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:Sequential CAR-T Cells Therapy for CD5/CD7 Positive T-cell Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma Using CD5/CD7-Specific CAR-T Cells
⚠ 该试验的登记信息已有 23 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 I/II 期注册临床试验,评估 CAR-T 细胞治疗淋巴瘤、白血病、急性淋巴细胞白血病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 60 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT06420076。
不限性别 · ≥ 2 Years 且 ≤ 90 Years
纳入标准:签署书面知情同意并自愿参加;诊断主要依据WHO 2008标准;诱导治疗后未达完全缓解,或完全缓解后复发,且外周血或骨髓白血病原始细胞负荷>5%;流式细胞术或免疫组化显示白血病原始细胞CD7或CD5阳性比例≥70%;预期生存期>12周;ECOG评分≤2;年龄2–60岁;血红蛋白≥70 g/L(可输血);总胆红素≤正常值上限3倍,AST和ALT≤正常值上限5倍。 排除标准:拒绝治疗知情同意;既往实体器官移植;以下任一心脏问题:房颤、过去12个月内心肌梗死、长QT综合征或继发性QT延长、临床显著心包积液、NYHA III/IV级心功能不全;严重肺功能障碍史;严重感染或持续感染无法有效控制;严重自身免疫病或先天性免疫缺陷;活动性肝炎;HIV感染;临床显著病毒感染或无法控制的病毒再激活(包括EBV)。
Inclusion Criteria: * Signed written informed consent; Patients volunteer to participate in the clinical trial; * Diagnosis is mainly based on the World Health Organization (WHO) 2008; * Complete remission cannot be achieved after induction therapy; recurrence occurs after completion remission; the burden of leukemic blasts in the peripheral blood or bone marrow is greater than 5%; * Leukemic blast cells express CD7/CD5 (CD7 OR CD5 positive by flow cytometry or immunohistochemistry ≥70%); * The expected survival period is greater than 12 weeks; * ECOG score ≤2; * Age 2-60 years old; * HGB≥70g/L (can be transfused); * Total bilirubin does not exceed 3 times the upper limit of normal value, and AST and ALT do not exceed 5 times the upper limit of normal value. Exclusion Criteria: * Patients declining to consent for treatment * Prior solid organ transplantation * One of the following cardiac issues: atrial fibrillation; myocardial infarction within the past 12 months; prolonged QT syndrome or secondary QT prolongation; clinically significant pericardial effusion; cardiac insufficiency NYHA (New York Heart Association) III or IV; * History of severe pulmonary dysfunction diseases; * Severe infection or persistent infection cannot be effectively controlled; * Severe autoimmune disease or congenital immunodeficiency; * Active hepatitis; * Human immunodeficiency virus (HIV) infection; * Clinically significant viral infections, or uncontrollable viral reactivation, including EBV (Epstein-Barr virus).
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:The number and incidence of adverse events after CD7/CD5 CAR infusion. · Evaluation of all possible adverse reactions, including the number, incidence, and severity of symptoms such as cytokine release syndromes and neurotoxicity within 3 months after CAR-T infusion · 28 days;Disease response to CD7/CD5 CAR T cells · The disease response to CD7/CD5 CAR T cells is evaluated by bone marrow biopsy and aspirate within 1 year after CAR infusion. The proportion of subjects receiving CD7/CD5 CAR T infusion to 1) morphological remission (blasts \<5%): 2) flow cytometry analysis was blast negative, and 3) molecular biological remission (if applicable). · 1 year
第−4至−2天静脉输注磷酸氟达拉滨,每次持续30分钟;第−2天静脉输注环磷酰胺,持续60分钟;第0天静脉输注CD5/CD7 CAR-T细胞,输注时间10–20分钟。若患者对初次输注有反应、未出现不可接受副作用且有足够细胞,可考虑再接受2或3次CAR-T细胞输注。
靶向CD19的CAR-T细胞已在血液和淋巴系统恶性肿瘤治疗中取得显著进展,CD22、CD30、BCMA和CD123等也可作为CAR-T靶点。本研究评估靶向CD5/CD7的序贯CAR-T治疗复发/难治性T-ALL、T-LBL或早期T细胞前体ALL(ETP-ALL)的安全性和疗效,重点评估安全性、细胞因子风暴及其他不良反应,并评价治疗后的疾病状态。
Chimeric antigen receptor (CAR)-modified T cells targeted against CD19 have demonstrated unprecedented successes in treating patients with hematopoietic and lymphoid malignancies. Besides CD19, many other molecules such as CD22, CD30,BCMA,CD123, etc. may be the potential to develop the corresponding CAR-T cells to treat patients whose tumors express those markers. In this study, investigators will evaluate the safety and efficacy of Sequential CAR-T Cells Targeting CD5/CD7 in patients with patients with relapsed or refractory T-ALL/LBL/ETP-ALL. The primary goal is safety assessment including cytokine storm response and any other adverse effects. In addition, disease status after treatment will also be evaluated.
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