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:A Study of CC-97540, CD-19-Targeted Nex-T CAR T Cells, in Participants With Severe, Refractory Autoimmune Diseases (Breakfree-1)
A Study of CC-97540, CD-19-Targeted Nex-T CAR T Cells, in Participants With Severe, Refractory Autoimmune Diseases (Breakfree-1)
分数与星级只用于站内排序 —— 不代表疗效、安全性或个人适用性。
这是一项 I 期注册临床试验,评估细胞治疗用于系统性红斑狼疮、多发性骨髓瘤、系统性硬化症的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 270 例。试验地点:美国 · 奥罗拉、丹佛、杰克逊维尔、迈阿密(共 46 个中心)。登记号:NCT05869955。
不限性别 · ≥ 18 Years
纳入标准 系统性红斑狼疮(SLE):符合2019年EULAR/ACR分类标准;筛查时抗dsDNA、抗组蛋白、抗染色质、抗Ro/SSA、抗La/SSB或抗Sm抗体至少一项阳性。筛查时疾病活动,近期至少一个主要器官系统BILAG A级(肌肉骨骼、皮肤黏膜及全身症状系统除外)。对糖皮质激素及下列至少两种治疗应答不足;每种治疗至少使用3个月:环磷酰胺、吗替麦考酚酸/衍生物、贝利尤单抗、硫唑嘌呤、阿尼鲁单抗、甲氨蝶呤、利妥昔单抗、奥妥珠单抗、环孢素、他克莫司或伏环孢素。 特发性炎性肌病(IIM):符合2017 EULAR/ACR可能或明确IIM分类标准;亚型为皮肌炎(DM)、免疫介导坏死性肌病(IMNM)、抗合成酶综合征(ASyS)或多发性肌炎(PM);筛查时或此前至少一种肌炎特异抗体(MSA)、相关抗体(MAA)或ANA阳性。疾病活动表现为中/重度肌肉和/或皮肤受累,并有活动性肌炎皮疹、近期肌肉活检、CK>ULN的3倍,或IIM合并HRCT显示进行性间质性肺病(ILD)之一。对糖皮质激素及至少两种治疗应答不足,且每种治疗至少3个月:硫唑嘌呤、甲氨蝶呤、环孢素A、他克莫司、吗替麦考酚酯、环磷酰胺、静脉注射免疫球蛋白(IVIG)、JAK抑制剂或利妥昔单抗。 系统性硬化症(SSc):符合2013 EULAR/ACR分类标准,筛查时或此前ANA阳性。弥漫型皮肤SSc,或弥漫/局限型皮肤SSc合并进行性ILD;且对以下至少一种治疗使用≥3个月后疗效不足:吗替麦考酚酯、环磷酰胺、利妥昔单抗、尼达尼布、硫唑嘌呤、托珠单抗或IVIG。 类风湿关节炎(RA):66/68关节计数至少3个肿胀关节且3个压痛关节,或诊断进行性ILD;并对至少一种传统合成DMARD及至少两种不同作用机制的生物/靶向合成DMARD治疗≥3个月后应答不足或不耐受。因进行性ILD入组者可已用尽上述疗法,或对以下至少一种治疗≥3个月后应答不足/不耐受:吗替麦考酚酯、托珠单抗、环磷酰胺、利妥昔单抗、硫唑嘌呤、尼达尼布或吡非尼酮。 排除标准 • 药物诱发SLE(而非特发性SLE)。 • 其他系统性自身免疫病(如多发性硬化、银屑病、炎症性肠病等);1型自身免疫性糖尿病、甲状腺自身免疫病、乳糜泻或继发性干燥综合征不排除。SLE重叠综合征(包括RA、硬皮病、混合性结缔组织病等)排除。 • 过去12个月内或当前有临床显著CNS病变。 • IIM排除:包涵体肌炎、无肌病性皮肌炎、任何青少年肌炎;非IIM肌炎(如药物性肌炎、HIV相关PM);肌炎损伤指数肌肉损伤医师VAS>10 cm量表的7 cm、非IIM原因永久性无力(如卒中),或累及心脏的肌炎。 • SSc排除:需积极治疗的SSc相关肺动脉高压;快速进展的SSc下消化道(小肠/大肠)受累且需肠外营养;活动性胃窦血管扩张;既往硬皮病肾危象。 • RA排除:既往或当前有RA以外的炎性关节病;关节损伤/畸形可能妨碍研究者准确评估病情活动。 • 其他方案规定的入排标准同样适用。
Inclusion Criteria \- Diagnosis of Systemic Lupus Erythematosus (SLE) defined as follows:. i) Fulfilling the 2019 European League Against Rheumatism (EULAR) / American College of Rheumatology (ACR) classification criteria of SLE. ii) Presence of anti-dsDNA, anti-histone, anti-chromatin, anti-Ro (anti-SS-A), anti-La (anti-SS-B), or anti-Sm antibodies at screening. \- SLE disease activity:. i) Active disease at screening, with recent ≥ 1 major organ system with a BILAG A score (excluding musculoskeletal, mucocutaneous, and/or constitutional organ system). ii) Inadequate response to glucocorticoids and to at least 2 of the following treatments, used for at least 3 months each: cyclophosphamide, mycophenolic acid or its derivatives, belimumab, azathioprine, anifrolumab, methotrexate, rituximab, obinutuzumab, cyclosporin, tacrolimus or voclosporin. * Diagnosis of Idiopathic Inflammatory Myopathy (IIM) defined as follows:. i) Fulfilling the 2017 EULAR/ACR classification criteria for probable or definite IIM. ii) Participant diagnosed with the following IIM subgroups: dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASyS), and polymyositis (PM). iii) Presence of at least 1 myositis specific antibody (MSA), associated antibody (MAA), or ANA at screening or prior to screening. * IIM disease activity:. i) Severe/moderate muscle AND/OR skin involvement. ii) Proof of activity as documented by:. A. An active myositis-associated rash OR. B. A recent muscle biopsy OR. C. An elevated CK \> 3 times the upper limit of normal OR. D. Participants diagnosed IIM AND progressive Interstitial Lung Disease (ILD) on high-resolution computed tomography (HRCT) iii) Inadequate response to glucocorticoids and at least 2 of the following treatments used for at least 3 months: azathioprine, methotrexate, cyclosporin A, tacrolimus, MMF, cyclophosphamide, IVIG, JAK inhibitors, and rituximab. * Diagnosis of Systemic Sclerosis (SSc) defined as follows:. i) Fulfilling 2013 EULAR/ACR classification criteria for SSc. ii) Antinuclear Antibody (ANA) positive at screening or prior to screening. \- SSc disease activity:. i) Participants diagnosed with diffuse cutaneous SSc OR diffuse or limited cutaneous SSc AND progressive ILD, AND. ii) Inadequate response to at least 1 of the following treatments used for at least 3 months: mycophenolate, cyclophosphamide, rituximab, nintedanib, azathioprine, tocilizumab, or intravenous immunoglobulins (IVIG). \- Rheumatoid Arthritis (RA) disease activity:. i) Minimum of 3 SJC and 3 TJC on a 66/68 joint count (SJC/TJC). ii) OR participants diagnosed with progressive ILD (interstitial lung disease). iii) AND Inadequate disease response or intolerance to at least one conventional synthetic disease-modifying antirheumatic drug (DMARD) and as well as ≥ 2 DMARDs with different mechanisms of action from the categories biologic disease-modifying antirheumatic drug (bDMARDs) or targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD) for a minimum of 3 months. A. Participants qualifying on progressive ILD may have exhausted the therapies above OR have demonstrated inadequate disease response or intolerance to at least one of the following treatments used for at least 3 months: mycophenolate, tocilizumab, cyclophosphamide, rituximab, azathioprine, nintedinib, pirfenidone. Exclusion Criteria \- Diagnosis of drug-induced SLE rather than idiopathic SLE. \- Other systemic autoimmune diseases (eg, multiple sclerosis, psoriasis, inflammatory bowel disease, etc) are excluded. Participants with type I autoimmune diabetes mellitus, thyroid autoimmune disease, Celiac disease, or secondary Sjögren's syndrome are not excluded. * SLE overlap syndromes including, but not limited to, rheumatoid arthritis, scleroderma, and mixed connective tissue disease, are excluded. * Present or recent clinically significant CNS pathology, within 12 months. * IIM disease activity:. i) Other forms of IIM: Inclusion Body Myositis, Amyopathic DM, any form of juvenile myositis. ii) Myositis other than IIM, eg, drug-induced myositis and PM associated with HIV. iii) Participants with severe muscle damage (Physician VAS for muscle damage in Myositis Damage Index \> 7 cm on a 10 cm scale), permanent weakness due to a non-IIM cause (eg, stroke), or myositis with cardiac involvement. \- SSc disease activity:. i) SSc related PAH requiring active treatment. ii) Rapidly progressive SSc related lower GI (small and large intestines) involvement (requiring parenteral nutrition); active gastric antral vascular ectasia. iii) Prior scleroderma renal crisis. \- RA disease activity:. i) Prior history of or current inflammatory joint disease other than RA. ii) Joint damage and/or deformity that may confound the investigator's ability to accurately assess disease activity. \- Other protocol-defined Inclusion/Exclusion criteria apply.
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:Number of participants with treatment-emergent adverse events (AEs) in each indication. · Up to 2 years after CC-97540 infusion;Number of participants with serious AEs (SAEs) in each indication. · Up to 2 years after CC-97540 infusion;Number of participants with AEs of special interest (AESI) in each indication. · Up to 2 years after CC-97540 infusion;Number of participants with laboratory abnormalities in each indication. · Up to 2 years after CC-97540 infusion;Number of participants with Dose Limiting Toxicities (DLT) in each indication. · Up to 2 years after CC-97540 infusion;Recommended Phase 2 Dose (RP2D) of CC-97540 in each indication. · Up to 2 years after CC-97540 infusion
次要终点:Proportion of participants achieving definition of remission in SLE (DORIS) remission;Proportion of participants achieving Lupus Low Disease Activity State (LLDAS);Change in proteinuria measured by urine protein creatinine ratio (UPCR);Change in Health Assessment Questionnaire - Disability Index (HAQ-DI);Proportion of participants achieving Myositis Response Criteria (MRC) Total Improvement Score (TIS) Major Response;Change in the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI);Proportion of participants with ILD with no worsening of pulmonary function including forced expiratory volume (FEV1) (> 10%), forced vital capacity (FVC) (> 10%), and diffusing capacity of the lung for carbon monoxide (DLCO) (> 15%);Proportion of participants achieving a minimal clinically important difference (MCID) of 24% change from baseline of the modified Rodnan Skin Score (mRSS)
给予靶向CD19的Nex-T CAR-T 细胞产品CC-97540,评估重度、难治性自身免疫病患者的耐受性、初步疗效及药代动力学。
本研究(Breakfree-1)旨在评估靶向CD19的Nex-T CAR-T 细胞产品CC-97540用于重度、难治性自身免疫病患者的耐受性、初步疗效及药代动力学。
The purpose of this study is to establish the tolerability, preliminary efficacy, and pharmacokinetics of CC-97540 in participants with severe, refractory autoimmune diseases (Breakfree-1).
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