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:Donor Derived CD19 CAR-T Cells in the Treatment of R/R B-cell Acute Lymphoblastic Leukemia
Donor Derived CD19 CAR-T Cells in the Treatment of R/R B-cell Acute Lymphoblastic Leukemia
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⚠ 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 CD19CAR-T 细胞治疗急性淋巴细胞白血病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 15 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT06793241。
不限性别 · ≥ 18 Years
纳入标准 1. 年龄≥18岁,性别不限。 2. B细胞免疫分型异常,CD19阳性。 3. 经组织学或免疫分型确诊为B细胞急性淋巴细胞白血病。 4. 符合复发/难治性B细胞急性淋巴细胞白血病(R/R B-ALL)诊断,并符合以下任一情况:标准化疗后未达到完全缓解(CR);首次诱导达到CR但缓解持续时间<12个月;接受一线或多线挽救治疗后仍为R/R B-ALL;复发≥2次。 5. 研究者认为患者已接受充分治疗,例如自体造血干细胞移植(auto-HSCT),或自体CAR-T 无法制备/制备失败。自体CAR-T 制备失败包括自体淋巴细胞数量过少(<1×10^9)、制备期间扩增不足或未达到放行标准。 6. 总胆红素≤51 μmol/L;ALT/AST≤正常值上限的3倍;肌酐≤176.8 μmol/L。 7. 中性粒细胞绝对计数≥0.5×10^9/L;血小板≥30×10^9/L;血红蛋白≥60 g/L。 8. 超声心动图显示左心室射血分数(LVEF)≥40%。 9. 预期生存期>3个月。 10. ECOG评分0至2分。 11. 有生育能力的女性和男性须同意在入组前、研究期间及输注后6个月内采取适当避孕措施;该治疗对胎儿的安全性尚不明确,风险未知。 12. 愿意参加研究,能够理解并签署知情同意书。 排除标准 1. 已知对研究预处理措施等过敏。 2. 有癫痫或其他中枢神经系统疾病史。 3. 有QT间期延长或严重心脏病史。 4. 异基因造血干细胞移植后不足100天。 5. HIV感染。 6. 活动性乙肝或丙肝病毒感染;或感染尚未治愈、仍处于活动期。 7. 对CD3/CD28共刺激信号的反应性扩增能力不足(扩增倍数<5倍)。 8. 筛查前3天内合并使用全身性类固醇(如泼尼松≥20 mg),但正在持续或间歇使用局部、吸入或鼻内类固醇者不在此限;或患有需长期使用免疫调节药物的全身性疾病。 9. 筛查前2周内接受抗癌化疗或其他药物治疗。 10. 研究者认为可能增加受试者风险或干扰研究结果的任何情况。
Inclusion Criteria: * 1\. Age ≥18 years old, gender unlimited; * 2\. Abnormal B cell immunotyping was CD19 positive; * 3\. Patients diagnosed with B-cell acute lymphoblastic leukemia by histological or immunotyping; * 4\. Meets the diagnosis of relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) and includes any of the following conditions: 1. No CR was obtained after standard chemotherapy; 2. CR was induced for the first time, but the duration of CR was less than 12 months; 3. R/R B-ALL that does not work after the first or more remedial treatments; 4. Two or more relapses; * 5\. The researchers believed that the patient had been adequately treated, such as auto-HSCT, auto-CART could not be prepared or preparation failed. Autologous CAR-T preparation failure was defined as including too few autologous lymphocytes (\<1×109) or insufficient expansion during preparation or failure to meet the release criteria; * 6\. Total bilirubin ≤51 ( μmol/L), alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ≤ 3 times the upper limit of normal, creatinine ≤176.8 (μmol/L); * 7\. Absolute neutrophil count: ≥ 0.5×109/L; Platelet: ≥ 30×109/L; Hemoglobin ≧60g/L; * 8\. Echocardiography showed left ventricular ejection fraction (LVEF) ≥40%; * 9\. The estimated survival is more than 3 months; * 10\. ECOG score 0-2; * 11\. 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); * 12\. Subjects who are willing to participate in the study are able to understand and have the ability to sign informed consent. Exclusion Criteria: * 1\. Known allergies to research preconditioning measures, etc; * 2\. People with a history of epilepsy or other central nervous system disorders; * 3\. People with a history of prolonged QT or severe heart disease; * 4\. Less than 100 days after receiving allogeneic hematopoietic stem cell transplantation; * 5\. Hiv-infected person; * 6\. Persons with active hepatitis B or C virus; Those who are not cured have active infections; * 7\. Insufficient amplification ability (\< 5x) in response to CD3 / CD28 costimulatory signals; * 8\. Combined use of systemic steroids (e.g., prednisone ≥20mg) within 3 days prior to screening, except for ongoing or intermittent use of topical, inhaled or intranasal steroids within 2 weeks or at present; Or have systemic diseases that require long-term use of immunological agents; * 9\. Patients who received anti-cancer chemotherapy or other drugs within 2 weeks prior to screening; * 10\. Any situation that the investigator believes may increase the risk of the subjects or interfere with the study 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:Dose-limiting toxicity (DLT) · Adverse events assessed according to NCI-CTCAE v5.0 criteria · Up to 28 days after Treatment;Incidence of treatment-emergent adverse events (TEAEs) · Incidence of treatment-emergent adverse events \[Safety and Tolerability\] · Up to 2 years after Treatment
次要终点:Duration of remission ,DOR;Overall survival, OS;Event-free survival (EFS)
采用标准3+3剂量递增设计,共设置3个剂量水平。
以上邮箱 / 电话是登记库里的申办方联系方式(中国内地座机),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。
本临床研究评估供者来源CD19 CAR-T 细胞治疗复发/难治性B细胞急性淋巴细胞白血病的安全性和有效性。
A Clinical Study on the Safety and Effectiveness of donor derived CD19 CAR-T Cells in the treatment of R/R B-cell acute lymphoblastic leukemia
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