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:Study of HBI0101 (NXC-201) CAR-T Therapy in Multiple Myeloma and Light-Chain Amyloidosis
⚠ 该试验的登记信息已有 17 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 II 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:招募中。计划入组 180 例。试验地点:其他 · 耶路撒冷(共 1 个中心)。登记号:NCT06971380。
不限性别 · ≥ 18 Years
纳入标准: 1. 签署知情同意书时年龄≥18岁。 2. 自愿签署知情同意书。 3. 确诊复发或难治性多发性骨髓瘤和/或轻链淀粉样变,筛查时存在可测量疾病。 4. 多发性骨髓瘤患者既往须接受至少2线治疗,包括蛋白酶体抑制剂、免疫调节剂(IMiD)或抗CD38抗体;功能性高危患者(例如治疗开始后18个月内首次复发)也可纳入。轻链淀粉样变患者既往须接受至少1线治疗,其中包括蛋白酶体抑制剂或抗CD38抗体;对至少一种抗CD38抗体和一种蛋白酶体抑制剂治疗应答不足(未达到非常好的部分缓解VGPR或完全缓解CR)者也可纳入。 5. ECOG体能状态评分0–2分。 6. 有生育能力女性(WCBP;指未接受子宫切除或输卵管结扎,且未自然绝经连续至少24个月的性成熟女性)治疗前血清妊娠试验须为阴性。所有有性生活的WCBP及男性受试者均须同意在研究期间采取有效避孕措施。 7. 既往治疗所致非血液学毒性已恢复至≤2级或基线水平;脱发和3级神经病变除外。 8. 能够且愿意遵守研究访视计划及所有方案要求。 9. 既往接受过异基因干细胞移植的复发性多发性骨髓瘤患者,须在停止任何免疫抑制治疗至少1个月后无移植物抗宿主病证据。 排除标准: 1. 存在研究治疗/程序禁忌证,或预计将接受可能妨碍研究程序实施的治疗/程序。 2. 已知存在大块中枢神经系统病变。 3. 肝功能不足:AST和/或ALT>正常值上限(ULN)的2.5倍,且直接胆红素>ULN的4倍。 4. 肾功能不足:血清肌酐清除率/估算清除率<20 mL/min。 5. INR或部分凝血活酶时间(PTT)>ULN的2倍;因血栓栓塞事件使用稳定剂量抗凝药者除外(该事件本身不属于排除情况)。 6. 骨髓功能不足:中性粒细胞绝对计数(ANC)<1000个/mm³、血小板<30,000/mm³或血红蛋白<8 g/dL。研究者可酌情排除绝对淋巴细胞计数<300个/mm³者,因为可能影响CAR-T细胞制备。 7. 超声心动图显示左室射血分数<40%。 8. 正在使用环孢素等慢性免疫抑制剂或全身性类固醇;生理替代剂量类固醇允许,最高为氢化可的松12 mg/m²/日或等效剂量。 9. 研究者判断存在会使受试者承担过度风险或干扰研究的显著合并症/疾病,例如肝硬化、脓毒症、近期严重创伤等。 10. 已知HIV阳性。 11. 活动性乙型或丙型肝炎感染。 12. 活动性巨细胞病毒(CMV)感染。 13. 过去3个月内有卒中、不稳定型心绞痛、心肌梗死或需要药物/机械控制的室性心律失常史。 14. 慢性房颤且心率控制不佳。 15. 过去2年内需要治疗的第二原发恶性肿瘤,或尚未完全缓解的第二原发恶性肿瘤。 16. 曾发生需抗凝治疗的静脉血栓栓塞事件(如肺栓塞或深静脉血栓),且符合以下任一项:抗凝稳定剂量使用不足1个月(急性导管置入相关血栓除外);过去30天内发生2、3或4级出血;血栓栓塞事件症状持续存在(如持续呼吸困难或仍需氧疗)。 17. 妊娠或哺乳期女性。 18. 筛查前30天内参加过其他介入性临床试验。
Inclusion Criteria:
1. ≥18 years of age at the time of signing informed consent.
2. Voluntarily signed informed consent form.
3. Diagnosis of multiple myeloma and/or light-chain amyloidosis with relapsed or refractory disease, with measurable disease at screening visit
4. Subject suffering from multiple myeloma must have been exposed to at least two prior lines of therapy including proteasome inhibitor, immunomodulatory (IMiDs) therapy or anti-CD38 antibody, or functionally high-risk patients (i.e. first relapse within 18 months of treatment initiation) may be included.
Subject with amyloidosis must have been exposed to at least one prior line of therapy which includes proteasome inhibitor or anti-CD38 antibody, or subjects with insufficient response (i.e. not achieving a VGPR or CR after exposure to at least an anti-CD38 antibody and a proteasome inhibitor) may be included.
5. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2.
6. Women of child-bearing potential (WCBP), defined as a sexually mature woman who has not undergone a hysterectomy or tubal ligation or who has not been naturally postmenopausal for at least 24 consecutive months, must have a negative serum pregnancy test prior to treatment. All sexually active WCBP and all sexually active male subjects must agree to use effective methods of birth control throughout the study.
7. Recovery to ≤ Grade 2 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 3 neuropathy.
8. Ability and willingness to adhere to the study visit schedule and all protocol requirements.
9. Subjects with relapsed multiple myeloma who have previously undergone allogenic stem cell transplantation must have no evidence of graft versus host disease after cessation of any immunosuppressive therapy for at least one month before recruitment to the study.
Exclusion Criteria:
1. Contraindication to a study treatment/procedure or is anticipated to receive treatment/procedure that may preclude performance of study procedures.
2. Known bulky central nervous system disease.
3. Inadequate hepatic function defined by aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) \> 2.5 x upper limit of normal (ULN) and direct bilirubin \> 4x ULN.
4. Inadequate renal function defined by serum creatinine clearance/estimated clearance of \<20(ml/min).
5. International ratio (INR) or partial thromboplastin time (PTT) \> 2 x ULN, unless on a stable dose of anticoagulant for a thromboembolic event (provided this event is not an exclusion criteria).
6. Inadequate bone marrow function defined by absolute neutrophil count (ANC) \< 1000 cells/mm\^3, platelet count \< 30,000 mm\^3, or hemoglobin \< 8 g/dL. Subjects with absolute lymphocyte count \< 300 cells/mm\^3 may be excluded (due to potential challenges with producing CART cells), per investigator judgement.
7. Echocardiogram with left ventricular ejection fraction \< 40%.
8. Ongoing treatment with chronic immunosuppressant such as cyclosporine or systemic steroids (physiological replacement doses of steroids are allowed up to 12 mg/m\^2/d hydrocortisone or equivalent)
9. Significant co-morbid condition or disease which in the judgment of the Investigator would place the subject at undue risk or interfere with the study; examples include, but are not limited to, cirrhotic liver disease, sepsis, recent significant traumatic injury, and other conditions.
10. Known human immunodeficiency virus (HIV) positive status.
11. Active Hepatitis B or Hepatitis C active infection.
12. Active CMV infection.
13. Known history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia requiring medication or mechanical control within 3 months.
14. Chronic atrial fibrillation with uncontrolled heart rate.
15. Second primary malignancies that has required therapy in the last 2 years or is not in complete remission.
16. Subjects who have had a venous thromboembolic event (e.g., pulmonary embolism or deep vein thrombosis) requiring anticoagulation and who meet any of the following criteria:
1. Have been on a stable dose of anticoagulation for \< 1 month (except for acute line insertion induced thrombosis.)
2. Have had a Grade 2, 3, or 4 hemorrhage in the last 30 days
3. Are experiencing continued symptoms from their venous thromboembolic event (e.g. continued dyspnea or oxygen requirement).
17. Pregnant or lactating women.
18. Participation in another interventional clinical trial within 30 days prior to screening visit.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:Clinical response to HBI0101 CART · Percentage of subjects who achieved partial response (PR) or better · 24 months
次要终点:Safety of HBI0101 CART;Overall response rate;Overall survival;Progression-free survival;Duration of response;Disease-free survival;Persistence of HBI0101 CART cells;Organ response
每位受试者接受单次800–1200(±20%)×10⁶个HBI0101 CAR-T细胞。
这是一项II期研究,评估HBI0101(NXC-201)BCMA靶向CAR-T治疗多发性骨髓瘤和轻链淀粉样变患者的疗效与安全性。
A Phase II study of HBI0101 (NXC-201) BCMA-CART in Multiple Myeloma and Light-chain Amyloidosis Patients. The goal of the study is to evaluate the efficacy and safety of HBI0101 CART.
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