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:CD19-Directed Chimeric Antigen Receptor (CAR) T-Cell Therapy for Relapsed/Refractory B-Lineage Leukaemia / Lymphoma - A Feasibility Protocol
⚠ 该试验的登记信息已有 43 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,评估抗 CD19CAR-T 细胞治疗白血病、急性淋巴细胞白血病、大 B 细胞淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 40 例。试验地点:亚太其他 · 新加坡(共 2 个中心)。登记号:NCT05648019。
不限性别 · ≥ 0 Years 且 ≤ 70 Years
纳入标准: 1. 符合以下疾病之一:复发/难治性B细胞ALL(须满足全部条件:骨髓穿刺形态学可见淋巴母细胞或筛查时MRD阳性;复发、难治或不适合造血干细胞移植;复发性B-ALL患者须有入组前3个月内骨髓或外周血CD19肿瘤表达证据,如流式细胞术);或接受≥2线全身治疗后复发/难治的大B细胞淋巴瘤,包括非特指型DLBCL、原发纵隔大B细胞淋巴瘤、高级别B细胞淋巴瘤及滤泡性淋巴瘤转化的DLBCL。 2. 筛查时年龄<18岁(儿童组)或≥18岁(成人组)。 3. 器官功能充分。 4. 预期生存期>12周。 5. 筛查时Karnofsky评分(≥16岁)或Lansky评分(<16岁)≥50。 6. 符合所在机构白细胞单采标准,或已有未动员细胞的单采产品并经生产机构接收。 排除标准: • B-ALL仅有孤立性髓外复发。 • 合并遗传综合征,如范可尼贫血、Kostmann综合征、Shwachman综合征或其他已知骨髓衰竭综合征;唐氏综合征患者不排除。 • Burkitt淋巴瘤/白血病(成熟B细胞ALL,即表面免疫球蛋白阳性且κ或λ限制性表达、FAB L3形态和/或MYC易位的白血病)。 • 筛查前8周内检测显示活动性或潜伏性乙肝、活动性丙肝,或筛查时存在任何未控制感染。 • 筛查前8周内HIV检测阳性。 • Ⅱ–Ⅳ级急性GVHD或广泛型慢性GVHD。 • 活动性CNS恶性肿瘤(按NCCN标准为CNS-3);CNS-2受累或既往CNS疾病已接受积极治疗者可入组。 • 筛查前30天内使用试验用药品。 • 妊娠或哺乳期女性。 • 有生育能力的女性及所有男性参与者,若未同意自CAR-T输注后1年内采用高效避孕方法则排除;所有有生育能力女性患者须在CAR-T输注前48小时内妊娠检测阴性。 以下情况不构成绝对排除,但须与主要研究者/中心主要研究者讨论:既往恶性肿瘤(以根治为目的治疗且无活动性疾病的皮肤或宫颈原位癌除外);既往接受基因治疗产品;既往接受抗CD19/抗CD3或其他抗CD19治疗。
Inclusion Criteria:
1. Eligible disease conditions:
1. Relapsed or refractory B-cell ALL (all must be satisfied)
* Presence of lymphoblasts in bone marrow aspirate by morphologic assessment or positive minimal residual disease at screening.
* Relapsed or refractory or ineligible for HSCT
* For relapsed B-ALL: Documentation of CD19 tumour expression (e.g. by flow cytometry) demonstrated in bone marrow or peripheral blood within 3 months of study entry
2. Relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B-cell lymphoma, high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma.
2. Age at screening:
1. \< 18 years (paediatric group); or
2. ≥ 18 years (adult group)
3. Adequate organ functions:
4. Life expectancy more than 12 weeks.
5. Karnofsky (age ≥ 16 years) or Lansky (age \< 16 years) performance status ≥ 50 at screening.
6. Must meet the institutional criteria to undergo leukapheresis or have a leukapheresis product of non-mobilized cells received and accepted by the manufacturing site.
Exclusion Criteria:
Patients with any of the following will be excluded:
* B-ALL with isolated extramedullary disease relapse
* Patients with concomitant genetic syndrome: such as patients with Fanconi anaemia, Kostmann syndrome, Shwachman syndrome or any other known bone marrow failure syndrome. Patients with Down syndrome will not be excluded.
* Patients with Burkitt's lymphoma/leukaemia (i.e. patients with mature B-cell ALL; leukaemia with B-cell \[sIg positive and kappa or lambda restricted positivity\] ALL, with FAB L3 morphology and /or a MYC translocation)
* Active or latent hepatitis B or active hepatitis C (test within 8 weeks of screening), or any uncontrolled infection at screening
* Human Immunodeficiency Virus (HIV) positive test within 8 weeks of screening
* Presence of grade 2 to 4 acute or extensive chronic graft-versus-host disease (GVHD)
* Active CNS involvement by malignancy, defined by CNS-3 per NCCN guidelines. Subjects with CNS-2 involvement or with history of CNS disease that have been actively treated are eligible.
* Patient has an investigational medicinal product within the last 30 days prior to screening.
* Pregnant or nursing women.
* Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) and all male participants, unless they are using highly effective methods of contraception for a period of 1 year after the CAR T-cell infusion. All female patients of childbearing potential must have a negative pregnancy test performed within 48 hours before infusion of CAR T-cells.
The following are not strictly exclusion criteria but must be discussed with PI/Site-PI:
* Prior malignancy, except carcinoma in situ of the skin or cervix treated with curative intent and with no evidence of active disease
* Treatment with any prior gene therapy product
* Has had treatment with any prior anti-CD19/anti-CD3 therapy, or any other anti-CD19 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:Protocol Feasibility · To describe feasibility of delivering point-of-care manufactured CD19-directed CAR T-cell therapy to patients with relapsed / refractory B-lineage leukaemia / lymphoma by assessing number and percentage of enrolled patients who have successful manufacturing of CAR T-cell product, and number and percentage of enrolled patients who go on to receive the CAR T-cell product. · 3 years
次要终点:Overall Response Rate;Toxicity Evaluations
CD19靶向CAR-T细胞治疗复发/难治性B系白血病/淋巴瘤。
本研究旨在评估为复发/难治性B系白血病/淋巴瘤患者提供即时制备的CD19靶向CAR-T细胞治疗的可行性。
The purpose of this study is to describe feasibility of delivering point-of-care manufactured CD19-directed CAR T-cell therapy to patients with relapsed/ refractory B-lineage leukaemia/ lymphoma.
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