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:CD19 CAR-T Cell Infusion as Consolidation Therapy in Adolescent and Adult Patients With Acute B-ALL Ineligible for Allogeneic HSCT: A Clinical Study
⚠ 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 I/II 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 30 例。试验地点:中国 · 广州(共 2 个中心,其中中国 2 个)。登记号:NCT07072494。
不限性别 · ≥ 14 Years 且 ≤ 80 Years
纳入标准: • 自愿参加、签署知情同意,并愿意且能够遵守访视、研究治疗、实验室检查及其他研究程序。 • 临床确诊新诊断或复发/难治性B-ALL(包括Burkitt淋巴瘤白血病和慢性髓性白血病急变期),经化疗或免疫治疗达到完全缓解(骨髓原始细胞<5%、外周血无原始细胞且无髓外白血病),但不适合异基因HSCT、无合适供者或拒绝移植。年龄14–80岁(含),男女不限;ECOG 0–2分。 • 初诊或复发时流式细胞术确认骨髓或外周血白血病细胞CD19阳性;签署同意书后预期生存期>3个月。 • 肝肾心肺功能充分:肌酐≤ULN的2倍;LVEF≥50%;血氧>92%;总胆红素≤ULN的2倍;ALT/AST≤ULN的3倍。细胞采集静脉通路充分,血红蛋白≥80 g/L、ANC≥1.0×10⁹/L、血小板≥75×10⁹/L;未达标时由研究者判定是否可进行单个核细胞采集。 • 有生育能力女性血清妊娠试验阴性;既往手术绝育或绝经至少2年者视为无生育能力。所有有生育能力男女同意研究期间避孕。 排除标准: • 混合谱系白血病或双表型白血病。筛选或预处理前既往接受CAR-T治疗。合并遗传性骨髓衰竭综合征,如Fanconi贫血、Kostmann综合征、Shwachman综合征或其他已知骨髓衰竭综合征。 • 病毒感染:HBV DNA高于定量下限;HCV抗体阳性;EBV或CMV DNA高于定量下限;HIV抗体阳性。过去5年内有恶性肿瘤史(研究者判断根治治疗后复发风险低且随访>5年者除外)。 • 心脏疾病:NYHA III/IV级心衰;需治疗的严重心律失常或心电图有临床意义的传导异常(QTc≥480 ms,QTcB=QT/√RR);标准治疗后仍未控制的高血压(收缩压≥150 mmHg和/或舒张压≥100 mmHg)或肺动脉高压;不稳定型心绞痛;细胞输注前6个月内心肌梗死、冠脉旁路移植或支架置入;有临床意义的瓣膜病或研究者认为不适合的其他心脏病。 • 未控制癫痫、脑血管缺血/出血史、小脑疾病或其他活动性CNS疾病;筛选时有临床显著心包或胸腔积液;筛选前6个月内深静脉血栓或肺栓塞史;对研究治疗成分已知超敏。 • 筛选前6周内接种活疫苗;严重未控制活动性感染。参加其他干预性临床试验并接受研究药物,包括细胞输注前3个月内使用未批准研究药物,或不足5个半衰期内使用已上市药物。 • 研究者认为不适合参加的其他情况;身体或认知状况影响知情同意或遵守程序,或不愿/不能遵守研究要求。
Inclusion Criteria:
1. The subject has voluntarily agreed to participate, signed the informed consent form, and is willing and able to comply with scheduled visits, study treatment, laboratory tests, and other study procedures.
2. The subject has been clinically diagnosed with newly diagnosed or refractory/relapsed B-cell acute lymphoblastic leukemia (B-ALL), including Burkitt lymphoma leukemia and blast-phase chronic myeloid leukemia, and has achieved complete remission (defined as \<5% bone marrow blasts, no peripheral blood blasts, and no extramedullary leukemia) after chemotherapy or immunotherapy, but is either ineligible for allogeneic hematopoietic stem cell transplantation (allo-HSCT), lacks a suitable donor, or declines transplantation.
3. Aged between 14 and 80 years (inclusive), male or female.
4. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
5. At the time of screening, leukemia cells in the bone marrow or peripheral blood must be confirmed as CD19-positive by flow cytometry at initial or relapse diagnosis.
6. An expected survival of more than three months from the date of signing the informed consent form.
7. Satisfactory liver, kidney, cardiac, and pulmonary function, defined as:
1. Creatinine ≤2× upper limit of normal (ULN);
2. Left ventricular ejection fraction (LVEF) ≥50%;
3. Blood oxygen saturation \>92%;
4. Total bilirubin ≤2× ULN; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3× ULN.
8. Adequate venous access for cell collection and meeting the following hematologic criteria:
Hemoglobin ≥80 g/L Absolute neutrophil count (ANC) ≥1.0 × 10⁹/L Platelet count ≥75 × 10⁹/L If the above criteria are not met, the investigator may determine eligibility for mononuclear cell collection.
9. Female subjects of childbearing potential must have a negative serum pregnancy test (women who have undergone surgical sterilization or have been postmenopausal for at least two years are considered non-fertile). Male and female subjects of reproductive potential must agree to use contraception during the study.
Exclusion Criteria:
1. Presence of mixed-lineage leukemia or biphenotypic leukemia.
2. Prior treatment with CAR-T cell therapy before screening or conditioning.
3. Patients with bone marrow failure syndromes associated with genetic disorders, such as Fanconi anemia, Kostmann syndrome, Shwachman syndrome, or any other known bone marrow failure syndromes.
4. Any of the following viral infections:
Hepatitis B virus (HBV) DNA detectable above the lower limit of quantification. Positive hepatitis C virus antibody (HCV-Ab). Epstein-Barr virus (EBV) or cytomegalovirus (CMV) DNA detectable above the lower limit of quantification.
Positive human immunodeficiency virus (HIV) antibody test.
5. History of or current malignancy within the past five years (excluding patients with a low risk of recurrence after curative treatment and more than five years of follow-up, as determined by the investigator).
6. Any of the following cardiac conditions:
New York Heart Association (NYHA) Class III or IV congestive heart failure. Severe arrhythmia requiring treatment or clinically significant conduction abnormalities on ECG, including QTc interval ≥480 ms (QTcB = QT/√RR).
Uncontrolled hypertension despite standard treatment (systolic blood pressure ≥150 mmHg and/or diastolic blood pressure ≥100 mmHg) or pulmonary hypertension.
Unstable angina. Myocardial infarction, coronary artery bypass grafting, or stent placement within six months before cell infusion.
Clinically significant valvular heart disease. Other cardiac diseases deemed inappropriate for study participation by the investigator.
7. Uncontrolled epilepsy, a history of cerebrovascular ischemia/hemorrhage, cerebellar disease, or other active central nervous system (CNS) disorders.
8. Clinically significant pericardial or pleural effusion at screening.
9. History of deep vein thrombosis or pulmonary embolism within six months before screening.
10. Known hypersensitivity to any component of the study treatment.
11. Live vaccine administration within six weeks before screening.
12. Severe, uncontrolled, active infection at screening.
13. Participation in other interventional clinical trials and receipt of an investigational agent, including:
An unapproved investigational drug within three months before cell infusion. A marketed drug within fewer than five half-lives before cell infusion.
14. Any other conditions deemed unsuitable for study participation by the investigator.
15. Physical or cognitive conditions that impair the ability to provide informed consent or comply with study procedures, or unwillingness or inability to adhere to study requirements.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:Leukemia-Free Survival(LFS) · Relapse defined by ≥ BM blasts(ELN 2022) · From Chimeric Antigen Receptor T-Cell infusion to relapse or death, assessed up to 12 months
仅自体静脉输注。推荐剂量0.5×10⁸个活CAR-T细胞;剂量范围0.25–0.5×10⁸(±20%,即0.2–0.6×10⁸个活CAR-T细胞)。
本临床研究为青少年及成人急性B淋巴细胞白血病(B-ALL)患者探索一种新治疗选择。异基因造血干细胞移植是白血病标准治疗,但部分患者因年龄、基础疾病或缺乏合适供者而不适合移植。本研究评估CD19 CAR-T细胞作为巩固治疗的潜力。
This clinical study investigates a novel treatment option for adolescents and adults with acute B-lymphoblastic leukemia (B-ALL). While allogeneic hematopoietic stem cell transplantation (HSCT) is a standard therapy for leukemia, some patients are ineligible due to factors such as age, underlying medical conditions, or the absence of a suitable donor. For these individuals, CD19 CAR-T cell therapy is being evaluated as a potential consolidation therapy.
MEMBER ACCOUNT
登录成功会直接打开下一页。