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:Autologous Hematopoietic Stem Cell Boost Study After CAR-T Therapy
⚠ 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 II 期注册临床试验,评估自体造血干细胞治疗弥漫大 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 18 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT06589089。
不限性别 · ≥ 18 Years
纳入标准: • 年龄≥18岁,性别不限。 • 按2016年WHO标准经组织学或细胞学确诊B细胞非霍奇金淋巴瘤。 • 既往接受CAR-T细胞免疫治疗。 • 白细胞单采前CAR-HEMATOTOX评分提示高血液学毒性风险,或临床判断免疫治疗后可能有较高血液学毒性风险(包括年龄≥60岁、ECOG评分≥2、既往治疗线数≥2等)。 • CAR-T治疗后出现研究者判定的骨髓抑制。 • 有储存的干细胞。 • 淋巴瘤病情稳定(研究者最终评估疗效为CR/PR)。 • 骨髓活检排除出血性疾病、感染及骨髓浸润。 • 器官功能充分。 • 能提供书面知情同意书,理解并同意遵守研究要求和评估时间表。 • 有生育能力患者同意在研究期间及末次治疗后120天内采用高效避孕方法。 排除标准: • 有异基因造血干细胞移植史。 • 有癫痫、脑血管缺血/出血、痴呆、小脑疾病或累及中枢神经系统的自身免疫病史。 • 过去2年内存在其他恶性肿瘤,但已治愈的宫颈原位癌、非黑色素瘤皮肤癌及浅表性膀胱肿瘤(Ta非浸润性肿瘤、Tis原位癌、T1浸润基底膜肿瘤)除外。 • 严重心血管疾病:Ⅱ级或以上心肌缺血/心肌梗死、控制不佳的心律失常、NYHAⅢ–Ⅳ级心功能不全或超声心动图提示LVEF<50%。 • 对试验药物或辅料过敏。 • 存在活动性自身免疫病(包括但不限于自身免疫性肝炎、间质性肺炎、葡萄膜炎、肠炎、肝炎、垂体炎、血管炎、肾炎、甲亢或甲减),有同种异体移植史,或长期/大量使用激素及其他免疫调节药物;或研究者判断会影响研究治疗的其他情况。 • 活动性感染。 • 有未控制的全身性疾病史,包括糖尿病、高血压和急性肺病。 • 已知HIV感染。 • 存在不适合使用研究药物、可能干扰结果解释或会增加治疗并发症风险的基础疾病,或酒精/物质滥用或依赖。 • 过去2年内自身免疫病导致终末器官损害(如克罗恩病、类风湿关节炎、系统性红斑狼疮),或需要全身免疫抑制/其他全身疾病控制药物。
Inclusion Criteria: * 18 years of age or older and gender-neutral; * Diagnosis of B-cell non-Hodgkin lymphoma confirmed histologically or cytologically according to World Health Organization 2016 criteria; * Prior CAR-T cell immunotherapy; * Patients who are at high risk according to the CAR-HEMATOTOX score prior to leukapheresis; or patients who are clinically considered potentially at high risk for hematologic toxicity following immunotherapy (including age ≥60 years; or Eastern Cooperative Oncology Group (ECOG) Performance Status≥ 2 points; or number of prior lines of therapy ≥ 2, etc.); * Myelosuppression as determined by the investigator has occurred after CAR-T therapy; * Have a storage of stem cell; * Stable lymphoma disease status (final investigator-assessed efficacy CR/PR); * Bone marrow biopsy to rule out hemophilia/infection/bone marrow infiltration; * Adequate organ function; * Able to provide written informed consent (ICF) and able to understand and agree to comply with the study requirements and assessment schedule; * Patients of childbearing potential must be willing to use highly effective contraception for the duration of the study, and for 120 days after the last dose of treatment. Exclusion Criteria: * History of allogeneic hematopoietic stem cell transplantation; * History of epilepsy, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, or any autoimmune disease involving the central nervous system; * Presence of or current concurrent other malignancies within the past 2 years, with the exception of cured carcinoma in situ of the uterine cervix, non-melanoma skin cancers, and superficial bladder tumors (Ta (non-invasive tumors), Tis (carcinoma in situ), and T1 (tumors infiltrating the basement membrane)); * Suffering from severe cardiovascular disease: grade II or greater myocardial ischemia or myocardial infarction, poorly controlled arrhythmias; grade III-IV cardiac insufficiency according to New York Heart Association (NYHA) criteria, or cardiac ultrasound suggestive of a left ventricular ejection fraction (LVEF) \<50%; * Allergy to any investigational drug or excipient; * Presence of any active autoimmune disease (including, but not limited to: autoimmune hepatitis, interstitial pneumonitis, uveitis, enteritis, hepatitis, pituitary gland inflammation, vasculitis, nephritis, hyperthyroidism, hypothyroidism), or known history of allograft transplantation, or patients with prolonged and heavy use of hormones or use of other immune-modulating agents or other patients who, as assessed by the Investigator Patients who are considered to have an impact on study treatment; * Have an active infection; * History of uncontrolled systemic disease, including diabetes mellitus, hypertension, and acute pulmonary disease; * Known human immunodeficiency virus (HIV) infection; * Presence of an underlying medical condition or alcohol/substance abuse or dependence that is not conducive to the administration of study medication, or that may interfere with the interpretation of results, or that puts the patient at high risk for developing treatment complications; * End-organ damage due to autoimmune disease (e.g., Crohns disease, rheumatoid arthritis, systemic lupus erythematosus) within the past 2 years, or the need for systemic immunosuppression or other systemic disease-control medications.
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:1-year overall survival · Overall survival was defined as the time from the date of leukapheresis to the date of death from any cause. · 1 year after CAR-T cell infusion
次要终点:Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v5.0;Best objective response rate;Best complete response rate;Time to reponse;Duration of response;Progression-free survival;Overall survival;Overall days of hospitalization
CAR-T细胞治疗后若患者的血液学毒性未缓解,可考虑输注预留的干细胞;若骨髓抑制仍未明显恢复,可再次进行干细胞输注。
这是一项前瞻性、单臂、开放研究,旨在观察CART-SCB方案的疗效和安全性。该临床方案拟通过自体造血干细胞(HSC)补充,改善嵌合抗原受体T细胞(CAR-T)免疫治疗后出现高风险免疫血液学毒性淋巴瘤患者的骨髓抑制。患者完成CAR-T治疗后,若血液学毒性未缓解,可考虑输注预留的干细胞;若骨髓抑制仍未明显改善,可再次进行干细胞输注。
This is a prospective, single-arm, open study to observe the efficacy and safety of the CART-SCB regimen (Clinical Regimen for the Prospective Study of Autologous Hematopoietic Stem Cell Boost for the Improvement of Bone Marrow Suppression in Patients with High-Risk Immunohematologic Toxicity Lymphoma After Chimeric Antigen Receptor T (CAR-T)-Cell Immunotherapy Therapy) . After the patient has completed CAR-T therapy, if the patient has unrelieved hematologic toxicity, consider infusing a reserve of stem cells; if myelosuppression has not been significantly relieved, stem cell infusion can be performed again.
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