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:CD7 CAR-T Cell Sequential Allo-HSCT for Non-malignant Blood and Immune System Diseases
⚠ 该试验的登记信息已有 20 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 CAR-T 细胞治疗相关疾病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 20 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT06787560。
不限性别
纳入标准: 1. 患有非恶性血液或免疫系统疾病,包括遗传性骨髓衰竭、先天性免疫缺陷、血红蛋白病及其他非恶性血液/免疫疾病,具体包括:已确诊遗传性骨髓衰竭综合征(如范可尼贫血、先天性纯红细胞再生障碍性贫血、先天性角化不良、Shwachman-Diamond综合征、先天性中性粒细胞减少症、骨髓衰竭相关先天性血小板减少症及其他未分类先天性骨髓衰竭疾病);符合免疫缺陷病的临床表现、免疫功能和基因诊断标准;或确诊输血依赖性血红蛋白病,血清铁蛋白<3,000 μg/L,心脏和肝脏铁含量提示中度或更轻的铁过载,有筛选前至少3个月铁螯合治疗记录,入组前3个月未使用羟基脲、芦可替尼、地西他滨或阿糖胞苷,脾脏未超过脐水平线或腹部中线,且有异基因造血干细胞移植指征并有合适的亲缘供者。 2. 总胆红素≤ULN的1.5倍,ALT和AST≤ULN的3倍。 3. 超声心动图显示左心室射血分数>50%。 4. 不吸氧时脉搏血氧饱和度≥92%。 5. 预期生存期>3个月。 6. ECOG评分0–1。 7. 通过腹部超声等检查评估脾脏大小;巨脾患者移植前应评估是否需要脾切除。 8. 有生育能力的女性和男性同意在入组前、研究期间及输注后6个月采取适当避孕措施;该治疗对胎儿的安全性未知。 9. 愿意参加研究、能够理解并签署知情同意书。 排除标准: 1. 有癫痫或其他中枢神经系统疾病史。 2. EB病毒(EBV)DNA阳性。 3. 有QT间期延长或严重心脏病史。 4. 活动性乙肝或丙肝病毒感染。 5. 结核、艾滋病或其他重大感染性疾病。 6. 脓毒症、肺部感染、肠道感染或其他重要器官感染控制不佳,和/或超敏C反应蛋白、降钙素原显著升高。 7. 既往参加其他临床研究或接受基因治疗。 8. 研究者认为可能增加受试者风险或干扰试验结果的任何情况。
Inclusion Criteria: * 1\. Non-malignant blood and immune system diseases include: hereditary bone marrow failure, congenital immune deficiency, hemoglobinopathy and other non-malignant blood and immune system diseases, 1. Confirmed hereditary bone marrow failure syndrome. Including: Fanconi anemia, congenital pure red cell aplastic anemia, congenital dyskeratosis, Scheux-Day syndrome, congenital neutropenia, various bone marrow failure related congenital thrombocytopenia and other unclassified congenital bone marrow exhaustion diseases; 2. It meets the criteria of clinical manifestation, immune function and gene diagnosis of immune deficiency disease; 3. Diagnosed with hemoglobinopathy and dependent on blood transfusions; serum ferritin levels are \< 3000 μg/L, with cardiac and hepatic iron content indicating moderate or lower iron overload; documentation of iron chelation therapy (including prescriptions or invoices) for at least three months prior to screening is available; no hydroxyurea, ruxolitinib, decitabine, or cytarabine has been administered in the three months preceding enrollment. The spleen size must not extend beyond the umbilical horizontal line or the midline of the abdomen. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is indicated, and suitable donors for related allo-HSCT are available. * 2\. Serum total bilirubin ≤1.5 times the upper limit of normal value, serum Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) ≤ 3 times the upper limit of normal value range; * 3\. Echocardiography showed Left ventricular ejection fraction (LVEF) \>50%; * 4\. Pulse oxygen saturation ≥92% (non-oxygen state); * 5\. The estimated survival is more than 3 months; * 6\. ECOG score 0-1; * 7\. Abdominal B-ultrasonography and other examinations were performed to evaluate spleen size. Splenectomy should be evaluated before transplantation for patients with giant spleen; * 8\. Women and men who are fertile must consent to the use of appropriate contraception before entering the study, during study participation, and for 6 months after transfusion (the safety of this therapy for the unborn child is not known, with unknown risks); * 9\. Subjects who are willing to participate in the study are able to understand and have the ability to sign informed consent. Exclusion Criteria: * 1\. People with a history of epilepsy or other central nervous system disorders; * 2\. Epstein-Barr virus (EBV) DNA positive; * 3\. People with a history of prolonged QT interval or serious heart disease; * 4\. People with active hepatitis B or C virus; * 5\. Tuberculosis, AIDS and other major infectious diseases; * 6\. Sepsis, pulmonary infection, intestinal infection and other major organ infection and poor control, and/or hypersensitive C-reactive protein, procalcitonin significantly elevated; * 7\. People who have previously received other clinical studies and gene therapy; * 8\. Any situation that the investigator believes may increase the risk to the subject 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 treatment-emergent adverse events (TEAEs) · Incidence of treatment-emergent adverse events · Up to 2 years after Treatment;Transplant related mortality rate · The proportion of patients who died after transplantation to the total number of transplant patients during the same period · Up to 100 days after Treatment
次要终点:Allogeneic hematopoietic stem cell transplant implantation rate;Time to neutrophil and platelet engraftment;Disease-feesurvival,DFS;Overall survival, OS
患者或供者接受白细胞单采。患者先接受环磷酰胺(CTX)、氟达拉滨(Flu)和依托泊苷(VP-16)淋巴细胞清除化疗,再输注CAR-T细胞;预处理48小时后可输注CAR-T细胞。
本临床研究旨在评估CD7 CAR-T细胞序贯异基因造血干细胞移植治疗非恶性血液及免疫系统疾病的安全性和有效性。
A Clinical Study on the Safety and Effectiveness of CD7 CAR-T Cell Sequential Allogeneic Hematopoietic Stem Cell Transplantation for Non-malignant Blood and Immune System Diseases
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