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:Combination Immunotherapy Targeting Melanoma
这是一项 I/II 期注册临床试验,评估 CAR-T 细胞治疗黑色素瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 30 例。试验地点:中国 · 深圳(共 1 个中心,其中中国 1 个)。登记号:NCT06739226。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
入选标准 • 黑色素瘤患者已接受标准一线治疗,并确诊为不可切除、转移性、进展性或复发性疾病。 • 免疫组织化学染色并证实表达黑色素瘤特异性抗原。 • 体重≥40 kg。 • 入组时年龄≥18岁且≤75岁。 • 预期生存期至少8周。 • 既往治疗要求:既往治疗方案数量不限;既往治疗引起的任何3或4级非血液学毒性须恢复至≤2级。单核细胞采集前至少1周未使用造血生长因子;生物制剂、靶向药、酪氨酸激酶抑制剂或低强度、非骨髓抑制方案治疗结束后至少间隔7天;含单克隆抗体的既往治疗结束后至少间隔4周;研究入组时距任何放疗至少1周。 • Karnofsky/Lansky评分≥70%。 • 心功能:左心室射血分数≥40/55%(登记记录为40/55%,未进一步说明适用标准)。 • 室内空气下脉搏血氧饱和度≥90%。 • 肝功能:ALT<3×正常值上限(ULN)、AST<3×ULN;血清胆红素和碱性磷酸酶<2×ULN。 • 肾功能:血清肌酐<3×ULN。 • 骨髓功能:白细胞≥1000/μL,中性粒细胞绝对计数≥500/μL,淋巴细胞绝对计数≥500/μL,血小板≥25,000/μL(不得通过输注达到该标准)。 • 已知骨髓转移者,只要满足血液学功能标准即可入组;其骨髓疾病不用于评估血液学毒性。 • 所有入组患者或其法定监护人均须签署知情同意书及相应同意文件。 排除标准 • 存在严重疾病(如显著心、肺、肝疾病等)或主要器官功能障碍;3级血液学毒性除外。 • 未治疗的中枢神经系统(CNS)转移。既往CNS肿瘤受累经治疗且治疗结束后稳定至少4周者可入组。 • 既往接受过其他基因工程改造的CAR-T细胞治疗。 • 活动性HIV、乙肝病毒(HBV)或丙肝病毒(HCV)感染,或未控制感染。 • 需要全身性皮质类固醇或其他免疫抑制治疗。 • 有证据提示肿瘤可能造成气道梗阻。 • 无法遵守研究方案要求。 • 可供治疗的T细胞数量不足。
Inclusion Criteria: * Patients with melanoma have received standard first-line therapy and have been diagnosed with non-resectable, metastatic, progressive or recurrent conditions. * The expression of melanoma specific antigens is immunohistochemically stained and verified. * Body weight greater than or equal to 40 kg. * Age: ≥18 year and ≤ 75 years of age at the time of enrollment. * Life expectancy: at least 8 weeks. * Prior Therapy: 1. There is no limit to the number of prior treatment regimens. Any grade 3 or 4 non-hematologic toxicity of any previous therapy must be resolved to grade 2 or less. 2. Participants must not have received hematopoietic growth factors for at least 1 week prior to mononuclear cells collection. 3. At least 7 days must have elapsed since the completion of therapy with any biologic agent, targeted agent, tyrosine kinase inhibitor or metronomic non-myelosuppressive regimen. 4. At least 4 weeks must have elapsed since prior therapy that includes a monoclonal antibody. 5. At least 1 week must has elapsed since any radiation therapy at the time of study entry. * Karnofsky/jansky score of 70% or greater. * Cardiac function: Left ventricular ejection fraction greater than or equal to 40/55 percent. * Pulse Ox greater than or equal to 90% on room air. * Liver function: defined as alanine transaminase (ALT) \<3x upper limit of normal (ULN), aspartate aminotransferase (AST) \<3x ULN; serum bilirubin and alkaline phosphatase \<2x ULN. * Renal function: Patients must have serum creatinine less than 3 times ULN. * Marrow function: White blood cell count ≥1000/ul, Absolute neutrophil count ≥500/ul, Absolute lymphocyte count ≥500/ul, Platelet count ≥25,000/ul (not achieved by transfusion). * Patients with known bone marrow metastatic disease will be eligible for study as long as they meet hematologic function criteria, and the marrow disease not evaluable for hematologic toxicity. * For all patients enrolled in this study, the patients or their legal guardians must sign an informed consent and assent. Exclusion Criteria: * Existing severe illness (e.g. significant cardiac, pulmonary, hepatic diseases, etc.) or major organ dysfunction, with the exception of grade 3 hematologic toxicity. * Untreated central nervous system (CNS) metastasis: Patients with previous CNS tumor involvement that has been treated and is stable for at least 4 weeks following completion of therapy are eligible. * Previous treatment with other genetically engineered CAR T cells. * Active HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) infection or uncontrolled infection. * Patients who require systemic corticosteroid or other immunosuppressive therapy. * Evidence of tumor potentially causing airway obstruction. * Inability to comply with protocol requirements. * Insufficient availability of T cells.
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:Number of patients with adverse events · The toxicity profile of CAR T, CTL or DCvac is determined by Common Toxicity Criteria for Adverse Effects version 4.0 · 1 year
次要终点:Anti-tumor effects;The expansion and persistency of antigen-specific CAR T cells;Immune responses after CAR T and CTL infusions and DCvac injections;Immune responses after CAR T and CTL infusions and DCvac injections;Immune responses after CAR T and CTL infusions and DCvac injections;Survival time of the patients;Survival time of the patients
使用抗原特异性CAR-T细胞、细胞毒性T淋巴细胞(CTL)及树突状细胞疫苗(DCvac)治疗黑色素瘤。
本研究旨在评估针对黑色素瘤的联合免疫治疗的可行性、安全性和疗效。治疗组合包括CAR-T细胞、细胞毒性T淋巴细胞(CTL)及经GM-CSF和B7-2(CD86)修饰的树突状细胞(DC)疫苗,分别靶向CAR-T特异性表面抗原(如GD2)、CTL特异性抗原(如MAGE-A4、gp100),以及由树突状细胞呈递的一组黑色素瘤特异性抗原。研究还将进一步了解患者体内CAR-T细胞及抗原特异性免疫效应细胞的功能和持久性。
The purpose of this study is to assess the feasibility, safety and efficacy of combination immunotherapy based on CAR T cells, cytotoxic T lymphocytes (CTLs), and dendritic cell (DC) vaccines modified with GM-CSF and B7-2 (CD86) against melanoma, which targets CAR T specific surface antigens such as GD2, CTL specific antigens such as MAGE-A4, gp100 and a pool of melanoma specific antigens presented by the DCs. Another goal of the study is to learn more about the function and persistence of the CAR T cells and antigen-specific immune effectors in patients.
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