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:Clinical Trial of CD5-targeted CAR-NK Therapy for Relapse/Refractory T-Cell Hematologic Malignancies
⚠ 该试验的登记信息已有 18 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 I 期注册临床试验,评估 NK 细胞治疗淋巴瘤的安全性、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 · 武汉(共 1 个中心,其中中国 1 个)。登记号:NCT06909474。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 年龄18–75岁(含),性别不限。 2. 确诊T细胞急性淋巴细胞白血病(T-ALL)或T细胞淋巴瘤。 • T-ALL:筛选时骨髓形态学原始/幼稚淋巴细胞≥5%和/或流式细胞术证实MRD阳性,并符合以下之一:至少2个标准诱导化疗周期后难治(未达CR);一线诱导达CR后12个月内复发;至少2线化疗后未达CR或复发;造血干细胞移植后复发。 • T细胞淋巴瘤:确诊T淋巴母细胞淋巴瘤(T-LBL)或T细胞非霍奇金淋巴瘤,包括PTCL-NOS、AITL、ALCL、结外NK/T细胞淋巴瘤、T-PLL、ATLL、ⅡB期及以上蕈样肉芽肿/Sezary综合征等;按Lugano 2014标准至少有1个双径可测量病灶(淋巴结长径>1.5 cm,结外病灶>1.0 cm),且至少2线化疗后难治、原发耐药或移植后复发。 3. CD5阳性:流式细胞术证实≥80%肿瘤细胞表达CD5且平均荧光强度(MFI)与正常T细胞相当;弱阳性定义为MFI比正常T细胞低≥1个对数;部分阳性为20%–80%肿瘤细胞表达CD5。或免疫组化显示>30%肿瘤细胞表达CD5。 4. ECOG体能状态0–2分;预期生存期≥12周。 5. 器官功能符合:超声心动图LVEF≥50%、心电图无显著异常;肌酐≤ULN的2倍;ALT/AST≤ULN的3倍(肝受累时≤5倍)、总胆红素≤ULN的2倍;室内空气血氧≥92%。 6. 无白细胞单采、静脉穿刺或细胞采集禁忌;无严重精神疾病。 7. 有生育能力者同意自知情同意至CAR-NK输注后1年内有效避孕。 8. 患者或法定监护人签署知情同意书,确认理解试验目的及程序。 排除标准: 1. 既往接受CAR-NK或基因修饰细胞治疗。 2. 筛选时活动性中枢神经系统受累;既往受累但治疗后已缓解者可入组。 3. 近期抗癌治疗:筛选前2周或5个半衰期(取较长者)内接受化疗、靶向治疗或试验药物;筛选前2周内接受放疗。 4. 筛选前1周内有活动性/未控制感染。 5. 筛选前6个月内发生脑血管事件或癫痫发作。 6. 病毒感染:HBsAg或HBcAb阳性者HBV DNA>ULN;HCV抗体阳性者HCV RNA>ULN;HIV、梅毒阳性或活动性结核。 7. 心脏病:NYHAⅢ/Ⅳ级心力衰竭;6个月内心肌梗死或冠状动脉旁路移植术;有临床意义的室性心律失常或无法解释的晕厥(血管迷走性/脱水相关除外);严重心肌病。 8. 活动性或未控制的自身免疫病。 9. 过去5年内有其他恶性肿瘤;已治愈的宫颈原位癌、基底/鳞状细胞皮肤癌、局限性前列腺癌或乳腺导管原位癌除外。 10. 筛选前4周内接种活疫苗。 11. 妊娠、哺乳期或计划在CAR-NK输注后1年内妊娠。 12. 研究者判定不适合参加研究的其他原因。
Inclusion Criteria:
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1.Gender and Age: No gender restriction; age 18-75 years (inclusive). 2.Diagnosis: Confirmed diagnosis of T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoma, including:
1. T-ALL Patients: Bone marrow morphology during screening shows ≥5% blasts/immature lymphocytes and/or flow cytometry confirms minimal residual disease (MRD)+, and meets any of the following:
1. Refractory to ≥2 cycles of standard induction chemotherapy (failure to achieve CR).
2. Relapsed within 12 months after achieving CR with first-line induction therapy.
3. Failure to achieve CR or relapse after ≥2 lines of chemotherapy.
4. Relapse after hematopoietic stem cell transplantation (HSCT).
2. T-cell Lymphoma Patients: Confirmed diagnosis of T-lymphoblastic lymphoma (T-LBL) or T-cell non-Hodgkin lymphoma (including but not limited to: peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL), extranodal NK/T-cell lymphoma (ENKL), T-cell prolymphocytic leukemia (T-PLL), adult T-cell leukemia/lymphoma (ATLL), mycosis fungoides/Sézary syndrome (MF/SS) stage IIB or higher), and meets both:
1. At least one bidimensionally measurable lesion per Lugano 2014 criteria: nodal lesions \>1.5 cm in long axis; extranodal lesions \>1.0 cm in long axis.
2. Refractory to ≥2 lines of chemotherapy, primary resistance, or relapse post-HSCT.
3.CD5 Positivity: Confirmed by flow cytometry (≥80% tumor cells express CD5 with mean fluorescence intensity \[MFI\] equivalent to normal T cells; Dim defined as MFI ≥1 log lower than normal T cells; partial positivity defined as 20-80% tumor cells expressing CD5) or immunohistochemistry (\>30% tumor cells express CD5).
4.ECOG Performance Status: 0-2 . 5.Life Expectancy: ≥12 weeks. 6.Organ Function:
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1. Cardiac: Left ventricular ejection fraction (LVEF) ≥50% by echocardiography; no significant ECG abnormalities.
2. Renal: Serum creatinine ≤2.0×ULN.
3. Hepatic: ALT/AST ≤3.0×ULN (≤5.0×ULN if liver involvement); total bilirubin ≤2.0×ULN.
4. Pulmonary: Oxygen saturation ≥92% (room air). 7.No Contraindications: To leukapheresis, venipuncture, or cell collection. 8.No Severe Psychiatric Disorders. 9.Contraception: Agreement to use effective contraception from informed consent until 1 year post-CAR-NK infusion (for patients of childbearing potential).
10.Informed Consent: Signed by the patient or legal guardian, confirming understanding of the trial's purpose and procedures.
Exclusion Criteria:
1. Prior CAR-NK therapy or genetically modified cell therapy.
2. Active CNS involvement at screening (prior CNS involvement with resolved status post-treatment is allowed).
3. Recent Anticancer Therapy:
1. Chemotherapy, targeted therapy, or investigational drugs within 2 weeks or 5 half-lives prior to screening.
2. Radiotherapy within 2 weeks prior to screening.
4. Active/Uncontrolled Infection: Within 1 week prior to screening.
5. Cerebrovascular Event or Seizure: Within 6 months prior to screening.
6. Viral Infections:
1. HBV DNA \> ULN (if HBsAg+ or HBcAb+).
2. HCV RNA \> ULN (if HCV Ab+).
3. HIV+, syphilis+, or active tuberculosis.
7. Cardiac Disease:
1. NYHA Class III/IV congestive heart failure.
2. Myocardial infarction or CABG ≤6 months prior.
3. Clinically significant ventricular arrhythmia or unexplained syncope (excluding vasovagal/dehydration-related).
4. Severe cardiomyopathy.
8. Active/Uncontrolled Autoimmune Disease.
9. Prior Malignancy: Within 5 years, except for cured cervical carcinoma in situ, basal/squamous skin cancer, localized prostate cancer, or ductal carcinoma in situ.
10. Live Vaccination: Within 4 weeks prior to screening.
11. Pregnancy/Lactation: Pregnant, breastfeeding, or planning pregnancy within 1 year post-CAR-NK infusion.
12. Other: Investigator-determined ineligibility.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 [Safety and Tolerability] · The incidence of adverse events after CAR-NK cell infusion was assessed by CTCAE, version 5.0. · 28 dyas;Objective response rate (ORR) · Objective Response Rate (ORR) within 3 Months:
1. For patients with T-cell lymphoma, ORR includes complete response (CR) and partial response (PR);
2. For patients with T-cell acute lymphoblastic leukemia (T-ALL), ORR includes CR, CR with partial hematologic recovery (CRh), CR with incomplete hematologic recovery (CRi), and morphologic leukemia-free state (MLFS). · 1month, 2 months, 3 months;Overall survival (OS) after CAR-NK infusion · OS is defined as the time from CAR-NK cell infusion to death from any cause, reflecting the long-term survival benefit of the therapy. · 2 years;Duration of response (DOR) after CAR-NK infusion · DOR measures the time from the first achievement of objective response to disease progression or death, evaluating the durability of treatment efficacy in responding patients. · 2 years;Progression-Free-Survival (PFS) after CAR-NK infusion · PFS is the time from CAR-NK cell infusion to disease progression or death from any cause, capturing both tumor control and survival outcomes · 2 years
次要终点:To obtain the cytodynamics data of CAR-NK cells in vivo【pharmacokinetics】;To obtain the cytodynamics data of CAR-NK cells in vivo【pharmacokinetics】;To obtain the cytodynamics data of CAR-NK cells in vivo【pharmacodynamics】
本研究为研究者发起的临床试验,评估抗CD5 CAR-NK细胞治疗复发/难治性T细胞血液系统恶性肿瘤患者的安全性和疗效。
This is a clincal trial initiated by investigator to evaluate the safety and efficacy of anti-CD5 CAR-NK in the treatment of patients with relapsed/refractory T-Cell hematologic malignancies.
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