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:A Clinical Study of Allogeneic CD19/BCMA CAR-T Cells for the Treatment of R/R B-cell Malignant Tumors
⚠ 该试验的登记信息已有 15 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,评估细胞治疗用于 B 细胞淋巴瘤、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 21 例。试验地点:中国 · 镇江(共 1 个中心,其中中国 1 个)。登记号:NCT06976437。
不限性别 · ≥ 18 Years
纳入标准: 1. 愿意参加试验并已签署知情同意书。 2. 按2017年修订版WHO标准确诊B淋巴细胞或浆细胞来源恶性肿瘤,包括B细胞急性淋巴细胞白血病(B-ALL)以及成熟B细胞淋巴瘤,如弥漫大B细胞淋巴瘤(DLBCL)、滤泡性淋巴瘤(FL)、边缘区淋巴瘤(MZL)、小淋巴细胞淋巴瘤/慢性淋巴细胞白血病(SLL/CLL)、套细胞淋巴瘤(MCL)和多发性骨髓瘤(MM)等。 3. B细胞或浆细胞来源恶性肿瘤复发/难治:标准治疗后未达到完全缓解,或一线/挽救治疗达到缓解后随访期间复发。 4. B-ALL患者已达到血液学缓解但仍有微小残留病(MRD)。 5. 按修订版国际工作组(IWG)标准,复发/难治淋巴瘤患者至少有一个最长径≥1.5 cm的可测量病灶。 6. 年龄≥18岁,性别不限。 7. 预期生存期≥12周。 8. 血清总胆红素<ULN的2倍,血清肌酐<ULN,ALT和AST<ULN的3倍。 9. 中性粒细胞绝对计数≥0.5×10⁹/L、血小板≥20×10⁹/L;明确骨髓受累的B细胞恶性肿瘤患者不受这两项计数要求限制。 10. ECOG体能状态0–2。 11. 左心室射血分数(LVEF)≥50%,且无心包积液。 12. 末次治疗(放疗、化疗、单克隆抗体治疗或其他治疗)结束至少2周。 排除标准: 1. 已知对异基因CD19/BCMA CAR-T或研究药物任何成分(包括氟达拉滨、环磷酰胺和利妥昔单抗)过敏、超敏、不耐受或有禁忌,或有严重过敏反应史。 2. 异基因造血干细胞移植后复发并有活动性GVHD,且需要类固醇或免疫抑制治疗。 3. 严重活动性感染。 4. 获得性或先天性免疫缺陷。 5. NYHAⅢ或Ⅳ级心力衰竭。 6. 有癫痫或其他中枢神经系统疾病史。 7. 淋巴瘤累及脑、肺或胃肠道等结外部位。 8. 有其他原发肿瘤,但经切除治愈的非黑色素瘤皮肤癌(如基底细胞癌)或已治愈的原位癌(如宫颈、膀胱或乳腺癌)除外。 9. 治疗前2周内接受全身大剂量类固醇。 10. 妊娠、哺乳,或计划在6个月内妊娠。 11. 过去1个月内参加其他临床试验。 12. 研究者认为可能增加风险或干扰试验结果的任何情况。
Inclusion Criteria: 1. Willingness to participate in the trial and provision of signed informed consent. 2. Patients diagnosed with B-lymphocyte or plasma cell-derived malignancies as per the 2017 revised WHO criteria, including acute B-lymphoblastic leukemia (B-ALL), and mature B-cell lymphomas such as diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), marginal zone lymphoma (MZL), small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), mantle cell lymphoma (MCL), multiple myeloma (MM), etc. 3. Refractory or recurrent B-lymphocyte or plasma cell-derived malignancies, defined as failure to achieve complete remission after standard treatment, or relapse during follow-up after achieving remission with first-line or salvage therapy. 4. Patients with B-cell acute lymphoblastic leukemia (ALL) who have achieved hematologic remission but have persistent minimal residual disease (MRD). 5. According to the revised International Working Group (IWG) criteria, relapsed/refractory lymphoma patients must have at least one measurable lesion with a longest diameter ≥1.5 cm. 6. 18 Years and older, regardless of gender. 7. An expected survival of ≥12 weeks. 8. Serum total bilirubin level \< twice the upper limit of normal, serum creatinine level \< upper limit of normal, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< three times the upper limit of normal. 9. Absolute neutrophil count ≥0.5×10⁹/L, platelets ≥20×10⁹/L; for B-lymphocyte malignancies with definitive bone marrow involvement, no requirements for neutrophil and platelet counts. 10. ECOG performance status of 0 - 2. 11. Left ventricular ejection fraction (LVEF) ≥50% and no pericardial effusion. 12. At least 2 weeks have passed since the last treatment (radiotherapy, chemotherapy, monoclonal antibody therapy, or other treatments). Exclusion Criteria: 1. Known allergies, hypersensitivity, intolerance, or contraindications to CD19/BCMA allogenic CAR-T or any components of the trial drugs (including fludarabine, cyclophosphamide, and rituximab), or a history of severe allergic reactions. 2. Recurrence after allogeneic hematopoietic stem cell transplantation with active graft - versus - host disease (GVHD) requiring steroid or immunosuppressive therapy. 3. Severe active infection. 4. Acquired or congenital immunodeficiency. 5. New York Heart Association (NYHA) Class Ⅲ or Ⅳ heart failure. 6. History of epilepsy or other central nervous system diseases. 7. Lymphoma with extranodal involvement of the brain, lungs, or gastrointestinal tract. 8. Other primary cancers, except: 1. Non-melanoma skin cancer (e.g., basal cell carcinoma) cured by resection. 2. Carcinoma in situ (e.g., cervical, bladder, or breast cancer) cured. 9. Systemic high-dose steroids within 2 weeks before treatment. 10. Pregnant, breastfeeding, or plans to become pregnant within 6 months. 11. Participation in another clinical trial within the past month. 12. Any situation the investigator deems may raise risks or interfere with trial 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 and severity of adverse events after RN1101 infusion · up to 24 weeks after RN1101 infusion
次要终点:Percentage of MRD negative patients after RN1101 treatment;ORR (PR, VGPR, CR and sCR) of patients receive RN1101 treatment;Progression free survival after RN1101 treatment;CAR copies and cell count of CAR-T in blood and bone marrow (if available) after RN1101 treatment;Duration of response after RN1101 treatment;Overall survival after RN1101 treatment
复发/难治性CD19阳性或BCMA阳性B细胞淋巴瘤或多发性骨髓瘤患者接受单次RN1101细胞输注。
这是一项单臂、开放标签的探索性研究,旨在确定靶向CD19和B细胞成熟抗原(BCMA)的异基因CAR-T细胞(RN1101)治疗复发/难治性B细胞或浆细胞来源恶性肿瘤的安全性和疗效。剂量递增试验计划纳入21名患者。主要目标是评估RN1101治疗的安全性和可行性,次要目标是评估疗效,探索性目标是评价RN1101的扩增、持续性及清除CD19或BCMA阳性细胞的能力。
A single arm, open-label pilot study is designed to determine the safety and efficacy of CD19 and B-cell maturation antigen (BCMA) targeted allogenic CAR-T cells (RN1101) in patients with relapsed/refractory B-cell or plasma cell-derived malignant tumors. 21 patients are planned to be enrolled in the dose-escalation trial. The primary objective of the study is to evaluation of the safety and feasibility of RN1101 for the treatment of relapsed/refractory B-cell or plasma cell-derived malignant tumors. The secondary objective is to evaluate the efficacy of RN1101 for the treatment of relapsed/refractory B-cell or plasma cell-derived malignant tumors. The exploratory objective is to evaluate expansion, persistence and ability of RN1101 to deplete CD19 or BCMA positive cells in patients with relapsed/refractory B-cell or plasma cell-derived malignant tumors.
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