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:CAR-T Cell Therapy Combined With Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed or Refractory Multiple Myeloma
CAR-T Cell Therapy Combined With Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed or Refractory Multiple Myeloma
⚠ 该试验的登记信息已有 18 个月未更新, 页面上显示的「尚未开始招募」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,评估细胞治疗用于多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 30 例。登记号:NCT06913179。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: * 年龄18–70岁; * 预期寿命超过12周; * 通过体格检查、病理学、实验室检查及影像学检查确诊多发性骨髓瘤; * 多发性骨髓瘤难治或复发; * ALT和AST<正常值上限(ULN)的3倍; * 总胆红素<2.0 mg/dL; * Karnofsky体能状态(KPS)>50%; * 无肝、肾、心等主要器官严重功能障碍; * 既往自体或异体造血干细胞移植失败;或不适合接受干细胞移植,或因其他限制拒绝移植; * 自愿接受针对B细胞来源血液恶性肿瘤的CAR-T细胞治疗; * 适合外周静脉采血,且无白细胞单采禁忌; * 能够理解并签署书面知情同意书。 排除标准: * 妊娠或哺乳,或计划在6个月内妊娠; * 存在感染性疾病(如HIV感染、活动性结核); * 活动性乙型或丙型肝炎病毒感染; * 预筛查显示,在CD3/CD28共刺激下,外周血T细胞转导率<10%或扩增倍数<5; * 生命体征异常或无法配合治疗程序; * 存在影响治疗依从性或疗效评估的精神或心理障碍; * 严重过敏或超敏反应史,尤其是对白介素-2(IL-2)过敏; * 存在需要抗感染治疗的全身或局部严重感染; * 心、肺、脑、肾等重要器官显著功能障碍; * 严重自身免疫性疾病; * 研究者认为不适合入组的其他情况。
Inclusion Criteria: Age between 18 and 70 years; Estimated life expectancy of more than 12 weeks; Diagnosis of multiple myeloma confirmed by physical examination, pathology, laboratory tests, and imaging studies; Patients with refractory multiple myeloma; Patients with relapsed multiple myeloma; ALT and AST \< 3 times the upper limit of normal; Total bilirubin \< 2.0 mg/dL; Karnofsky Performance Status (KPS) \> 50%; No severe dysfunction of major organs such as liver, kidney, or heart; Prior failure of autologous or allogeneic hematopoietic stem cell transplantation; Ineligible for stem cell transplantation or patients who declined transplantation due to other constraints; Voluntarily willing to receive CAR-T cell therapy for B cell-derived hematologic malignancies; Suitable for peripheral venous blood collection with no contraindications to leukapheresis; Able to understand and sign a written informed consent form. Exclusion Criteria: Pregnant or lactating women, or women planning pregnancy within 6 months; Presence of infectious diseases (e.g., HIV infection, active tuberculosis); Active hepatitis B or C virus infection; Pre-screening indicates peripheral blood T-cell transduction efficiency \< 10% or expansion fold \< 5× under CD3/CD28 co-stimulation; Abnormal vital signs or inability to cooperate with treatment procedures; Presence of psychiatric or psychological disorders that affect treatment compliance or outcome assessment; History of severe allergy or hypersensitivity, particularly to interleukin-2 (IL-2); Systemic or localized severe infections requiring anti-infective therapy; Significant dysfunction of critical organs such as heart, lung, brain, or kidney; Patients with severe autoimmune diseases; Any 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:Overall Response Rate (ORR) · The proportion of patients achieving partial response (PR) or better according to the IMWG criteria. · Month 6, 12, 18 and 24
次要终点:Progression-Free Survival (PFS);Overall Survival (OS)
所有入组患者先接受CAR-T细胞治疗。CAR-T输注后达到完全缓解(CR)的患者,将根据临床评估继续接受异体造血干细胞移植(allo-HSCT)。整个治疗过程采用标准化流程并密切监测,随访评估不良事件、植入成功情况、复发风险及总生存。
研究标题:CAR-T细胞治疗联合异体造血干细胞移植治疗复发或难治性多发性骨髓瘤。 研究目的:评估CAR-T细胞治疗后序贯异体造血干细胞移植(allo-HSCT)治疗复发/难治性多发性骨髓瘤患者的安全性和疗效,为这一高危人群探索新的治疗策略。 研究设计:单中心、开放标签、单臂临床研究,计划纳入30名复发/难治性多发性骨髓瘤患者。所有受试者先接受标准化CAR-T细胞治疗,随后接受allo-HSCT,并进行系统观察和随访以评估疗效与安全性。 纳入条件包括:年龄18–70岁;预期生存期>12周;经体格检查、病理、实验室及影像学检查确诊多发性骨髓瘤;疾病难治或复发;ALT和AST<正常值上限(ULN)的3倍;总胆红素<2.0 mg/dL;Karnofsky体能状态(KPS)>50%;无严重肝、肾、心等主要器官功能障碍;既往自体或异体造血干细胞移植失败,或不适合移植/因其他限制拒绝移植;自愿接受针对B细胞来源血液肿瘤的CAR-T治疗;适合外周静脉采血且无白细胞单采禁忌;能够理解并签署书面知情同意。 排除条件包括:妊娠、哺乳或计划在6个月内妊娠;感染性疾病(如HIV感染、活动性结核);活动性乙肝或丙肝;预筛查显示CD3/CD28共刺激下外周血T细胞转导率<10%或扩增倍数<5;生命体征异常或无法配合治疗;影响治疗依从性或疗效评估的精神/心理障碍;严重过敏或超敏反应史(尤其对白介素-2);需抗感染治疗的全身或局部严重感染;心、肺、脑、肾等重要器官显著功能障碍;严重自身免疫病;或研究者认为不适合入组的其他情况。 治疗方案:所有入组者先接受CAR-T细胞治疗。CAR-T输注后达到完全缓解(CR)的患者,将根据临床评估继续接受allo-HSCT。整个治疗过程将标准化并密切监测,随访关注不良事件、植入成功、复发风险和总生存。
1. Study Title CAR-T Cell Therapy Combined with Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed or Refractory Multiple Myeloma 2. Study Objective This study aims to evaluate the safety and efficacy of CAR-T cell therapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with relapsed or refractory multiple myeloma. The goal is to explore a novel treatment strategy for this high-risk patient population. 3. Study Design This is a single-center, open-label, single-arm clinical study. A total of 30 patients with relapsed or refractory multiple myeloma will be enrolled. All participants will receive standardized CAR-T cell therapy followed by allo-HSCT and will undergo systematic observation and follow-up to assess therapeutic efficacy and safety. 4. Sample Size A total of 30 patients will be enrolled in this study. 5. Eligibility Criteria (1) Inclusion Criteria Age between 18 and 70 years; Estimated life expectancy of more than 12 weeks; Diagnosis of multiple myeloma confirmed by physical examination, pathology, laboratory tests, and imaging studies; Patients with refractory multiple myeloma; Patients with relapsed multiple myeloma; ALT and AST \< 3 times the upper limit of normal; Total bilirubin \< 2.0 mg/dL; Karnofsky Performance Status (KPS) \> 50%; No severe dysfunction of major organs such as liver, kidney, or heart; Prior failure of autologous or allogeneic hematopoietic stem cell transplantation; Ineligible for stem cell transplantation or patients who declined transplantation due to other constraints; Voluntarily willing to receive CAR-T cell therapy for B cell-derived hematologic malignancies; Suitable for peripheral venous blood collection with no contraindications to leukapheresis; Able to understand and sign a written informed consent form. (2) Exclusion Criteria Pregnant or lactating women, or women planning pregnancy within 6 months; Presence of infectious diseases (e.g., HIV infection, active tuberculosis); Active hepatitis B or C virus infection; Pre-screening indicates peripheral blood T-cell transduction efficiency \< 10% or expansion fold \< 5× under CD3/CD28 co-stimulation; Abnormal vital signs or inability to cooperate with treatment procedures; Presence of psychiatric or psychological disorders that affect treatment compliance or outcome assessment; History of severe allergy or hypersensitivity, particularly to interleukin-2 (IL-2); Systemic or localized severe infections requiring anti-infective therapy; Significant dysfunction of critical organs such as heart, lung, brain, or kidney; Patients with severe autoimmune diseases; Any other conditions deemed unsuitable for enrollment by the investigator. 6\. Treatment Protocol All enrolled patients will first receive CAR-T cell therapy. Patients who achieve complete remission (CR) following CAR-T infusion will subsequently undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT) based on clinical assessment. The entire treatment process will be standardized and closely monitored, with follow-up evaluations focusing on adverse events, engraftment success, relapse risk, and overall survival.
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