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:A Study of CT0596 in Relapsed/Refractory Multiple Myeloma and Relapsed/ Refractory Plasma Cell Leukemia
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗白血病、多发性骨髓瘤的安全性、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 · 苏州(共 1 个中心,其中中国 1 个)。登记号:NCT06730256。
不限性别 · ≥ 18 Years
纳入标准: * 受试者必须满足以下所有标准方可入组: 1. 患者必须自愿签署知情同意书(ICF),并且必须愿意且能够遵守试验访视计划和其他方案要求,并同意按照监管指南的要求进行长达15年的长期随访(LTFU)。 2. 年龄 ≥ 18岁; 3. 接受过至少3线既往治疗的R/RMM患者,包括至少1种蛋白酶体抑制剂和至少1种免疫调节剂(IMiD)。RRpPCL患者接受过至少1线既往治疗。治疗线数根据Rajkuma[1]r 2015提供的指南定义。患者每线治疗必须至少接受过1个完整周期的治疗。 4. 根据多发性骨髓瘤IMWG 2016和浆细胞白血病IMWG 2013,患者必须在末次治疗后或治疗期间出现疾病进展。 5. 患者必须基于以下至少一项参数具有可测量病灶: 6. 预期生存期 > 12周; 7. 美国东部肿瘤协作组(ECOG)评分 0-1; 8. 患者应满足以下检查结果 9. 有生育能力的女性患者在筛选时以及接受淋巴细胞清除治疗前必须妊娠试验阴性,并愿意在接受研究治疗后1年内使用高效可靠的避孕方法,且在研究期间接受研究治疗输注后1年内绝对禁止捐献卵子;男性患者如果与有生育能力的女性有性行为,愿意在接受研究治疗后1年内使用高效可靠的避孕方法。所有男性患者在研究期间接受研究治疗输注后1年内绝对禁止捐献精子。 排除标准: * 1. 妊娠或哺乳期女性;2. 患者存在任何重大疾病、实验室异常或精神疾病,可能损害患者接受或耐受计划治疗的能力,或根据研究者判断,参与研究不符合患者的最佳利益(例如,损害其健康),或可能阻止、限制或混淆方案规定的评估;3. HIV血清阳性、活动性丙型肝炎病毒(HCV)或活动性乙型肝炎病毒(HBV)感染的患者。如果病毒载量通过qPCR和/或核酸检测检测不到,则允许有已治疗的乙型或丙型肝炎病史;4. 患有任何未控制的的活动性感染的患者,包括但不限于活动性结核病患者(研究者判断);5. 既往治疗引起的毒性未恢复至常见不良事件评价标准(CTCAE)≤ 1级,除脱发和研究者在判断为可耐受的其他事件外;6. 既往接受过异基因干细胞移植;在签署知情同意书前12周内接受过自体干细胞移植;7. 在知情同意前14天内接受过针对该疾病的治疗;8. 在知情同意前28天内接受过细胞治疗。9. 在知情同意前7天内使用相当于泼尼松 > 15 mg/天的全身性糖皮质激素,局部糖皮质激素除外;10. 在知情同意前4周内接种过减毒活疫苗、灭活疫苗或RNA疫苗;11. 对淋巴细胞清除、托珠单抗过敏或不耐受,或对CT0596 CART细胞输注制剂中的成分(DMSO)过敏;或既往有其他严重过敏史,如过敏性休克;12. 筛选时患有继发性浆细胞白血病、华氏巨球蛋白血症、POEMS综合征或原发性轻链淀粉样变性的患者;13. 在筛选前6个月内患有以下任何心脏疾病的患者:14. 需要补充氧气以维持氧饱和度 > 92%的患者;或已知或疑似COPD且肺功能检查中第1秒用力呼气容积(FEV1)< 预测正常值的50%的患者;15. 患有活动性自身免疫性疾病的患者,包括但不限于银屑病、类风湿关节炎和其他需要长期免疫抑制治疗的疾病;16. 除MM外患有第二原发恶性肿瘤的患者,如果第二原发恶性肿瘤在过去2年内需要治疗或未达到完全缓解,则不符合资格。例外情况包括以下已成功治疗的 - 非转移性基底细胞或鳞状细胞皮肤癌、非转移性前列腺癌、乳腺或宫颈原位癌、非肌层浸润性膀胱癌;17. 有症状的中枢神经系统(CNS)疾病或疑似CNS转移的患者;18. 在知情同意前2周内进行过大手术,或计划在研究期间或给予研究治疗后4周内进行大手术(不包括白内障等局部麻醉手术)
Inclusion Criteria: * Participants must meet all of the following criteria to be enrolled: 1. Patients must voluntarily sign the informed consent form (ICF) and must be willing and be able to adhere to the trial visit schedule and other protocol requirements and agree to be in long term follow-up (LTFU) for up to 15 years as mandated by the regulatory guidelines. 2. Age ≥ 18 years; 3. Patients with R/RMM who have received at least 3 prior lines of therapy, including at least 1 proteasome inhibitor and at least 1 immunomodulator (IMiD). Patients with RRpPCL had received at least 1 prior line of therapy. Number of lines of therapy was defined according to the guidelines provided in Rajkuma\[1\]r 2015 . Patients must have received at least 1 complete cycle of therapy for each line of therapy. 4. According to multiple myeloma IMWG 2016 and plasma cell leukemia IMWG 2013, patients must have progressive disease following or during the last treatment. 5. Patients must have measurable disease based on at least one of the following parameters: 6. Expected survival \> 12 weeks; 7. Eastern Cooperative Oncology Group (ECOG) score 0- 1 ; 8. Patients should meet the following test results 9. Female patients of childbearing potential must have a negative pregnancy test at screening and prior to receiving lymphodepletion therapy and are willing to use a highly effective and reliable method of contraception for 1 year after receiving study treatment and are absolutely prohibited from donating eggs for 1 year after receiving study treatment infusion during the study ;Male patients are willing to use a highly effective and reliable method of contraception for 1 year after receiving study treatment if they are sexually active with a female of childbearing potential. Sperm donation is absolutely prohibited within 1 year following study treatment infusion for all male patients during the study. Exclusion Criteria: * 1\. Pregnant or lactating women; 2. Patient has any significant condition(s), laboratory abnormality or psychiatric illness that would impair the ability of the patient to receive or tolerate the planned treatment or in the opinion of the investigator, participation would not be in the best interest of the patient (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments 3. Patients seropositive for HIV, active hepatitis C virus (HCV), or active hepatitis B virus (HBV) infection. History of treated hepatitis B or C is permitted if the viral load is undetectable per qPCR and or nucleic acid testing; 4. Patients with any uncontrolled active infection, including but not limited to patients with active tuberculosis (investigator 's judgment); 5. Toxicities caused by previous treatment have not recovered to Common Terminology Criteria for Adverse Events (CTCAE) ≤ Grade 1, except alopecia and other events that are judged tolerable by the investigator; 6. Previous allogeneic stem cell transplantation; autologous stem cell transplantation within 12 weeks prior to signing informed consent; 7. Have received treatment for the disease within 14 days before informed consent 8. Have received cell therapy within 28 days before informed consent. 9. Systemic glucocorticoids equivalent to \> 15 mg/day prednisone within 7 days prior to informed consent, with the exception of topical glucocorticoids; 10. Vaccination with live attenuated vaccines , inactivated vaccines or RNA vaccines within 4 weeks prior to informed consent; 11. Allergic or intolerant to lymphodepletion, tocilizumab, or allergic to components (DMSO) in CT0596 CART cell infusion preparation; or previous history of other serious allergies such as anaphylactic shock; 12. Patients with secondary plasma cell leukemia, Waldenström macroglobulinemia, POEMS syndrome, or primary light chain amyloidosis at Screening; 13. Patients with any of the following cardiac conditions within 6 months prior to screening: 14. Patients who require supplemental oxygen to maintain oxygen saturation \> 92%; or Patients with known or suspected COPD who have Forced Expiratory Volume in 1 second (FEV1) \< 50% of predicted normal on spirometry; 15. Patients with active autoimmune diseases, including but not limited to psoriasis, rheumatoid arthritis and other diseases requiring long-term immunosuppressive therapy; 16. Patients with second primary malignancies in addition to MM are not eligible if the second primary malignancy has required treatment within the past 2 years or is not in complete remission. Exceptions include the following that have been successfully treated - nonmetastatic basal cell or squamous cell skin carcinoma, non-metastatic prostate cancer, carcinoma-in-situ of breast or cervix, non-muscle invasive bladder cancer 17. Patients with symptomatic central nervous system (CNS) disease or suspected CNS metastases; 18. Major surgery within 2 weeks before informed consent or planned during the study period or within 4 weeks after giving study treatment (excluding local anesthesia such as cataract)
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:Adverse Events (AE) after CT0596 infusion · An assessment of severity grade will be made according to the National Cancer Institute Common Terminology Criteria · 12 months after CT0596 infusion];Maximum tolerated dose and/or dose range · Evaluate Dose limited toxicity and recommended dosage range after CT0596 infusion · 12 months after CT0596 infusion
次要终点:Overall response rate (ORR) as assessed by the investigator;Complete response/stringent complete response (CR/sCR) rate;Rate of very good partial response (VGPR) and above;Duration of response (DOR);Minimal residual disease (MRD) negative rate;Time to response (TTR);Progression-free survival (PFS);Test Copy number of CAR
药物:CAR-T细胞输注 嵌合抗原受体T细胞
一项探索CT0596 CAR-T细胞注射液在复发/难治性多发性骨髓瘤和浆细胞白血病患者中的安全性、疗效及细胞代谢动力学的临床研究。
A Clinical Study to Explore the Safety, Efficacy, and Cellular Metabolic Dynamics of CT0596 CAR-T Cell Injection in Patients With Relapsed/Refractory Multiple Myeloma and Plasma Cell Leukemia.
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