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 CMD63 Chimeric Antigen Receptor T-cell (CAR T-cell) in Children With Acute Lymphoblastic Leukemia (ALL)
这是一项 I 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 16 例。试验地点:亚太其他 · 曼谷、清迈(共 3 个中心)。登记号:NCT07078929。
不限性别 · ≥ 1 Year 且 ≤ 18 Years
纳入标准: 1. 复发或难治性ALL,且至少接受过1线治疗。疾病须在末线方案后进展,或末线治疗未达到完全缓解。费城染色体阳性ALL患者如在一线治疗(包括酪氨酸激酶抑制剂)后进展、疾病稳定或复发,也可入组。 2. 免疫组化或流式细胞术证实肿瘤CD19阳性。 3. 年龄1–18岁。 4. 男性或女性。 5. Lansky或Karnofsky评分≥50。 6. 器官功能正常:AST<ULN的5倍;ALT<ULN的5倍;总胆红素<ULN的3倍;肌酐<ULN的5倍;室内空气下SpO2≥90%。 7. 计划白细胞单采前须满足既往治疗洗脱期:末次化疗/生物治疗后≥7天;末次抗肿瘤抗体给药后3个半衰期或30天(取较短者);末次细胞输注后至少30天。入组前1周全身皮质类固醇治疗须稳定或递减,甲泼尼龙最高0.5 mg/日;允许生理性替代治疗。 8. 参与者和/或照护者能够理解并愿意签署书面知情同意书。 排除标准: 1. 入组前4周内存在需全身免疫抑制治疗的活动性GVHD。 2. 除非黑色素瘤皮肤癌和原位癌(如宫颈、膀胱或乳腺)外,有活动性恶性肿瘤史。 3. 存在未控制的并发疾病,包括活动性感染、有症状的充血性心力衰竭、不稳定型心绞痛、心律失常、肺部异常、GVHD,或可能妨碍遵守研究要求的精神疾病/社会状况。 4. 妊娠或哺乳期女性。CAR-T治疗可能有致畸或导致流产风险;有生育能力女性须血清妊娠检测阴性并停止哺乳。有生育能力的参与者同意自入组至CAR-T输注后4个月采取避孕措施。 5. 任何治疗开始前的骨髓活检显示骨髓增生异常或提示骨髓增生异常的细胞遗传学异常。 6. 血清学检查提示活动性HIV、乙肝或丙肝感染;乙肝核心抗体、乙肝表面抗原或丙肝抗体阳性者须在入组前PCR检测阴性。 7. 有白蛋白过敏性休克史。
Inclusion Criteria: 1. Participants must have relapsed, or refractory ALL treated with at least one lines of therapy. Disease must have either progressed after the last regimen or presented failure to achieve complete remission with the last regimen. \- Participant with Philadelphia Chromosome positive ALL are eligible if the progressed, had stable disease or relapsed after one line of therapy including tyrosine kinase inhibitors (TKIs) 2. The participant's disease must be CD19 positive either by immunohistochemistry or flow cytometry analysis 3. Age 1 - 18 years 4. Sex: Male or Female 5. Performance status: Lansky or Karnofsky score greater than or equal to 50 6. Normal organ function: * AST (SGOT) less 5 times the upper limit of normal (ULN) * ALT (SGPT) less 5 times the upper limit of normal (ULN) * Total bilirubin less 3 times the upper limit of normal (ULN) * Creatinine less 5 times the upper limit of normal (ULN) * SpO2 room air greater than or equal to 90% 7. Prior therapy wash-out before planned leukapheresis 7.1 Greater than or equal to 7 days post last chemotherapy/biologic therapy administration 7.2 Three half-lives or 30 days, whichever is shorter after the last dose of antitumor antibody therapy 7.3 At least 30 days from most recent cellular infusion 7.4 All systemically administered corticosteroid treatment therapy must be stable or decreasing within 1 week prior to enrollment with a maximum of 0.5 mg/day dose of methylprednisolone. Corticosteroid physiologic replacement therapy is allowed 8. Participants and/or care givers must have the ability to understand and willingness to sign a written informed consent document Exclusion Criteria: 1. Active GVHD that required systemic immunosuppressant with 4 weeks of enrollment 2. History of active malignancy other than non-melanoma skin cancer and carcinoma in situ (e.g. cervix, bladder, breast). 3. Participants with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, pulmonary abnormalities, Graft Versus Host Disease or psychiatric illness/social situations that would limit compliance with study requirements. 4. Pregnant or breastfeeding women are excluded from this study because CAR-T cell therapy may be associated with potential for teratogenic or abortifacient effect. Women of child bearing potential must have negative serum pregnancy test. Because there is an unknown, but potential risk for adverse events in nursing infants secondary to treatment of mother with CAR-T cells, breast feeding should be discontinued. These potential risks may also apply to other agents used in this study. Participants of child-bearing or child-fathering potential must be willing to practice birth control from the time of enrollment on this study and for four months after receiving CAR-T cell infusion. 5. Evidence of myelodysplasia or cytogenetic abnormality indicative of myelodysplasia on any bone marrow biopsy prior to initiation of therapy. 6. Serologic status reflecting active HIV, hepatitis B or C infection. Participants that are positive for hepatitis B core antibody, hepatitis B surface antigen or hepatitis C antibody must have negative PCR prior to enrollment. 7. Participants who have a history of anaphylactic reaction to albumin.
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 of CD19-IL7Ra CAR T-cells infusion in B-cell acute lymphoblastic leukemia patients. · The incidence of adverse events assessed by the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE), Version 5.0 · 7 days, 14 days, 21 days, 30 days, 60 days, 90 days, 6 months and 12 months after CD19-IL7Ra CAR-T cell infusion
次要终点:The overall response rate of B-cell acute lymphoblastic leukemia
靶向CD19的嵌合抗原受体T细胞,加入IL-7受体α信号结构域。剂量水平:0.5×10⁶或1×10⁶个细胞/kg。
这是一项Ⅰ期临床试验,旨在评估靶向CD19并带有IL-7Rα信号的嵌合抗原受体T细胞(CAR-T),治疗完成标准治疗后的复发/难治性B细胞急性淋巴细胞白血病(ALL)儿童患者的安全性和早期疗效。
A Phase 1 clinical trial to evaluate the safety and early efficacy of Chimeric Antigen Receptor T-cell (CAR T-cell) with IL-7Rα signaling targeting CD19 in children with relapsed and refractory B-cell Acute Lymphoblastic Leukemia (ALL) after complete standard treatments.
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