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:Evaluation of the Safety and Efficacy of Human CI-135 (FLT3) Targeted CAR-T Cells Injection for Subjects with Relapsed/Refractory Acute Myeloid Leukemia
Evaluation of the Safety and Efficacy of Human CI-135 (FLT3) Targeted CAR-T Cells Injection for Subjects with Relapsed/Refractory Acute Myeloid Leukemia
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⚠ 该试验的登记信息已有 21 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。
这是一项早期 I 期注册临床试验,评估人源 CAR-T 细胞治疗急性髓系白血病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 7 例。试验地点:中国 · 苏州(共 1 个中心,其中中国 1 个)。登记号:NCT06760260。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准(须全部符合): • 自愿参加临床试验,理解试验内容,签署知情同意书,并愿意完成全部试验程序。 • 年龄18–70岁(含),男女不限;预期生存期>12周。 • 按2017年ELN更新标准确诊急性髓系白血病(AML),且符合以下至少一项:至少3个标准诱导化疗周期后未达完全缓解(CR);诱导治疗后达CR但1年内复发;诱导后缓解超过1年但复发后接受1个原方案化疗周期仍未缓解;移植后复发;或复发≥2次。若符合前三种情形且存在FLT3突变,须至少接受过一次酪氨酸激酶抑制剂(TKI)治疗但未达CR或CR后复发;不能耐受TKI或存在TKI禁忌者除外。 • 白血病细胞基因检测证实FLT3突变,或FLT3表达≥35%。 • ECOG体能状态1–2分。 • 肝、肾、心、肺功能符合要求:GFR≥60 mL/min/1.73 m²或血清肌酐≤ULN的2倍;AST/ALT≤ULN的3倍且总胆红素≤ULN的1.5倍;血氧饱和度>92%;LVEF≥50%,超声未见心包积液,且无有临床意义的心电图异常。 • 能理解研究并签署知情同意书。 排除标准: • 急性早幼粒细胞白血病(APL,M3型)。 • 合并其他未控制的恶性肿瘤,但研究者评估其不太可能影响试验安全性或疗效评价者除外。 • 既往接受CAR-T 细胞或其他基因修饰细胞治疗。 • 有显著心血管风险史或证据,包括充血性心力衰竭、不稳定型心绞痛、有临床意义的心律失常(如心室颤动或室性心动过速)、给药前6个月内冠状动脉成形术、植入式心脏除颤器,或研究者认为可能危及安全、干扰评估/程序/完成研究的其他临床相关合并症。 • 外周血HBsAg阳性或乙肝核心抗体阳性且HBV DNA≥检测下限;HCV抗体阳性且可检出HCV RNA;HIV抗体阳性;或梅毒检测阳性。 • 急性或慢性丙型肝炎;已完全清除病毒的急性丙肝,或治疗后24周达到持续病毒学应答(SVR24)且病毒载量不可检出的慢性丙肝可例外。 • 入组前3个月内有动脉或静脉血栓史。 • 有需要全身免疫调节治疗的移植物抗宿主病(GVHD)史。 • 有需治疗的中枢神经系统疾病或状况(如未控制癫痫)。 • 未控制的活动性感染。 • 已知对CI-135 CAR-T 制剂任何成分或淋巴清除方案(环磷酰胺、氟达拉滨)过敏。 • 妊娠或哺乳期;女性计划在细胞输注后1年内妊娠,或男性受试者的伴侣计划在输注后1年内妊娠。 • 研究者认为不适合入组的其他情况。
Inclusion Criteria: Subjects must meet all of the following criteria to be enrolled: * Subjects volunteer to participate in clinical trails, understand and inform the trials and sign informed consent form, be willing to complete all the trial procedures; * Aged from 18 to 70 years (including cut-off value), Male and female; * Expected survival \> 12 weeks; * Previously diagnosed as Acute Myeloid Leukemia by ELN updated criteria (2017) and one of the following indicators that is satisfied: 1. AML patients who have not achieved complete remission (CR) after at least three cycles of standard induction therapy, or 2. AML patients who achieved complete remission after induction therapy but relapsed within one year, or 3. AML patients who achieved complete remission after induction therapy for more than one year but did not achieve remission after one cycle of chemotherapy with the original regimen following relapse, or 4. AML patients who relapsed after transplantation, or 5. AML patients who experienced two or more relapses. Note: For patients meeting conditions a), b), or c) with FLT3 mutations, they must have undergone at least one treatment with a tyrosine kinase inhibitor (TKI) without achieving complete remission or have relapsed after achieving complete remission, except for those who cannot tolerate TKI therapy or have contraindications to TKI treatment. * Positive for FLT3 mutation confirmed by leukemia cell genetic testing, or FLT3 expression ≥35%; * ECOG performance status score of 1-2; * Liver, kidney, heart, and lung functions meeting the following criteria: 1. Glomerular filtration rate (GFR) ≥60 ml/min/1.73 m² or serum creatinine ≤2 times the upper limit of normal (ULN); 2. Serum AST and ALT ≤3 times of ULN, and total bilirubin ≤1.5 times the ULN; 3. Oxygen saturation \> 92%; 4. Left ventricular ejection fraction (LVEF) ≥50%, with no pericardial effusion observed on ultrasound, and no clinically significant electrocardiographic abnormalities. * Able to understand the study and sign the informed consent form. Exclusion Criteria: * Diagnosed as acute promyelocytic leukemia (APL M3); * With any presence of other uncontrolled malignancies (unless evaluated as unlikely to interfere with the safety or efficacy assessment of the trial); * Previously treated with CAR-T cells or other genetically modified cellular therapies * Displayed history or evidence of significant cardiovascular risks, including any of the following: congestive heart failure, unstable angina, clinically significant arrhythmias (e.g., ventricular fibrillation, ventricular tachycardia), coronary angioplasty within 6 months before administration, implantable cardiac defibrillator, or any clinically relevant comorbidities that pose safety risks or interfere with study assessments, procedures, or completion; * Positive for hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) with HBV DNA levels ≥ the detection limit in peripheral blood; positive for hepatitis C virus (HCV) antibody with detectable HCV RNA; positive for human immunodeficiency virus (HIV) antibodies; or positive for syphilis testing; * Positive for acute or chronic hepatitis C. Exceptions: acute hepatitis C with complete viral clearance; chronic hepatitis C with a sustained virological response (SVR24) 24 weeks post-treatment confirming undetectable viral load; * Having history of arterial or venous thrombosis within 3 months prior to enrollment; * Having history of Graft-versus-host disease requiring systemic immunomodulators; * Having history of central nervous system diseases or conditions requiring treatment (e.g., uncontrolled seizures); * Having uncontrolled active infections; * Known allergy to any components of CI-135 CAR-T cell formulation or the lymphodepletion regimen (cyclophosphamide and fludarabine); * Currently pregnant or lactating female, or female subjects planning pregnancy within 1 year after cell infusion, or male subjects with partners planning pregnancy within 1 year after infusion; * Having other conditions deemed unsuitable for enrollment by the investigator.
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:Dose limited toxicity (DLT) · Safety Indicator · 28 days post infusion
次要终点:Pharmacokinetics parameters - Maximum CAR level in peripheral blood (Cmax);Pharmacokinetics parameters -Time to maximum CAR level in peripheral blood (Tmax);Pharmacokinetics parameters - 28-day Area under Curve of CAR level in peripheral blood (AUC0-28);Pharmacodynamics characteristics - Cytokines Concentrations, cytokines level in peripheral blood;Overall Response Rate (ORR);Progression-free Survival (PFS);Overall Survival (OS);Duration of Response (DOR)
单次给药,剂量水平为0.5×10⁶ CAR-T 细胞/kg或1.0×10⁶ CAR-T 细胞/kg。
以上邮箱 / 电话是登记库里的申办方联系方式(+86,中国),通常不直达某家医院。中国中心的联系方式请以医院或登记平台最新公示为准。
本单组、开放标签、剂量递增研究旨在探索人源CI-135(FLT3)靶向CAR-T 细胞注射液的安全性、耐受性及药代动力学/药效学特征,并初步观察其治疗复发/难治性急性髓系白血病患者的疗效。
This study is a single-arm, open-label, dose-escalating trial to explore the safety, tolerability and pharmacokinetic/pharmacodynamics characteristics of anti human CI-135 (FLT3) CAR-T Injection , and to preliminarily observe the efficacy of the trial drug in patients with relapsed/refractory Acute Myeloid Leukemia.
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