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:Clinical Study of Cord Blood-derived IL-10/IL-15 CD19-CAR NK in the Treatment of Refractory/Relapsed B-cell NHL
这是一项 I 期注册临床试验,评估抗 CD19CAR-NK 细胞治疗非霍奇金淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 24 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT06707259。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 自愿参加研究并签署知情同意书;年龄18–75岁,性别不限。 2. 组织学确诊弥漫大B细胞淋巴瘤(DLBCL)、转化型滤泡性淋巴瘤(TFL)、原发纵隔B细胞淋巴瘤(PMBCL)、套细胞淋巴瘤(MCL)或其他惰性B细胞淋巴瘤转化类型。复发/难治DLBCL包括:两线治疗后未达完全缓解;治疗期间疾病进展或疾病稳定期≤6个月;或自体造血干细胞移植后12个月内进展/复发。复发/难治MCL须对BTK抑制剂耐药或不耐受;惰性B细胞淋巴瘤须三线治疗失败/复发。既往治疗须包括抗CD20单克隆抗体(CD20阴性者除外)及蒽环类药物。 3. 至少1个最长径≥1.5 cm的可测量病灶;肿瘤穿刺组织CD19表达阳性。 4. 预期生存期≥12周;ECOG体能状态0–2分。 5. 器官功能储备充分:ALT/AST≤ULN的2.5倍;按Cockcroft-Gault公式计算的肌酐清除率≥60 mL/min;总胆红素及碱性磷酸酶≤ULN的1.5倍;GFR>50 mL/min;心脏射血分数≥50%;室内空气下基础血氧>92%。允许既往接受造血干细胞移植。 6. 已获批的抗B细胞淋巴瘤治疗(如系统化疗、放疗及免疫治疗)须在研究用药前至少3周结束。既往CAR-T治疗失败或经评估3个月后复发者可入组。 7. 有生育能力女性妊娠试验阴性并同意试验期间有效避孕;新冠病毒检测两次阴性。 排除标准: 1. 对细胞产品任一成分过敏;有其他肿瘤史。 2. 既往发生Glucksberg标准Ⅱ–Ⅳ级急性GVHD或广泛慢性GVHD,或正在接受抗GVHD治疗。 3. 过去3个月内接受基因治疗。 4. 存在需治疗的活动性感染(单纯尿路感染或细菌性咽炎除外);允许预防性抗生素、抗病毒及抗真菌治疗。 5. 乙肝(HBsAg阳性,但HBV DNA<10³者不排除)、丙肝(包括病毒携带)、梅毒或其他获得性/先天性免疫缺陷(包括HIV)。 6. NYHA心功能Ⅲ/Ⅳ级。 7. 既往抗肿瘤治疗毒性尚未恢复至CTCAE 5.0版≤1级;疲劳、食欲减退、脱发除外。 8. 癫痫或其他中枢神经系统疾病史;头部增强CT/MRI提示中枢神经系统淋巴瘤。 9. 既往接受其他CD19靶向药物。 10. 哺乳期且不愿停止哺乳。 11. 研究者认为可能增加受试者风险或干扰研究结果的其他情况。
Inclusion Criteria: 1. Volunteer to participate in this study and sign an informed consent form; 2. Age 18-75 years old, no gender limit; 3. Histologically diagnosed as diffuse large B-cell lymphoma (DLBCL), transforming follicular lymphoma (TFL), primary mediastinal B-cell lymphoma (PMBCL), mantle cell lymphoma (MCL) and other inert B-cells NHL conversion type:(1) Refractory or relapsed DLBCL refers to the failure to achieve complete remission after 2-line treatment; disease progression during any treatment, or disease stable time equal to or less than 6 months; or disease progression or recurrence within 12 months after autologous hematopoietic stem cell transplantation ; (2) Refractory or relapsed MCL must be resistant to or intolerable to BTK inhibitors; (3) Refractory or relapsed indolent B-cell NHL is the failure or recurrence of third-line treatment; (4) Previous treatment must include CD20 monoclonal antibody treatment (unless the subject is CD20 negative) and anthracyclines; 4. At least one measurable lesion with the longest diameter ≥ 1.5 cm exists; 5. The expected survival period is ≥12 weeks; 6. The puncture section of the tumor tissue was positive for CD19 expression; 7, ECOG score 0-2 points; 7. Sufficient organ function reserve: (1) Alanine aminotransferase, aspartate aminotransferase ≤ 2.5× UNL (upper limit of normal value); (2) Creatinine clearance rate (Cockcroft-Gault method) ≥60 mL/min; (3) Serum total bilirubin and alkaline phosphatase ≤1.5× UNL; (4)Glomerular filtration rate\>50Ml/min Cardiac ejection fraction (EF) ≥50%; (5) Under natural indoor air environment, basic oxygen saturation\>92% . 8. Allow a previous stem cell transplantation. 9. The approved anti-B-cell lymphoma treatments, such as systemic chemotherapy, systemic radiotherapy, and immunotherapy, have been completed for at least 3 weeks before the study medication; 10. Allow patients who have previously received CAR-T cell therapy and have failed or relapsed after 3 months of evaluation; 11. Female subjects of childbearing age must have a negative pregnancy test and agree to take effective contraceptive measures during the trial. 12. Two tests for the new coronavirus were negative. Exclusion Criteria: 1. Those who have a history of allergies to any of the ingredients in cell products; 2. History of other tumors; 3. Previously presented with II-IV degree (Glucksberg criteria) acute GvHD or extensive chronic GvHD; or are receiving anti-GvHD treatment; 4. Have received gene therapy in the past 3 months; 5. Active infections that require treatment (except for simple urinary tract infections and bacterial pharyngitis), but preventive antibiotics, antiviral and antifungal infection treatments are allowed; 6. Hepatitis B (HBsAg positive, but HBV-DNA \<103 is not an exclusion criterion) or hepatitis C virus infection (including virus carriers), syphilis and other subjects with acquired and congenital immunodeficiency diseases, including but not limited to people living with HIV; 7. According to the New York Heart Association's Heart Function Classification Standard, it is classified as Grade III or Grade IV impaired subjects; 8. Those who have received anti-tumor therapy in the early stage but the toxic reaction has not recovered (the CTCAE 5.0 toxic reaction has not recovered to ≤1, except for fatigue, anorexia, and hair loss); 9. Subjects with a history of epilepsy or other central nervous system diseases; 10. Enhanced CT or MRI of the head showed evidence of central nervous system lymphoma; 11\. Have any other drugs that target CD19; 12. Women who are breastfeeding and unwilling to stop breastfeeding; 13. Any other situation that the investigator believes may increase the subject's risk or interfere with the test results.
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 of dose limiting toxicity (DLTs) · To evaluate the safety, and tolerability, and determine the recommended dosage of cord blood-derived Anti-CD19 IL10/IL15-CAR-NK Cell Therapy for B-cell Non-Hodgkin Lymphoma · Up to 28 days
次要终点:Complete response rate (CR);Progression free survival (PFS);Duration of response (DOR);Overall survival (OS);Partial response rate (PR);Overall response rate (ORR)
所有受试者均接受IL-10/IL-15 CD19 CAR-NK细胞静脉输注。
本研究旨在评估脐带血来源IL-10/IL-15共表达CD19 CAR-NK细胞治疗B细胞非霍奇金淋巴瘤患者的安全性和疗效。
To study the safety and effectiveness of cord blood-derived IL-10/IL-15 CD19-CAR NK in patients with B-cell non-Hodgkin's lymphoma
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