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:CNCT19 for Patients With Autoimmune Hemolytic Anemia After Failure ≥3 Lines of Therapy.
⚠ 该试验的登记信息已有 17 个月未更新, 页面上显示的「进行中(不再招募)」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 I 期注册临床试验,评估细胞治疗用于多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 6 例。试验地点:中国 · 天津(共 1 个中心,其中中国 1 个)。登记号:NCT06231368。
不限性别 · ≥ 12 Years
入选标准 • 受试者和/或其法定个人代表充分理解研究内容并自愿签署知情同意书。 • 男女不限,年龄≥12岁。 • 自身免疫性溶血性贫血(AIHA)或Evans综合征患者,且≥3线治疗失败。须同时满足:血红蛋白<10 g/dL且有贫血症状;一线皮质类固醇治疗失败;二线利妥昔单抗治疗失败;至少一种三线治疗失败(脾切除、环孢素、环磷酰胺、硫唑嘌呤、吗替麦考酚酯、氟达拉滨、硼替佐米等)。 • 有生育能力女性入组前7天内血清HCG检测阴性。有生育能力受试者须从入组起至细胞输注后1年随访结束遵守避孕要求。 • 器官功能检查充分:ALT和AST≤3×ULN;肺储备至少达到呼吸困难≤1级,非吸氧状态下血氧饱和度>93%。 • ECOG体能状态≤2。 • 预期生存期>3个月。 排除标准 • 有其他淋巴增殖性肿瘤史。 • 药物或感染所致继发性AIHA。 • Evans综合征患者血小板<30×10^9/L。 • 妊娠或哺乳。 • 入组前规定时间内接受以下治疗:抗CD20单克隆抗体<12周;sutimlimab或其他已上市生物制剂<5个半衰期;血浆置换<4周;脾切除术后<12周。 • 既往接受器官或干细胞移植。 • 过去6个月内发生新发血栓或器官梗死。 • 结缔组织病处于活动期。 • 有其他遗传性或获得性溶血性疾病。 • 活动性感染,如脓毒症、菌血症、真菌血症、未控制肺部感染或活动性结核等。 • HBsAg或HBeAg阳性;HBeAb或HBcAb阳性且HBV DNA拷贝数高于可测下限;HCV抗体阳性;HIV抗体阳性;梅毒检测阳性。 • 筛选前4周内接受重大手术且研究者认为不适合入组。 • 入组前5年内患有恶性肿瘤;转移或死亡风险可忽略、且可治愈的肿瘤除外,如已充分治疗的宫颈原位癌、皮肤基底细胞癌等。 • 有以下任一心血管疾病:LVEF≤45%;活动性心脏病或NYHA III/IV级充血性心衰;需治疗的严重心律失常(房颤、阵发性室上性心动过速除外);男性QTcB≥450 ms或女性QTcB≥470 ms;研究前6个月内心肌梗死、冠状动脉旁路手术或支架置入;或研究者认为不适合入组的其他心脏病。 • 入组前6周内接种活减毒疫苗。 • CNCT19 CAR-T治疗期间参加其他干预性临床研究,且研究药物半衰期<5;或研究期间使用活性试验药物、计划参加其他临床试验,或计划接受方案规定以外的治疗。 • 癫痫或其他活动性中枢神经系统疾病史。 • 对本研究所用药物成分过敏。 • 既往接受CAR-T细胞治疗。 • 研究者基于上述以外原因认为不适合参加研究。
Inclusion Criteria: * Subject and/or subject's legal personal representative fully understand and voluntarily sign informed consent forms * Male or female age ≥ 12 years * Subjects with autoimmune hemolytic anemia or Evans syndrome after Failure ≥3 lines of therapy. The Failure of ≥3 lines of therapy meets all the following conditions: Hemoglobin less than 10g/dl and symptoms of anemia; Failure of first-line corticosteroid therapy; Failure of second-line rituximab therapy; Failure of any one or more of the third-line treatments (splenectomy, cyclosporine, cyclophosphamide, azathioprine, mycophenolate mofetil, fludarabine, bortezomib, etc.) * Female subjects of childbearing potential must have a negative Serum HCG test within 7 days before enrollment. Subjects of childbearing potential will be required to follow contraception requirements from the time of enrollment until the 1-year follow-up after cell infusion * Laboratory tests of adequate organ function: Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3×ULN; and have a minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea and the blood oxygen saturation in a non-oxygenated state is \>93% * ECOG performance status ≤2 * Subject with a life expectancy of more than 3 months Exclusion Criteria: * History of other lymphoproliferative neoplasms * Secondary AIHA caused by drugs or infection * Platelets in subjects with Evans syndrome\<30×10\^9/L * Pregnant or breast-feeding subjects * Treatment with any of the following within the noted period prior to study entry: a.anti-CD20 monoclonal antibodies \<12 weeks, b.sutimlimab or other marketed biologics \<5 half-lives; c.plasma exchange \<4 weeks; d.post-splenectomy \<12 weeks * Previously received organ or stem cell transplantation * History of new thrombosis or organ infarction in the past 6 months * Diagnosis of the active stage of the connective tissue disease * Had other inherited or acquired hemolytic diseases * Have active infections, such as sepsis, bacteremia, fungemia, uncontrolled pulmonary infection and active tuberculosis, etc. * Positive hepatitis B surface antigen (HBsAg) or hepatitis B e antigen (HBeAg); positive hepatitis B e antibody (HBe-Ab) or hepatitis B core antibody (HBc-Ab), and the HBV-DNA copy number is above the lower limit of the measurable capacity; positive hepatitis C (HCV) antibody; positive human immunodeficiency virus (HIV) antibody; positive syphilis test * Received major surgery within 4 weeks before screening that was assessed by the researcher as unsuitable for enrollment * Have malignant tumors within 5 years before enrollment, except tumors with negligible risk of metastasis or death and curable tumors, such as adequately treated cervical carcinoma in situ, cutaneous basal cell carcinoma, etc. * Have any of the following cardiovascular diseases: a.Left ventricular ejection fraction (LVEF) ≤45%, b. presence of active heart disease or congestive heart failure (New York Heart Association \[NYHA\] Class III or IV)), c.severe arrhythmias requiring treatment (except atrial fibrillation, paroxysmal supraventricular tachycardia), d.QTcB interval ≥450ms for men and ≥470ms for women, e.have myocardial infarction, bypass surgery, or stent placement within the 6 months before the study, f.other heart diseases judged by the researcher to be unsuitable for enrollment * Have a history of live attenuated vaccines within 6 weeks before enrollment * Participate in other interventional clinical studies during CNCT19 CAR T-Cell therapy, and the drug has a half-life of \<5. Subjects treated with active investigational drugs or intend to participate in another clinical trial or receive treatment other than that specified in the protocol throughout the study period * Have a history of epilepsy or other active central nervous system diseases * Have an allergy to the ingredients of the medicine used in this study * Previously received CAR-T cell therapy * Patients considered to be ineligible for the study by the investigator for reasons other than the above
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:Incidence and the severity of the adverse event · Use Common Terminology Criteria for Adverse Events (CTCAE) Version 5 to assess the adverse event · Within 12 months
次要终点:Percentage of patients with hematological response
预处理后输注CNCT19细胞。CAR-T输注后须严密监测24小时,并建议输注后至少住院14天。住院及观察时长由研究者综合评估受试者情况决定。
这是一项I期、单臂、开放标签、剂量递增及剂量扩展研究,旨在评估CNCT19 CAR-T细胞治疗≥3线治疗失败的自身免疫性溶血性贫血患者的安全性、耐受性及疗效。受试者经预处理后接受CNCT19细胞输注,并随访1年。
This is a Phase 1, single-arm, open-label, dose-escalation and dose-expansion study. The main purpose is to evaluate the safety and tolerability, efficacy of CNCT19 CAR T-cell therapy in patients with autoimmune hemolytic anemia after failure of three or more lines of therapy. Participants will receive CNCT19 cell infusion after preconditioning, and they will receive a 1-year follow-up.
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