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:Treatment of Relapsed or Refractory B-cell Lymphoma With Chimeric Antigen Receptor (CAR) T-cell Therapy Produced by a New Technology
这是一项 I/II 期注册临床试验,评估 CAR-T 细胞治疗 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 27 例。试验地点:欧洲 · 巴塞罗那、略夫雷加特河畔奥斯皮塔莱特、马德里、埃尔帕尔马(共 8 个中心)。登记号:NCT06378190。
不限性别 · ≥ 18 Years 且 ≤ 80 Years
纳入标准: 1. 确诊复发或难治性B细胞淋巴瘤,包括DLBCL、原发性CNS DLBCL、套细胞淋巴瘤、1/2/3a级滤泡性淋巴瘤或边缘区淋巴瘤(脾型、淋巴结型或MALT型)。 2. 年龄>18岁且<80岁。 3. ECOG体能状态评分0–1分。若ECOG为2分且由血液系统疾病导致,可酌情纳入(见附录3)。 4. 骨髓造血储备充分。 5. 预期生存期至少2个月。 6. 有适合淋巴细胞单采的静脉通路,且无淋巴细胞单采禁忌证。 7. 患者或法定监护人已签署知情同意书。 排除标准: 1. 医生认为患者可从其他已获批且可能治愈的治疗选择(包括商业化CAR-T)获益。 2. 入组前4周内使用过任何研究性或未上市物质,或正在参加其他治疗性临床试验。 3. 既往或当前诊断其他肿瘤;完全缓解超过3年、非黑色素瘤皮肤癌或已完全切除的原位癌患者可纳入。有克隆性T淋巴细胞当前或既往病史者亦排除。 4. 异基因造血干细胞移植后早期复发(淋巴细胞单采前<3个月、TranspoCART19输注前<6个月),或正在接受针对移植物抗宿主病的免疫抑制治疗(皮质类固醇或其他全身性免疫抑制剂)。 5. 存在需全身药物治疗的活动性感染。 6. HIV感染。 7. 研究者认为有风险的并发未控制疾病,包括心脏、肾脏、肝脏、胃肠、内分泌、肺部、神经或精神疾病。 8. 乙肝血清学阳性:HBsAg阳性;若HBsAg阴性但抗HBc抗体阳性,须检测HBV DNA,阳性者排除。 9. 丙肝病毒(HCV)血清学阳性:抗HCV抗体阳性且重组免疫印迹试验(RIBA)确认。 10. 严重器官受累:心脏射血分数<40%;DLCO<40%;计算GFR<30 mL/min;基线血氧饱和度<92%;胆红素>ULN的2倍(Gilbert综合征除外)或转氨酶>ULN的2.5倍。 11. 妊娠或哺乳期女性;有生育能力女性筛查时须妊娠试验阴性。 12. 有生育能力女性(包括筛查前一年内仍有月经者)不愿或不能从研究开始至结束采用高效避孕方法。 13. 男性不愿或不能从研究开始至结束采用高效避孕方法。 14. 需要长期使用泼尼松>10 mg/日等效剂量的糖皮质激素或其他慢性免疫抑制剂。 15. 既往接受抗CD19 CAR-T治疗;允许既往接受其他抗CD19策略,但须经肿瘤活检确认CD19表达。 16. 对活性成分或任何辅料过敏。
Inclusion Criteria: 1. Patients diagnosed with relapsed or refractory B-cell lymphoma (Diffuse large B-cell lymphoma, Primary diffuse large B-cell lymphoma of the Central Nervous System (CNS), Mantle cell lymphoma, Follicular lymphoma grades 1, 2 or 3a or Marginal lymphoma, including splenic, nodal and MALT). 2. Age over 18 years and under 80 years. 3. Functional status Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1. Patients with ECOG 2 may be included if motivated by haematological disease (Annex 3). 4. Adequate bone marrow haematopoietic reserve. 5. Life expectancy of at least 2 months. 6. Adequate venous access for lymphapheresis. Absence of contraindications for lymphapheresis. 7. Signed informed consent (patient or legal guardian). Exclusion Criteria: 1. Patients who, in the opinion of a physician, may benefit from other approved potentially curative therapeutic options, including commercial CAR-Ts. 2. Treatment with any experimental or non-commercialised substance in the four weeks prior to recruitment, or who are actively participating in another therapeutic clinical trial. 3. Diagnosis of another neoplasm, past or present. Patients who have been in complete remission for more than 3 years, or with a history of non-melanoma skin cancer or completely resected carcinoma in situ may be included. A current or previous history of clonal T-lymphocytes is also an exclusion criterion. 4. Early relapse after allogeneic haematopoietic stem cell transplantation (less than 3 months for lymphapheresis, less than 6 months for TranspoCART19 infusion) or patients on active immunosuppressive treatment for graft-versus-recipient disease (corticosteroids or other systemic immunosuppressants). 5. Active infection requiring systemic medical treatment. 6. HIV infection. 7. Concurrent and uncontrolled medical illnesses including cardiac, renal, hepatic, gastrointestinal, endocrine, pulmonary, neurological or psychiatric illnesses that in the opinion of the investigator pose a risk to the patient. 8. Positive serology for hepatitis B, defined as a positive test for HBsAg. In addition, if the patient is HBsAg negative but has anti-HBcore antibodies, a hepatitis B virus DNA test will be required, and if the result is positive the patient will be excluded. 9. Positive serology for hepatitis C virus (HCV), defined as a positive test for anti-HCV antibodies that is confirmed by Recombinant immunoblot assay (RIBA). 10. Severe organ involvement, defined as cardiac ejection fraction \<40%; diffusing capacity of the lungs for carbon monoxide (DLCO) \<40%; calculated glomerular filtration rate \<30 ml/min; baseline O2 saturation \<92%; bilirubin \> 2 times upper limit of normal (unless due to Gilbert's syndrome) or transaminases \> 2.5 upper limit of normal. 11. Pregnant or lactating women. Women of childbearing age should have a negative pregnancy test at screening. 12. Women of childbearing age, including those whose last menstrual cycle was in the year prior to screening, who are unable or unwilling to use highly effective methods of contraception\* from the start of the study until the end of the study. 13. Men who are unable or unwilling to use highly effective methods of contraception\* from the start of the study until the end of the study. 14. Need to take glucocorticoids chronically in doses greater than 10 mg/day of prednisone (or equivalent) or other chronic immunosuppressants. 15. Previous anti-CD19 CAR-T therapy. Previous treatment with other anti-CD19 strategies is permitted, provided that CD19 expression has been confirmed in the tumour biopsy. 16. Hypersensitivity to the active substance or to any of the excipients.
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:Maximum tolerated dose (MTD) · Determine the maximum tolerated dose (MTD) and/or recommended dose of TranspoCART19 cells in patients with relapsed or refractory B-cell lymphoma. · 1 month;Efficiency · Determine best response rate achieved (overall and complete). · 3 month
次要终点:Procedure-related mortality (PRM);Toxicity assessment;Response (overall and complete);Duration of response;Progression-free survival (PFS);Overall survival (OS);Perceived general well-being
给予经扩增和基因修饰的成人自体外周血T淋巴细胞。
本临床试验旨在评估新技术制备的TranspoCART19治疗复发/难治性B细胞淋巴瘤患者的安全性和疗效,主要评估最大耐受剂量(MTD)及缓解率。患者将接受研究性药物治疗,并随访36个月。
The goal of this clinical trial is to to evaluate the safety and efficacy of TranspoCART19 in patients with relapsed/refractory B-lymphoma. The main questions it aims to answer are: Maximum tolerated dose (MTD) Response rates Participants will be treated with the investigational medicinal product and will be followed for 36 months.
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