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:The Safety and Efficacy of BRL-201 in the Treatment of r/r B Lymphocyte Non-Hodgkin Lymphoma
这是一项 I 期注册临床试验,评估 CD19CAR-T 细胞治疗非霍奇金淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 18 例。试验地点:中国 · 武汉、天津、杭州(共 3 个中心,其中中国 3 个)。登记号:NCT05741359。
不限性别 · ≥ 18 Years
纳入标准: 1. 愿意参加本临床研究并签署知情同意书。 2. 年龄≥18岁。 3. 预计生存期≥3个月。 4. 至少有1个按2014年Lugano淋巴瘤疗效评价分类可测量病灶:CT横断面图像显示淋巴结病灶长径>15 mm或结外病灶长径>10 mm,且FDG-PET阳性。接受过放疗的病灶仅在放疗后明确进展时方可视为可测量病灶。 5. 组织病理学确诊侵袭性B细胞非霍奇金淋巴瘤(B-NHL),免疫组化或流式细胞术检测肿瘤CD19阳性,病理类型符合WHO 2016淋巴瘤分类。 6. 疾病复发或难治。 7. 已接受充分的既往治疗。 8. 头颅MRI未见中枢神经系统(CNS)淋巴瘤侵犯。 9. 血液学指标符合要求。 10. 血液生化指标符合要求。 11. LVEF≥55%。 12. 无严重肺部疾病。 13. 既往抗淋巴瘤治疗引起的毒性稳定且已恢复至≤1级。 14. ECOG评分0–1分。 15. 具备外周血单采条件。 16. 愿意遵守研究方案规定。 排除标准: 1. 妊娠或哺乳期女性。 2. 既往接受过异基因细胞治疗,包括异基因干细胞移植。 3. 既往接受抗CD19靶向治疗者排除;本研究中接受BRL-201且符合再次输注条件者除外。 4. 既往接受任何CAR-T细胞产品或其他基因修饰T细胞治疗。 5. 有慢性淋巴细胞白血病(CLL)Richter转化史。 6. 存在需要全身治疗的未控制真菌、细菌、病毒或其他感染;单纯尿路感染或咽炎经治疗有效者可入组。 7. HBsAg阳性,或HBcAb阳性且外周血HBV DNA高于检测上限;HCV抗体阳性且外周血HCV RNA阳性;HIV抗体阳性;或梅毒检测阳性。 8. 严重精神障碍;有CNS疾病史(如癫痫、脑血管缺血/出血、痴呆、小脑疾病或累及CNS的自身免疫病)。 9. 活动性自身免疫性疾病需免疫治疗,包括过去2年内自身免疫病造成的终末器官损害(如Crohn病、类风湿关节炎、系统性红斑狼疮),或需要全身使用免疫抑制剂/其他药物控制疾病。 10. 原发性免疫缺陷。 11. 有其他恶性肿瘤史。 12. 严重心血管疾病,包括淋巴瘤浸润心房或心室,或入组前12个月内心肌梗死、心脏血管成形术/支架置入、不稳定型心绞痛或其他临床显著心脏病史。 13. 入组前6个月内有深静脉血栓或肺栓塞史。 14. 正在接受口服抗凝治疗;未接受抗凝药物时PT、APTT或INR>1.5倍ULN。 15. 存在留置管路或导管(如经皮肾造瘘管、留置导尿管、胸腔/腹腔/心包腔导管);专用中心静脉通路导管(如Port-a-Cath或Hickman导管)允许。 16. 脑脊液中检出淋巴瘤细胞、存在脑转移,或有CNS淋巴瘤/脑脊液淋巴瘤细胞/脑转移史。 17. 因肿块(如肠梗阻或血管受压)需要紧急治疗。 18. 对本研究使用的任何药物有严重速发型超敏反应史。 19. 预处理方案开始前≤6周内接种活疫苗;COVID-19疫苗除外。 20. 研究者判断可能增加受试者风险或干扰研究结果的其他情况。
Inclusion Criteria: 1. Willing to participate in this clinical study and sign an informed consent form; 2. Age ≥ 18 years old; 3. Estimated survival time ≥ 3 months; 4. Presence of at least one measurable lesion as assessed according to Lugano Classification 2014 for response assessment in lymphomas (i.e., the cross-sectional images obtained by CT show that the long diameter of lymph node lesions is \> 15 mm or the long diameter of extranodal lesions is \> 10 mm, and FDG-PET scan results are positive). Lesions, for which radiotherapy was provided, can be regarded as measurable lesions only if there is an unequivocal progression after radiotherapy; 5. Histopathologically confirmed aggressive B-NHL; positive expression of CD19 in tumors detected by immunohistochemistry or flow cytometry; pathological types of B-NHL (according to WHO Lymphoma Classification 2016); 6. Relapsed or refractory diseases; 7. Subjects who must receive adequate prior therapy; 8. Absence of invasion of central nervous system (CNS) lymphoma by cranial magnetic resonance imaging (MRI); 9. Hematological parameters meeting the requirements; 10. Blood biochemistry meeting the requirements; 11. LVEF ≥ 55%; 12. No severe pulmonary disorders; 13. Toxic reactions induced by prior anti-lymphoma therapy must be stable and resolved to grade ≤ 1; 14. Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1; 15. Patients with physical conditions for apheresis of peripheral blood; 16 . Willing to abide by the rules formulated in the study protocol. Exclusion Criteria: 1. Pregnant or lactating women; 2. Subjects who previously received allogeneic cell therapies, including allogeneic stem cell transplant; 3. Subjects who previously received anti-CD19 targeted therapy, except those who receive BRL-201 and are eligible to receive reinfusion in this study; 4. Prior treatment with any CAR-T cell product or other genetically modified T cell therapies; 5. History of Richter's transformation of chronic lymphocytic leukemia (CLL); 6. Presence of uncontrollable fungal, bacterial, viral, or other infections requiring systemic therapy. Patients can be enrolled if the simple urinary tract infection or pharyngitis responds to treatment; 7. Subjects with positive hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) and peripheral blood HBV DNA titer higher than the upper limit of detection; hepatitis C virus (HCV) antibody positive and peripheral blood HCV RNA positive; human immunodeficiency virus (HIV) antibody positive; syphilis test positive; 8. Severe mental disorders; history of CNS disorders (e.g., epileptic seizure, cerebrovascular ischemia/hemorrhage, dementia, cerebellar diseases, or any CNS-involved autoimmune disorders); 9. Active autoimmune disorders requiring immunotherapy, including but not limited to end organ damages caused by autoimmune disorders (e.g., Crohn's disease, rheumatoid arthritis, and systemic lupus erythematosus) in the past 2 years, or requiring systemic application of immunosuppressive drugs or other drugs for systemic control of diseases; 10. Primary immunodeficiency; 11. History of other malignancies; 12. Patients with severe cardiovascular disorders, including but not limited to those with lymphoma infiltration in the cardiac atrium or ventricles and those with a history of myocardial infarction, cardioangioplasty or stent implantation, unstable angina, or other clinically significant heart diseases within 12 months before enrollment; 13. History of deep venous thrombosis or pulmonary embolism within 6 months before enrollment; 14. Patients who are receiving oral anticoagulant therapy; prothrombin time (PT), activated partial thromboplastin time (APTT), or international normalized ratio (INR) \> 1.5 × ULN without anticoagulant therapy; 15. Presence of any indwelling tube or catheter (e.g., tube or catheter for percutaneous nephrostomy, indwelling catheter, or catheter in pleural cavity/peritoneal cavity/pericardium). Dedicated central venous access catheters (e.g., Port-a-Cath or Hickman catheter) are permitted; 16. Lymphoma cells detected in cerebrospinal fluid, presence of brain metastases, history of CNS lymphoma, or history of lymphoma cells detected in cerebrospinal fluid or brain metastases; 17. Conditions (e.g., intestinal obstruction or vascular compression) requiring emergency treatment due to tumor masses; 18. History of severe immediate hypersensitivity to any drug to be used in this study; 19. Vaccination of live vaccines, excluding corona virus disease 2019 (COVID-19) vaccines, within ≤ 6 weeks before the start of the pretreatment regimen; 20. Any circumstances that possibly increase the risk of subjects or interfere with the study results as judged 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:DLT · The number and severity of dose-limiting toxicity (DLT) events · Within 28 Days After BRL-201 Infusion;AEs · The total number, incidence, and severity of AEs · Up to 24 Months After BRL-201 Infusion;RP2D · The recommended phase 2 dose · Within 28 Days After BRL-201 Infusion
给药剂量为5–10.0×10⁶/kg体重。
这是一项多中心、单臂、开放标签临床研究,计划纳入12–18名受试者。
This is a multi-center, single-arm, open-label clinical study, and the sample size is set to 12-18 subjects.
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