNA positive; Human Immunodeficiency Viral (HIV) antibody positive; syphilis positive; * Any uncontrolled systemic diseases, including but not limited to unstable angina pectoris, 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), uncontrolled diabetes mellitus (glycosylated hemoglobin HbAlc \>8% at screening),severe arrhythmia, liver, kidney, or metabolic diseases that are poorly controlled by medications; * Subjects who have a history of pacemaker and brain pacemaker implantation; * Subjects who have received CAR-T treatment or other genetically modified cell therapies, as well as other BCMA-targeting drugs; * Subjects with any hematopoietic stem cell transplant performed within the first two months of screening, or any immunosuppressive therapy due to graft-versus-host disease performed during the screening period; * Subjects who were receiving systemic steroid treatment within 14 days before the screening period and who were judged by the investigator to require long-term use of systemic steroid therapy during treatment (except inhalation or topical use); or subjects who received any systemic anti-tumor therapy ( except for local anti-tumor therapy) ; * Subjects who have received live attenuated vaccine within 4 weeks prior to apheresis; * 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; * Pregnant or lactating woman, or planned pregnancy during treatment or within 1 year after treatment, or male subject whose partner plans to have a pregnancy within 1 year after cell transfusion; except participants of childbearing age are willing to use a very effective and reliable method of contraception for 1 year after study treatment; * Subjects who have a disease that affects the signing of written informed consent or who are unable to comply with research procedures; or who are unwilling or unable to comply with research requirements; * Subjects who have had severe immediate hypersensitivity reactions to any drugs used in this research; * Subjects who are considered unsuitable to participate in this trial by the investigator.
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:Objective Response Rate (ORR) at 3 months post infusion as evaluated by the Independent Review Committee · ORR at 3 months post infusion as evaluated by the Independent Review Committee (IRC) includes stringent complete response (sCR), complete response (CR), very good partial response (VGPR), and partial response (PR). · 3 months post infusion
次要终点:Duration of remission (DOR) after administration;Progression-free Survival (PFS) after administration;Overall Survival (OS) after administration;Objective Response Rate (ORR) at 3 months post infusion as evaluated by the Investigator;Objective Response Rate (ORR) at 6 months post infusion as evaluated by the Independent Review Committee;Percentage of Subjects With Negative Minimal Residual Disease (MRD);Duration of Subjects With Negative Minimal Residual Disease (MRD);Number of Subjects with Adverse Events
单次给药:6.0×10^6个CAR阳性T细胞/kg。
这是一项II期临床研究,评估人源BCMA靶向T细胞注射液(BCMA CAR-T)治疗复发/难治性多发性骨髓瘤的疗效和安全性。 患者将先接受氟达拉滨和环磷酰胺组成的预处理化疗方案,随后单次输注BCMA CAR阳性T细胞。
A Phase Ⅱ Clinical Study Evaluating the Efficacy and Safety of Human BCMA Targeted T Cells Injection(BCMA CAR-T) Therapy for R/R MM. Patients will be given a conditioning chemotherapy regimen of fludarabine and cyclophosphamide followed by a single infusion of BCMA CAR+ T cells.
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