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 RD06-03 CART Cell Injection in Patients With R/R Acute B-lymphoblastic Leukemia
⚠ 该试验的登记信息已有 20 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。
这是一项早期 I 期注册临床试验,评估细胞治疗用于淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 9 例。试验地点:中国 · 合肥、武汉(共 2 个中心,其中中国 2 个)。登记号:NCT06307600。
不限性别 · ≥ 3 Years 且 ≤ 70 Years
纳入标准: • 年龄≥3岁且≤70岁,性别和种族不限。 • 骨髓检查确诊为B细胞急性淋巴细胞白血病(B-ALL),且符合以下复发或难治标准: 复发性B-ALL:①首次缓解后12个月内复发;或②一线/多线治疗后挽救化疗期间复发;或③自体或异基因造血干细胞移植后复发。 难治性B-ALL:①接受2个周期标准诱导化疗后未达到完全缓解;或②一线/多线治疗后挽救化疗未达到完全缓解。 • Ph+ ALL受试者符合以下任一条件者可入组:①至少接受2种酪氨酸激酶抑制剂(TKI)治疗后复发/难治;若伴T315I/A、V299L、F317L/V/I/C、G250E、Y253H、E255K/V、F359V/C/I等TKI耐药突变,则无须先接受至少2种TKI治疗;或②不能耐受TKI治疗;或③存在TKI治疗禁忌证。 • 筛选期骨髓原始细胞比例≥5%(形态学检查),且筛选期骨髓或外周血肿瘤细胞检测到CD19表达。 • 器官功能及实验室检查符合:血清总胆红素<ULN的2倍,血清ALT和AST均<ULN的3倍,血清肌酐<ULN的1.5倍;凝血功能:INR或凝血酶原时间(PT)≤ULN的1.5倍;经胸超声心动图显示左心室射血分数(LVEF)≥50%;静息室内空气下血氧饱和度(SpO₂)≥92%;预计生存期>3个月。 • ECOG评分0~2分。 • 有生育能力的女性须同意从白细胞单采前至少28天至CAR-T细胞输注后6个月采取高效避孕措施。有生育能力男性的伴侣须同意从白细胞单采开始至CAR-T细胞输注后6个月采取有效屏障避孕措施;整个试验期间不得捐献精液或精子。 排除标准: • 患有Fanconi贫血、Kostmann综合征、Shwachman综合征或任何其他已知骨髓衰竭综合征等遗传性综合征。 • 对细胞产品中的任何成分有过敏史。 • 筛选时存在活动性中枢神经系统白血病(CNSL)。 • 仅有髓外复发。 • 筛选前3个月内接受过异基因造血干细胞移植(HSCT),或输注前4周内发生Ⅱ~Ⅳ级活动性移植物抗宿主病(GVHD)。 • 筛选前12个月内存在显著心血管功能障碍,包括但不限于:纽约心脏病协会(NYHA)Ⅲ或Ⅳ级心力衰竭、心肌梗死、不稳定型心绞痛、未控制或有症状的房性心律失常、任何室性心律失常。 • 存在或疑似未控制的活动性感染且需要静脉治疗(单纯尿路感染、细菌性咽炎除外)。 • 有其他原发癌症史;以下情况除外:已通过切除治愈的非黑色素瘤皮肤癌(如基底细胞癌);宫颈原位癌、局限性前列腺癌、导管原位癌且接受适当治疗后无病生存≥2年。 • 患有需要治疗的自身免疫性疾病、免疫缺陷或需要免疫抑制治疗。 • 筛选前4周内接种过减毒活疫苗,或计划在研究期间接种减毒活疫苗。
Inclusion Criteria: * Aged ≥3 and ≤70 years, gender and race unrestricted. * Bone marrow examination confirms the diagnosis of acute B-cell lymphoblastic leukemia (B-ALL) and meets one of the following conditions: Relapsed B-ALL: ① Relapse within 12 months after the first remission; or ② Relapse after salvage chemotherapy in first-line/multi-line treatment; or ③ Relapse after autologous or allogeneic hematopoietic stem cell transplantation; Refractory B-ALL: ① Failure to achieve complete remission after 2 cycles of standardized induction chemotherapy; or ② Failure to achieve complete remission after salvage chemotherapy in first-line/multi-line treatment; * Ph+ALL subjects are eligible if they meet one of the following criteria: ① Relapse or refractory after receiving at least 2 tyrosine kinase inhibitors (TKIs) treatments; if accompanied by TKI-resistant mutations such as T315I/A, V299L, F317L/V/I/C, G250E, Y253H, E255K/V, F359V/C/I, subjects are not required to receive at least two TKI treatments; or ② Unable to tolerate TKI treatment; or ③ Contraindications to TKI treatment. * The proportion of bone marrow blasts during the screening period is ≥5% (morphological).Expression of CD19 on bone marrow or peripheral blood tumor cells is detected during the screening period. * Organ function and laboratory tests meet the following criteria: Serum total bilirubin \<2× upper limit of normal (ULN), serum ALT and AST both \<3× ULN, serum creatinine \<1.5× ULN; Coagulation function: International normalized ratio (INR) ≤1.5× ULN, or prothrombin time (PT) ≤1.5× ULN; Transthoracic echocardiogram shows left ventricular ejection fraction (LVEF) ≥50%; Resting oxygen saturation (SpO2) ≥92% in ambient air; Estimated survival period of more than 3 months; * ECOG score 0-2; * Fertile women must agree to use highly effective contraception from at least 28 days before leukapheresis to 6 months after CAR-T cell infusion. Their partners, fertile men, must agree to use effective barrier contraception from the start of leukapheresis to 6 months after CAR-T cell infusion, and should not donate semen or sperm during the entire trial period. Exclusion Criteria: * Suffering from genetic syndromes such as Fanconi anemia, Kostmann syndrome, Shwachman syndrome, or any other known bone marrow failure syndromes; * History of allergy to any component of the cellular product; * Presence of active central nervous system leukemia (CNSL) at screening; * Patients with purely extramedullary relapse; * Received allogeneic hematopoietic stem cell transplantation (HSCT) within 3 months before screening or experienced grade II to IV active graft-versus-host disease (GVHD) within 4 weeks before infusion; * Significant cardiovascular dysfunction within 12 months before screening, including but not limited to: New York Heart Association (NYHA) class III or IV heart failure, myocardial infarction, unstable angina, uncontrolled or symptomatic atrial arrhythmias, any ventricular arrhythmias. Presence or suspicion of uncontrollable active infection requiring intravenous therapy (excluding simple urinary tract infections, bacterial pharyngitis); * Subjects with a history of other primary cancers, excluding the following: Non-melanoma skin cancers such as basal cell carcinoma that have been cured by resection; Cervical carcinoma in situ, localized prostate cancer, ductal carcinoma in situ with disease-free survival ≥2 years after adequate treatment; * Subjects with autoimmune diseases requiring treatment, immunodeficiency, or requiring immunosuppressive therapy; * Received live attenuated vaccines within 4 weeks before screening, or planned to receive live attenuated vaccines during the study.
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:Dose-limiting toxicity · DLT · Up to 2 years
入组患者接受1剂RD06-03 CART细胞注射。
本研究旨在探索RD06-03 CART细胞注射治疗复发和/或难治性B细胞急性淋巴细胞白血病患者的安全性和疗效。
This study is designed to explore the safety and efficacy for patients with relapsed and/or refractory B-cell lymphoblastic leukemia.
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